ncreasing the tax on sweetened beverages 2022 – here we go again!
Dr. C.V. Alert MB BS, DM. FCCFP.
Family Physician.
In the recent National Budget in Barbados the Right Honourable Prime Minister announced the introduction of an increase in the tax on sugar sweetened beverages (SSBs) from the 10% introduced in 2015 to 20%, from April 1st 2022 (All Fools Day). Is the initial tax not working, or has the non-communicable disease (NCD) gotten so much worse that additional measures are now needed?. What would an additional 10 percent tax do that the initial 10 percent didn’t?
As a reminder, back in 2015, the then Minister of Finance announced the introduction of the 10% tax on SSBs, suggesting that the tax could “nudge” persons to reduce, if not completely eliminate, the consumption of SSBs. Some three to four months later the then Minister of Health chimed in, suggesting that reducing sugar consumption could have a significant direct impact on our chronic non-communicable picture, particularly on obesity in the younger members of our population. It was suggested that the taxes collected could be funnelled into tackling rising costs associated with managing the NCDs.
Three years later that same Minister of Finance announced major budget cuts to the Barbados Drug Service, and perhaps to other areas in our Health Services; this supported the arguments of those who suggested that the initial SSB tax was introduced primarily for financial, as opposed to health, reasons. Certainly the SSB tax did not provide additional resources to fight the NCDs.
There are different schools of thought about whether sugar is addictive. If one defines an addiction as persistent use of a ‘drug’ despite substantial harm and adverse consequences, then sugar is an addictive drug. People often enjoy the ‘high’ associated with a neuro-chemical release (dopamine) that consumption of sugar brings. Cocaine similarly causes a release of dopamine in the brain, and cocaine is classified as an addictive drug. People use the SSBs legally or cocaine illegally because the use makes them feel good.
“Feeling good”, in the short term, seems to take precedent over long-term ‘harm and adverse consequences’. Cigarette smoking is an addiction, but people smoke because smoking make them feel good. People continue to use cigarettes in spite of the long term effects associated with cigarette smoking, including a variety of cancers including lung cancer, a variety of cardiovascular diseases including hypertension and its complications including heart attacks and strokes.
Alcohol also induces the ‘feel good’ feeling, and some persons progress from the casual drinker phase to the chronic and addicted drinker phase – moving through Dizzy and Delightful, to Drunk and Disorderly, to Danger of Death phases. The latter phases suggest addiction. In addition to crashing their cars, losing their jobs, friends and families, spending all their savings on alcohol, alcoholics still often end up in the Psychiatric or General Hospitals with a variety of alcohol-related psychiatric or general health problems. In the case of cigarettes, cocaine and alcohol, and also the SSBs, people use them, regardless of whether they are legal or not, regardless of whether they are cheap or not, and in many cases regardless of whether they are experiencing any adverse consequences from their continued use, because they have become addicted.
Repetitive drug use can alter brain function in ways that perpetuate craving and undermines self control. This makes it infinitely harder to treat addictions. So smokers continue to smoke cigarettes, rum drinkers continue to drink rum, cocaine users use any means possible to get their hands on more cocaine. Would persons who have been using SSBs all their lives, especially since they were very young, give up the sugar, even if they have to pay a few cents more for it? The experience with other drugs of addiction is instructive.
Our calypso writers/singers remind us of how many ‘professional rum drinkers’ we have; our “Bottle Return” lines at supermarkets remind us of how many SSBs people consume weekly. In fact, even our ‘paros’ think collecting empty drink bottles is a profitable venture. Our governments have raised the white flag towards our marijuana users, even while marijuana is considered an addictive drug. Meanwhile wards at the Psychiatric Hospital are overfilled with alcohol, marijuana and cocaine addicts, and wards at our main hospital are overfilled with patients suffering from one or more of the complications of the ncds.
If you think that the consumption of sugar has become an addiction, then (like other addictions) it will not be reversed by merely ‘wishing it away’ and emphasizing self-control; much thought, and a lots of hard work, are needed to reverse a trend that has been incubating in our communities for the last couple of decades.
Unfortunately, addiction is difficult to treat. In the simplest of terms, we need to remove the individual from the drug for a long enough periods that we can get past the withdrawal symptoms, a process called detoxification. This is usually accomplished under close medical supervision, utilizing intensive resources that we have very little of. After detoxification, long term follow up by support groups are usually required, so that a relapse(s) does not occur and are addressed as soon as they do. Experience has showed us that relying on self-control is not a viable option for the majority of addicts.
As in many other medical issues, an ounce of prevention is better than a pound of cure. Specifically, as related to the SSBs, reducing the quantity of sugar in each drink reduces the quantity each person consumes, in a situation where higher consumption seems to propel the user towards addiction at an accelerated rate. As suggested in some European countries a few years ago, by incrementally reducing the quantity of sugar in each SSB over time, slowly desensitizing the individual consumer, the ‘addicted’ user is gradually exposed to less and less sugar – a form of slow detoxification. The SSB manufacturers, concerned about losing sales (and having to lay off workers if an SSB tax raises the price of their product), are reassured as they have to spend less in input costs, and hence can retain their sale numbers without the price of their product increasing. The country wins by preserving sales, maintaining employment, keeping consumer costs down, reducing individual sugar consumption and hopefully slowing the epidemic of NCD related issues.
This needs to be accompanied by a few other simultaneous national steps, such as capping the price of bottled water (in some stores bottled water cost more than equivalent sized SSBs), the alternative to SSBs in our hot climates. Aggressive health promotion plans that educate all levels of the population about healthy eating, drinking, and food choices; upgrading our Primary Care to change the focus from treating disease to promoting health and wellness, are important steps if the burden of the NCDs is to be reduced.
The Ministry of Health and Wellness has not made public the details on the actual numbers of SSBs sold before and after the last SSB tax introduction in 2015 – and while analysis in the first year after its introduction suggests that consumption patterns of SSBs had not changed, another medical paper ( that looked at the purchasing patterns in one major supermarket chain) three years later suggest that purchasing patterns as far as the SSBs were concerned, had changed (positively). So at the moment it is unclear whether the 10 percent tax had any influence on the national NCD situation, and whether this additional 10 percent is designed to correct, or improve, deficiencies noted after the tax was initially introduced in 2015. These analyses looked at the SSB consumption: we have not been provided any statistics on the NCD situation. Time, and the actual statistics related to the NCD incidence, will tell. Ultimately, the 10 percent tax hike did not result in more funds being made available to fight the NCDs; hopefully the 20 percent tax will provide sufficient resources to upgrade our Primary Health Care services.
The ultimate goal is to produce healthier and resilient communities, and to reduce our NCD burden. Some of this burden is created by addictive behaviour, and we need to refocus our attention towards prevention, particularly while addiction is so difficult and so expensive to treat. In increasing the tax on our SBBs, one hopes this can be accomplished. The jury is deliberating. Stay tuned.
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