Yann Le Bodo

Is Sugar the new Tobacco? Insights from Laboratory Studies, Consumer Surveys and Public Health

In the Americas, mean energy intake from added sugar exceeds recent World Health Organization recommendations for free sugars in the diet. As a leading contributor to this excess, sugar-sweetened beverage (SSB) overconsumption represents a risk for the population’s health. This article provides an overview of clinical and epidemiological evidence, marketing practices, corporate influence and prevention strategies related to added sugar and SSB. For each aspect of this multidimensional profile, we briefly compare SSB to the case of tobacco pointing to similarities but also major differences. Tobacco control has demonstrated the effectiveness of long term multifaceted prevention strategies in multiple settings supported by strong public policies which may be applied to the consumption of SSB. However, translating these policies to the specific case of SSB is urgently needed, to inform preventive actions, decide which intervention mix will be used, and evaluate the process and impact of the chosen strategy.

PotentialSSB TaxationSignal Effects “Signal” EffectsSignal Effects, SSB Taxation from Sugar-Sweetened Beverage Taxation

Many characteristics of the market, school and family environments contribute to making or maintaining frequent soda consumption a social norm, particularly among youth. In such circumstances, soda/sugar-sweetened beverage (SSB) taxation could be used as “alarm signal” facilitating the emergence of a “moderate consumption” norm, provided the price hike is sufficiently salient, the population aware of the tax, and these two conditions sustained by a communication campaign. Unfortunately, such effects remain weakly documented and counterproductive effects cannot be ruled out. SSB taxation could also be used as a coercive signal pushing manufacturers to move beyond voluntary commitments, be this in terms of product reformulation and/or in terms of marketing to children. On this particular point, the evidence remains mixed and anecdotal. A tax linearly indexed on the sugar content of the beverages or based on a threshold of sugar content above which beverages are taxed may provide additional benefits. Here again, it remains to be demonstrated.

Feasibility of Sugar-Sweetened Beverage TaxationFeasibility, of SSB Taxation in Canada in CanadaSSB Taxationin CanadaFeasibility of

Exploring the feasibility of soda/sugar-sweetened beverage (SSB) taxation in Canada requires considering federal and provincial powers and prerogatives in terms of public health and taxation. In this chapter, the applicability of various types of soda taxes is considered for both jurisdictions. Overall, excise duties generally are the more documented and recommended option to tax soda. Introducing such a tax in Canada is likely feasible, but at the federal level only. At provincial level, the introduction of a special tax on SSBs sold at retail according to the tobacco and alcohol special tax models is an avenue deserving particular attention. Defining the tax scope would likely raise some issues since generally, in the Canadian fiscal nomenclature, all carbonated beverages are considered regardless of their calorie content and composition. As regards taxation rate, Chaps. 6 and 7 of this book suggest that it is reasonable to expect SSB consumption to decrease as a result of a significant tax (i.e. provided it generates a 10–20 % price hike). Finally, a robust mechanism facilitating the administration and the earmarking of tax revenues for health promotion initiatives and social programmes would likely be desirable and feasible in Canada.

Soda Taxes: The Importance of Analysing Policy Processes; Comment on “The Untapped Power of Soda Taxes: Incentivising Consumers, Generating Revenue, and Altering Corporate Behaviours”

Sarah A. Roache and Lawrence O. Gostins recent editorial comprehensively presents soda taxation rationales from a public health perspective. While we essentially agree that soda taxes are gaining momentum, this commentary expands upon the need for a better understanding of the policy processes underlying their development and implementation. Indeed, the umbrella concept of soda taxation actually covers a diversity of objectives and mechanisms, which may not only condition the feasibility and acceptability of a proposal, but also alter its impact. We briefly highlight some conditions that may have influenced soda tax policy processes and why further theory-driven case studies may be instructive.Sarah A. Roache and Lawrence O. Gostin’s recent editorial comprehensively presents soda taxation rationales from a public health perspective. While we essentially agree that soda taxes are gaining momentum, this commentary expands upon the need for a better understanding of the policy processes underlying their development and implementation. Indeed, the umbrella concept of soda taxation actually covers a diversity of objectives and mechanisms, which may not only condition the feasibility and acceptability of a proposal, but also alter its impact. We briefly highlight some conditions that may have influenced soda tax policy processes and why further theory-driven case studies may be instructive.

