Obesity and Diabetes are Regressive: A Soda Tax? Not So Much

Obesity and Diabetes are Regressive: A Soda Tax? Not So Much

David Katz 26/03/2019 4

As I write this, I am just back from the Connecticut State Legislature, where I gave testimony in support of a “soda tax” proposed by our Governor. Before answering the questions (and provocations) of legislators (again) both favorably and ill-disposed to the measure, I had roughly 3 minutes to make my case. I lay it out for you below, along with the embellishments that did not fit in so tight a space.

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1)  Of Punishment, and Crime

Well, to be fair, a modest tax on sugar-sweetened beverages, be it an excise tax (as I favor), or a sales tax (as the current legislative language under consideration here in CT posits) involves neither punishment, nor crime. But the references are germane just the same, because of an expression we all know: let the punishment fit the crime.

Excise taxes are applied when products are sold at the potential expense of the well-being of those buying them. The best-known examples are alcohol and tobacco. I don’t see many people now, at any position on the political spectrum, arguing that taxes on tobacco should be revoked. Those taxes- along with actual punishment of tobacco companies for actual crimes- have raised revenue put to good use advancing public health. And, perhaps more importantly, they played an important role in reducing smoking rates.

If you think the Big Soda playbook is much different from the Big Tobacco playbook, think again. The parallels are overwhelming, as laid out in copious detail in Soda Politics, a book by NYU professor Marion Nestle.

Connecticut, like the rest of the United States, is awash in obesity, type 2 diabetes, and other chronic disease in adults and children alike, and almost none of it needs to happen. These modern plagues are much fueled by empty calories and added sugar that is both a scourge in its own right, and a goad to appetite, causing more over-consumption, and more obesity. While far from the only source of empty calories and added sugar, soda is decisively in the vanguard. A tax applied here is a modest response to a well-established threat, and well aligned with precedent and the relevant lessons of history.

2) Two Arguments for

The two primary arguments for a soda tax are that (1) it will raise revenue that can, and in my view should, be used for public health programming aimed at adding years to lives, and life to years; and (2) it works to dissuade people from drinking quite so much soda.

Connecticut is not inventing this wheel. Several cities in California; Boulder, Colorado; Philadelphia, Pennsylvania; and other countries have instituted soda taxes. Revenue goes up, and soda consumption goes down every time. There are lots of ways to spin the data, or climb a tree to pick a nit off a leaf while overlooking the forest, but that really is the gist: where soda taxes are passed, revenue is garnered, and soda consumption declines.

3) Two Argument Against the Two Main Arguments Against

Those opposed to a soda tax always raise two main arguments, as they did in response to my testimony today. The first, and I think lesser, because it is falsifiable with data, is that soda taxes hurt business. The second is that soda taxes are regressive, i.e., impose the greatest burden on those least able to pay. I gave what I consider to be the very robust rebuttals to both today.

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As noted, Connecticut is not inventing this concept; it’s been done. And overall, the evidence makes clear that business do not suffer. It’s not as if people stop getting thirsty, drinking, or shopping because of an excise tax on soda. If the tax doesn’t deter them, they keep buying soda anyway, paying just a bit more if the manufacturers pass along the costs. If the cost does deter them…they drink something else. There is no evidence of anyone, anywhere, ever suffering thirst as a result of a soda tax. Really.

When people drink something else, they often buy the “something else”- teas, waters, seltzers, and so on- from the same companies selling the soda. One of the salient trends in the beverage industry is merger and acquisition because smart people run big companies, and they can read the writing on the wall. As soda rightly acquires its reputation as heir to the ills of tobacco, more and more informed people are saying: “no, thanks.” Big beverage companies would much prefer selling them something they do want to drink, than losing their business. So they have long been acquiring companies that make and sell better alternatives. As just one example: while it operates rather independently, Honest Tea is owned by Coca Cola. There’s a lot of that going around.

Let’s leave it there: soda taxes don’t hurt business.

Nor, in my view, are they regressive- because they are much less regressive than obesity and diabetes and all the other epidemiologic mayhem that disproportionately assaults disadvantaged communities. This has been the focus of my lab, the Yale-Griffin Prevention Research Center, these past 20 years: health disparities here in CT. I know this space very intimately, and it’s a fact that fast food, junk food, and soda are marketed and sold preferentially in communities of lesser economic means. It’s a fact of epidemiology that the modern plagues of obesity and diabetes preferentially target these same communities. The costs of these conditions, in both dollar and human terms, are monumentally greater than the pennies involved in the proposed tax. To whatever degree a soda tax helps to right these wrongs, it is the very opposite of regressive; it is anti-regressive. It helps to level a very tilted playing field.

4) Of Taxes, Carrots, and Stick

Finally, some comments I had no time to make at the Capitol today. For starters, I don’t like taxes. I pay them like everybody else (well, almost everybody else, apparently…)- and they are no fun at all. When used to “nudge” behavior, they are stick, not carrot.

The things we say about carrots and sticks all come to us from the world of horses. Horses love carrots, and the idea is that you can cajole them into many of the things you might want them to do (famously, drinking not included) with the offer of that orange, crunchy treat. Horses, understandably, don’t like being whacked with a stick (riding crop), but that rebuke can, as well, dissuade them from untoward behavior, or compel a preferred alternative. So, in general, we speak of carrots and sticks as alternative means of nudging horses toward some desired behavior. We use the same expression, metaphorically, when referring to ourselves.

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As a health promotion expert who has spent years studying behavior change methods, this is of general and professional interest to me. But it is of rather more intimate interest to me, too, because I have a horse. Troubadour and I have at this point spent countless hours, many in the company of others, but most of them alone together riding the fields and forests of Bridgewater (a gem in Connecticut’s rural crown). Troubadour is my horse - my mighty friend - and I love him.

Accordingly, I much prefer carrots to sticks, as does he, and our relationship is very much oriented that way. We talk about carrots quite a bit (well, I talk, and he mostly listens- although if we allow that the various angulations of a horse’s ear constitute communication, he does reply), and he always gets a batch after a ride. We both like that.

I do, however, carry a stick- much as I rarely use it. The simple fact is, Troubadour is roughly 1300 lbs of muscle prone to spook (as all horses are, especially the smart ones) at every unexpected sound, sight, or shadow. He could quite readily kill me by accident. Good riding is the best defense, but occasionally, a smart application of the stick is the most reliable remedy.

In public health, my attitude is much the same. I prefer carrots all around. 

But food companies, including those that sell us sugary beverages none of us needs, methodically design products to be all but addictive. An excise tax is the smart application of a stick to mitigate harm. That harm is rampant obesity and diabetes in adults and children alike with which the wares of Big Soda are incontrovertibly linked.

A 1300-pound mountain of equine muscle with a relatively small brain in charge of it all can kill you, even by accident. A large company with a relatively small conscience and a voracious appetite for profit can kill you, too, albeit slower, and arguably, on purpose. The judicious application of a stick may be warranted for safety in both cases.

Dr. David L. Katz

Author, The Truth about Food. All book proceeds go to support the True Health Initiative, a federally authorized 501c3 non-profit. 

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  • Natalie Durham

    Everyone who goes across the street for their soda will go to the ballot box and still check off names that have a D next them.

  • Alison Murray

    Whenever they say tax money is going to schools (see lottery money for a good example), they just move other tax money that would have been going to schools and use it elsewhere.

  • Ross Davidson

    People who are pro taxation don't understand basic economics

  • Katie Abbott

    Great article

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David Katz

Science Guru

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.

   

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