'Coz I'm the tax man

I get asked a lot about whether taxing soda is effective. There has been a lot published on taxing food and beverages that are deemed bad for us. So what gives? Does taxing soda have any impact on our health? This is my take on the science, but first, let this jig run through your head….

Should five percent appear too small
Be thankful I don't take it all
'Cause I'm the taxman
Yeah, I'm the taxman

I'll tax the street
(If you try to sit, sit) I'll tax your seat
(If you get too cold, cold) I'll tax the heat
(If you take a walk, walk) I'll tax your feet

TAXMAAAAAAAN!!!

Sugar-sweetened beverages (SSBs) are nonalcoholic beverages containing added caloric sweeteners. In addition to carbonated soft drinks or sodas, SSBs include energy and sports drinks, less-than-100-percent fruit or vegetable juices, ready-to-drink teas and coffees, sweetened waters, and milk-based drinks. SSBs are widely consumed worldwide, and the retail sales of these beverages have been increasing over the last decade. Their consumption has been associated with obesity, diabetes, heart disease, and other detrimental non-communicable diseases (NCDs). Because of their unhealthy nature, the World Health Organization has included a range of policy priorities, including SSB taxes, to help countries combat NCDs and improve the overall health of the global population.

Taxes on SSBs have been introduced in 118 countries, with 105 at the national level and 13 at the subnational level, covering 51% of the world’s population. Most SSB taxes are implemented using excise taxes (88%), with a handful of other countries implementing them through mechanisms such as import taxes, differential Value-Added Tax (VAT), Goods and Services Tax (GST), or regional sales tax (see the figure below). These excise taxes occur mainly as tax pass-throughs, in which the price increase of the taxed product falls on the consumer. In the U.S., for example, 70% of SSB taxes are passed onto consumers through higher-priced SSBs.

Types of SSB taxes being implemented around the world

In a systematic review and meta-analysis of 62 empirical studies of SSB taxes across 45 countries, the majority of SSB taxes were implemented as a tax pass-through. While the impacts were heterogeneous across the countries, the demand for SSBs was sensitive to tax-induced price increases, with a mean reduction in sales of SSBs by 15%. The sales resulted in no substitution towards healthier, untaxed beverages (e.g., bottled water). Another review argued that SSB taxes provide no substantive changes to dietary or purchasing behavior due to the lack of substitution towards healthier alternatives. Another study found that while SSB taxes modestly reduced the purchases of some taxed beverages in the taxing jurisdiction, consumers respond to the taxes by increasing cross-border shopping, in which they go outside the taxing jurisdiction and buy those same taxed beverages at a lower cost. However, taxes may spur downstream effects on other industry responses and policies, including reformulating products to reduce sugar consumption in those beverages, as was seen with the graduated sugar tax implemented in the UK.

Of the tax policies around the world, 73% are implemented in low- and middle-income countries (LMICs), with the highest in South Asia. However, LMICs face many challenges in implementing SSB taxes, including a lack of political will and resources, weak national capacity to implement policies, large informal food sectors, and substantial influence of the food and drink industry on policy development.

The question remains whether SSB taxes can result in healthier dietary patterns and reduce the health implications accompanying excess consumption of these products – particularly NCDs. Most of the evidence — particularly from  Nakhimovsky et al., 2016; Niebylski et al., 2015; Teng et al., 2019; and Thow et al., 2014 — suggests that SSB taxes have impacted the purchases of taxed products to varying degrees, but not necessarily long-term and impactful behavior change towards healthier diets and improvements in health. One potential reason may be that the SSB taxes translate to only a 5 to 22-kilocalorie reduction per capita daily. This is insufficient to have a meaningful impact on disease outcomes. Some researchers suggest that one way to deal with this is to raise the current tax rates from the current approximate 5% to 20%. This would also be aligned with the WHO’s recommendation for at least a 20% tax on SSBs. Several countries, such as Qatar and Saudi Arabia, have substantive (50-100%) excise taxes on SSBs, which are more in line with the taxation rates of tobacco.

The question is whether other foods, particularly red meat, should be taxed due to their significant implications on the environment and contributions to climate change. While consuming red meat in high amounts can contribute to NCDs, red meat is also a source of important nutrients. If a tax on red meat makes them prohibitively expensive for those who already struggle to afford these foods, it could put these nutrient-dense foods even further out of reach for the world’s poor. Thus, a “carbon tax” on red meat might be appropriate in wealthy countries with strong social protective measures and in countries with disproportionately high levels of red meat consumption.

