Building momentum: lessons on implementing a robust sugar sweetened beverage tax - wcrf.org/policy - World Cancer Research Fund International
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Building momentum: lessons on implementing a robust sugar sweetened beverage tax wcrf.org/policy
About World Cancer Research Fund International World Cancer Research Fund International leads and unifies a network of cancer prevention charities with a global reach. We are a leading authority on the links between diet, nutrition, physical activity and cancer. We work collaboratively with organisations around the world to encourage governments to implement policies to prevent cancer and other non-communicable diseases. Acknowledgements This report was written by Bryony Sinclair and Fiona Sing (World Cancer Research Fund International) with input from members and observers of WCRF International’s Policy Advisory Group: Dr Simón Barquera (National Institute of Public Health, Mexico), Anita George (McCabe Centre for Law and Cancer, Australia); Prof Sir Trevor Hassell (Healthy Caribbean Coalition, Barbados); Dr Hasan Hutchinson (Health Canada, Canada); Prof Shiriki Kumanyika (University of Pennsylvania, US); Dr Feisul Idzwan Mustapha (Ministry of Health, Malaysia); Dr Anna Peeters (Deakin University, Australia); Sandhya Singh (National Department of Health, South Africa); Dr Francesco Branca (World Health Organization, Switzerland); Dr Heather Bryant (Canadian Partnership Against Cancer, Canada); and Dr Kate Allen, Louise Meincke and other WCRF International colleagues. We would like to gratefully acknowledge those who were interviewed during our research: Dr Anne Marie Thow (University of Sydney, Australia); Cyril Gill (Ministry of Revenue, Barbados); Maisha Hutton (Healthy Caribbean Coalition, Barbados); Dr Esperanza Cerón (Educar Consumidores, Colombia); Ateca Kama (National Food and Nutrition Centre, Ministry of Health and Medical Services, Fiji); Premila Deo (Fiji Consumer Council, Fiji); Angela Carriedo (Mexico); Anjali Chainani (Office of the Mayor, Philadelphia, US); Prof Melvyn Freeman (National Department of Health, South Africa); Carmen Cabezas Peña (Health Department, Catalunya, Spain); Conxa Castell i Abat (Health Department, Catalyuna, Spain); Diana Oread Perez (Finance Department, Catalunya, Spain); Marta Espasa Queralt (Finance Department, Catalunya, Spain); Natalia Caba i Serra (Finance Department, Catalunya, Spain); Prof Barry Popkin (University of North Carolina, US); Aaron Schwid (Global Health Advocacy Incubator, US); Dr Lynn Silver (Public Health Institute, US); Jim O’Hara (Center for Science in the Public Interest, US), Abby Dilk (Center for Science in the Public Interest, US) and those who wished to remain anonymous. How to cite the report World Cancer Research Fund International (2018). Building momentum: lessons on implementing a robust sugar sweetened beverage tax. Available at www.wcrf.org/buildingmomentum
Table of contents
Key Messages 2
Introduction 3
Background
Where we are now 4
SSBs and NCDs 4
Global consumption of SSBs 5
Effects of SSB taxes 6
Pathways of effects 6
Effects of implemented SSB taxes 6
Robust Design
Context 8
Evidence as a foundation 9
Policy objectives 10
Monitoring and evaluation 10
Tax design 10
What types of products should be taxed? 11
What type of tax should be used? 11
How high should the tax be? 13
Who should the tax be levied on? 13
Should it be a general or an earmarked tax? 13
Stakeholder engagement 13
Whole-of-government approach 14
Mobilisation of civil society organisations 15
Industry engagement 16
Framing 17
Earmarking 17
The government’s role in protecting and promoting public health 18
Defending SSB Taxes
Public campaigns 19
Common challenges to a SSB tax 19
Addressing challenge 1: Discriminatory – taxes apply to certain products and not to others 20
Addressing challenge 2: Jurisdictional issues – no mandate to implement a tax 20
Addressing challenge 3: Unconstitutional – breach of rights 21
Addressing challenge 4: Unenforceable – unclear, illogical drafting 21
Addressing challenge 5: Regressivity 21
Addressing challenge 6: Economic reality 21
Addressing challenge 7: Individual responsibility 21
Lessons learned: advice on designing an SSB tax 22
Perfect storm 24
Examples of ‘perfect storms’ 24
Conclusion 27
Appendix 28
Seven core principles for evaluating SSB taxes 28
References 29
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 1
Key Messages
• More action is urgently needed to reach the global non-communicable disease (NCD) targets.
Sugar sweetened beverage (SSB) taxes are recommended by the World Health Organization
(WHO) as an effective intervention to reduce sugar consumption and help address NCDs.
• Results from rigorous monitoring and evaluation research on the effects of implemented SSB
taxes are encouraging policymakers across the globe to take action. SSB taxes have been
shown to be effective and should be a key component of a comprehensive approach to prevent
and control diet-related NCDs.
• Lessons can be drawn from governments that have successfully passed and implemented or
attempted to pass an SSB tax. This report outlines the lessons learned from those examples on:
• what evidence is required;
• how to design the tax;
• how to run and sustain a public and political campaign in support of the tax;
• how to frame the tax;
• how best to engage with stakeholders;
• and how to defend against common arguments against the tax.
• Common elements exist for developing and implementing robust SSB taxes in countries and
local jurisdictions worldwide. While lessons can be drawn from international experience, it is
fundamental to understand the local context when designing and defending the implementation
of the SSB tax. Understanding the jurisdiction – including what will resonate with the public,
how the political system works and tailoring the tax design and campaign to that context – will
increase the likelihood of successfully passing the tax.
• The tax will likely be challenged, but the experiences of how other countries and local
jurisdictions defended their tax against challenges can help others prepare and defend their
proposed SSB taxes.
• The implementation of health policies to prevent and control NCDs is a political process.
An exploration of the motivations and enablers of the various implemented SSB taxes can
contribute to an understanding of the common elements that create a ‘perfect storm’ of political
and public will to successfully introduce and implement an SSB tax. Examples of these ‘perfect
storms’ from Barbados, Fiji, Mexico, Philadelphia and South Africa are explored.
