Sugary drink policy 2017 State of Play

Transcription

1 Sugary drink policy 2017 State of Play JIM KRIEGER, MD, MPH JUNE 2, 2017

2 A reminder: Why focus on sugary drinks? o Primary source of added sugar in U.S. diet o Major source of added calories fueling the obesity epidemic o Consumption higher among low income and minority populations o Cause obesity, diabetes, dental decay, liver, and heart disease o Do not affect appetite o Heavily marketed (and youth and minorities targeted) o No nutritional benefits ACTION FOR HEALTHY FOOD

3 How much sugar is in that drink: QUIZ TIME! 16 oz 16 oz 20 oz 32 oz 11 oz 12 tsp 13 tsp 15 tsp 13 tsp 8 tsp And for a bonus: What is the recommended daily limit for sugar intake? DGA: <10% daily calories, ~12 tsp/day AHA: 6-9 tsp/day

4 Dramatic increase in sugary drink availability Gallons of Soft Drink Availability triple what it was 60 years ago Regular soft drinks Juice drinks Sports drinks Sources: ( ): Beverages Table. United States Department of Agriculture, Economic Research Service Food Availability (Per Capita) Data System Website. Updated February 1, Accessed September 9, ( ): Beverage Digest annual estimates; Caloric CSDs based on estimate that 70% of CSDs are caloric and 30% are non-caloric/diet.

5 Progress, but the decrease may be stalling Half of adults and two-thirds of youth consume at least one sugary drink on a given day

6 Reducing sugary drink consumption Acceptability/Appeal Availability Affordability

7 What are the most active sugary drink policies? o Current SSB tax Kids Meals Procurement Schools, out-of-school, and childcare nutrition standards o In the wings Warning labels SNAP subsidies and incentives Marketing restrictions in schools Portion sizes?

8 Acceptability & Appeal

9 Increase awareness of sugary drinks

10 Building Public Awareness: Countermarketing Campaigns

11 Warning labels ACTION FOR HEALTHY FOOD

12 Board of Health Resolution ACTION FOR HEALTHY FOOD

13 Availability

14 ACTION FOR HEALTHY FOOD Kids meals A third of all US children and adolescents aged 2 19 consume fast food on a given day. Kids who eat at fast food drink more SSBs and less milk. o Ban soda as default beverage option or ban completely o Stockton, Davis, Perris, Santa Clara County (CA) have adopted bills. o More being considered in CA, Vermont, Montgomery Co, PG Co, NYC, NY, Lafayette. o Many fast food chains are voluntarily removing SSBs from kids meals

15 Changes in kids meals beverage offerings from Source: CSPI, 2017

16 Procurement: Government o Vending o Cafeterias o Government programs: Parks and Recreation Sites Child care and before/after school programs o Government contracts

17 Procurement: Hospitals o o o o o ACTION FOR HEALTHY FOOD In 2006, 99% of hospital cafeterias sold SSBs Partnership for a Healthier America: 150 hospitals now serve healthier drinks Healthier Hospitals: 500 hospitals committed to healthier foods UCSF: Eliminated the sale of sugar sweetened beverages and removed from menus Santa Clara County: Ban sales at county health facilities

18 Schools o Much progress through Healthy, Hunger Free Kids and Smart Snacks o Work remains: Assure implementation Seek total elimination (HS vending, after-school hours, events, fundraisers) Address in-school marketing Fully implement school wellness policies o No pouring rights After listening carefully to the concerns and information I received from our students, faculty, and staff, I have decided not to move forward with the process of establishing a partnership with a beverage company. - SF State president Les Wong ACTION FOR HEALTHY FOOD

19 Child care and out of school o Need to follow the Child and Adult Care Food Program guidelines, but these don t limit sugary drinks/sweetened milk o Food quality can be improved through: Licensing and regulation Voluntary policies Quality reporting Offering technical assistance to implement healthy practices and ACTION FOR HEALTHY FOOD policies

