Healthcare Costs & Tax Revenue

It is undisputed that worldwide there is an obesity and type two diabetes mellitus (T2DM) epidemic and that both of these conditions contribute to chronic diseases like Metabolic Syndrome (MetSyn) all associated with increased morality. As discussed earlier there are those who agree and those who disagree that adding a small tax to sugar-sweetened beverages (SSB) would have an impact on decreasing this epidemic.

Healthcare costs

In 2015, the Center for Disease (CDC) put out an obesity prevalence report stating 1:3 adults and 1:6 adolescents are considered obese. In 2008 the estimated obesity health related costs were $147 billion dollars. According to the CDC and the American Diabetes Association (ADA) 28 million Americans are diagnosed with T2DM. In 2012 the estimated T2DM health related costs were $245 billion dollars.

Why focus on a small SSB tax?

The focus has been placed on adding a small tax to SSBs because 4747% America’s added sugar comes from SSBs. The American Heart Association recommends a daily allowance of added sugar for women 6 tsp/day (25 grams/day) and a man 9 tsp/day (37.5 grams/day).

  • One 12 oz. can of soda is 39 grams
  • one fruit juice box is 30.6 grams
  • one 20 oz. bottle of Gatorade is 34 grams.

Tax Revenue

In January 2017, Philadelphia instituted a 1.5 cent/oz tax on SSBs. The city’s revenue department, show preliminary SSB tax revenue results in first month was $5.7 million dollars and is expected to increase!

In Berkeley, California, a 1 cent/oz tax on SSBs brought in $116,000 dollars the first month. The SSB Products Panel of Experts Commission was established to manage and distribute the revenue. In 2014, the panel allocated $675,000 dollars towards public school health and wellness projects, intended to educate and encourage healthier eating habits by teaching children how to cook and garden. In addition, they are funding Berkeley YMCA’s Diabetes Prevention and Obesity programs as well as other health and wellness programs like the Healthy Black Families, Inc.

Briefly, it is clear that SSB tax policies have been established in several US cities. Philadelphia and Berkeley are publicly reporting their tax revenues and how they are distributing the money to support health and wellness programs. While the evidence is not yet substantial, the available information received to date are leading indicators that SSB taxes will in fact lead to a positive and significant reduction in healthcare costs by decreasing obesity and T2DM rates.

References

Aguilar, M., Bhuket, T., Torres, S., Liu, B., & Wong, R. J. (2015, May 19). Prevalence of metabolic syndrome in the United States, 2003 – 2012. The Journal of American Medical Association, 313(19). http://dx.doi.org/10.1001/jama.2015.4260

American Diabetes Association. (2015). A1C and eAG. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/

Center for Disease Control and Prevention. (2014). National  diabetes statistics report, 2014. Retrieved from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

Centers for Disease Control and Prevention. (2015). Adult obesity facts. Retrieved from http://www.cdc.gov/obesity/data/adult.html

World Health Organization. (2015). WHO calls on countries to reduce sugars intake among adults and children. Retrieved from http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

Technology and Privacy in the Sugar-Sweetened Beverage Universe

There is technology that affects and interacts with all facets of our daily lives, including the foods and beverages that we consume. Technology impacts our consumption of sugar-sweetened beverages (SSB) also. This blog entry will touch upon a few areas where technology can be used both positively and negatively in relation to our consumption of SSBs. Technology and information surrounds us, and a non-exclusive list of those technologies that will be discussed here includes mobile apps, social media, pod casts, cinema, the electronic transfer of funds, and the ever-present concern about privacy issues.

Mobile Apps

There are some mobile apps that calculate how many teaspoons of “added sugar” is found within a product. In North America, there is the “Sugar Rush” app. In the United Kingdom there is the “Change4Life”. And, in Australia there is  “That Sugar App”.

added sugar app         British     american.png   change for life  australian

These apps are easy to add to your smartphone or computer device. First, you download the app, then you need to register your name, email address, and sometime your zip code. Next, you “grant permission” so that the program can use your camera, etc. Now you are ready to scan the bar code of your selected product. If the manufacturer included the amount of added sugar in their bar code then the number of teaspoons of added sugar will appear. However, while these apps may be appealing they may not work and can be frustrating to use. For example, you may not get a number, so must be aware that many manufacturers have not started including added sugar are their nutrition labels.

Using these apps does present some privacy concerns. The Federal Trade Commission published an information sheet for mobile apps concerning privacy issues, access to our information, access to our camera, sharing our information, and collecting our personal data.

Social Media

Recently, a hot topic has been “fake news”. The National Bureau of Economics reported that 14% of Americans considered social media the single most important source of information gathering for the 2016 election. A 2017 study investigated among healthcare providers which media platform was the used and responded to most frequently in regards to searching for continuing education hours. They compared email, Facebook, and Twitter, and found that the most effective social media platform was Facebook (p<0.001).

The public has easy access to numerous Facebook pages related to public health issues concerning SSB taxes, including: People against Sugar Tax, Metabolic Syndrome Peer Reviewed,  American Beverage Association, American Diabetes Association, and other key stakeholders’ public pages.

Twitter, another popular social media platform, is accessible globally and is easy to use and find organizations and key stakeholders’ public interest feeds.

However, it is always important to be aware of privacy concerns whenever you surf the internet and click onto sites.