2 Building momentum: lessons on implementing a robust sugar sweetened beverage tax
Introduction
Sugar sweetened beverage consumption promotes weight gain and contributes to
rising rates of diet-related NCDs globally.(1–3) This report provides guidance about
designing, defending and implementing a robust SSB tax based on the experiences
from countries and local jurisdictions around the world who have attempted to
implement a tax. The report explores common barriers and enablers to SSB tax
implementation.
This report is aimed primarily at policymakers seeking to implement SSB
taxes. It is informed by a literature review, as well as interviews conducted with
policymakers, advocates and academics involved in SSB tax development, advocacy
and implementation around the world (see Methods box).
Methods
A literature review was undertaken
using relevant key search terms on the
implementation challenges governments
have encountered when designing and
implementing SSB taxes.
Seventeen semi-structured interviews
were carried out with key policymakers,
academics and advocates, from different
countries, who were involved with designing,
advocating for and implementing SSB taxes
around the world. A thematic analysis of the
interviews was undertaken as part of the
qualitative research to inform the report.
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 3
Timeline for sugary
drinks taxes being
Background
implemented around
the world: Where we are now
The taxation of SSBs is WCRF International’s
NOURISHING database keeps
gaining momentum. The
Norway 1981 track of implemented SSB taxes
passage, implementation from around the world.
Samoa 1984 and subsequent evaluation
French of Mexico’s SSB tax See ‘U – Use economic tools
2002 (implemented 1 January to address food affordability
Polynesia
2014) acted as a tipping and purchase incentives’
Palau Sept 2003
point for global action. The www.wcrf.org/NOURISHING
Micronesia 2004 confidence of policymakers is
increasing as more SSB taxes
Nauru 2007
are being implemented and demonstrating anticipated effects (see
Finland 2011 Effects of implemented SSB taxes). In 2017 alone, 12 SSB taxes
were implemented in countries and local jurisdictions globally.(4,5)
Hungary Sept 2011
The World Health Organization (WHO) recommends taxation of
France Jan 2012 SSBs as an effective intervention to reduce sugar consumption
and help address NCDs.(6) This recommendation has helped drive
Mauritius Jan 2013 further action, but more action is urgently needed to make progress
in reaching the global NCD targets by 2025 and the Sustainable
Tonga 2013
Development Goals by 2030.(7) A comprehensive approach is
Mexico Jan 2014 needed to tackle NCDs, with SSB taxation forming one key part of
a wider package of policies. See Key WHO resources list for more
Kiribati 2014 information. Industry interference
remains a major challenge in
Cook Islands 2014
Sugar sweetened beverages
developing and implementing
SSB taxes. This report aims to
St Helena May 2014
provide advice on how to design
City of a robust SSB tax to help counter
Berkeley, Nov 2014
California (US)
these challenges and increase
the likelihood of successfully
Chile Jan 2015 contribute to weight gain
implementing a tax (see Defending
SSB taxes).
Vanuatu Feb 2015
Navajo
Nov 2015
Nation (US) SSBs and NCDs
Barbados June 2015 Consumption of SSBs contributes
leads to being overweight
or obese to diet-related NCDs. SSB
Brighton consumption promotes weight
& Hove City Aug 2015
Council (UK) gain, and increases the risk of
overweight and obesity, which
Dominica Sep 2015
increases the risk of at least
Belgium Jan 2016 12 cancers, cardiovascular
disease and diabetes.(9,10) SSB
increases risk of
Ecuador May 2016 diet-related NCDs consumption has also been linked
directly to diabetes.(3)
4 Building momentum: lessons on implementing a robust sugar sweetened beverage tax
St Vincent
Key WHO resources list & the May 2016
• Guideline: Sugars intake for adults and children (World Grenadines
Health Organization, Geneva; 2015) Fiji June 2016
• “Best buys” and other recommended interventions
for the prevention and control of noncommunicable Mauritius Oct 2016
diseases. (World Health Organization, Geneva; 2017)
City of
• Fiscal policies for diet and prevention of Albany, Nov 2016
noncommunicable diseases: technical meeting report, California (US)
5-6 May 2015 (World Health Organization, Geneva;
Norway 2017
2016)
• Technical workshop on sugar-sweetened beverages: Portugal Jan 2017
Meeting Report; Manila 21-22 September 2016 (World
Health Organization, Regional Office for the Western City of
Philadelphia,
Pacific; 2017) Jan 2017
Pennsylvania
• Using Price Policies to Promote Healthier Diets (World (US)
Health Organization, Regional Office for Europe; 2015) Spain,
May 2017
Catalonia
Saudi Arabia June 2017
City of
Boulder, July 2017
Obesity rates have risen dramatically in all parts of the world over the Colorado (US)
past several decades. Between 1980 and 2013, global overweight
and obesity rates increased by 28% in adults and 47% in children City of
Oakland, July 2017
and no country has been able to stop the rise to date.(11) In 2016, California (US)
more than 1.9 billion adults were overweight and of these over 650
million were obese. In 2016, 41 million children under the age of five Brunei April 2017
were overweight.(12,13) Fiji April 2017
The 2018 World Cancer Research Fund Cancer Prevention India July 2017
Recommendations include “Be a healthy weight” and, for the first
time, a standalone recommendation about SSBs: “Limit consumption UAE Aug 2017
of sugar sweetened drinks”. The Recommendations are only made
Thailand Sep 2017
when evidence is sufficiently strong and are based on an analysis of
the body of scientific evidence, which is subsequently judged by an Bahrain Dec 2017
independent expert panel.(14)
Philippines Jan 2018
City of
Global consumption of SSBs Seattle, Jan 2018
Washington (US)
The WHO recommends that adults and children restrict consumption
City of
of free sugars to less than 10% of total daily energy intake (and San Francisco, Jan 2018
preferably less than 5%).(15) Sugar consumption in many countries California (US)
exceeds this amount, and SSBs are a major contributor to sugar
South Africa Apr 2018
intake in many parts of the world.
