“Sin taxes”—the language is wrong, but the evidence is clearBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4616 (Published 11 July 2019) Cite this as: BMJ 2019;366:l4616
All rapid responses
I am in complete agreement with the author regarding the effectiveness of sugar levy to tackle obesity but the term ‘sin tax’ is unacceptable. Perhaps alternative terminology such as ‘sugar tax’ may be used as one is highlighting the product or ingredient that is being taxed.
Studies have established that taxation on sugary drinks is an effective means to reduce sugar consumption . Evidence shows that a tax on sugary drinks which rises prices by 20% can lead to a decrease in consumption of around 20% . But introducing a levy on products that are regularly consumed by low-income households could take a greater share of income from these poorer households.
The relation between low-income households and obesity is due to the fact that these income groups buy cheaper, high energy food alternatives instead of healthier options. Many families with children and single-parents substitute healthy fruits and vegetables for cheaper high calorie, ultra-processed food which are high in fat, sugar and saturated fats as part of their daily diet. Such substitution has been consistent in many families as the food price has increased by 30% between 2007 and 2012 while the national salary in the United Kingdom only rose by 1.5%-4.0% for the same period . As such families only spend less than 15% of their income on food, these energy-dense foods of poor nutritional value are cheaper than more nutritious foods such as vegetables and fruit, and relatively poor families with children purchase food primarily to satisfy their hunger . Reports suggests that most of the low-income families in Europe are aware of different constituents of a healthy diet but its affordability, accessibility and availability of food that acts as a main challenge in consuming them .
More and more households in the United Kingdom are struggling to meet the increasing cost of living: the introduction of such taxes would make things even harder. Rather than making it harder for struggling households, it is the responsibility of the government, law-makers, and community to make healthier food affordable and accessible.
Some recommendations include:
a. Providing free (or subsidised) school meals for children (as is the case in England, Wales, and Finland)
b. Welfare payments in vouchers such as France’s fruit and vegetable vouchers and UK’s Healthy Start vouchers
c. Calculating the cost of a healthy food basket and adjust accordingly the minimum wage levels, especially for families with children.
1. Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: World Health Organization; 2017.
2. Powell, LM., Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obesity Reviews, 2013; 14:110-128.
4. Griffith R, O’Connell M, Smith K. Food expenditure and nutritional quality over the Great Recession. IFS Briefing Note BN143. London: Institute for Fiscal Studies; 2013 (http:// www.ifs.org.uk/bns/bn143.pdf, accessed 4 December 2013).
5. European Commission 2013. https://ec.europa.eu/eurostat/statistics explained/index.php/Overweight_and_obesity_-_BMI_statistics
Competing interests: No competing interests
We agree completely with the author that the sugar levy is a valuable tool in trying to tackle the obesity epidemic1. We also feel, as the author does, that the term “sin” tax is not an acceptable term1.
You have a patient sitting in front of you who has very little social support, who works unsociable hours and is scared after a recent heart attack; there is no question about how they are feeling. They already feel down and scared and the last thing they need is to feel ashamed and be labelled sinners.
Instead of labelling people it is the government’s responsibility to help them.
As the author wrote, there is public support for the tax1,2. There is however also a level of weariness and distrust in government policies3.
It is important for the government to not waver, thereby further disrupting the public’s trust in the policies. It is vital to stick by the sugar levy and allow it enough time to be effective and to allow the public to gain more confidence in the policy.
Yes, it will have a greater affect on lower income households but instead of querying the status and evolution of the tax, why not make healthy eating more accessible?
Why not make fruits and vegetables even cheaper and increase their advertising?
1. Briggs Adam. “Sin taxes”—the language is wrong, but the evidence is clear BMJ 2019; 366 :l4616 https://www.bmj.com/content/366/bmj.l4616?hwshib2=authn%3A1563184386%3A2...
2. Pell D, Penney T, Hammond D, Vanderlee L, White M, Adams J. Support for, and perceived effectiveness of, the UK soft drinks industry levy among UK adults: cross-sectional analysis of the International Food Policy Study. BMJ Open2019;9:e026698.doi:10.1136/bmjopen-2018-026698. https://bmjopen.bmj.com/content/9/3/e026698. pmid:30827952
3. Swift, J. A., Strathearn, L. , Morris, A. , Chi, Y. , Townsend, T. and Pearce, J. (2018), Public health strategies to reduce sugar intake in the UK: An exploration of public perceptions using digital spaces. Nutr Bull, 43: 238-247. doi:10.1111/nbu.12346
Competing interests: No competing interests