There's been a lot of hyperventilating over the past week since the Grattan Institute and then the Australian Greens kicked off serious discussion about a tax on sugar-sweetened beverages to tackle the obesity epidemic in Australia.
Although public health advocates have been talking about a sugar tax for a long time, the government has taken a 'nothing to see here' approach, ignoring the growing support for a sugar tax here and abroad. Or, in the case of Barnaby Joyce, the 'bonkers mad' approach.
Who was glued to the United States election night waiting to find out the outcome of local proposal for sugar taxes? Okay, it might have just been me. Regardless, sugar taxes were voted for in San Francisco, Oakland, Albany, Cook County and Boulder, and with up to a 70 percent 'yes' vote were significantly more popular than either Donald Trump or Hillary Clinton.
And before we go on, let's not forget that this is not just an issue about obesity and overweight, which affects one in four Australian children and two in three adults, but is also an issue for diabetes, cardiovascular disease and, most importantly (at least from my perspective), tooth decay, which affects more than 50 percent of our children and the vast majority of adults.
Across both social and traditional media, opponents of a sugar tax have been running hot. We've had Henry Ergas and Nick Cater in The Australian arguing strongly against the imposition of a sin tax. I've been accused on social media of being a moralising crusader who only wants to punish the poor, told that diet-related diseases are the fault of the individual, that a sugar tax won't actually solve anything anyway, and asked why the focus on sugar-sweetened beverages when there is sugar in other foods and drinks. Someone even told me that since knives and water could potentially harm people, maybe we should tax them too. Quality debate.
Let's look at some of these arguments, and pick them apart.
On the moral issue, I'm accused of wanting to punish poor, soft-drink consumers by imposing a tax that will cost the average person who consumes one can of soft drink per day a grand total of $54.75 per year -- hardly a significant punishment.
But it unfairly targets the poor, they cry. Newsflash people -- diet-related diseases unfairly target the poor. The burden of obesity, type II diabetes and tooth decay is disproportionately higher in disadvantaged population groups across Australia. We need to reduce consumption of sugar, and a price signal is one way to help do that. So rather than being penalised, poorer people stand to benefit the most in improved health outcomes. An added bonus is that a sugar tax acts to educate about the health impacts of soft drinks.
I've had dozens of armchair experts this week tell me that in their humble opinion, all of these people with tooth decay are simply not brushing their teeth enough -- along the same lines of the calories in/calories out crew who argue that lack of exercise is the cause of obesity.
Tooth brushing is very important for good oral health (and exercise is important for general health), but we've known for many years that sugar is the primary driver in tooth decay. This was reiterated by eminent public health expert Professor Aubrey Sheiham last year, who said that "the only cause of caries (decay) is dietary sugars." Modifying factors such as fluoride and oral hygiene are important, but if we remove the added sugar from the diet, then we address the main cause of tooth decay.
We are constantly told by the food and beverage industry that all we need to do to avoid obesity or tooth decay is exercise personal responsibility. Yet they exercise none. Blaming the consumer is a favoured line of industry, and fortunately for them they have plenty of libertarian allies willing to sing from the same song book.
"It's the parents fault", they all bleat. "When I was a kid, my parents just said no." That's true, and so did mine. But when I was a kid, I wasn't surrounded by wall-to-wall advertising and marketing of junk food in the same way that my kids are. Where is the corporate responsibility here? When was the last time you saw a warning label on a can of soft drink telling you that excess consumption might cause tooth decay or diabetes? Where are the television advertisements promoting moderate consumption?
I'm constantly told that a sugar tax won't solve anything. Public health groups campaigning for a sugar tax are doing so as part of a suite of measures aimed to reduce sugar consumption. This includes education and health promotion, efforts to reduce marketing, advertising and sponsorship (especially to children), better food labelling to help people make healthier food choices, and reformulation to reduce the amount of sugar in many foods.
What about the effectiveness of sugar taxes? Increasing taxation has been an important part of the strategy to help reduce smoking rates in Australia, and there's no reason to think it won't work for sugar. Indeed, increasing the price of sugar-sweetened beverages has been shown to reduce consumption in places such as Mexico, Berkeley and even the Alfred Hospital. Interestingly, the proposed sugar tax in the UK has even seen Tesco decide to reduce the sugar content of their beverage range to below 5 grams per 100ml, to avoid the sugar tax. That sounds like success to me.
Why focus on soft drinks? A can of soft drink contains around 10 teaspoons of sugar, and a 600ml bottle has 16 teaspoons. These are marketed and sold as a serve -- they are not designed to share. The World Health Organisation recommends reducing added sugar intake to fewer than six teaspoons per day, so soft drinks and sports drinks in most serving sizes significantly exceed this daily amount. And the average Australian teenager consumes more than 20 teaspoons of added sugar per day, with more than one third (or seven teaspoons) coming from sugar-sweetened beverages. So measures targeted specifically at these drinks can go a long way to reducing sugar consumption and improving health.
Anti-tax crusaders never offer any alternative solutions -- believe me, I've asked, and when challenged all I hear is silence. And meanwhile, Coca Cola alone is spending $4 billion dollars globally marketing their products -- associating it with sports (hello AFL and the Olympics) and Christmas (because we all know that Santa just loves Coke) to entice kids to drink more.
I would challenge some of these well-meaning but misguided people to go and spend a day or too at their local public dental clinic, and observe the problems that we are faced with in the dental profession. See the children with tooth decay so severe that they are having general anaesthetic operations to remove multiple teeth at the age of three years. And then turn around and tell the parents that it's all their fault. After all, you know it's all the parents fault, right?