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Tax policy and good health  

GUESTXCOLUMNThe Minister of Finance was recently commenting on the ‘sweetened beverage’ tax, introduced in the 2015 Budget, with the stated objective of reducing the consumption of ‘items that contained high calorie sweeteners’.

These sweeteners are a prime suspect in the development of the large numbers of obese persons in our community. In turn, these persons serve as focal points to generate our epidemic of chronic non-communicable diseases (NCDs), affecting both the limbs and lives of our people, and the economy of families and the country at large.

According to the quote in the newspapers last week, the Minister said: “We haven’t seen a dramatic decline in the use of sweetened beverages yet, but it comes with time”. He was referring to the 10 per cent tax on carbonated soft drinks, juice drinks, sports drinks [it is not generally considered that sport drinks have ‘high calorie’ sweeteners] and fruit juices.

During the 2015 Budget presentation, it was announced that the tax was designed to raise awareness about NCDs and engage the public in finding alternatives to sweetened beverages. A financial policy that attempts to discourage the use of ‘unhealthy’ foods, and ‘nudge’ individuals towards more healthy alternatives, needs to ensure that unhealthy foods cost a lot more than the healthy ones. 

The 2015 sweetened beverage tax did not do that and the pricier sweetened drinks still were among the cheaper alternative beverages available to consumers who (1) had developed a sweet tooth over many years; and (2) were dealing with a climate that is very hot, confirming the predictions of those scientists who said that global warming is here to stay. Drinking lots of liquids is very important in this environment.

So with no healthier alternatives in the same budget range,  and no ‘healthy’ alternatives being allowed to drop into the same price range as the sweetened beverages (by, for example, an enlightened tax policy), consumers continued to buy the sweetened beverages and increase Government’s tax collection.

But the increased cost of soft drinks also drew another response from our food retailers.  Beers “4 for $10” and “5 for $10” posters appeared in our newspapers and outside stores so that we had a new phenomenon: an alcoholic beverage (beer), at least in the same price range as, or sometimes cheaper, than soft drinks.

Already faced with a problem of alcohol use in our community, the potential problem of increased use cannot be understated. The Queen Elizabeth Hospital’s Accident & Emergency Department’s spokespersons, and the Hospital Director, periodically refer to the relationship of alcohol, motor vehicle accidents and the depletion of resources that alcohol-related accidents cause.

Alcohol contributes to a large number of severe medical, psychiatric and many social problems. The Psychiatric Hospital has to devote resources and ward space to alcohol-related problems, and alcohol is a legal drug. Unfortunately, alcohol also serves as a ‘gateway drug’: its use seems to encourage heavier use over time, and the graduation to illegal drugs.

As the Minister of Finance suggested, it is probably too early to fully judge the consequences of his soft-drink tax one year after its introduction, but the early signs are not encouraging, as far as the overall non-financial health of Barbados is concerned. Even though the Minister admitted that the tax collection from the sweetened beverages was not proceeding as initially envisioned, he gave no timetable as to when this initiative will be formally reviewed or modified.

The National Social Responsibility Levy (NSRL), introduced in the 2016 Budget, is scheduled to raise the costs of both healthy and unhealthy foods, and is added on top of the sweetened beverage tax of 2015. Like the sweetened beverage tax, the NSRL is also unlikely to change consumption patterns in a population addicted to unhealthy eating and drinking.

Unfortunately, in the interim, the NCD epidemic continues with the force of a strong hurricane. The media report about 2-3 people dropping down suddenly each week, challenging the numbers who are the victims of gunshot crimes.  Earlier this year, the Ministry of Health, in the face of public speculation about an apparent spate of sudden deaths, pointed out that the numbers of ‘sudden deaths’ for the first six months of 2015 and 2016 were 21 and 24 respectively, a mere increase of 14 per cent. The population should not be alarmed, the Ministry assured.

The Chief Medical Officer’s annual reports, missing in action since 2009, have not previously reported statistics on sweetened beverages, or even alcohol consumption. Now that these items are being recognized by Government ministries as being particularly important to health, it would make interesting reading, when reports become available, to view official statistics on consumption patterns of these items, to view the influence of the ‘sweetened beverage tax’ on use of these items, and perhaps to link these to both our NCDs as well as our alcohol-related diseases.

The approach taken in the UK to sweetened beverages may be instructive for us. The Government was able to ‘negotiate’ with members of the processed food sector, including the sweetened beverage industry, to reduce by 10 per cent per annum the amount of both sugar and salt added to food  products. Thus, over five years, the amount of added sugar and salt in processed foods will be reduced by 50 per cent.

Consumers can gradually adjust to the taste of foods with reduced sugar and salt over a few years, until safer levels of these ingredients are achieved. Manufacturers can reduce their input of added sugar and salt, thus reducing input costs of their products while maintaining consumer prices. For the same price, consumers can purchase a ‘healthier’ product.

This translates to a win-win scenario for consumers and the processed food sector. Many major medical bodies in the UK would have preferred that the Government legislate (as opposed to negotiate) this scenario, but are nonetheless encouraged by the majority acceptance by the manufacturers, and are wary of the political lobby strength that a multi-billion dollar food sector industry can exert if the sector feels that they are being pushed into a losing scenario.

Our Ministry of Health officials need to pay close attention to the consumption patterns of local consumers, if efforts to combat the NCDs are going to be successful. While financial policy has an important role to play, it needs careful consideration.

Dr C.V. Alert, MB, BS, DM is a Family Physician.

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