Tax on junk food can help defuse ticking obesity timebomb
Francis Finucane
Given the recent suspension of bariatric surgical activity at the country's flagship unit in St Vincent's Hospital because of a lack of funding, the Irish Heart Foundation seminar on taxation of sugar sweetened drinks (SSDs) couldn't have come at a better time. Most Irish adults are now overweight or obese and while there is no doubt that this arises from adverse lifestyle behaviours, there is a growing realisation that asking people to eat less and exercise more hasn't been very effective.
Within an obese environment, some people find it easier than others to maintain a healthy weight and the causes of this variation are complex. Rather than a moral failure, obesity is now recognised as a neurobehavioural disorder which is strongly genetic and highly sensitive to environmental changes that have occurred over the last three decades. Proposed health-related food taxes to mitigate these changes and reverse the rise in obesity generate criticism for a number of reasons.
Firstly, there is no doubt that the tax would be unpopular. It would represent an additional financial burden at a time of economic hardship. But what tax is popular? Governments use taxation all the time to modify people's behaviour and the consumption of things like alcohol and tobacco. So the unpopularity of a health-related food tax is real and understandable, but shouldn't be a barrier to its implementation.
Despite predictions of civil disobedience at the time of the smoking ban in 2004, Irish people seemed to understand the rationale for it and recognised it was a positive step. Taxing junk food hardly represents a significant escalation in "nanny stateism". Lobbyists from the food industry seem reluctant to accept these taxes because of concerns that they will affect consumption, sales and profits. In a sense there is unanimous agreement between proponents of junk food taxation and those lobbyists that taxation will reduce the consumption of unhealthy foods.
Secondly, critics say that ring-fencing the money generated from such a tax in order to fund anti-obesity initiatives is harder than it seems and may not be worth the financial hassle. Again, there is an Irish precedent that illustrates just how straightforward and effective taxation can be at changing behaviour and generating revenue to fund solutions to a specific problem.
In 2002, in an attempt to reduce plastic bag consumption, the government introduced a levy of 15c per bag. Overnight, per capita consumption fell from 328 to 21 bags, a 93.6pc reduction. Aside from an effective impact on an adverse behaviour, very significant funds were generated for improved waste management. In the 10 years to 2012, €185m was pledged for different environmental projects nationally. Why couldn't the revenue generated from a health-related food tax be quantified and reinvested in the same way?
A third concern around the introduction of such a tax is the apparent lack of evidence that it would have the desired effect. However, we know for certain that consumption of unhealthy food is associated with adverse health effects. The impact of the tax on each individual's health within the general population is likely to be small and thus difficult to quantify and measure in a scientific context. However, the overall effect on the whole population is likely to be large, with a significant reduction in the so-called "population attributable risk" of overweight and obesity. Achieving large overall health benefits (which are difficult to quantify) in the context of small individual changes is a core principal of preventive medicine.
There is a lack of hard evidence that junk food taxation leads to weight loss because the scientific means to conduct such an "experiment" do not exist. That lack of evidence arises not because the intervention isn't effective but because we aren't very good at measuring the things that change with the intervention. We need to invoke the "precautionary principle" and apply the intervention on the grounds that it is likely to have desirable effects and unlikely to do harm. We cannot afford to wait for an evidence base that is never going to materialise.
Finally, health-related food taxes are regressive in that they have a disproportionate effect on people who are less well-off. While this is true, poorer people also have a higher risk of obesity and related problems such as diabetes and cardiovascular disease. So, a proportionally greater disincentive to buy unhealthy foods might serve to reverse some of the health inequalities across society. The assertion that poorer people will be materially adversely affected by reduced affordability of sugar sweetened drinks doesn't really stand up to scrutiny at a time of water metre introduction. We need to change how we see the obesity epidemic. Rather than just seeing the adverse lifestyle behaviours of obese individuals as the problem, we need to see the environment that encourages obesity as the problem. With the introduction of the 20pc tax on sugar sweetened drinks proposed by the Irish Heart Foundation, Ireland could again exemplify the approach that is needed to tackle a major health problem. We can't afford not to.
Francis Finucane MD MRCPI is a consultant endocrinologist and Galway University Hospital's honorary senior lecturer in medicine, NUI Galway
Irish Independent
