Fuse open science blog
Thursday, 22 December 2016
Friday, 16 December 2016
Understanding the health benefits of the ‘sugar tax’: how will the soft drinks industry respond?
Guest post by Oliver Mytton, Centre for Diet and Activity Research (CEDAR) & MRC Epidemiology Unit, University of Cambridge
Today our paper, a health impact assessment of the government’s proposed ‘sugar tax’ was published in the Lancet Public Health. The government’s proposal, announced in April of this year, took health campaigners by surprise. Not only was it unexpected, but the government’s proposal was unusual.
Other countries, notably Mexico, have introduced a sales or excise tax on sugary drinks. However, the UK government proposed a levy on soft drinks manufacturers or importers based on the volume of sugary drinks sold. There will be two levels of tax, a higher level on drinks with more than 8g per 100ml, and a lower level on drinks with 5g to 8g per 100ml.
With others, I have previously modelled the potential health benefits of a ‘simple’ excise tax on sugary drinks, but the industry levy is more complicated.
The levy might lead to a reduction in sugary drinks consumption through a number of pathways, and from listening to industry experts and reviewing statements made by soft drinks manufacturers, it was apparent that nobody knew quite how the industry would respond.
The nature and magnitude of these responses might lead to very different health outcomes, which is what we describe in our paper. For our health impact assessment, we identified three broad responses that the industry might make:
From these six scenarios, we were able to estimate changes in consumption of sugary drinks. We then estimated changes in health, using data describing the relationship between sugary drinks consumption and three outcomes (dental caries, type 2 diabetes and obesity).
The most beneficial modelled scenario for health was reformulation (reduction of sugar content by 15% for ‘mid-sugar’ drinks and 30% for ‘high-sugar’ drinks), with an estimate of 140,000 fewer adults and children with obesity; 19,000 fewer incident cases of diabetes each year, and 270,000 fewer decayed, missing, or filled teeth annually in the UK. Important reductions in disease were also associated with the maximum expected price increase (equivalent to half the levy cost being passed onto consumers) and changes in marketing share.
The least beneficial modelled scenario for health was a change in market share that resulted in consumers switching not only from high-sugar drinks, but also from diet drinks, to low sugar drinks. This might result in an (small) increase in consumption of sugary drinks and consequent (small) increase in disease (using the measures we looked at). If the price is passed on to all soft drinks (rather than just sugary drinks) the health benefits were also substantially reduced.
Across the scenarios the most striking finding was the concentration of the health benefits in terms of obesity and dental caries amongst children and younger adults. They are the major consumers of sugary drinks. Diabetes follows a different pattern with many more cases likely to be prevented amongst adults than children, because there are relatively few incident cases of type 2 diabetes among children and young adults.
In doing this, we have not made an overall estimate of the health benefits of the new levy, rather we have identified the benefits attributable to different industry responses to the levy and put upper and lower bounds on those responses.
Our assessment shows that the health benefits of the levy will be greatly affected by how the industry responds. We have identified scenarios where the health benefit is minimal (or conceivably negative). However, we think this is unlikely: there are strong signs from industry that there will be significant reformulation, consumers appear to be turning away from sugary drinks and most of the scenarios we modelled were beneficial for health.
While we are not as optimistic about reformulation as others, our work does further suggest that reformulation of sugary drinks has potential to mitigate some of the health risks associated with regular consumption of sugary drinks. Reformulation of soft drinks probably has more scope than I previously thought. The government levy may, particularly by using two tiers, be a relatively effective tool to incentivise reformulation.
It also suggests that the industry levy may not be a ‘simple’ intervention. Whilst we have described discrete responses, it is possible that the levy may stimulate several changes. Not just the changes described in our study but others, e.g. changes in consumer attitudes, reductions in portion sizes and introduction of new low sugar products. If it does do this, the government’s approach may be very effective, perhaps more effective than a ‘simple’ excise tax.
On the flipside, it may also be more uncertain or risky as its success depends on how industry responds. This creates a potential role for government and health organisations to apply pressure on industry to respond in ways that improve health. This uncertainty also underscores the need for a careful evaluation that can capture the important industry responses.
Finally, whilst there are reasons to be optimistic and the government should be applauded for this initiative, it does underscore the need for ‘brave and bold’ action across a variety of areas concerned with food and physical activity (which the recent Childhood Obesity Plan failed to deliver) to markedly reduce obesity. As I have written before, this measure alone will not ‘solve’ obesity, but it can be an important step towards improving population health.
Today our paper, a health impact assessment of the government’s proposed ‘sugar tax’ was published in the Lancet Public Health. The government’s proposal, announced in April of this year, took health campaigners by surprise. Not only was it unexpected, but the government’s proposal was unusual.
