Recently there have been disquieting moves by social engineers in
several countries proposing use of taxes to force the public to eat
healthier. Examples are: Denmark introduces food fat tax and from the UK: Fat tax' on unhealthy food must raise prices by 20% to have effect, says study.
I didn't worry much about it when those proposals were in far-off
places; I was confident that Aussies were much too sensible to let
that happen here. But now our media are starting to join the push: Chew the fat on a sugar tax to trim waistlines.
I should have seen it coming when the “Traffic Lights” concept
was first proposed: The WA Health Traffic Light System and Green Light, Eat Right.
It appears that those who wish to save us from ourselves - and from overloading the public health system - are resolved to make us eat healthier whether we like it or not.
There are a lot of things I dislike about that concept, not the
least being the idea that the government or its agencies has any
right to direct me on a matter as basic as the food I choose to put
in my mouth, apart from ensuring that it is not actually poisonous and is safely and humanely
produced. I'll leave that philosophical side of the discussion for now and concentrate on the practical aspects.
There are two separate parts to the question:
- Does prohibitively taxing items based on their impact on health have a significant effect on public use of those items?
- If taxes or public education programmes are used with the intention of improving public health are the right food groups being taxed, promoted or discouraged?
Do Taxes Work To Change Bad Habits?
There are two clear examples in this country. In Australia the Federal government has been steadily increasing
taxes and excise on tobacco and alcohol over the past century. Our taxes are
quite heavy on those items when compared to many other countries. For example, a packet of 20 Marlboro is over $16 and a 700ml (24oz US) bottle of cheap whisky starts at $28. Our dollar and the US dollar are close to parity at the moment.
Historically each time taxes or excise were increased on either commodity there
were short-term reductions in use, but time shows those were
just temporary blips. Changes in alcohol taxes sometimes led to
changes in preferences from beer to spirits or wine or vice versa, but had
little effect on overall consumption or consequent health problems
such as youth drunkenness or adult alcoholism.
We had a recent specific example with the alcopops tax. The
government was concerned with drinking problems in teenagers. They
decided that the root cause was alcopops, a form of popular
alcoholic soft drinks. They decided that drastically increasing the
taxes on those was the way to fix the problem.
Effect of the increase in “alcopops” tax on alcohol-relatedharms in young people: a controlled interrupted time series
Objective: To
measure alcohol-related harms to the health of young people
presenting to emergency departments (EDs) of Gold Coast public
hospitals before and after the increase in the federal government
“alcopops” tax in 2008.
Design, setting and
participants: Interrupted time series analysis over 5 years
(28 April 2005 to 27 April 2010) of 15–29-year-olds
presenting to EDs with alcohol-related harms compared with
presentations of selected control groups.
Main outcome measures:
Proportion of 15–29-year-olds presenting to EDs with
alcohol-related harms compared with (i) 30–49-year-olds with
alcohol-related harms, (ii)15–29-year-olds with asthma or
appendicitis, and (iii) 15–29-year-olds with any non-alcohol and
non-injury related ED presentation.
Results: Over a
third of 15–29-year-olds presented to ED with alcohol-related
conditions, as opposed to around a quarter for all other age groups.
There was no significant decrease in alcohol-related ED presentations
of 15–29-year-olds compared with any of the control groups after
the increase in the tax. We found similar results for males and
females, narrow and broad definitions of alcohol-related harms,
under-19s, and visitors to and residents of the Gold Coast.
Conclusions: The
increase in the tax on alcopops was not associated with any reduction
in alcohol-related harms in this population in a unique tourist and
holiday region. A more comprehensive approach to reducing alcohol
harms in young people is needed.
Similarly, taxes on cigarettes have had only a marginal effect.
1991-92 to 2007-08 (2007-08 dollars)
Note that smoking was relatively unchanged when taxes were
increased in the early '90s but dropped significantly later despite steady
taxes from the mid-90s on. The significant reductions in cigarette
smoking in this country came from better public education and
various new State laws such as restriction of advertising, labelling changes, restricting sales to minors and drastically reducing the public places where people could
legally smoke; allied to a paradigm shift in public acceptance of
smoking in social situations. For example:
5 CONCLUSION
The current focus of the anti-tobacco lobby on the rights and health of non-smokers has led to a proliferation of smoking bans in enclosed public places. The NSW Parliament only recently passed the Smoking Environment Amendment Act 2004 which will gradually phase-in an extension of smoking bans to include licensed premises in NSW. The support for such smoking bans has been growing and the implementation of similar restrictions in Ireland and New York appears to have been successful.
