Public Health Association of Australia: Policy-at-a-glance Health Levy on Sugar Sweetened Beverage Position Statement Key message: PHAA will 1. Advocate for a health levy on sugar sweetened beverages (SSB) in Australia, as an evidence-informed strategy as part of a comprehensive package to address poor diets and dietrelated ill-health. 2. Advocate for the direction of revenue raised from a SSB health levy to support public nutrition health nutrition initiatives, particularly those which aim to improve population nutrition. 3. Advocate for the continued development of an evidence base to inform policy in this area, particularly with regard to implementation and effectiveness. Summary: Audience: The PHAA supports the implementation of a health levy on sugar sweetened beverages in Australia. This should be included as one strategy as part of a comprehensive Australian Nutrition Policy of evidence-informed actions to address poor diets and diet related ill-health. The evidence that a health levy on SSB will effectively reduce consumption is strong, increasing and consistent. PHAA further supports the allocation of revenue raised from a health levy on SSB into public health nutrition initiatives that aim to improve population health, particularly for lower socioeconomic groups. Federal, State and Territory Governments, policy makers Drafted by: PHAA s Food and Nutrition Special Interest Group. Policy Position approved in: October 2017 Contacts: Helen Vidgen & Amanda Lee, Co-Convenors, Food and Nutrition Special Interest Group 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 T (02) 6285 2373 F (02) 6282 5434 E phaa@phaa.net.au W www.phaa.net.au
Health Levy on Sugar Sweetened Beverage Policy Position The Public Health Association of Australia notes that: 1. Australians consume too much free i sugar. The World Health Organization (WHO) strongly recommends adults and children restrict their daily free sugar intake to less than 10% of their total energy intake, or 5% for additional health benefit. 1 Just over half of all Australians (aged over 2 years) exceed this recommendation, particularly children and teenagers. 2 The latest available data show that in 2011-12, 52% of free sugar intake in the Australian diet was consumed from sugar sweetened beverages (SSB). 2 2. SSB can be defined as any non-alcoholic beverage containing added sugar. These include sugarsweetened soft drinks, flavoured mineral waters, fortified waters, energy and electrolyte drinks, fruit and vegetable drinks and cordials. Milk-based products, 100% fruit and/or vegetable juice or non-sugar sweetened beverages (i.e. artificial, non-nutritive or intensely sweetened) are often considered exempt. 3. On any given day approximately one third of Australians aged 2 years and over consume SSB. Adolescents and young adults are the highest consumers of SSB. 3 4. SSB have been singled out for a health levy because: a) They are a contained product category and provide minimal or no nutritional benefit. b) Consumption has been associated with excess weight gain, dental decay leading to dental caries and other chronic diseases 3 all of which are all high in prevalence in Australia. 4 c) Authoritative health organisations recommend limiting SSB consumption. 1, 3 d) Consumption of SSB is high in Australia, particularly among children, adolescents, young adults, Aboriginal and Torres Strait Islander people and low income groups. e) The evidence demonstrating positive fiscal and health impacts of taxing SSB is growing. 5 5. Based on reasonable and increasing evidence in terms of both reducing SSB consumption and revenue raising, the WHO recommends an appropriately designed levy on SSB, with the aim of raising the retail price of SSB by 20% or more. 6 6. The objectives of a health levy on SSB include: a) To increase the price of SSB and reduce the purchase and consumption for consequent population health benefits. i Free sugars refer to sugars added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 2
b) If the SSB levy is designed to be directly tied to the amount of free or added sugar contained in the beverage, providing an incentive for manufacturers to reformulate to lower the added sugar content of their products, improving the food supply for all. c) To generate revenue to reinvest back into population nutrition and health. d) To increase consumer awareness of the need to reduce consumption of added sugar in their diet and that regular consumption of SSB is not part of a healthy dietary pattern. 7. Similar policies are implemented or forthcoming in at least 20 other jurisdictions including Mexico, France, Chile, Finland, the United Kingdom, South Africa, Portugal and several US cities. 5 8. Evidence from multiple study designs, including the real-world evaluation of similar policies in Mexico 7 and Berkeley, California, 8 demonstrates a reduction in SSB purchase 12-24 months post policy implementation, particularly for low-income households. 9. Australian modelling suggests a 20% health levy on SSB would raise an estimated AUD$400 million a year and reduce annual health expenditure by up to $29 million. 9 10. Young people, Aboriginal and Torres Strait Islander people, and those on low-incomes are most at risk of excess weight gain and chronic disease. These population sub-groups are likely to be the most responsive to price changes and consequently the most likely to receive the greatest health gains. Although a health levy could result in these groups paying a higher proportion of their income in additional tax, the financial burden is likely to be small, 10 and offset by savings to individual healthcare expenditure in the longer term. 11 Further benefits may be realised if the revenue is reinvested into nutrition and health prevention policies that benefit these population sub-groups. 11. At all times it is essential that all Australians have access to free, clean and palatable drinking water as an accessible alternative to SSB. 3 The Public Health Association of Australia affirms the following principles: 12. Fiscal and regulatory measures are an essential component of a comprehensive food and nutrition strategy to improve Australian dietary intakes. These unobtrusive strategies support individual responsibility strategies by shaping the food environment to assist individuals by making the healthier choices the easier choice. 13. Government leadership is required to ensure appropriate regulation is developed to address the problem of excessive free or added sugar intake. 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 3
The Public Health Association of Australia believes that the following steps should be undertaken: 14. The Australian Federal Government should prioritise and implement an appropriately designed health levy on SSB. 15. Revenue should be earmarked for public health initiatives that aim to improve public health nutrition and population health, particularly for socioeconomically disadvantaged population sub-groups. The Public Health Association of Australia resolves to undertake the following actions: 16. PHAA will continue to advocate for a health levy on SSB, building both public and political support. 17. PHAA will advocate for monitoring and surveillance to support the planning and evaluation of fiscal public health strategies. CREATED 2017 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 4
References 1. World Health Organization. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015. 2. Australian Bureau of Statistics. Australian Health Survey: Consumption of added sugars, 2011-12. ABS Cat no 4364.0.55.011. Canberra: Australian Bureau of Statistics.; 2016. 3. National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: National Health and Medical Research Council.; 2013. 4. Australian Institute of Health and Welfare. Australia's Health 2016 Cat. no AUS 199. Canberra: Australian Institute of Health and Welfare; 2016. 5. Backholer K, Blake M, Vandevijvere S. Have we reached a tipping point for sugar-sweetened beverage taxes? Pub Health Nutr. 2016;19(17):3057-61. 6. World Health Organization. Fiscal policies for diet and prevention of noncommunicable diseases. Technical Meeting Report. 5-6 May 2015, Geneva, Switzerland. Geneva: World Health Organization; 2016. 7. Colchero MA, Rivera-Dommarco J, Popkin BM, Ng SW. In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax. Health Aff (Millwood). 2017;36(3):564-71. 8. Silver LD, Ng SW, Ryan-Ibarra S, Taillie LS, Induni M, Miles DR, et al. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study. PLoS Med. 2017;14(4):e1002283. 9. Veerman JL, Sacks G, Antonopoulos N, Martin J. The Impact of a Tax on Sugar-Sweetened Beverages on Health and Health Care Costs: A Modelling Study. PLoS One. 2016;11(4):e0151460. 10. Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, et al. The impact of a tax on sugarsweetened beverages according to socio-economic position: a systematic review of the evidence. Public Health Nutr. 2016;19(17):3070-84. 11. Lal A, Mantilla-Herrera AM, Veerman L, Backholer K, Sacks G, Moodie M, et al. Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A costeffectiveness and equity analysis. PLoS Med. 2017;14(6):e1002326. 20 Napier Close Deakin ACT Australia 2600 PO Box 319 Curtin ACT Australia 2605 5