Other countries, notably Mexico, have introduced a sales or excise tax on sugary drinks. However, the UK government proposed a levy on soft drinks manufacturers or importers based on the volume of sugary drinks sold. There will be two levels of tax, a higher level on drinks with more than 8g per 100ml, and a lower level on drinks with 5g to 8g per 100ml.
With others, I have previously modelled the potential health benefits of a ‘simple’ excise tax on sugary drinks, but the industry levy is more complicated.
Industry levy – how it might work
The levy might lead to a reduction in sugary drinks consumption through a number of pathways, and from listening to industry experts and reviewing statements made by soft drinks manufacturers, it was apparent that nobody knew quite how the industry would respond.
The nature and magnitude of these responses might lead to very different health outcomes, which is what we describe in our paper. For our health impact assessment, we identified three broad responses that the industry might make:
- reformulation (reducing sugar content);
- price rises that pass the cost on to consumers; and
- changes in marketing practices to ‘shift’ consumer preferences, e.g. away from high sugar drinks to diet drinks.
Modelled health benefits
From these six scenarios, we were able to estimate changes in consumption of sugary drinks. We then estimated changes in health, using data describing the relationship between sugary drinks consumption and three outcomes (dental caries, type 2 diabetes and obesity).
The most beneficial modelled scenario for health was reformulation (reduction of sugar content by 15% for ‘mid-sugar’ drinks and 30% for ‘high-sugar’ drinks), with an estimate of 140,000 fewer adults and children with obesity; 19,000 fewer incident cases of diabetes each year, and 270,000 fewer decayed, missing, or filled teeth annually in the UK. Important reductions in disease were also associated with the maximum expected price increase (equivalent to half the levy cost being passed onto consumers) and changes in marketing share.
The least beneficial modelled scenario for health was a change in market share that resulted in consumers switching not only from high-sugar drinks, but also from diet drinks, to low sugar drinks. This might result in an (small) increase in consumption of sugary drinks and consequent (small) increase in disease (using the measures we looked at). If the price is passed on to all soft drinks (rather than just sugary drinks) the health benefits were also substantially reduced.
Across the scenarios the most striking finding was the concentration of the health benefits in terms of obesity and dental caries amongst children and younger adults. They are the major consumers of sugary drinks. Diabetes follows a different pattern with many more cases likely to be prevented amongst adults than children, because there are relatively few incident cases of type 2 diabetes among children and young adults.
In doing this, we have not made an overall estimate of the health benefits of the new levy, rather we have identified the benefits attributable to different industry responses to the levy and put upper and lower bounds on those responses.
Policy implications
 |
| Consumers appear to be turning away from sugary drinks |
Our assessment shows that the health benefits of the levy will be greatly affected by how the industry responds. We have identified scenarios where the health benefit is minimal (or conceivably negative). However, we think this is unlikely: there are strong signs from industry that there will be significant reformulation, consumers appear to be turning away from sugary drinks and most of the scenarios we modelled were beneficial for health.
While we are not as optimistic about reformulation as others, our work does further suggest that reformulation of sugary drinks has potential to mitigate some of the health risks associated with regular consumption of sugary drinks. Reformulation of soft drinks probably has more scope than I previously thought. The government levy may, particularly by using two tiers, be a relatively effective tool to incentivise reformulation.
It also suggests that the industry levy may not be a ‘simple’ intervention. Whilst we have described discrete responses, it is possible that the levy may stimulate several changes. Not just the changes described in our study but others, e.g. changes in consumer attitudes, reductions in portion sizes and introduction of new low sugar products. If it does do this, the government’s approach may be very effective, perhaps more effective than a ‘simple’ excise tax.
On the flipside, it may also be more uncertain or risky as its success depends on how industry responds. This creates a potential role for government and health organisations to apply pressure on industry to respond in ways that improve health. This uncertainty also underscores the need for a careful evaluation that can capture the important industry responses.
Finally, whilst there are reasons to be optimistic and the government should be applauded for this initiative, it does underscore the need for ‘brave and bold’ action across a variety of areas concerned with food and physical activity (which the recent Childhood Obesity Plan failed to deliver) to markedly reduce obesity. As I have written before, this measure alone will not ‘solve’ obesity, but it can be an important step towards improving population health.
Thursday, 8 December 2016
The one where we ask you to vote...
Posted by Mark Welford, Fuse Communications Officer, Teesside University
This post is a little like those episodes of Friends in which one of the cast says: “Do you remember the time when [cue wobbly vertical lines]…” and the rest of the 22-23mins is made up of clips from previous shows.