20 Limit portion sizes Larger portion sizes lead to greater consumption. o Limit portion sizes of drinks served in restaurants o Limit portion sizes of bottled SSBs sold in stores ACTION FOR HEALTHY FOOD

21 SNAP demonstration projects o Exclude sugary drinks and add healthy food incentives o Farmers Market subsidies o Minimum stocking standards ACTION FOR HEALTHY FOOD

22 Working with industry: reformulation

23 Affordability

24 Sugary drink tax o Reduces consumption o Increases awareness about adverse health effects o Generates revenue to support community health and wellbeing o Predicted to reduce disease and health care spending o May induce product reformulation

25 Sugary Drink Tax Policy Trends Across the United States Seattle Albany Berkeley Multnomah County San Francisco Oakland Boulder Cook County Philadelphia Navajo Nation Implemented Enacted Under consideration

26 US Adopted Taxes 8.3 million people benefitting $342 million per year Location Population Est. annual revenue ($1,000,000) Tax rate per ounce Type of beverage Use of Revenue Vote Philadelphia, PA - Council 1,567,442 $91 $ Sweetened Pre-k, parks 13-4 Berkeley, CA Measure D 112,580 $2 $ Sugary Health 74% Albany, CA Measure O1 19,735 $0.2 $ Sugary Health 71% Oakland, CA Measure HH 419,267 $7 $ Sugary Health 61% San Francisco, CA Measure V 864,816 $15 $ Sugary Health 62% Boulder, CO Measure 2H 107,349 $4 $ Sugary Health 54% Cook County, IL - Commission 5,238,216 $223.8 $ Sweetened Justice 9-8 Total 8,329,405 $342.3

27 Berkeley: November 2014 Berkeley Healthy Child Coalition, a diverse, grassroots group of parents, teachers, health professionals, community leaders, and residents Endorsed by every local elected official. Began early - softened the ground with education. Focused on children s health and future. Used social media Involved communities most affected

28 Philadelphia: June 2016 Mayor Kenney proposed the measure, Council passed it Strong and diverse coalition supported ECE support key. The American Beverage Association aggressively fighting tax - funded No Philly Grocery Tax campaign, filed law suit, trying to repeal.

29 SODA TAX WARS

30 2016 Tax campaign spending Albany Oakland San Francisco Bay Area $30.2M $22.5M Boulder $954K $822K Cook County $80K $95K Philadelphia $11.1M $2.5M > $26 million spent by advocates and counting > $42 million spent by industry and counting Source: CSPI

31 Lessons learned Ballot measure and legislative paths are viable Significant financial support has evened the playing field Political and grassroots organizing Strong communications operation Starting first and effective framing to control the debate Effective use of community-based messengers and influential champions.

32 Philadelphia Mayor Jim Kenney "What we're looking to do is to take some of that profit, to put it back into the neighborhoods that have been their biggest customers, to improve the lives and opportunities for the people who live there." 2)

33 Big Soda aggressively fighting adopted taxes Law suit in Philly Earned media TV, radio, full page ads more than $1.5M in Philly Digital media Lobbying council to repeal Misinformation about tax by storeowners and distributors

34 Mayor Kenney: I didn t think it was possible for industry to get any greedier They are so committed to stopping this tax from spreading to other cities, that they are not only passing the tax they should be paying onto their costumer, they are actually willing to threaten working men and women s jobs rather than marginally reduce their seven figure bonuses. Howard Wolfson: Either there are preexisting problems with the business model, or jobs are being sacrificed to make a political point.

35 Taxes are regressive Since when did Big Soda start caring about poor people except as marketing target? Taxing sugary drinks is a progressive public policy: o No one has to pay the tax. o Low income people now spend more on sugary drinks the tax will reduce the spending gap between rich and poor. o In Berkeley, no change in total grocery spending by supermarket customers. o Low-income communities reap the most health benefits from lowered consumption and from increased investments in their communities.

