Tax on sugar sweetened beverages and influence of the industry to prevent regulation
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Peer-reviewed | Manuscript received: 24.07.2017 | Revision accepted: 18.10.2017
Tax on sugar sweetened
beverages and influence of the
industry to prevent regulation
Katrin Schaller, Ute Mons
diseases, reduced quality of life, and
Abstract lower life expectancy [9, 10] (• Fi-
gure 1). The prevalence of obesity and
Consumption of sugar sweetened beverages in Germany is high compared to
T2DM has taken on alarming pro-
other nations worldwide. Sugar sweetened drinks contribute to the development
portions. In Germany, 18 % of adults
of obesity and type 2 diabetes mellitus. Secondary diseases are presenting the
are obese, that number being on the
health care system with enormous challenges, which is why prevention of those
rise [11], and even 6 % of children and
diseases must be a priority. A tax on sugar sweetened beverages as part of a
adolescents are severely overweight
comprehensive strategy can contribute substantially to obesity prevention, as
[12]. 7.7 % of adults in Germany suffer
experience has shown in Mexico, France, and the USA. The food industry is using
from diabetes (type 1 and type 2, not
the same tactics as the tobacco industry to prevent effective regulation. With
including gestational diabetes) [13].
strong political will and support from professionals and the public, however,
The severe health consequences of
it is possible to introduce a tax on sugar sweetened beverages despite massive
obesity and diabetes put an enormous
resistance by the industry.
burden, not only on the affected per-
Keywords: obesity, prevention, food industry, sugar tax, nutrition policy sons but also on society and the social
health insurance systems. According
to an estimate, the long-term health
effects of obesity in Germany result
in costs of about € 63 billion per year
Introduction [14]. It is therefore essential to prevent
Germany is among the top ten coun- the development of obesity, and to re-
tries in the world when it comes to duce the number of existing cases of
consumption of sugar sweetened obesity in order to minimize the oc-
beverages [1], and is also at the top currence of secondary diseases.
of the list in terms of juice consump-
tion as compared to other European
countries [2]. In 2016, German per
Solution strategies
capita consumption of sugar sweete-
ned beverages was nearly equal to the The ideal way to prevent obesity
consumption of mineral water: 116 L is a combination of behavioral and
soft drinks, 33 L juice, and 153 L structural prevention. Behavioral
mineral water [3]. Especially chil- prevention aims to change the health
dren, adolescents, and young adults behavior of individuals; structural
consume large quantities of sugar prevention means to modify the
Citation:
sweetened beverages: In this group, living environment in such a way
Schaller K, Mons U (2018) Tax
almost half of the drinks consumed that it promotes a healthy lifestyle
on sugar sweetened beverages
are juices and soft drinks [4]. [15]. Current living environments,
and influence of the industry to
Sugar sweetened beverages contribute however, tend to stimulate physical
prevent regulation. Ernahrungs
to the development of obesity [5], inactivity and an increased intake of
Umschau 65(2): 34–41
type 2 diabetes mellitus (T2DM) [6], energy-dense foods.
This article is available online: and caries [7, 8]. Obesity and T2DM What is needed, therefore, is a com-
DOI: 10.4455/eu.2018.007 are particularly significant, as they prehensive strategy that addres-
are primary causes of several severe ses many different areas of life in
34 Ernaehrungs Umschau international | 2/2018Copyright!
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written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden.
Health consequences Major diabetes order to effectively prevent the de-
of obesity complications velopment of obesity – ideally du-
ring childhood. The World Health
type 2 diabetes
stroke Organization (WHO) recommends
mellitus cardiovascular disease a package of several effective mea-
blindness
11 types of cancer sures1, some of which target the re-
dyslipidemia heart attack duction of sugar consumption [16,
sleep apnea 17] (• Figure 2).
kidney failure
shortness of breath
amputation
orthopedic complications
Influence of the
Fig. 1: Health consequences of obesity and diabetes food industry
[own illustration according to (9, 10)]
Some important obstacles will
have to be overcome before a tax
on sugar sweetened beverages can
problem
be introduced (• Box), because the
high sugar consumption increases the risk of food industry is opposed to any
- type 2 diabetes mellitus measures that would lead to a re-
- obesity duced consumption. The industry
- caries
goes to great lengths to prevent
effective regulation, employing the
consequences same tactics as the tobacco industry
[18, 33]. These include direct policy
- reduced quality of life interference (lobbying), influencing
- reduced life expectancy research and the media, as well
- cost to society as corporate social responsibility
€
(• Figure 3). Manufacturers use
these tactics to build up opposition
solution strategy against such measures in politics
supplementing behavioral prevention with structural prevention as well as in the population, while
- change of living environment (“Make the healthy choice the easy choice.”) promoting weak voluntary com-
- political action §§§ mitments and education measures
- policies reach the entire population instead.