Generating knowledge, dutifully and honestly

“Maybe working on the little things as dutifully and honestly as we can is how we stay sane when the world is falling apart.”

— Haruki Murakami

This quote by Murakami really speaks to researchers and scientists: Keep focused. Crowd out the noise. Discover. Be dutiful and honest.

But as Tony Fauci, head of the National Institutes of Infectious Disease of the United States gets the cold shoulder from our dear Potus, with attempts to undermine his evidence-based warning calls of a worsening COVID-19 pandemic here in America, it is hard to ignore the last part of that quote - the falling apart bit.

As researchers, we often keep our heads down and dig deep into the details with laser sharp focus to keep generating data and evidence for the greater good of science and knowledge. But we can no longer sit quietly behind our benches and laptops and blissfully hope that someone, anyone, will read that peer reviewed paper that you just published in Journal X. We need to be attuned to the political climate.

Speaking of publications, I was asked to contribute to an exciting, upcoming Johns Hopkins University Press publication COVID19 and World Order. In my piece, I make a series of technical recommendations on what it would take to achieve resilient food systems and potential measures to address our current pandemic and avoid catastrophic future zoonotic pandemics. I bring up this publication because none of the recommendations to fix food systems I made in the paper will stand on two legs with the current fractured and sclerotic global political enabling environment. In order for food systems to function effectively, equitably, and sufficiently during the pandemic and long after, the political environment must be one that embraces global cooperation and inclusion and minimizes political polarization and geopolitical competition. And we, as scientists and researchers, cannot remain silent, disengaging from the political process, however dismal it may be.

Murakami.jpg

Politics matter for the world and for science, and now more than ever. Frank Fukuyama wrote: “Countries with dysfunctional states, polarized societies, or poor leadership have done badly, leaving their citizens and economies exposed and vulnerable.” It is not surprising that states led by populist, inward-facing leaders such as the United States, Brazil, and Mexico are not sufficiently addressing the pandemic. This has led to dire consequences for the citizens living in these countries with many who are struggling with food insecurity and high COVID-related morbidity and mortality.

The COVID-19 response has also displayed the weaknesses of the multilateral system and existing institutions. Within this, the “global food architecture” is often slow, outdated and needs 21st-century support and strategic know-how. One of those entities - the World Health Organization - has tragically and sadly just lost its support from the United States during a time in what may be one of the most crucial global health issues of the century. Multi-lateral cooperation looks perilous and science and the data that it bears is being undermined.

However, cooperation can happen in times of crisis - we have seen it before. Perhaps the UN Food Summit in 2021 can be a moment to create a global strategy for food governance that is nimble, modern, and inclusive, backed by an Intergovernmental Panel on Climate Change-like body that provides evidence and science to support actions.

As the Editor-in-Chief of the Global Food Security Journal, my co-editors and I share our perspectives on the food security challenges that face humanity and lay out our vision and call for stronger food systems research and science in the 2020s. I think this piece comes at a critical moment in food policy with COVID and climate change, because the challenges and opportunities for food systems research that lay ahead are significant, requiring that high-quality science be translated into policy faster than ever before.

“Our vision is one in which research and science, and the evidence stemming from their application, not only inform food and environmental policy, but are adopted and mainstreamed into actions at the national, regional, and global levels.”

In the paper, we write: “At a time when facts, science, and evidence are under ever greater scrutiny, and even openly disregarded as suspect by some political and business leaders, the rigors of research have never been more critical. It is also important not to become disheartened by the slow speed of change in policy and practice, even when the appropriate course of action is clear ‘to us.’ Research can and does bring about wholesale changes in attitudes, political thought, and action, but change takes time.

We argue that the food systems have transformed, but with that transformation, we are left with profound and widening gaps to address sustainability and equity. These gaps will make future food security and continuity of life on the planet difficult to say the least. As researchers, we will have to fill in those gaps to ensure we meet the demands of a growing population sustainably while co-existing in amity with the planet.

We also need to find the stitched pockets of progress and small glimmers of hope as the basis of our knowledge to move forward - dutifully and honestly.