Smoking bans are only one method of tobacco control. The use of tobacco is also controlled through restrictions on the way it is packaged and advertised. Particular strategies are applied to minors such as prohibiting the manufacture and sale of toys and confectionery that resemble tobacco or the act of smoking, as well as prohibiting the sale of tobacco to persons under the age of 18. Health warnings have been included on tobacco packages for thirty years but have continued to adapt to contemporary requirements with graphic warnings the most recent development. The price of tobacco may be influenced by taxation policies and smoking cessation can be encouraged through media campaigns, and the availability of nicotine replacement therapy and telephone counselling. Litigation may also affect the activities of tobacco companies.
Tobacco continues to be the cause of much death and disease not only in Australia but also worldwide. The damage attributed to tobacco has been recognised by the World Health Organization and by the numerous countries to have signed and/or ratified the Framework Convention on Tobacco Control. Accordingly, governments continue to seek strategies that will encourage the minimisation, prevention and cessation of tobacco use.
I write as a long-term heavy smoker, who became increasingly
annoyed as those changes occurred over the past few decades but
eventually gave up in 2001. Now I look back and wonder why I took so
long to wake up to the harm it was doing to me.
Will They Tax The Right Foods?
In my opinion this question is actually more important. If we accept the dubious hypothesis that taxes will work to solve the problem, to
have any chance of success those taxes should target the right foods. Similarly any public education initiatives should be providing valid and useful information.
Based on the present proposals the foods to be targeted are fats,
sugar and salts. The West Australian "Traffic Light" system clearly indicates what we could expect:
Green Foods and Drinks
Foods and drinks
classified as Green are the healthiest choices. They are excellent
sources of important nutrients needed for health and wellbeing, and low
in saturated fat, added sugar and salt, and are lower in energy
density.
Can be eaten every day or at every meal.
Examples include: Plain or
whole grain breads and cereals, vegetables and salads, fruit, low fat
milks and dairy products, lean meats, fish and poultry, eggs, and nuts
and legumes.
Amber Foods and Drinks
Foods and drinks
classified as Amber are mainly processed foods. They have some
nutritional value but contain moderate levels of saturated fat, added
sugar and/or salt and can, in large serve sizes, contribute to excess
energy intake.
Should be carefully selected and eaten in moderation.
Examples include: Full fat
milk and dairy products, some breakfast and cereal bars, some un-iced,
plain, lower fat cakes and muffins, some processed meats (e.g. ham,
pastrami), poly- or mono-unsaturated spreads, breakfast cereals with no
added sugar or fat.
Red Foods and Drinks
Foods and drinks
classified as Red are energy dense and nutrient poor foods and drinks
that are high in saturated fat, sugar and/or salt. They can contribute
to excess energy intake if consumed in large amounts or on a frequent
basis.
Red foods also include deep fried foods, confectionary and
chocolate (energy size limit), crisps, corn chips and similar salty
snacks (energy size limit), sugar sweetened soft drinks, energy and
sports drinks (energy size limit).
Should only be eaten occasionally.
Examples include: Fried foods, savoury
commercial products such as pies and sausage rolls, snack bars, sweet
biscuits, cakes and sweet pastries, small size confectionary and
packets of crisps, some sweetened drinks and processed meats such as
salamis.
Logically, taxes would be highest on the "Red Foods" and education would be focused on promoting the "Green Foods". In other words, we would be taxed and educated to eat in a way that is extreme low-fat and high-carbohydrate.
I can't imagine many programmes likely to lead to worse results. That would entrench the terrible low-fat high-whole-grains doctrine of the 20th century that I am becoming convinced is a significant factor in the so-called obesity epidemic occurring in the 21st.
Fat consumption in moderation is a trivial part of the problem and sugar is only part of the problem. My definition of moderation in that context is very different to the dieticians who advise governments; it is more like my Grandma, who wasted very little of the sheep when Grandfather killed it. She lived to 102.
The real problem is excessive carbohydrate consumption; sugar is only part of the carb load. A tax on sugar, even if it worked to cut sugar consumption, would have only a minimal effect as the nation continued to start its day with a wonderful 'healthy' bowl of highly processed cereal, drenched in milk, accompanied by some low-sugar spread on multigrain toast and margarine, washed down with a glass of 'healthy' fruit juice. Then, after a 'healthy' breakfast the day continues with an overload of 'healthy' multigrain breads and loads of fruit, spuds, corn, rice and pasta. All, of course, fat-free and low-sugar; so wonderfully healthy. Yeah, right.
Taubes puts it together better than I can; I agreed with him long
before I had heard of him: Why
We Get Fat and Good
Calories, Bad Calories.
I believe that the suggestions to tax foods for public health reasons are misguided at best and may be counter-productive at worst.
Cheers, Alan, T2, Australia
Everything in Moderation - Except Laughter
PS See also this follow-up post: The Fat Tax: Dare I say I Told Them So?