A systematic review of the litera-
ture regarding the influence of the
policies recommended by the WHO (among other)
industry was conducted. For this
- tax on unhealthy foods and subsidy of healthy foods
€
review, the literature published bet-
- reduction of sugar in foods ween 1 January 1987 and 31 Au-
and non-alcoholic beverages
gust 2017 was searched in the liter-
- reduction of advertising for unhealthy foods to children
ature database PubMed on 31 Au-
- policies to motivate food producers to improve Kekse
the availability, affordability, and acceptance
gust 2017. Search terms included
of healthy foods “sugar sweetened beverage*, ssb*,
- improved food labeling Kekse soda*, soft drink*, carbonated beve-
rage*, sugar-sweetened*, beverage*,
sugar, industry, economic, interfe-
results
- reduction of sugar consumption in the population
- reduction of damage caused by secondary diseases
- declining consumption
- change of products/product range necessary
Fig. 2: Consequences of high sugar consumption, strategies for reduction of 1
Article “Instrumente der Ernährungspoli-
sugar consumption and consequences for public health and manu- tik. Ein Forschungsüberblick” (Instruments of
facturers [own illustration according to (9, 10, 15–17)] nutrition policy. A research overview) [19]
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Powerful policy: tax on sugar sweetened beverages
One key element of a comprehensive strategy is the implementation of fiscal policies, because they have
multiple effects. A price increase for unhealthy foods, for instance, motivates consumers to buy less of these
products. For sugar sweetened beverages, price elasticity of demand, i.e. the change in demand as a reaction
to price changes, is –0.79 to –1.3 [18, 19]; that means that a price increase of 10 % would decrease con-
sumption by 7.9–13 %. Persons with low incomes, young people, and overweight people are particularly
price sensitive [18]. Modeling and experimental studies point out that a tax increase raising the price of sugar
sweetened beverages by at least 20%, likely would decrease the consumption and the associated health
consequences proportionate to the price increase [18].
Simultaneous significant reduction of the value-added tax on healthy foods like fruits and vegetables could
avoid a disproportionate burden on low-income individuals and at the same time promote switching to
healthy foods [20]. Ideally, the health consequences – particularly obesity – would decline in the long term
as a result of the reduced consumption of unhealthy products. At the same time, taxes on unhealthy foods
are an incentive to the industry to change unhealthy products by improving their nutritional quality – this,
too, contributes to a healthier diet [18, 21]. Beyond that, taxes on unhealthy foods increase government
revenue, which could be earmarked for obesity prevention [18]. Price-related measures are particularly sig-
nificant because they address the lower income segment of the population, where excess weight and obesity
are more prevalent than among people with higher incomes. This way, price-related measures can even
contribute to mitigating health inequalities [22].
According to intervention and modeling studies, a tax on sugar sweetened beverages has the largest effect
of all pricing measures. It has the potential to positively influence consumer behavior, particularly if it is
imposed simultaneously with financial incentives on fruits and vegetables [18]. Several countries currently
levy a tax on sugar sweetened beverages, among them Mexico, France, Ireland, and the United Kingdom,
other countries are considering the option [18]. However, the industry has prevented such a tax from being
introduced in several countries. Denmark, for instance, cancelled a proposed sugar tax in 2012 in response
to intensive lobbying by the sugar industry. Finland refrained from an increase on the tax on sweets that has
been in effect since 2010 because of a complaint by the Finnish Food and Drinks Industries’ Federation to
the European Court of Justice [23, 24].