UK Apr 2018
Globally, patterns of SSB consumption are changing.(16) In 2014,
North America and Latin America were the largest consumers Ireland May 2018
of SSBs per capita.(16) And while sales fell in North America,
Peru May 2018
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 5
Australasia and Western Europe between 2009 Other aims of SSB taxes are to generate
and 2014, sales increased in all other regions. revenue, which often goes to a general fund or is
Consumption is increasing dramatically in sometimes formally or informally directed to social
emerging markets, including China, Thailand and initiatives and projects related to health and/or
the Philippines. This trend can be partly explained NCD prevention; to raise public awareness about
by the fact that SSB companies are increasingly sugar consumption; and to reformulate products
targeting emerging markets to make up for to reduce sugar content.
diminishing sales in high-income countries.(15)
Having clear pathways of effects are helpful
In addition, the sugar content of internationally
when setting policy objectives and beneficial
produced SSBs varies widely, with sugar content
for monitoring and evaluation purposes (e.g.
often higher in beverages sold in low- and middle-
assessing whether the tax is meeting stated
income countries.(19)
objectives). It is necessary to track intermediate
outcomes along the pathways of effects since
the longer-term outcomes are affected by many
Effects of SSB taxes
other factors.
Pathways of effects
Effects of implemented SSB taxes
A main aim of taxing SSBs is to decrease
Evaluations of SSB taxes to date have
consumption, thereby reducing diet-related risk
demonstrated that they increase price (to varying
factors for NCDs. Understanding the pathways
degrees depending on the pass through rate),
of effects through which SSB taxes operate are
decrease purchases and reduce consumption
integral to their successful design, development,
of SSBs. For example, six months following the
implementation, defence and monitoring and
implementation of a 10% excise SSB tax in
evaluation. Figure 1 illustrates the pathways of
Barbados, average SSB prices rose 5.9%.(20)
effects for an SSB tax, including how it can reduce
In Mexico, purchases of taxed SSBs reduced
the risk of NCDs.
following the implementation of a 10% excise
Definitions lemonade.(8) While most SSB taxes only
include sugar sweetened beverages, some
• Price elasticity of demand: The degree to
countries and local jurisdictions also include
which demand for a good or service varies
beverages to which non-caloric sweeteners
with its price.(8)
have been added.
• Free sugars*: Refers to both added
• SSB tax: See Types of tax graphic on
sugars, like sucrose or table sugar, and
page 12.
sugars naturally present in honey, syrups,
fruit juices and fruit concentrates. Most free • Pass through rate: The rate of an excise
sugars consumed are added to foods and tax that is transferred from producer to
beverages. Free sugars do not include sugar consumer.
that is naturally built into the structure of • Earmarking: Using the money derived from
foods or to sugars naturally present in milk an SSB tax for spending on a specific issue
and milk products. or programme (e.g. reducing child obesity or
• Sugar sweetened beverages: Beverages increasing access to drinking water).
containing added caloric sweeteners, such • Nutrient profiling: The science of
as sucrose, high-fructose corn syrup or fruit classifying or ranking foods according to
juice concentrates. These include, but are their nutritional composition for reasons
not limited to, carbonates, fruit beverages, related to preventing disease and promoting
sports beverages, energy and vitamin health.(8)
water beverages, sweetened iced tea and
*Throughout this report ‘sugar’ refers to ‘free sugars’.
6 Building momentum: lessons on implementing a robust sugar sweetened beverage tax
tax, and these reductions were sustained two There is also some evidence showing SSB taxes
years post implementation (on average purchases can lead to reformulation of products.(19) The
decreased by 8.2% over the first two years).(21) effects of SSB taxes are well documented (4,25)
And in Berkeley, the one cent per ounce excise tax and taxes continue to be monitored
decreased consumption of SSBs by 21%.(22) and evaluated.
For a summary of what is known to date see the WCRF International
evidence table available online at www.wcrf.org/buildingmomentum
Figure 1: Pathways of Effects
Sugar Sweetened Beverage Tax
PRODUCT GENERATES REVENUE
PUBLIC
REFORMULATION PRICE Potential to fund
AWARENESS
TO SUGAR OF SSBs programmes promoting
ABOUT SUGAR public health or a
CONTENT CONSUMPTION social good
PURCHASES
OF UNTAXED PURCHASES
BEVERAGES OF SSBs
CONSUMPTION
CONSUMPTION
OF UNTAXED
OF SSBs
BEVERAGES
RISK OF
BMI DIABETES
& OTHER
DISEASES
RISK OF NCDs
Source: World Cancer Research Fund International. (2018) Building momentum: lessons on implementing a robust sugar
sweetened beverage tax.
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 7
Robust Design
Context
“You need movers and shakers. But
Economic, political, social and cultural factors
first of all, do good research – that is
all shape the approach used to introduce and
extremely important. What is happening
implement an SSB tax. Therefore, approaches in other countries? How are they
must be context-specific to increase the likelihood addressing their issues?”
of successfully introducing and implementing an
SSB tax. However, common elements exist for Premila Deo (Fiji Consumer Council, Fiji)
developing and implementing a robust SSB tax
across countries and local jurisdictions.
tax. Therefore, a robust tax design is crucial in
The lessons learned from countries and local order to ensure the implementation of the tax can
jurisdictions around the world show that SSB withstand strong anti-tax campaigning. A robustly
taxes are often, but not always, met with designed tax, based on lessons learned from
significant opposition, and even interference, from other governments, can increase the chance of
stakeholders whose interests conflict with the SSB successfully implementing an SSB tax.
“Understanding economic, political, legal, social and cultural factors are essential
in developing an advocacy strategy, mobilising society, convincing decision makers
and facing the interference of industry. Industry and its diverse strategies must also
be thoroughly known. In the same way, the media should be investigated – who are
they? To whom do they belong?”
Dr Esperanza Cerón (Educar Consumidores, Colombia)
8 Building momentum: lessons on implementing a robust sugar sweetened beverage taxEvidence as a foundation
For more information on
Evidence must be at the heart of policy design.
this type of evidence, see the
In order to design and implement an SSB tax, WCRF International evidence
policymakers should utilise evidence for SSB taxes table available online at
and their effect on price, purchasing behaviour www.wcrf.org/buildingmomentum
and consumption.
