Sodas and other sugar-sweetened beverages, or SSBs, largely produced by big companies such as Coke and Pepsi, are all around us. The problem is that consumption of SSBs and other forms of added sugar increases the risk of developing serious metabolic diseases such as obesity and diabetes and contributes to sky-high health care costs. Public health experts continue to generate innovative solutions to address these issues, but one salient option has been to tax the producers and distributors of sugary beverages.
Similar to how tobacco companies are held accountable for selling products with known adverse health risks by paying “user fees” to the U.S. Food and Drug Administration, SSB taxes force beverage companies to be held responsible for some of the costs of diabetes and other illnesses exacerbated by their products. Sugary beverage taxes also have the potential to generate important revenues to fund health and education programs, which reduce economic, racial and ethnic disparities. Emerging evidence suggests that these taxes, which have been adopted in Berkeley, San Francisco, Oakland, Philadelphia and other cities around the country, are effective and deserve serious consideration. It is crucial that we include a similar statewide measure on California’s 2020 ballot.
As a graduate student at the UC Berkeley School of Public Health, I study how the food we consume affects our well-being. Nearly two-thirds of children and half of all adults in the U.S. consume at least one sugary beverage on a given day. A standard 20-ounce bottle of Coke contains 65 grams of added sugar — 180 percent and 260 percent of the American Heart Association’s recommended daily limit for added sugar for men and women, respectively. This overload of sugar in the body is one of the key players in the development of obesity, diabetes and heart disease. According to the Centers for Disease Control and Prevention, approximately 30.3 million people in the U.S. suffer from diabetes, to the tune of $245 billion spent annually on related health costs. Interventions, including SSB taxes, to reduce the risk of developing diabetes by lowering intake of added sugars aren’t just proactive — they’re long overdue.
Studies on existing SSB taxes in the U.S. have been promising. In the three years after implementation of the excise tax in Berkeley, a 1 cent per ounce tax reduced consumption of SSBs in low-income neighborhoods by more than 50 percent. In Philadelphia, consumption of regular soda decreased by 38 percent just two months after the rollout of a similar policy. A tax-based model presents unique opportunities to not only curb consumption but also generate revenue for schools, nonprofit organizations and other public health interventions to support a healthier population. In Berkeley, tax funds from 2018 and 2019 will support the Berkeley Unified School District’s education infrastructure, LifeLong Medical Care’s low-income dental services and the YMCA’s Diabetes Prevention Program, in addition to several other projects aimed at reducing consumption of sugary beverages.
Many industry representatives critique SSB taxes for two reasons: First, they believe the government has no place in deciding what goes on our plates and in our glasses, and second, they claim the tax burden is disproportionately borne by low-income groups.
In actuality, beverage companies, through their expansive marketing campaigns and advertising budgets, already significantly influence our diet choices. They have a real financial incentive to keep other players, including public health advocates, away from that decision-making process. Earlier this year, The New York Times reported on efforts made by a group called the International Life Sciences Institute, or ILSI, within China’s Center for Disease Control and Prevention to maintain industry interests in Chinese health policymaking. The ILSI was founded by a Coca-Cola vice president in 1978, and the Chinese branch is now supported by 38 of the most prominent food industry multinational corporations. Even academic institutions in the U.S. are not immune. A contract between Pepsi and UC Berkeley has led to the exclusive sale and promotion of Pepsi products on campus since 2011.
Taxes on sugar-sweetened beverages are a tool that can level the playing field and ensure that consumers are well-informed about the potential health consequences of certain foods. The argument that SSB taxes burden low-income folks ignores a body of evidence that says otherwise. In Mexico and Berkeley, the greatest reductions in SSB consumption after a tax occurred in low-income communities, suggesting that higher-income communities may indirectly pay a higher proportion of the total tax cost. Disadvantaged groups often already lack access to health services and are unable to buffer the economic burden of diabetes and obesity. Preventative measures such as taxes on unhealthy products could indirectly lower these costs.
If we want to improve population health, we as consumers need to recognize that our votes matter. We have to recognize what works and what doesn’t. This is why rigorous scientific studies from cities implementing SSB taxes are so important. A statewide tax on SSBs, already backed by the California Dental and Medical associations and likely to appear on California’s 2020 ballot, is projected to raise $1.7 billion in much-needed revenue for critical health programs. If ongoing work continues to corroborate the initial successes we’ve seen in local settings, then a serious discussion is absolutely warranted on whether similar taxes on sugary beverages should be implemented at the state or even national level.
Matthew Lee is a graduate student at the UC Berkeley School of Public Health.