Intended for healthcare professionals


UK’s sugar tax hits the sweet spot

BMJ 2021; 372 doi: (Published 10 March 2021) Cite this as: BMJ 2021;372:n463

Linked Research

Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy

  1. Alexandra Jones, research fellow1,
  2. Jason H Y Wu, associate professor1,
  3. Kent Buse, professor2
  1. 1The George Institute for Global Health, UNSW, Sydney, Australia
  2. 2The George Institute for Global Health, Imperial College, London, UK
  1. Correspondence to: A Jones ajones{at}

Consumption of sugar from soft drinks falls within a year

Excess consumption of free sugars is a major contributor to diet related diseases, including tooth decay, type 2 diabetes, obesity, and cardiovascular disease.1 Sugar sweetened beverages (SSBs) provide a substantial source of free sugars in the global diet yet offer no nutritional benefit, making them a reasonable target for public health action.234 The World Health Organization recommends that governments implement taxes on SSBs as part of a comprehensive policy response,5 and around 50 jurisdictions worldwide do so.6

The UK soft drinks industry levy was at the forefront of progressive policy design when announced in 2016. Targeted at manufacturers, its tiered structure imposes higher taxation on products with higher sugar content, providing motivation to reformulate to reduce sugar levels.

Now fresh evidence shows it is working exactly as intended.7 In a linked paper, Pell and colleagues(doi:10.1136/bmj.n254) report a reduction in sugar purchased in soft drinks one year after implementation of the levy, but no overall change in the total volume of drinks sold. They consider this a “win-win”: consumers are buying less sugar, while industry’s bottom line remains largely unscathed.

These findings offer lessons for other countries exploring strategic regulatory options to promote healthier diets.

The first is compelling yet unsurprising: embedding profit motives in regulation is an effective way to shift the behaviour of profit driven enterprises. Here, the benefits of the levy’s legislative approach are most clear. Beyond the decrease in sales and consumption of drinks experienced in other jurisdictions with SSB taxes,8 the levy has catalysed widespread reformulation with potential benefits to population health, even without reliance on consumer behaviour change. Compare the progress made by a mandatory industry levy, for example, to Public Health England’s concurrent attempts to get food companies to cut salt and sugar in other products voluntarily—which have largely failed.9

The UK is not alone in maintaining these “softer” forms of engagement with industry, despite well known limitations.10 In Australia, for example, an SSB tax has been sidelined by a voluntary industry pledge to reduce sugar sold in beverages by 20% over a decade.11 Its terms are vague, lack full market coverage, and will not be subject to independent evaluation. There appears no good reason why Australians should wait a decade for benefits that the soft drinks industry levy demonstrates can occur in a much shorter timeframe.712

Secondly, in highlighting industry’s steady sales as a valuable benefit, Pell and colleagues provide insight into the costs and benefits associated with public health taxes. Their findings might bolster the political confidence of leaders implementing similar taxes, despite vocal opposition from industry, but should not be a prerequisite for policy action.

Policy makers might be legitimately less concerned with the impact of SSB taxes on industry profits and more concerned with harnessing taxation to distribute further wins among less powerful stakeholders. As with other jurisdictions that tax SSBs, the UK government has generated significant new revenue from its industry levy—at least £576m ($801m; €660m) by June 202013—pledged towards programmes to improve children’s health.14 Elsewhere, countries such as the Philippines have used ring fenced taxes on unhealthy products to fund health services for the poorest and most vulnerable people.15 In efforts to promote healthier diets, there is potential to pair taxes on unhealthy products with subsidies for healthier ones such as fruit and vegetables (also a WHO recommended policy5), to multiply these wins.

Thirdly, although outcomes produced by the current levy are already promising, there is opportunity to strengthen regulation further. One way is to include thresholds for taxation that lower progressively over time to encourage ongoing sugar reduction.16 Another is to periodically review the scope of sugar reduction policies—for example, to consider whether milk based drinks and fruit juices, which can contain high levels of free sugars, should also be taxed.

It might also be prudent to monitor the impact of SSB taxes on use of non-nutritive sweeteners, and to introduce regulatory incentives that discourage their proliferation. Mexico’s new front-of-pack label is a regulatory trailblazer in this respect, requiring products that contain non-nutritive sweeteners to bear a stop sign warning that consumption is not recommended for children.17

Finally, as the world moves towards policies that promote healthier and more sustainable diets, the challenge is to design regulations that improve nutritional quality and reduce the environmental impact of the foods we eat—considering carbon dioxide emissions, water extraction, and plastic pollution, for example. There is potential here to deliver not only health benefits but also benefits for the planet and all those whose lives depend on it now, and for future generations. Wouldn’t that be the ultimate win-win?