In order to design an SSB tax that is fit-for-purpose and context appropriate, and to increase
public and political support for the tax, it is common practice for governments to draw on the
following types of evidence:
• The severity of the overweight and • The projected fiscal revenue that will be
obesity problem in the country or local collected from the tax;
jurisdiction; • Modelling the effects of SSB taxes on
• Evidence showing the amount of sugar the contribution of diet as a risk factor
in SSBs; for developing NCDs;
• Evidence of the link between sugar • Modelling the impact of SSB taxes on
consumption, weight gain, overweight different socio-economic groups;
and obesity; • The WHO Guideline on Sugars intake for
• Evidence of household purchases or adults and children;
sales per capita of SSBs; • National and regional dietary guidelines;
• SSB consumption in the country or • Evidence that SSB taxes are
local jurisdiction, including highest recommended at an international level
consumers; by the WHO, through the updated
• Evidence on the price elasticity of Appendix 3 of the WHO NCD Global
demand for SSBs; Action Plan; and
• The health effects associated with SSB • Evidence that SSB taxes are effective
consumption, including diet-related at influencing consumer behaviour
NCDs; (e.g. purchases and consumption).
• The cost of diet-related NCDs to the
health care system;
A well-documented example of a country
“Get your science and research correct, get
that utilised many types of evidence when
academics behind you before you start pushing
designing their SSB tax is Estonia.(18,26)
and identify your opponents if you can. Ultimately
However, some governments do not have
you need to be ready for serious battles and
the resources to carry out this research
pushbacks and you need strong advocacy to
themselves, in which case evidence from
fight opposition quickly and with the right kind of
other jurisdictions can be used provided
facts in answer to their arguments. You’ve got to
consideration is given to the applicability
know the arguments and know the answers. You
of that evidence to their domestic
need sophisticated advocacy – people that know
context.(27) Evidence demonstrating the
media, know advocacy, know lobbying and know
effects of SSB taxes is increasing, which
how to find groups to do it and help fund them.”
is useful for other governments seeking to
implement similar taxes. Prof Barry Popkin (University of North Carolina, US)
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 9Policy Objectives It is also important that policymakers assess the
As standard practice, policymakers must set overall context in which the SSB tax is being implemented
objectives at the outset for a specific policy. In the and look at other policies and practices that could
case of an SSB tax, objectives tend to be health- be amended to support the effectiveness of the
related and/or revenue-related. Our qualitative SSB tax. For example, price promotions are often
research shows that setting clear objectives is used for SSBs, which could affect the overall
an important first step in designing a robust SSB impact of a tax if they were used frequently.
tax. In order to withstand challenges, the stated Evaluations should be high quality, independent
objectives of the SSB tax need to be supported by and free from conflicts of interest (regarding the
independent and robust evidence.(27) findings). Some countries or local jurisdictions
have created independent advisory committees to
provide oversight of the evaluation (e.g. Mexico’s
Monitoring and evaluation Evaluation Advisory Committee for SSB and ‘junk
A framework for monitoring and evaluating an SSB food’ taxes). Advisors provide input on the data
tax should be developed prior to implementation. and methods used for the evaluation, review
This requires dedicated resources and appropriate preliminary results and interpretation of the
skill sets, as well as the availability of baseline results, review final papers and provide credibility
data, with the opportunity to collect follow-up and transparency to the evaluation. Mexico’s
data. Evaluation Advisory Committee developed seven
Generally, a good monitoring system will identify core principles to guide their work and ensure
whether the implementation of the SSB tax is on a high degree of quality in the evaluations (see
course and performing as expected. Monitoring Appendix).(30)
compliance is also important for enforcement At a global level, World Cancer Research Fund
purposes. Policy evaluation assesses the tax’s International’s NOURISHING policy database
design, implementation and outcomes. Having can be used to track implemented SSB taxes in
clear pathways of effects is important for policy different countries and local jurisdictions, with
evaluation to ensure the appropriate outcomes links to published evaluations.(31)
are being assessed. For an SSB tax, it is not
Tax design
appropriate to solely evaluate the effectiveness of
the tax based on obesity rates, as this is a long- Taxes are shaped by context and vary by country
term outcome in the pathways of effects. and local jurisdiction. The following questions
should be considered when designing an SSB tax:
Implemented policies can have unintended
positive, negative or neutral impacts. This further • What types of products should be taxed?
demonstrates the importance of monitoring and
evaluating SSB taxes to determine whether they
• What type of tax should be used?
are having the anticipated impact and if not, • How high should the tax be?
why, so that the policy can be adjusted. To do
so, high-quality research designs, with reliable • Who should the tax be levied on?
indicators, are necessary to ensure relevant • Should it be a general or an earmarked tax?
outcomes are measured.(28) For example,
Hungary undertook iterative refinement of their tax What types of products should be taxed?
after implementation to ensure it was the most Governments that have designed an SSB tax
effective.(29) This helped remove any loopholes that has been successfully implemented have
in the definition of the tax that producers and carefully considered what products will fall under
manufacturers had exploited to avoid the tax.(29) the tax, with some using a nutrient profile to
define taxed products.(8,32) It is important to be
transparent about what products are subject to
and not subject to the tax and the rationale for
10 Building momentum: lessons on implementing a robust sugar sweetened beverage taxthe distinction. Governments have found that it tax. Both content-based and volumetric excise
is important to use standard criteria (e.g. sugar taxes are recommended because they create a
content) to determine what beverages are subject higher relative price increase in cheaper goods,
to the tax. For example, with specific content- which discourages consumers from choosing less
based excise taxes, a threshold of a certain costly but equally unhealthy products (substitution
quantity of sugar or added caloric sweeteners effect).(8,18,33,34) Nutrient/content-based
in a product is established, and any product, excise taxes have the advantage of targeting
regardless of its origin or type, will be subject the amount of sugar in a product, which can
to the tax.(5) However, not all governments will encourage industry product reformulation.(8)
have the resources to carry out extensive analysis The WHO recommends specific excise taxes
of sugar content in SSBs, which is an important calculated based on nutrient content in
consideration when deciding what type of tax to jurisdictions that have strong tax administration
implement (see Type of tax). because such taxes will have a greater impact.(8)
Ad valorem excise taxes and sales taxes have the
Mexico’s SSB tax has defined the subject advantage of being easily adjusted for inflation.
