Intended for healthcare professionals


BMA calls for 20% sugar tax to subsidise cost of fruit and vegetables

BMJ 2015; 351 doi: (Published 13 July 2015) Cite this as: BMJ 2015;351:h3803

Re: BMA calls for 20% sugar tax to subsidise cost of fruit and vegetables

We agree with the BMA and other public health researchers that tax should be added to sugar sweetened drinks.(1) Many major retailers in the past have used fiscal measures to successfully alter the purchasing behaviour of their customers whilst health promoters have also effectively used fiscal measures.(2,3) But, on its own it may have little effect and may even be counterproductive.

We believe that in general, health promoters should not just be involved in tinkering around with one tool for bringing about changes in behaviour – the obesity epidemic needs a well-structured comprehensive programme. In addition to fiscal measures, a diverse range of approaches are needed including: developing personal skills; creating supportive environments; and reorienting health services so that they move increasingly towards health promotion (4,5).

In the past there has been too much focus on individuals. An approach to health education which only focuses on individuals rather than the external forces that influence an individual person may result in victim-blaming and be ineffective.(6) We need to transform our obesogenic environments into health promoting ones; and taxation is one way of doing this. Key settings, including hospitals and schools also need to change so that they are more health promoting.(5)

Schools should be an important setting for health promotion where more could be achieved. Teachers, catering staff and school nurses are just some who potentially have important roles to play across and beyond the curriculum. However, they will need external support if they are to fulfil their health promoting roles. A vital first step would be the re-introduction of the Healthy Schools initiative.(9)

For those who are against environmental approaches it is important to note that many of the great public health successes in the past have been the result of environmental changes and some of these have had quick results. Injury prevention and smoking are just two areas where lessons can be learned.(7,8)

Obesity has reached epidemic proportions and should be considered one of the most serious public health challenges as its consequences include heart disease, cancers and diabetes (10-15). Curbing this epidemic will require a population-based multisectoral approach. Fiscal measures should be included but they should be one element of a comprehensive mulitifaceted campaign. Urgent action and a shift in momentum are needed so that we do not abrogate our responsibility to the next generation.


1) Torjesen I. BMA calls for 20% sugar tax to subsidise cost of fruit and vegetables. BMJ 2015;351:h3803

2) World Health Organization, Global strategy on diet, physical activity and health. Geneva: World Health Organization, 2004.

3) Townsend J. Price and consumption of tobacco. Br Med Bull. 1996;52(1):132-42.

4) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

5) Watson M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

6) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001

7) Hemenway D, While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.

8) Callinan JE, Clarke A, Doherty K, et al. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2010;(Issue 4).

9) Lloyd J. President’s Letter. International Journal of Health Promotion and Education. 2013;51(2):121-122

10) Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004, 5(Suppl 1):4–104.

11) Foresight. Tackling Obesities: Future Choices – Project Report. Government Office for Science: London. 2007

12) World Health Organization. Global status report on noncommunicable diseases. Geneva: World Health Organization, 2010.

13) World Health Organization. Population-based approaches to Childhood Obesity Prevention. Geneva: World Health Organization, 2012.

14) NICE. Local government public health briefings - Preventing obesity and helping people to manage their weight. London: NICE, 2013

15) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013

Competing interests: No competing interests

14 July 2015
Michael Craig Watson
Associate Professor of Public Health.
Dr John Lloyd (Immediate Past President, Institute of Health Promotion and Education).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA