N.E.J.M. article calls for sugar-based beverage tax

by Keith Nunes
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BOSTON — Noting "the science base linking the consumption of sugar-sweetened beverages to the risk of chronic disease is clear," an article published on-line by the New England Journal of Medicine Sept. 16 and authored by several prominent public health officials, proposes taxation of the beverages with the revenue generated going to public health initiatives.

The American Beverage Association called the effort an "ineffective approach."

The authors of the N.E.J.M. paper, who include Kelly D. Brownwell, director of the Rudd Center for Food Policy and Obesity at Yale University; Thomas Farley, New York City’s health commissioner; Walter C. Willett, chair of the department of nutrition at the Harvard School of Public Health; and Barry M. Popkin, professor of nutrition at the Carolina Population Center at the University of North Carolina-Chapel Hill, among others, said a federal tax of 1% per oz on sugar-sweetened beverages would raise $14.9 billion in the first year alone.

The article proposes two taxation options. One would be an excise tax of 1% per oz for beverages that have any added caloric sweetener. A second option would be to tax beverages that exceed a threshold of grams of added caloric sweetener or of kilocalories per oz.

The authors add that a controversial issue within their proposal is the issue of whether to tax beverages that are sweetened with noncaloric sweeteners.

"No adverse health effects of noncaloric sweeteners have been consistently demonstrated, but there are concerns that diet beverages may increase calorie consumption by justifying consumption of other caloric foods or by promoting a preference for sweet tastes," said the authors.

In addressing objections and industry reactions to the proposal of taxing sugar-based beverages to reduce the incidence of obesity and the negative health effects of increased calorie consumption, the authors frequently draw a comparison to taxation efforts to reduce the negative effects of tobacco consumption and smoking.

"One objection to a tax on sugar-sweetened beverages is that it would be regressive," the authors write. "This argument arose with respect to tobacco taxes but was challenged successfully by proponents of the taxes, who pointed out that the poor face a disproportionate burden of smoking-related illnesses that nearly all smokers begin to smoke when they are teenagers, and that both groups are sensitive to price changes. In addition, some of the tobacco revenue has been used for programs developed specifically for the poor and for youth.

"A second objection is that taxing sugar-sweetened beverages will not solve the obesity crisis and is a blunt instrument that affects even those who consume small amounts of such beverages. Seat-belt legislation and tobacco taxation do not eliminate traffic accidents and heart disease but are nevertheless sound policies.

"Opposition to a tax by the beverage industry is to be expected, given the possible effect on sales; opposition has been seen in jurisdictions that have considered such taxes and can be predicted from the behavior of the tobacco industry under similar circumstances. PepsiCo threatened to move its corporate headquarters out of New York when the state considered implementing an 18% sales tax on sugar-sweetened beverages. The tobacco industry fought policy changes by creating front groups with names that suggested community involvement. The beverage industry has created Americans Against Food Taxes. These reactions suggest that the beverage industry believes that a tax would have a substantial impact on consumption."

Susan Neely, president and chief executive officer of the A.B.A., said the compendium of science, regardless of the funding source, does not show soft drinks or other sweetened beverages uniquely contribute to obesity.

"While the authors suggest a 1c per oz tax for any beverage with caloric sweeteners, there is no science to support that this would have a measurable impact on our nation's waist line," she said. "Importantly, taxes will not teach our children how to live a healthy lifestyle. In fact, excise taxes on soft drinks simply do not reduce obesity rates. West Virginia and Arkansas are two prime examples — both have excise taxes on soft drinks, yet rank fifth and sixth highest in the nation for obesity rates."

Calling the taxation proposal "the wrong public policy for such a complex problem," Ms. Neely said the focus must be on nutrition education that underscores the balancing of all calories with calories burned through physical activity.

"By doing so we give our children the tools to maintain a healthy weight throughout their life," she said.

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