of their tax as all beverages with added In countries and local jurisdictions with limited
sugar, excluding milks and yoghurts. tax infrastructure or resources, taxes that apply
Chile’s taxed beverages include all non- a fixed rate to a product price are also more
alcoholic beverages with added sweeteners, easily applied, and therefore less likely to face
including energy drinks and waters, and complications in implementation and enforcement.
the tax applies at varying rates depending (5) Building on existing tax infrastructure is
on quantity of sugar per 100ml. France important to ensure effective implementation
and India’s taxes apply to beverages with of taxes.(35)
added sugar and non-caloric sweeteners.
The Philippines taxes products (at different
Mexico has an excise tax of one peso per litre
rates) that use purely caloric sweeteners
of sugary beverage; Barbados has a 10%
and purely non-caloric sweeteners or high-
excise tax on local and imported products;
fructose corn syrups or a mixture of these
various US cities have a one to two penny
products. Portugal taxes non-alcoholic
per ounce excise tax on SSBs; Fiji has an
beverages with a sugar content of less
excise duty on locally produced beverages of
than 80 grams per litre at a lower rate than
$0.35 Fijian dollars per litre and an ad valorem
beverages with a sugar content that exceeds
excise duty on imported products of 15%; and
80 grams per litre.
Chile has an 18% ad valorem tax on SSBs
that contain more than 6.25g of sugar per
Products that require special consideration include 100ml and a 10% tax on beverages with less
milk beverages, non-caloric sweetened beverages than 6.35g of sugar per 100ml.
and 100% fruit and vegetable juices. Some
countries and local jurisdictions have chosen to add
those products to the definition of taxed beverages Some countries choose to use custom or import
(particularly non-caloric sweetened beverages), and duty taxes in their SSB tax design. However, it
others have not. More research is needed on non- is important to note that using only customs or
caloric sweetened beverages and their impact on import duties, which tax international products,
obesity and NCDs. This additional research will be will make the tax susceptible to challenge, as
helpful for policymakers in defining which beverages under international trade law countries cannot
should be included in an SSB tax. tax international products differently from similar
What type of tax should be used? domestic products. For more information see
Defending SSB taxes.
Excise taxes are most commonly used by countries
and local jurisdictions when implementing an SSB
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 11Figure 2: Types of Tax
Specific Value added tax
excise tax tax on each stage of production that adds value to a product or
process – suppliers, manufacturers, distributors and retailers all
20¢ litre collect the value added tax on taxable sales at relevant points
$
per (e.g. 20% VAT on all sales in SSBs supply chain).
Volumetric
based on the volume of the
beverage (e.g. $0.20 per litre). SUPPLY CHAIN
m
gra
per
5¢ ugar
$ of s
Custom/Import
n im
por
ted
duty tax x o
ta duct s
Nutrient/content-based
based on the sugar content of the
beverage (e.g. $0.05 per gram of sugar).
% pro
taxes levied on products that are
imported from international sources
(e.g. 15% tax on imports of SSBs).
Ad valorem tax
rice ax tax
% of p pre-t s ales l
n
20 ed o rice Sales tax 15%origina rice
bas duct p
%
on duct p
pro
% pro
method for charging a duty, fee or tax tax collected from consumers at point
according to the value of goods and of purchase by retailers (e.g. 15%
services, instead of by a fixed rate, or sales tax on original product price).
by weight or quantity (e.g. 20% tax on
original pre-tax product price).
Thailand has a graded excise tax where the
tax increases over time. Introduced in 2017,
it taxes beverages with different sugar contents
at different levels (0.10 baht per litre for
beverages containing between 6-8 grams of In the Pacific, in countries like Fiji and Samoa,
sugar per 100ml of sugar, and one baht per the relevant Ministries of Revenue or Customs
litre for beverages containing over 14 grams of implemented domestic excise taxes and import
sugar per 100ml). The tax then increases every duties on international products so not to
two years and by 2023 the tax will be 1 baht discriminate between ‘like’ products. (35,36)
per litre for beverages with 6-8 grams of sugar
per 100 ml and 5 baht per litre for beverages
with more than 10 grams of sugar per 100ml.
This graded tax has the benefit of encouraging
industry product reformulation to avoid the
tax increases, and also normalises the tax
among the public as the increases happen
incrementally.
12 Building momentum: lessons on implementing a robust sugar sweetened beverage taxHow high should the tax be? entities. It is less onerous on retailers if the tax
When designing an SSB tax, it is important to has already been collected before the product
carefully consider the amount of the tax. The aim is reaches the shelves, unlike a sales tax that is
to ensure that the tax is high enough to impact the administered and collected by the retailer from
purchasing behaviour of consumers. Governments consumers.
that have implemented an SSB tax have found that Should it be a general or an earmarked tax?
increasing the price of SSBs by a minimum of 10%
Governments sometimes also choose to earmark
has an effect on the purchasing behaviour of their
the tax, although few constitutions allow
populations.(4,34,37) Studies reviewing modelling
earmarking. An earmarked tax is where revenue
of SSB taxes and other health taxes have shown
generated from the SSB tax is allocated to a
that an increase of 20% is the most effective
specified aim, such as reducing child obesity
rate for reducing consumption of SSBs and other
or NCDs, or funding a specific government
unhealthy foods.(25,34,37) Where possible, it is
programme like an education project. The funds
advised to carry out research on how price elastic
from a general SSB tax are channelled into
SSBs are in the specific country or local jurisdiction
the government’s general revenue and used as
to help set the value of the tax (see Evidence as
general tax revenue by the government. Evidence
a foundation).(4,8,32) The tax should also be
suggests that taxes that are earmarked for a social
adjusted in line with inflation and economic growth
or public good increase public and political support
to ensure that it maintains the effect on purchasing
for the tax.(38,39) See Earmarking.
behaviour. (8,33)
To further reduce consumption, France is
considering increasing the rate of their existing Stakeholder engagement
SSB tax and some countries including Fiji and Ensuring a broad base of support for the tax from
Norway have already implemented increases on a wide range of stakeholders, including civil society
their existing SSB taxes.(37) organisations (CSOs), as well as a multi-sectoral
approach within government, is recommended to
Who should the tax be levied on? increase the chance of successfully passing and
implementing a tax. Industry is another major
“Tax as high up in the chain as stakeholder in the policy process, and managing
you can, it makes tax collection their involvement will be discussed further below.
easier and puts the burden on
the manufacturers or distributors
instead of consumers.”