36 Effective implementation

37 The evidence is emerging Taxes are working as predicted Studies available from Berkeley, Mexico and France Consumption and sales of SSBs dropping and water increasing Revenues are addressing vital community needs

38 Modeling the health impact of a tax PHILADELPHIA: 1.5 CENTS/OZ. ON SUGARY & DIET DRINKS SAN FRANCISCO: 1 CENT/OZ. ON SUGARY DRINKS 1.5 2

39 Contact us! Get answers to your questions Technical assistance and support Tools and resources Media and communications help

40 Extra slides ACTION FOR HEALTHY FOOD

41 Philadelphia: the legal challenge Industry argues that beverage tax duplicates sales tax, rendering it illegal. City argues that it is taxing distribution, not sale. Lower court rejected industry suit in December. Appellate court heard case in April. Stay tuned and note any ruling is specific to Pennsylvania law.

42 Evaluating taxes o Published Berkeley, Mexico, France o Currently in field Philadelphia, Oakland, Cook County And more in the works o Key questions Price and pass-through Sales/purchases Consumption (including substitution) of taxed and non-taxed beverages Effects on total dietary intake Economic impacts jobs, revenues, regressivity Cross border effects Norms/attitudes Implementation experience

43 Trends in consumption: Mexico

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45 A can of soda: more than a day s worth of sugar relative to AHA guidance Children <2 years Children 2-18 years Adult Women Adult Men 0 tsp/day 6 tsp/day 6 tsp/day 9 tsp/day 10 tsp

46 A 20 ounce soda has 16 tsp sugar - equal to: = = Alexlukin/Bigstock.com mikeledray/bigstock.com = Duplass/Bigstock.com

47 What are sugary drinks? Energy Drinks Fruit Drinks Sports ACTION FOR HEALTHY FOOD Drinks Soda Sweet Iced Tea & Coffee

48 Black youth consume frequently: two or more sodas per day [VALUE]% [VALUE]% [VALUE]% [VALUE]% Black White Overall Hispanic High School Youth Risk Behavior Survey : 38 states

49 Even the youngest children consume too much 31% of toddlers age months consume sugary drinks on any given day. ACTION FOR HEALTHY FOOD

50 Black and Hispanic and low-income adults consume more sugary drinks Percent drinking one or more sugary drinks on a given day Income Disparities [VALUE] % [VALUE] % [VALUE] % [VALUE] % <$25,000 $25,000 $49,999 $50,000 $74,999 $75,000 NHANES: NCHS data brief, no 270. January 2017 BRFSS 2013

51 ACTION FOR HEALTHY FOOD Sugary drinks cause chronic diseases 2 sodas/day for just 2 weeks: LDL cholesterol & triglycerides by 20%. 2 sodas/day for 6 months: Visceral fat, fatty liver disease. 1 soda/day: Risk of overweight/obesity by 55% (children). Risk of diabetes by 26%. Risk of dying from heart disease by almost 1/3. Risk of stroke by 22%. Risk of tooth decay by 30% with daily consumption (adults).

52 Schools in California o Sale of SSBs at elementary and middle schools prohibited (SB ) o Sale of SSBs at high schools prohibited (SB ) o Must provide access to free, fresh drinking water in food service areas (SB ) o Sale of full calorie sports drinks prohibited (SB )

53 Sugar Reduction Expert Conference: Assessment of 36 sugar reduction strategies Median quartile Low Feasibility High Low Impact High Source: HFA Summit survey, March 2015 (n=22)

54 The evidence: Taxes decrease sugary drink consumption Impact of a 1 cent per ounce tax in Berkeley Percent change in consumption among low income five months after tax Berkeley 4% Oakland/ San Francisco -21% Falbe et al. Impact of the Berkeley Excise Tax on Sugar-Sweetened Beverage Consumption. AJPH 2016.

55 Taxes decrease sugary drink sales Impact of a 1 cent per ounce tax in Berkeley Silver, et al. PLoS Med Apr 18;14(4):e

56 Taxes decrease sugary drink sales Impact of a 10% tax in Mexico Colchero. Health Affairs 2017