Let me take you back to a post on Thursday 7 January in which we made a shameless plea to ask for your votes in the UK Blog Awards 2016. In that post we told you how the blog’s 334 posts had received just over 167,000 views. Eleven months on and 40 additional blog posts later, the page views have risen to nearly 325,000 - a fantastic achievement I hope you’ll agree! I discovered this when an ambitious academic asked me if I could provide them with some killer stats about the blog to support their bid for a promotion. The power this blog wields!
This year we have had posts covering everything from Dry January, the ‘nanny state’, animation, Jamie Oliver's school dinner and sugar tax campaigns, to ‘fat shaming’, indigenous Australians, Baywatch, energy drinks, Grandmothers, e-cigarettes, and 'legal highs'.
Five years on from the blog's inception and we have reached the point where people are actively approaching us and generously giving up their time to write posts, rather than having to send in our crack team (the fear inducing) ‘blog working group’ to chase, harry and cajole*. Could this - and the increased viewing figures - have something to do with the little matter of winning a UK Blog Award last year? I'd like to think so.
And now, we come to the crux of this post. It is you, our dear readers and contributors that make the blog a success and it is thanks to you that we won a national award. So we've decided to go for it again in the UK Blog Awards 2017!
Here comes the shameless plug
The blog has again been entered into two categories: 'Health and Social Care', and 'Education'. You can vote for us in either category but of course we would really appreciate it if you voted for us in both.
Vote now by following this link
The above link takes you to our profile page on the UK Blog Awards website in which we have chosen two of our favourite posts from 2016:
Hopefully it won't be a maple syrup bottle we'll be holding aloft in celebration come April 2017!
Thank you for your support.
*We do still need your posts! Please contact me (m.welford@tees.ac.uk) if you would like to write a post for the Fuse blog. Here’s how to take part.
This post is a little like those episodes of Friends in which one of the cast says: “Do you remember the time when [cue wobbly vertical lines]…” and the rest of the 22-23mins is made up of clips from previous shows.
 | |
| Courtesy of photobucket.com/user/xuyu79/media/blog/s7/s07e18 / Warner Bros. |
This year we have had posts covering everything from Dry January, the ‘nanny state’, animation, Jamie Oliver's school dinner and sugar tax campaigns, to ‘fat shaming’, indigenous Australians, Baywatch, energy drinks, Grandmothers, e-cigarettes, and 'legal highs'.
Five years on from the blog's inception and we have reached the point where people are actively approaching us and generously giving up their time to write posts, rather than having to send in our crack team (the fear inducing) ‘blog working group’ to chase, harry and cajole*. Could this - and the increased viewing figures - have something to do with the little matter of winning a UK Blog Award last year? I'd like to think so.
And now, we come to the crux of this post. It is you, our dear readers and contributors that make the blog a success and it is thanks to you that we won a national award. So we've decided to go for it again in the UK Blog Awards 2017!
The blog has again been entered into two categories: 'Health and Social Care', and 'Education'. You can vote for us in either category but of course we would really appreciate it if you voted for us in both.
Vote now by following this link
The above link takes you to our profile page on the UK Blog Awards website in which we have chosen two of our favourite posts from 2016: - From school dinners to sugar tax: Jamie Oliver to the rescue! - Victoria McGowan looks at whether celebrity endorsement has really helped some of the biggest food campaigns.
- England won’t make it past the quarter finals - Clare Bambra analyses the huge health divides across Europe ahead of Euro 2016 (with added infographics, video and social media content).
Hopefully it won't be a maple syrup bottle we'll be holding aloft in celebration come April 2017!
Thank you for your support.
*We do still need your posts! Please contact me (m.welford@tees.ac.uk) if you would like to write a post for the Fuse blog. Here’s how to take part.
Thursday, 1 December 2016
The biology of inequality and the role of the generalist
The increase in data linkage to routinely collected data records (e.g. education surveys linked to health records) is also allowing us to research the long-term health consequences of social and economic circumstances, even after studies and surveys have stopped running. It may also be possible in the future to carry out such linkage between health and social data with biomarker data, collected when visiting your doctor for example. There are obviously many ethical, financial and practical challenges and questions linked to these types of data linkage ideas, but they offer possibilities to broaden our knowledge of the social determinants of health. It is also becoming slightly more common to see intervention studies including biomarker measures that will allow us to see the physiological effects that will be occurring long before we ‘feel’ or see changes in health, perhaps changing how we can demonstrate ‘effectiveness’.
If you’re interested in finding out more, please visit Tony’s website www.BiologyOfInequality.com and you can also find him on Twitter @tonyrobertson82
Photo attribution:
- “jack-of-all-trades” by shai aharony via Flickr.com, copyright © 2016: https://www.flickr.com/photos/139807035@N05/25607414481
- “match_maker_love_machine” by Capes Treasures via Flickr.com, copyright © 2012: https://www.flickr.com/photos/26652069@N07/8390808924
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