Dr Lynn Silver
(Public Health Institute, US) “Industry will hit hard no matter what
you do. So you need to start early,
start quietly and build a strong base of
Excise taxes are paid by producers, who can support that’s as broad as possible. Try
respond by passing the costs on to consumers, and bring on influential stakeholders in
by absorbing the costs, or by reformulating the your community, city and country to add
product so that less tax is due. The majority their support before the industry has
of producers do pass an SSB excise tax on a go at them. This includes community
to consumers at varying rates (see WCRF activists and leaders, civil society
International evidence table), but it can also lead organisations and researchers. Most
to a higher rate of product reformulation to reduce people will be supportive when they
the sugar content in the products. understand the size of the problem.”
Administratively, it can be easier to collect Dr Lynn Silver
a tax that is levied at the producer level, as (Public Health Institute, US)
governments already collect taxes from such
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 13Whole-of-government approach
Taking a whole-of-government approach helps
build political and public support for an SSB
tax. Taking such an approach enables the
government to ensure that the tax is feasible and
implementation is possible within the country’s or Pacific: The Ministries of Health, Finance and
local jurisdiction’s tax infrastructure. It also helps Revenue in four Pacific countries interacted
to increase political support for the tax, which early on and throughout the process, leading to
will increase the chance of the tax being passed successfully implemented SSB taxes that used
and help defend against industry challenge. existing taxation mechanisms.(35)
(8,33,34,40–42)
“The idea of the relationship
between tax and behaviour was
not new to the Ministry of Finance
Hungary: “Inter-sectoral action enabled
because we work very closely with
them on things like tobacco and accurate problem definition, development of
alcohol tax.” an appropriate policy solution, and effective
implementation.[...] Public health experts from
Prof Melvyn Freeman (National
the Ministry of Health, National Institute for
Department of Health, South Africa)
Health Development, National Institute for Food
and Nutrition Science, the Ministry of Finance,
Evidence shows that early engagement between and WHO worked closely together to formulate
health and other government departments, the final version of the tax and to see the
particularly finance departments, allows for legislation through a number of revisions.” (29)
priorities to be set and cross-departmental
coalitions to be established.(18,33–35) Experts
recommend designing an SSB tax through
engaging the health, finance, agriculture, trade
and commerce departments/ministries, as
Barbados: While the Barbados tax was
well as the legislative and executive branches
successfully enacted and implemented, one
of government to increase the likelihood of
criticism was that the tax policy process was
passing and implementing the tax.(8,41) Our
mainly led by the Ministry of Finance, with
qualitative research shows that continued internal
very little engagement with other government
communication throughout the policy process
departments. The Healthy Caribbean Coalition
is imperative to ensure that all stakeholders are
considers this to be a missed opportunity as
engaged and kept informed.
the tax could have formed part of a wider and
more comprehensive public health campaign to
reduce SSB consumption in Barbados.(41)
“It will be challenging to convince your
government to implement a tax, but it
must be done.” “It will be challenging to convince your government
to implement a tax, but it must be done.”
Ateca Kama (National Food and Nutrition
Ateca
Centre, Ministry of Health and Kama (National Food and Nutrition Centre,
Medical
Services, Fiji) Ministry of Health and Medical Services, Fiji)
14 Building momentum: lessons on implementing a robust sugar sweetened beverage taxMobilisation of civil society organisations
Civil society organisations can play a pivotal
role in rallying communities around an SSB
tax, providing the necessary support to
increase public and political support for the
tax. When CSOs are mobilised, they can
create a strong coalition to help withstand
challenges from industry.(33) Berkeley and
Mexico’s success in the implementation of
their SSB taxes, for example, is credited to
the strong mobilisation of CSOs, who helped
to increase public and political support for
the taxes.(33) Pro-tax campaigners from the Healthy Living Alliance in South Africa
Credit: South Africa Health E-News.
CSOs can help raise the importance of an SSB
tax on the political agenda, carry out grassroots
advocacy work garnering support from politicians,
Mexico: Three
academics, members organisations played
of the public andaother Berkeley: “When efforts for sugary-drinks
largeaspart
CSOs, wellinas
influencing the development
organise and help finance public taxes are driven and supported by community
awareness campaigns that educatetax.
and implementation of the SSB theEach
public on coalitions that build public awareness early
organisation had a different but important on, they are better able to withstand industry
function. The National Institute of Public attacks. Strong coalitions are vital both to
Health generated scientific evidence and adopt new taxes and to ensure they remain
analysis, convened experts and assisted to curb consumption and generate funds
with knowledge translation; El Poder del for public health programs. In Berkeley, the
Consumidor improved public awareness industry waged a $2 million anti-tax campaign.
through media campaigns; and an organisation We credit the success of the tax effort there
called Polithink analysed the political context, to a broad-based community coalition — a
lobbied and linked decision-makers. Additional united front of the local N.A.A.C.P. [National
advocacy was undertaken through the creation Association for the Advancement of Colored
of the Nutrition Health Alliance integrating a People], Latinos Unidos, teachers’ unions and
significant number of civil society organisations many more groups. This compact was strong
from different areas. These organisations enough to withstand the industry’s onslaught.
continue to work together.(33) We won decisively, with 76 percent of the vote.
Community engagement is key.” (43)
“12 Spoonfuls of Sugar”
campaign in Mexico City
subway station (May -
August 2013) asks “Would
you drink 12 spoonfuls of
sugar?” Soda is sweet,
diabetes isn’t.