Effects of Taxation on Sugar-Sweetened Beverage Prices

When the primary objective of a tax on sugar-sweetened beverages (SSBs) is to discourage consumption on the short term, a key issue is to know whether the tax is actually passed onto retail prices. On the one hand, when the tax is levied on manufacturers, they may decide to under- or overshift the tax. On the other hand, larger contextual factors (e.g. seasonal effects, other policies) may counteract or attenuate tax effects on prices. In this chapter, we present key pieces of evidence from various places where soda taxes have been implemented across the world. Overall, the evidence suggests that such taxes are generally followed by price increases in the short term, sometimes beyond or below the increase theoretically generated by the tax.

Sugar-Sweetened Beverage Taxation Logics and Ethical Concerns

Three sugar-sweetened beverage (SSB) taxation logics generally emerge in the literature: (1) increasing SSB prices in order to decrease consumption and impact the health of the population; (2) raising fiscal revenues that may be earmarked for health-related causes; and (3) sending a salient signal to consumers as a way to change social norms, and to manufacturers as a way to encourage product reformulation. Making clear which short-term and long-term logics are pursued is an essential prerequisite to assess the relevancy of an SSB tax proposal in Canada. Furthermore, the economic and ethical justification of SSB taxation remains controversial (e.g. as regards freedom of choice and autonomy) and should be carefully considered before implementation. A democratic dialogue involving all stakeholders (including consumers) may help disentangle this debate.

Sugar-Sweetened Beverage Taxation as a Public Health Policy Instrument

The manufacturing cost of sugar-sweetened beverages (SSBs) is particularly low. It contributes to making these drinks particularly affordable and to encourage consumption. Taxation has been increasingly suggested as a way to increase SSB price and discourage demand, as part of a comprehensive prevention strategy. Lessons from tobacco control confirm that taxation can be a valuable instrument, although the comparison with SSB should be made cautiously. Economic simulations tend to position SSB taxes among the most cost-effective interventions because of their low cost of implementation, the critical mass of the population they may reach, the revenues they generate and their sustainability. Evidence from soda taxes implemented in the “real world” has to be considered to confirm these predictions.

Distribution of Sugar-Sweetened Beverage Taxation Effects in the Population

The evidence reviewed in Chaps. 5 and 6 suggests that a tax on soda/sugar-sweetened beverages (SSBs) causing a 10–20 % price increase could result in a lower-average SSB consumption in the population. But beyond average values, would the poorest consumers be disproportionally burdened by the tax? Would they benefit from larger health gains? Overall, the evidence suggests that the financial contribution to tax revenues would be relatively modest for most consumers and not much different across income groups. Low-income households consuming large SSB amounts and not prone to reduce their consumption may be more negatively impacted than other consumers. As regards SSB taxation health benefits, these are hardly predictable (see Chap. 7) and it remains unclear whether these could be greater in lower-income households and in the heaviest SSB consumers. Inequity concerns surrounding SSB taxation could be somewhat mitigated through the earmarking of tax proceeds for health promotion causes.

Evaluability of Sugar-Sweetened Beverage Taxation

Taxes on soda/sugar-sweetened beverages (SSBs) implemented across the world are still little evaluated. Yet, evaluating the effects and impact of soda taxes is critical to provide evidence with more confidence and external validity than what currently provide simulations and experimental trials. Planning a detailed and robust evaluation prior to implementation is essential. In the case of a price-induced behavioural logic, evaluation should focus on SSB price, SSB intakes, energy balance and eventually health outcomes. Key methodological aspects have to be considered in order to be able to disentangle tax-specific effects from other factors. In the case of a fiscal logic, the evaluation would minimally consist in the collection and monitoring of tax revenues as well as in the monitoring of how tax proceeds are earmarked for specific uses, such as health promotion initiatives. Finally, in the case of a signal-induced denormalization logic, evaluation may focus on the public perception of the tax as well as on reactions of manufacturers.

Reasons for Specifically Targeting Sugar-Sweetened Beverages

Sugar-sweetened beverages (SSBs) generally designate non-alcoholic beverages containing added sugars. Conclusive epidemiological evidence indicates that overconsuming those beverages places individuals at greater risk of developing overweight, type 2 diabetes, and dental caries. SSB overconsumption is supported by intense marketing practices in terms of offer, distribution, price and promotion. In Canada, sugar-sweetened beverages are a significant dietary source of sugars in some groups of the population, particularly in adolescents. Specific prevention efforts are required at a large scale to tackle SSB consumption trends at population level and to limit SSB contribution to daily energy intakes at individual level.