Soda Taxes Take Off Across the Country
From Philadelphia, PA, to Berkeley, CA, cities across the country have begun imposing taxes on sugary beverages to curb their consumption and to raise funds. Early data suggest that the approach works and may have health benefits; however, the tactic has faced strong opposition in many cities.
In November 2014, Berkeley became the first city in the country to pass a tax on sugary drinks. Previously, numerous municipalities and even the state of California had unsuccessfully tried for years to impose so-called soda taxes to reduce obesity and related health concerns. In 2016, Philadelphia became the next city to successfully pass such a tax, although the city took a decidedly less health-centric approach. Since then, several other local governments across the country have followed suit, including San Francisco, CA; Oakland, CA; Boulder, CO; Albany, CA; and Cook County, IL, which is home to Chicago and some of its suburbs.
The American Heart Association supports strategies to help reduce the consumption of sugar-sweetened beverages to reduce obesity, including research on the effect of soda taxes on consumption (http://bit.ly/1UkntYA). So far, the data have been promising, suggesting reductions in sugary beverage consumption of 8% to 22% in Berkeley. But a legal challenge against Philadelphia’s law backed by the beverage industry and opposition in many cities linger. Still, proponents say the momentum has begun to shift in favor of this approach, which they say leverages lessons learned from laws aimed at curbing smoking.
“The only way to change behavior is to hit people’s pocketbook,” said Kristine Madsen, MD, MPH, a pediatrician and associate professor at the Berkeley School of Public Health.
Taking the Lead
Berkeley was among the first to embrace a soda tax. But Madsen said the effort could not have been successful without the groundwork laid by previous attempts to pass soda tax laws, which raised public awareness about the potential health effects of sugar-laden drinks.
“It pushed the soda industry to change their language,” Madsen said. She noted that even soda makers have begun promoting moderation and offering smaller portion sizes.
Madsen and her colleagues were surprised to find a 21% reduction in consumption of sugar-sweetened beverages in low-income Berkeley neighborhoods 4 months after the implementation of the law. A potential limitation of the study, which was published in the American Journal of Public Health, was that it relied on self-reported consumption of sugary beverages, she noted. Another study published in PLoS Medicine by Oakland Public Health Institute’s Lynn Silver, MD, MPH, and colleagues analyzed beverage sales at 2 large grocery chains in the Berkeley area and found a 9% reduction in sales to low-income households. The study also found a 15.6% increase in water sales, a 0.63% increase in plain milk sales, and a 4.37% increase in sales of untaxed fruit, vegetable, and tea drinks.
It is too soon to know if comparable reductions in sugary drink consumption are occurring in Philadelphia. But simulation by Harvard’s T.H. Chan School of Public Health before enactment suggested that the tax could help 36 000 people avoid becoming obese each year. This, in turn, could reduce the incidence of diabetes mellitus by >2200 cases a year and save 730 lives over the course of a decade.
But Brian Galle, JD, a professor at Georgetown University in Washington, DC, cautioned that it is too soon to judge how successful the policies will be. He noted that it would be important to monitor whether individuals shift their behavior to other unhealthy habits.
“It’s a promising direction,” Galle said. “We don’t yet know the full effect.”
A Tale of 2 Cities
Berkeley’s and Philadelphia’s paths to victory on the soda tax were very different.
In Berkeley, the soda tax was explicitly promoted as a way to boost the community’s health and to provide revenue for nutrition education.
“It was a real grassroots effort,” Madsen said. “It was all about trying to promote the health of children.”
But Philadelphia tried and failed twice to pass a soda tax based on its public health merits. So, when a new mayor took the reins, the proposed tax was instead promoted as a way to raise revenue to fund universal preschool education and upgrades to the city’s recreational facilities, explained Jonathan Purtle, DrPH, MSc, an assistant professor at Drexel University’s Dornsife School of Public Health in Philadelphia. Purtle and his colleagues published an analysis of the effort in Journal of Public Health Management and Practice.
The health argument flopped in Philadelphia because people viewed it as “the nanny state telling you what you should and shouldn’t do,” Purtle explained. But framing the tax as a way to fund early education garnered more broad support. He suggested that other municipalities might want to consider a similar approach that emphasized economic benefits or how the funds will be used to support community programs.
“Consider emphasizing how the money from the tax is going to be used,” Purtle said. “It seems people are more supportive if the tax dollars are going to a very specific thing with broad public support.”
Philadelphia also has faced legal challenges to its soda tax from the beverage industry and local businesses. An attempt by New York City to ban large soda sizes was blocked by a state judge.
One criticism that has been levied against soda taxes in many cities is that they disproportionately burden the poor. But Madsen argued that the beverage industry spends millions a year on advertising. In addition, studies have found that ads for high-calorie foods are often disproportionately targeted at lower-income, minority communities.
“To act as if government intervention is draconian doesn’t take into account what’s happening on the other side,” she said. “There are a lot of efforts to sway people’s choices the other way.”
Galle also noted that the effect of the taxes on low-income communities depends on how the tax proceeds are used. If they are reinvested in low-income communities, there may be a net benefit. He also noted that other approaches that reward healthy behaviors such as subsidizing healthier options might be considered more progressive.
Ultimately, it will likely take a more comprehensive approach to reduce excess sugar consumption in throughout the US diet, Galle noted. For example, curbs on tobacco advertising worked in concert with higher taxes on tobacco products and smoking bans in many public places.
“We don’t know what will be successful, so we should try more than one approach,” Galle said.
Circulation is available at http://circ.ahajournals.org.
- © 2017 American Heart Association, Inc.