Credit: Alianza por la Salud Alimentaria. Photo: Dzilam Méndez.
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 15Colombia: Even though the tax was not “Although we did not manage to get the
passed and implemented, CSOs, such as tax passed, without a doubt we placed
Educar Consumidores, played a large part the issue on the public agenda, which
in getting the tax onto the political agenda until a few months ago had never been
and raised awareness of the issue with the discussed, and many opinion mobilisers
general public.(44) continue to discuss the topic.”
Dr Esperanza Cerón
(Educar Consumidores, Colombia)
CSOs can help raise the importance of an SSB
tax on the political agenda, carry out grassroots
advocacy work garnering support from politicians, Many governments carry out public consultation
academics, members of the public and other when they are developing new laws. In these
CSOs, as well as organise and help finance public cases, stakeholders, including industry can
awareness campaigns that educate the public on provide comments on tax proposals. However,
the need for the tax and bolster public support industry should not have a seat at the policy
for the tax. The success or failure of an SSB tax table due to inherent and unavoidable conflicts
can depend on public campaigns carried out by of interest. Following the public consultation
pro-tax and anti-tax campaigners, underlying the process, governments then finalise tax design
importance of mobilising a strong civil society and proceed with implementation. It is up to the
movement. Governments should engage with government’s discretion whether to incorporate
CSOs to capitalise on these potential benefits. industry comments to ensure that the tax will be
enforceable and that any loopholes are addressed.
In reality, many countries struggle with the
In 2016, in Fiji, the Healthy Living presence of strong and influential industry actors.
Alliance comprising of the Fiji Consumer In order to assist governments to sufficiently
Council, Diabetes Fiji and National manage the influence of industry, the WHO and
Food and Nutrition Centre, carried out leading academics recommend that governance
research to gather evidence for an SSB mechanisms should be put in place to manage
tax and submitted a proposal to the Fijian conflicts of interest.(45–48)
government for a tax design. This research
was taken on-board by the government
Framing
and the evidence and initial proposal The majority of SSB tax campaigns have had
submitted by the Alliance was used in three main framings, social good (such as health
the development of the SSB tax promotion) (Hungary, Nauru, French Polynesia,
policy. The Alliance also ran the public Berkeley, Fiji, Mexico and the UK), revenue raising
awareness campaign that contributed to a (Finland, France and Samoa) or a combination of
successfully implemented tax. both (Philadelphia).(32)
Lessons learned
Governments commonly the Pacific
fromframe suggest
the argument for
that highlighting both the health and
introducing an SSB tax using the types of evidence
Industry engagement
revenueabove
discussed implications of health-promoting
(see Evidence as a foundation).
The role of industry in policy design and
taxes can increase public
Framing the SSB tax as a mechanism and political
that will
implementation is a contentious issue given the
inherent conflict of interest the food and beverage helpsupport.(35,36) Research
control the obesity epidemic showed, in the
and reduce
the context
economic burden the Pacific,
of caused that both
by diseases theto
related
industry has in ensuring their business and
public and politicians
overconsumption of SSBs responded
is a popular to the
approach.(49)
profit margins are not impacted by government
double framing of the tax improving health
regulation. Earmarking
outcomes and generating revenue.(35)
16 Building momentum: lessons on implementing a robust sugar sweetened beverage taxGovernments commonly frame the argument for
introducing an SSB tax using the types of evidence A qualitative study was carried out on the
discussed above (see Evidence as a foundation). framing of the 2017 Philadelphia SSB tax.
Framing the SSB tax as a mechanism that will The study found the following:
help control the obesity epidemic and reduce “The mayor’s administration deliberately
the economic burden caused by diseases framed the SSB tax as a strategy to finance
related to overconsumption of SSBs is a popular universal pre-kindergarten and improvements
approach.(49) to recreational facilities – not as a health
intervention. Interviewees expressed that
Earmarking
the non-health frame shifted the policy
The most successful way to frame an SSB tax in debate away from contentious arguments
order to gain more public and political support has about government involvement in individual
been to state that the funds raised by the tax are behavior to discussions about how to finance
earmarked for a social good.(38) One study found investments in youth and communities – goals
that while governments are primarily interested in for which broad support existed. Interviewees
raising additional funds from the taxes, framing cited a poll conducted during the policymaking
the tax as a tool to increase spending on a social process that found that 84% of Philadelphians
good (e.g. funding health promotion or social felt that universal pre-kindergarten was “very
programmes) at the same time as creating health important”. The non-health frame also allowed
benefits leads to the highest likelihood of the tax a wide range of research findings to enter the
passing.(38) policy debate. Interviewees and news articles
cited research about the long-term benefits of
pre-kindergarten on education outcomes and
associated cost savings. This contributed to
the SSB tax proposal being perceived as an
evidence-based education policy that would
increase levels of educational attainment and
improve the social and economic trajectories
of low-income Philadelphia youth.”(51)
Credit Matt Rourke/AP/
REX/Shutterstock
Anti-tax (above)
and pro-tax (right)
campaigners in
Berkeley California
Credit Matt Rourke/AP/REX/Shutterstock
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 17“A poll of New York City residents found that United Kingdom: “[..] celebrity chef Jamie
52% supported a “soda tax,” but the number Oliver was at the centre of the debate as an
rose to 72% when respondents were told SSB tax advocate. Oliver consistently accused
that the revenue would be used for obesity food industry [of] ‘damaging children’s
prevention.”(50) health’ and advocated for a tax as a matter
of ‘parental responsibility of the government
for children’s health’. [The] UK government
Earmarking the tax for a social or public good, in
framing follows similar logic, as the tax is
particular providing for low income populations, can
named the ‘soft drinks industry levy’ and the
also help governments counter arguments that the
government mentions the tax will incentivize
SSB taxes are regressive in nature.(33,34,40,42)
industry to reformulate their products by
reducing sugar amounts.”(32)
Cook County: “The measure was pitched
largely as a means to plug a $1.8 billion
budget gap, and secondarily as a means to that some pro-tax campaigns, for example in the
improve public health by discouraging the UK, Mexico and Philadelphia, have successfully
consumption of drinks linked to obesity and used a human rights angle to counter the anti-
other conditions.”(52) tax arguments. Focusing on the negative impacts
of industry influence (for example, marketing of
Our qualitative research shows that one SSBs) and the obesogenic environments people
of the factors in the repeal of the newly live in can increase both public and political
implemented SSB tax in Cook County support for an SSB tax.(32,38,44,53) Using
was that the tax was not earmarked for a a human rights lens can rebut the arguments
social good, and therefore had less public that obesity and SSB consumption is a matter
support because it was perceived as solely a of personal responsibility and not a place for
revenue raising mechanism. governments to interfere.(32,38,44,53) This
framing approach links with CSO mobilisation,
The government’s role in protecting and discussed above, because the role of CSOs is
promoting public health to act as an advocate for the rights of citizens
they represent.
