Will the sugar tax help to combat obesity?

On 6 April, the ‘sugar tax’ (officially, the ‘Soft Drinks Industry Levy’) will be implemented in the UK.

This will see a tax on sugar-sweetened beverages with over 5g of sugar per 100ml (18p per litre), and a higher tax for those with more than 8g per 100ml (24p per litre). With these extra costs likely to be passed on to customers, the Government and health campaigners hope it will deter consumers from buying the most sugary drinks, and lead to a significant decline in obesity.

Obesity was one of the four case studies in our Public health: ethical issues report – and one that continues to be relevant in the decade since its publication. Obesity remains a major public health issue in the UK, and increasingly in the world. Obesity increases the risk of a number of diseases, including type 2 diabetes, cardiovascular disease, and certain cancers, and puts a major strain on the NHS. According to Public Health England, the NHS spends around £6 billion per year treating obesity-related conditions.

As we state in our report, there are a number of different factors that contribute to obesity, and there is no ‘magic bullet’ to reduce it. Effective strategies are likely to incorporate many small changes implemented over a long period of time by many different parties. Any changes introduced through legislation, product reformulation, marketing, infrastructure that encourages a more active lifestyle, education – are likely to take years to make an impact. In addition to these changes, reducing obesity requires behavioural and societal change, which could take generations.

The sugar tax is an example of ‘guiding choice by disincentives’ – the third rung of our intervention ladder which we set out in our report as a useful way of thinking about the different ways that public health policies can affect people’s choices.

In our report, we argued that the state, acting as a ‘steward’, has a duty to provide conditions that allow its citizens to lead healthy lives. The food industry also has a responsibility to help individuals make healthier choices, and should, therefore, review the composition of products they manufacture, and the way they are marketed and sold. Where the industry fails to uphold its responsibilities, whether through reformulating products or adopting easy-to-read packaging across the sector, regulation by the government is ethically justified.

There have been a number of voluntary initiatives directed at the food industry to create healthier products, primarily aimed at reducing sugar, salt, saturated fats, and/or trans fat. Many of these voluntary initiatives have shown that much can be achieved through self-regulation. For example, in the 7-8 years after the introduction of the Food Standards Agency’s voluntary salt reduction programme, the salt content of many food products was reduced through reformulation, alongside the introduction of a number of low-salt versions of products to the market.

For all the merits of voluntary initiatives, there are a number of factors that can interfere with them – government changes, departmental shifts within government, changes in public opinion, resistance from industry, or the state of the economy, to name a few examples.

Some believe that voluntary schemes are not enough, and the only way to achieve widespread reductions in salt, sugar, fat or calories of food products is through mandatory regulation and taxation.

A leading argument against these sorts of interventions is that it hinders an individual’s personal freedoms or autonomy; regulation is the product of a ‘nanny state’ telling you what to eat or drink. However, the notion of individual choice is difficult to apply in relation to obesity, since people’s behaviour ‘choices’ may be heavily influenced by others – e.g. what consumers choose to eat is partly influenced by the products available and the way they are promoted, priced, and distributed.

Front-of-pack traffic light labelling: an example

In our report, we used the example of food labelling to examine the role of the food industry’s corporate social responsibility in reducing obesity. In 2013, the Government recommended that food businesses implement a front-of-pack ‘traffic light’ labelling scheme. Each front-of-pack (FoP) label contains categories for energy, fat, saturated fat, sugars, and salt content that are colour-coded: red indicating a food contains a high amount of the category, yellow: medium, and green: low. The aim is to make it easy for consumers to quickly make informed decisions about what they choose to eat.

The Department of Health has issued guidelines for a universal labelling scheme, and around two-thirds of products in the UK have adopted FoP labelling. However, some food manufacturers are choosing to use traffic light labelling on some, but not all, of their products – particularly for cereals or items that might be perceived as ‘healthy’, but contain a great deal of sugar. Because of these discrepancies, the Local Government Association recently called on the government to make traffic light labelling a legal requirement after Brexit.

I decided to do my own little investigation at the local supermarket, focusing on the crisp and cereal aisle. I found major inconsistencies across the major brands: in the crisp aisle, some had the full FoP colour-coded labelling; some had no FoP labelling; and some had FoP labelling, but not colour-coded.

For leading brands of cereals, some didn’t have any FoP labelling; others had FoP labelling, but not colour-coded; and some had FoP traffic light labelling in the top corner of the box. I almost missed one of the labels because I was so used to looking for it in a certain place.

The placement of the label also varies. For most products, the label seem to be in the bottom corner, although the Department of Health guidelines only states that the label should be in the ‘principal field of vision’ of a package. I peeked into a chain ‘organic’ store and was surprised to find that none of the crisps or snacks had any FoP labelling.

Traffic light FoP labelling is a prime example of how voluntary initiatives can be taken up by the food industry to enable consumers to make healthier choices without much intervention. But is it good enough? Well, using the recommendations and conclusions of our report as a guide, this is an example where legislation could be ethically justified. A voluntary scheme was initiated as the first port of call, and industry was given the opportunity to implement labelling, but one-third of products in the UK still don’t have the recommended labelling. The food industry has an ethical duty to help individuals make healthier choices, and the state has a duty to intervene if this isn’t being done.

It will be interesting to see if the government takes the Local Government Association’s recommendation to make universal FoP traffic light labelling a legal requirement post-Brexit. As we point out in our report, the only way of establishing whether a new policy is likely to lead to improved health is often by trialling it, and in the case of a serious public health matter like obesity, it is desirable to explore the potential of a range of measures that could help to tackle the problem. For government, policies with potential long-term benefits are difficult to reconcile with short-term priorities, but should not to be ignored. Doing nothing is an active policy decision, and so both action and inaction require justification on the part of the government.

From tomorrow, the process of gathering evidence on the impact of the sugar tax will begin, but already some manufacturers have reduced the sugar content of their products. This seems a good place to start.