First evaluation studies in countries with a tax on sugar sweetened beverages indicate that these taxes are
effective, at least in the short term: They lead to price increases and are thereby passed on to consumers,
although the extent differs between the various types of taxed drinks and the point of sale [23, 25–27]. Also,
the tax influences consumer behavior: Demand declined in all countries that were evaluated [23]. In Mexico
and in Berkeley (California/USA), the tax caused a reduction in purchases of sugar sweetened beverages of 6
and 9%, respectively, and sales of untaxed drinks, particularly water, increased by 4 and 15% [28–30]. This
trend continued in Mexico during the second year after the introduction of the tax [31]. The effect varied
in intensity depending on socioeconomic status: low-income households reduced the purchases of sugar
sweetened beverages more significantly [29, 31, 32]. There is no evidence as yet to what degree these taxes
have long-term effects on consumer behavior, body weight, and public health.
rence, influence, regulation, tax”, and lobby control organizations were industry and its lobby organizations
were linked with operators. The ini- included. argue that taxing sugar sweetened bev-
tial search identified 1,539 articles, of erages is ineffective, undifferentiated,
which 104 were selected based on the has a disproportionate effect on low-in-
title. After exclusion of duplicates, come households, promotes cross bor-
Influence on politics
editorials, commentaries, news, es- der shopping and smuggling, harms
says, features, and contributions In order to prevent strict regulation, the economy, and destroys jobs [34].
with unsuitable topics, 19 articles producers are not only influencing The industry points out that it could
were included in the review; 3 more politicians directly, but are also crea- solve the problem by reformulating
were located by means of cross-ref- ting special interest groups and front the products and that education, prod-
erences. In addition, hand-searched groups that represent their interests uct labeling, and nutritional guide-
reports by economic, health, and to policy makers and the public. The lines are more effective [34, 35].
36 Ernaehrungs Umschau international | 2/2018Copyright!
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food industry
marketing, sponsoring
financing of studies
goals:
food industry public health
- sales increase
- prevention of
regulatory measures
research
political will
ev lobbying
id
e
rt
public pr
po
e goal: prevention
influence m ven
nc
health of regulatory measures
sup
ea tio
su n
e
on the res
scientific public - “measures are
ineffective”
community health
evidence - “limitation of
goal: research population policies personal choice”
to cause „Make
the healthy choice - “limitation of
uncertainty n e - tax increases
io nc brand rights”
among the at ide the easy choice.“ - advertising bans
io n
r m v - “distortion of
population with fo t e - product regulation
in ou competition”
tat
ev
contradictory - mandatory
media ab u - recommendation
en
research results
al
at quality standards
io n le m of self-regulation
imp for canteen meals
effect - education - development of
campaigns ineffective, industry-
media reports: low for weak policies high for effective policies - etc. financed prevention
- “responsible citizens” programs
- “not the type of food
is essential, but the Corporate Social Responsibility:
relation of energy goal:
and exercise” to create an image of a responsible industry with positive impact on society
Fig. 3: Influence of the food industry to prevent effective regulation [own illustration]
In public discourse in Germany, the ened soft drinks as part of a “diverse Self-regulation
special interest groups of the sugar and balanced, yet pleasurable diet” As an alternative to strict regula-
and soft drink industry take the po- can certainly be a component of ba- tion, the industry offers voluntary
sition that there is no correlation lanced nutrition [36]. commitments. However, these are
between sugar consumption and In the USA, Coca-Cola, PepsiCo, and generally weak, give a lot of leeway,
excess weight. They explain that their lobbies resisted 29 regulations usually do not include sanctions, and
the sole driving factor is a person’s or proposed regulations between measurable effects are rather sparse
energy balance, and that the source 2011 and 2015. Between 2011 and [42, 43].
of the energy makes no difference 2014, Coca-Cola spent about $6 For instance, in the EU Pledge to reg-
whatsoever; they also emphasize million per year for this lobbying ulate food and beverage advertising
each person’s individual responsibi- activity, PepsiCo spent around $3 aimed at children, the participating
lity for their own diet [36, 37]. Ar- million, and the American Beverage companies set different age limits for
guments against a sugar tax are: A Association about $1 million [39]. the definition of “children” and selec-
sugar tax has no effect on consump- In 2009, PepsiCo threatened to move ted different products to fall under the
tion and excess weight, leads to loss its headquarters out of New York pledge [44]. The definitions of a simi-
of jobs and limits citizens’ freedom when the state considered introdu- lar US commitment were similarly
of choice [33, 36, 38]. The pro- cing an 18% tax on sugar sweetened inadequate; furthermore, companies
ducers’ lobby declares that “respon- beverages [40]. In Mexico, the food not participating in the pledge con-
sible consumers” are able to decide and beverage industry influenced the tinued to advertise products excluded
based on the mandatory informa- responsible ministries, successfully by the agreement [45].