YouTube has numerous conferences/opinions from around the world, serving both opponents and proponents of positions.

Cinema

Several movies have come on recently about added sugars, SSBs, and the impact on the obesity and T2DM epidemic. When “Super Size Me” came out years ago, it had a significant impact on the fast food industry. It seems likely that these sugar movies and documentaries my have similar significant impact.

Movies include: That Sugar Film and Fed Up.

SNAP and Electronic Funds Transfer 

In 1984, the Supplemental Nutrition Assistance Program (SNAP) program first offered the Electronic Benefits Transfer (EBT) gold card, which at the beginning of each month is uploaded with a designated qualifying dollar amount of credit. Convenience for both the SNAP program and users is obvious. However, there are privacy concerns. The Food and Nutrition Service (FNS) provides a consumer-friendly description of the privacy policy stating they “may use technologies to gauge browsing habits or web surfing”. They report that they do use cookies to track activity but do not personally identify consumers and do not accept responsibility for privacy issues that may occur on other websites.

Summary

Technology affects all of us every day. It affects our consumption of sugar-sweetened beverages (SSB).  The convenience of information is some what off set by the loss of personal information and other privacy concerns.

References

Electronic Benefit Transfer (EBT) Card Balance. (2017). Arizona EBT card balance. Retrieved from http://www.ebtcardbalance.com/arizona-ebt-card-balance-eb3

Federal Trade Commission. (2017, February). Understanding mobile apps [Press release]. Retrieved from https://www.consumer.ftc.gov/articles/0018-understanding-mobile-apps#privacy

Flynn, S., Hebert, P., Korenstein, D., Ryan, M., Jordan, W. B., & Keyhani, S. (2017). Leveraging socialmedia to promote evidence-based continuing medical education. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168962

United States Department of Agriculture: Food and nutrition service. (2017). Privacy policy. Retrieved March 24, from https://www.fns.usda.gov/privacy-policy

USA.gov. (2017). Online safety. Retrieved March 31, from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168962

 

Private Sector Influences on Sugar-Sweetened Beverage Taxes

The private sector, which includes companies, lobbyists, non-governmental organizations (NGO), grass-roots organizations, and individuals, have a lot of influence on whether there should be a sugar-sweetened beverage (SSB) tax.  All of them are passionate about their perspective, whether based on evidence, fears, finances, or other reasons. This passion fuels the debate and at times the stakeholders can be manipulative and fierce. Let’s consider some of the perspectives of the various private sector stakeholders.

ontario public health tax photo

Some Food and Beverage Companies and Their Lobbyists

The American Beverage Association (ABA) represents companies like Coca-Cola and Pepsico. Their lobbyists are plainly outspoken against SSB taxes. They have conducted a lot of internally- sponsored research, and as a result, know how to focus millions of dollars in fighting against SSB taxes. They sponsor advertising campaigns, organized protests, and disseminate articles that support their cause. Their lobbyists make sure consumers understand that there are economic consequences to SSB taxes, including job losses, increased consumer expenses for food and beverages. Further, they assert that SSB taxes won’t by themselves make anyone healthier, it will just make you poorer. Meanwhile, SSB taxes arguably take away individuals’ freedom of choosing the beverages of their choice.

Image result for american beverage association

The ABA is a powerful organization that has taken numerous steps to improve their “unhealthy” reputation by introducing diet education and obesity prevention campaigns including: The School Beverage Guidelines, research articles supporting no tax on SSB products, and Protecting Consumer Choice advocacy.

Some NGOs

In June 2016, the American Heart Association and the American Stroke Association published policy statement that supports SSB taxes as a way to reduce consumption. They also emphasized the urgency to reduce SSB consumption.

The World Health Organization has devoted much of its time attempting to educate individuals and organizations on the importance of decreasing obesity and diabetes rates. They encourage municipalities to institute SSB taxes as a way to slow down the growing obesity and diabetes epidemics.

 Grass-Root Organization and Individuals

In Berkeley, California a grass-root community group worked tirelessly to pass Measure D, a 1 cent per fluid ounce SSB tax. The ABA spent $2.4 million fighting against Measure D.

Some individual proponents, like Dr. Robert Lustig, an American pediatric endocrinologist, Image result for robert lustig sugaris an outspoken supporter of SSB taxes and wants us to understand how the obesity epidemic is real and growing. He has been a strong advocate for the dangers of added sugars on individuals’ health. For example, he asserts that sugar is addictive and causes serious health risks like obesity, T2DM, and heart disease. He promotes SSB taxes as an approach that will decrease this growing epidemic and ultimately result in overall lower healthcare costs.

 

 

References

American Beverage Association. (2017). We are America’s beverage companies. Retrieved from http://www.ameribev.org/

American Heart Association. (2016). Reducing sugar-sweetened beverage consumption a focus on sugar-sweetened beverage taxes [Policy Statement]. Retrieved from https://www.heart.org/idc/groups/ahaecc-public/@wcm/@global/documents/downloadableucm_490766.pdf

Berkeley vs Big Soda. (2017). Berkeley vs big soda. Retrieved from http://www.berkeleyvsbigsoda.com/

Lustig, R. (2017). Physician, author of fat chance, and International Nutrition Board President. Retrieved from @RobertLustigMD

World Health Organization. (2015). WHO calls on countries to reduce sugars intake among adults and children. Retrieved from http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/