Framing that asserts that government intervention is
necessary in order to counter the power imbalances The WHO’s position in encouraging governments
caused by industry influence can help increase political to introduce such fiscal policies through the
and public support for an SSB tax. (32,38,44,53). updated Appendix 3 of the NCD GAP establishes an
It is argued that it is the government’s responsibility international norm that encourages governments to
to protect and promote the health of their citizens take responsibility for progressively recognising their
against strong negative influences and products that citizens’ right to health.(53)
have no nutritional value. Our
qualitative research found
“12 Spoonfuls of Sugar”
campaign, Mexico (May - August
2013) asks “Would you give
them 12 spoonfuls of sugar?
Why give them soda?”
Credit: Alianza por la Salud
Alimentaria.
18 Building momentum: lessons on implementing a robust sugar sweetened beverage taxDefending SSB taxes
“Every campaign is different, you
Most governments who have proposed an SSB tax can’t take one campaign model
have encountered opposition. This has occurred and apply it to every community.
in the political and public space, often driven by You have to understand what
industry. Evidence developed during the design of are the drivers? Who are the
an SSB tax can be used to help defend the tax influencers?”
against opposition (see Evidence as a Foundation).
Jim O’Hara (Center for Science
in the Public Interest, US)
Public campaigns
While a limited number of SSB taxes are
challenged in the courts, the debate surrounding
an SSB tax is often played out in the public
Common challenges to an SSB tax
domain by pro-tax and anti-tax campaigners.
Strategies used by successful pro-SSB tax SSB taxes can be legally challenged by third
campaigns have included using billboards, parties for the following reasons:
TV advertisements and social media; preparing Challenge 1: Discriminatory – taxes only apply to
reports and evidence to counter false reports certain products and not others (i.e. based on
and evidence proffered by the opposing side; and country of origin or product type, e.g. SSBs versus
mobilising communities through organising town other sugar-sweetened products);
hall meetings, flyer drops and door knocking.
Public awareness needs to be sustained after the Challenge 2: Jurisdictional issues – no mandate
implementation to ensure continued support for or jurisdiction to introduce a tax;
the tax. Challenge 3: Unconstitutional – restricts or
Finding funding for such campaigns or using impinges on rights to trade/commerce or rights of
volunteers as much as possible can increase the consumer; or
effectiveness of the campaigns. Challenge 4: Unenforceable – the tax drafting is
unclear and/or illogical.
Campaign in Colombia: Don’t hurt yourself by drinking
sugary drinks. It’s better to drink water.
Take care of your life. Take it seriously.
Credit: Alianza por la Salud Alimentaria
Pro-tax campaigners in South Africa
Credit: South Africa Health E-News.
Building momentum: lessons on implementing a robust sugar sweetened beverage tax 19SSB taxes are also challenged by third parties
using the following arguments:
Challenge 5: Regressivity – an SSB tax is “You need to design a coherent,
regressive because it is a tax that takes a larger logical tax that treats different
percentage of income from low-income earners products fairly.”
(largest consumers of SSBs) than from high-income Aaron Schwid (Global Health
earners.(54,55) Advocacy Incubator, US)
Challenge 6: Economic reality – an SSB tax will
impact the local economy (54,55) because it will
To ensure that the SSB tax is not considered
result in:
inconsistent with existing law, countries such as
- job losses at local SSB production/ Hungary designed the tax so that the tax liability
manufacturing companies depends on the composition of the product,
independent of where the product originates from
- it will hurt small business owners who will
or the type of product.(29)
lose customers
- industry will move their production out of
Addressing challenge 2: Jurisdictional issues –
that country
no mandate to implement a tax
Challenge 7: Individual responsibility –
individuals are responsible for their own actions
and governments should not intervene.(54,55)
Addressing challenge 1: Discriminatory – “Every country has the right to tax and
taxes apply to certain products and not every country has the right to have a
to others fiscal policy in their constitution”
SSB taxes can be subject to threats of litigation Prof Barry Popkin (University of
if the tax discriminates against products from a North Carolina, US)
certain country, or because the taxes target SSBs
instead of other sugary products or products high in
other unhealthy components like saturated fat.(27) Governments are sometimes challenged for
Mexico’s 2004 tax measures targeting SSBs implementing taxes that they do not have the
containing non-cane sugar sweeteners were found jurisdiction to introduce.(57) This is particularly
to be inconsistent with international trade law relevant to local governments who are considering
because taxes imposed on imported products implementing SSB taxes. Local governments need
were not equally imposed on domestic ‘like’ to closely consider the delegated authority they
products.(56) However, countries in the Pacific have when introducing an SSB tax, either as a
researched their regional and bi-lateral trade sales tax or an excise tax.(57) Local governments
agreements and where countries had a domestic also need to monitor any changes to state or
sugar market, excise duties were implemented federal level legislation that may change their
on domestic products and import duties were ability to enact an SSB tax.
implemented on international products so as not National governments have a sovereign right
to discriminate against imported products.(35) to introduce taxes and our qualitative research
found that a challenge to the legitimacy of the
government to introduce an SSB tax is unlikely to
be successful.
20 Building momentum: lessons on implementing a robust sugar sweetened beverage taxYou can also read