tion of food labels “what prod- delaying the introduction of a vol- Companies participating in the Ca-
ucts meet their wishes and current untary commitment to fight obesity nadian Children’s Food and Beverage
needs”; furthermore, sugar sweet- and weakening the guidelines [41]. Advertising Initiative pledge to either
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advertise only those foods to children uncertainty among researchers and newspaper articles appeared in 2014
that satisfy defined nutritional crite- the public. For instance, the sugar which declared that not sugar is re-
ria, or to not advertise to children at industry in the USA sponsored a sponsible for excess weight, but an
all. According to an analysis of food research program as early as the unbalanced diet. They emphasized
and beverage advertising on several 1960s and 1970s, which came to individual responsibility for one’s
TV channels, the agreement had no the conclusion that fat and choles- diet and focused on the importance
significant effect on the children’s TV terol are the main causes of cardio- of physical activity for weight con-
food advertising environment [46]. vascular disease; the role of sugar trol [60].
On the other hand, a report by Ad- in this context was downplayed
vertising Standards Canada, an in- [52]. The correlation between sugar
dustry-supported entity responsible consumption and obesity is also Corporate Social Responsibility
for monitoring this voluntary com- questioned. Several current reviews Producers present themselves as part
mitment, confirmed “full compliance” show that studies that involve a of the solution by initiating Corporate
in the TV advertising [47]. In Spain, conflict of interest with the food in- Social Responsibility (CSR) programs
almost half of the ads on television did dustry are significantly less likely that include physical exercise and
not comply with the requirements of to find any correlation between the nutrition education. For instance,
the voluntary commitment for food consumption of sugar sweetened the PepsiCo Foundation supported
and beverage advertising directed at beverages and body weight and the programs promoting a healthy life-
children [48]. consequences of obesity than do in- style and healthy diet with $1 mil-
In Australia, where the industry in- dependent studies [53–55]. lion in 2012. Dr Pepper Snapple
troduced the Daily Intake Guide as In caries research, the sugar indus- sponsored the establishment and
a voluntary initiative, most food try in the USA was able to influence maintenance of playgrounds with
producers did not use the food label the research of the National Caries $15 million, and the Coca-Cola
recommended as a standard in the Program, so that it did not focus on Foundation grants about a third of
initiative, which lists the energy the caries-causing effects of foods, its philanthropic expenditures to or-
content as well as the amounts of but on methods of preventing caries ganizations that fight obesity, with
fat, saturated fat, sugar, and salt. without restricting sugar consump- promotion of exercise being a special
Instead they generally used the least tion [56]. The sugar industry also focus [35, 61, 62].
informative label, which only lists tried to influence the WHO’s guide-
energy content [49]. lines on reducing sugar intake. The Marketing
A voluntary regulation on the sale main strategy consisted of spread-
of soft drinks in elementary schools ing doubt about the scientific basis Producers use advertising not only
was largely unfamiliar to schools in of the guidelines, introducing other to promote their own products, but
Spain [50], and in the USA, such an risk factors like lack of exercise into also to prevent planned regulation.
agreement was not very restrictive, the discourse, and suggesting solu- The beverage industry in the USA,
involved only the three largest bev- tions for reducing the risk of caries for example, invested over $10 mil-
erage producers, and was voluntary by administering fluoride [57, 58]. lion in an extensive ad campaign
for the schools [42]. According to a on TV, radio, and billboards, and
study supported by the American in paid staffers going out into the
Influence on the media
Beverage Association, an entity re- public in Berkeley and San Francisco
presenting the interests of the US The industry tried to use the media to turn the population against the
beverage industry, the voluntary to downplay the health risks of planned tax on sugar sweetened bev-
commitment was effective: After sugar consumption and thus im- erages and to prevent the regulation
the agreement was established, pact public opinion. Industry re- [18].
the proportion of sugar sweetened presentatives appear in the media
drinks sold in schools declined, the primarily when regulation is to be
Situation in Germany
proportion of water increased, and introduced. Their main arguments
the energy content and bottle size of are that sugar sweetened bever- In German politics, a tax on sugar
beverages both decreased [51]. ages alone are not responsible for sweetened beverages currently
obesity, and that the proposed reg- meets with little support. Instead,
ulatory measures are exaggerated Germany focuses its obesity preven-
Influence on research
and damaging to the industry. In- tion mainly on behavioral preven-
The industry is influencing research stead, self-regulatory measures are tion in children and adolescents, and
with the goal of generating contra- presented as being effective [59]. In relies on voluntary commitments
dictory research results, which cause the British press, producer-friendly by manufacturers [15]. However,
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said that unhealthy diet and obesity ation among the population. Pro-
Countermeasures are particularly prevalent in the low- ducers are employing different meth-
by the industry er-income segment of the popu- ods to prevent effective regulation
Experience in countries which lation – a tax could therefore have such as a tax on sugar sweetened
have introduced a tax on sugar greater effect on this target group beverages. Being able to introduce
sweetened beverages, particu- especially. In addition, a regressive a regulatory tax despite massive re-
larly Mexico and the USA (Ber- effect could be counteracted by ma- sistance takes strong political will
keley), shows that it is possible king healthy foods and beverages and public support. Scientific associ-
to introduce such a tax despite more affordable through tax breaks ations and health organizations can
massive resistance by the indus- or subsidies [18, 19, 23]. Substitu- contribute substantially to the effort
try. Prerequisite is a well-planned tion processes must also be consid- by providing sound information.
campaign supported by a broad ered: Consumers replace the taxed
coalition of decision makers, products with other sugar sweet-
health organizations, and grass ened products (e.g. juice), switch to
cheaper brands or stores, or turn to Conflict of Interest
roots organizations [18] – a base
low-sugar/sugar free products (e.g. The authors declare no conflict of interest.
movement that has yet to be
formed in Germany. water, diet varieties). With a care-
fully thought-out tax structure,
these substitution processes can be
Dr. Katrin Schaller1
controlled in such a way that pos- PD Dr. Ute Mons
sible negative health effects are kept Stabsstelle Krebsprävention/WHO-Kollabora-
effective obesity prevention requires to a minimum or avoided [18]. tionszentrum für Tabakkontrolle
a combination of different measures According to two simulation cal- Deutsches Krebsforschungszentrum
Im Neuenheimer Feld 280, 69120 Heidelberg
that address different issues at the culations, a sales tax on beverages 1
k.schaller@dkfz.de
same time, and motivate individu- with added sugar (not including
als to change their behavior in ad- juices and dairy products) of 20% in
dition to creating a health-promo- addition to the value added tax could
ting environment. A tax on sugar reduce sugar and energy consump-
sweetened beverage as part of such tion in Germany. According to the
a package of measures can make an calculations, this effect would be
important contribution to obesity much more pronounced in men
prevention [16, 19]. than in women, and also in youn-
Health organizations support such ger and low-income persons. The
a tax. For instance, the German Al- calculations also reveal that such a
liance Non-communicable Diseases tax could reduce the development
(Deutsche Allianz Nichtübertragbare of caries and lower the number of
Krankheiten = DANK) recommends, persons with excess body weight
among other policies, a health-pro- by 3%, and with obesity by 4% [64,
moting restructuring of food taxa- 65].
tion: This includes lowering the
sales tax on healthy foods with low
fat, sugar, and/or salt content, and
Conclusion
a simultaneous tax increase for pro-
cessed foods with a high fat, sugar, In Germany, measures available
and/or salt content. The tax struc- for obesity prevention are far from
ture is to provide incentives for a being fully utilized, despite urgent
healthy diet, without unduly in- need for action. A tax on sugar
creasing the burden on citizens [63]. sweetened beverages would have the
However, certain aspects of such a potential to motivate consumers to
tax could be problematic: A tax on consume less sugar sweetened bev-
sugar sweetened beverages could, erages. At the same time it can be
for example, have a regressive effect, an incentive for the industry to re-
meaning it could affect low wage duce the sugar content in bevera-
earners more than higher income ges. In the long term, it can lead to
brackets. In that context it must be healthier diets and weight stabiliz-
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