Sugar-Sweetened Beverages’ Low Taxes in Maryland May Be a Poison for Children and Adults

by

Other group member: Mujan Varasteh Kia

In 2015, 30% of the people in Maryland were clinically obese. Sugar-Sweetened Beverages (SSB) is strongly associated with obesity which can lead to the number one leading cause of preventative deaths (1 in 4 deaths) due to heart disease, stroke, type 2 diabetes, and certain types of cancer, and can play a role in preterm delivery.

A constructive SSB taxation policy can help to reduce many of the obesity-related health problems and alleviate the amount of money spent to treat these cases long-term. The goal is that “increasing [the tax] will discourage individuals, especially children, and teenagers, from excessive consumption of these beverages.” Currently, Maryland imposes a 6% sale tax on SSBs. No significant reduction in obesity has been recognized as a result of this taxation. It has been argued that the sales tax is too little to prevent people from reducing their bad habits which urges the need for a more substantial taxation to reduce soda consumption. In a study, they found that participants would buy fewer SSBs with 20% tax and would completely eliminate their SSB consumption if 50-100% tax was implemented.

Shortly after Mexico passed soda tax law in 2013, there was an average 12% decline in soda sales and a 4% increase in bottled water purchases. The soda industries have argued that soda taxation is not going to “change the behaviors that lead to obesity,” and that the public will find their calories elsewhere. However, in the studies they referred to the taxes were too small or they were applied in the form of sales taxes that could have gone unnoticed by the consumers.

Philadelphia was the first big city in the nation to pass a soda taxation policy in 2016. Despite the approximate $5 million advertisements against this taxation by The American Beverage Association, a non-profit campaign was created with the help of the former New York City Mayor, Michael Bloomberg to support the soda taxation law. We also urge the Maryland state legislature to support and follow the same initiatives as those of Philadelphia mayor’s 1.5-cents-per-ounce levy on SSBs. These policies may not fully eliminate the obesity crisis, but even a small reduction in soda consumption will make a difference.

thanks1

Image credit: Philly.com

 

 

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11 Responses to “Sugar-Sweetened Beverages’ Low Taxes in Maryland May Be a Poison for Children and Adults”

  1. ryandlangblog Says:

    This was an excellent post. I agree that the consumption of sugar-sweetened beverages is one of the most significant risk factors influencing the development of obesity. In my internal medicine practice, I counsel dozens of patients who are obese, and the conversation usually includes an assessment of their drinking patterns. Many of these patients are regular soda drinkers, usually in excess of what is considered a healthy practice.

    I strongly support legislation that introduces taxes on sugar-sweetened beverages as this is one of the most effective ways to limit consumption of these drinks. In Baltimore, there are many individuals and organizations that also support this legislation as well. City Heath a Commissioner Dr. Leana Wen is a prime example as she commended Philadelphia health officials after passing their own soda tax legislation (http://health.baltimorecity.gov/news/press-releases/2016-06-16-baltimore-city-health-commissioner-commends-philadelphia-city-council), and she could provide expert testimony to state elected officials on this issue of obesity related to sugary drink consumption. Sugar Free Kids Maryland is another strong supporter of healthy vending options for children and would likely be a great ally in this push as well (http://baltimore.cbslocal.com/2017/01/26/cdc-report-shows-children-drinking-too-many-sugary-drinks/). If I would do anything differently than what is suggested in this post, I would advocate for this tax being introduced first in Baltimore and then, if successful, petition the state to consider this tax.

  2. marysmithsbf Says:

    Thank you for this post. I, like you, was interested in the problem of SSB related obesity, but did not consider a legislative sales tax solution, which I think is a very interesting proposition. I completely agree with your assessment and studies that showed that a 20%, 50%, or 100% sales tax would drastically decrease SSB consumption, I am only dubious of the feasibility of passing such legislation, and would the opposition prove too much to surmount? For example, I know that the president of Maryland Retailers Association, Cailey Tolle, vehemently opposes SSB legislation, stating that it puts undue burden on business owners and would make it harder to conduct business (1). Also, Ellen Valentino, the executive vice president of the Maryland-Delaware-DC Beverage Association, voiced the association’s concern in the press that the city’s already struggling to retain businesses and grocery stores in the area, and a taxation would unfairly further hamper retailers (1). Although, in theory, a taxation bill which would increase the existing sales tax would be extremely helpful in combating the city’s obesity epidemic, I fear it with such heavily funded opposition, it would be very difficult to get passed.
    While of speaking of heavily funded opposition, another interesting option would be to targeting the marketing and advertisement of sugar sweetened beverages. Beverage companies spend billions of dollars marketing sugar sweetened beverages, with a large portion targeted at children and teenagers 2-17 years old (2). In addition, Studies have shown that beverage companies disproportionately market to low-income communities that are already disproportionately affected by health disparities (3). Although, the beverage industry is a multi-billion dollar industry that would be difficult opposition, a top-down targeting approach starting directly with advertisement could be very effective if accomplished.

    1. http://www.wbaltv.com/article/bill-would-require-warning-for-sugar-sweetened-beverages/7098189
    2. https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-drinks/
    3. http://health.baltimorecity.gov/baltimore-statement-dangers-sugar-sweetened-beverages

  3. bulumkofutshane Says:

    Thank you for this excellent post.I really enjoyed it and find it informative, it raised my interest in the topic. South Africa is busy drafting a policy to regulate sugar-sweetened beverages and from this fiscal year treasury has introduced what we call “sugar-tax”. There has been a lot of resistance from the industry but I was quite amazed about the resistance coming from several political parties. This made me to research more about the topic and also try to understand which interests these group are protecting. I think South Africa can learn a lesson or two from countries and states that have implemented this policy and the possible challenges we might be faced with.

  4. shawngul Says:

    Great post! This is a very controversial topic, but I enjoyed your blog post and I agree with your argument. As you mentioned, SSBs have been shown to worsen many health outcomes, and thus place a public health burden. In order to deter the behavior and generate government revenue that can be used for health care costs, a tax is certainly warranted. If Philadelphia’s tax has demonstrated a greater efficacy in deterring SSB consumption, it seems like a great idea for Maryland to look into implementing something similar.

    I know this was our first blog post, so it was difficult to know this ahead of time, but it is difficult to read the text in the graphic you included alongside your post. I’m not sure, but it could also be my computer that’s not allowing me to click the image.

    In any case, great job again! You argued your perspective very well and I agree with your plan!

  5. csalmero Says:

    Wonderful and very timely post, as the latest health affairs publication features a study that reports the success and potential long-term sustainability of Mexico’s SSB tax. (http://content.healthaffairs.org/content/36/3/564) The study found that not only did purchases of taxed beverages decrease by 5.5% in the first year, but they continued to decrease even more ~9% in 2015. Furthermore, they have data suggesting that the lowest SES level households stand to benefit the most from such taxes as they showed the largest decreases in purchases of SSB in the two year study. In cities like Baltimore that have a large population suffering from diabetes and other obesity caused illness primarily, amongst low SES populations, these types of policy changes and monetary incentives or disincentives may be the most effective route. Along with promotion of healthier alternatives the SSB tax is poised to really make a difference. I completely agree that it’s time that Maryland get on board with SSB tax legislation and make plans to use the generated funds to reinvest into the much needed health promotion programs within the state.

  6. xiyuwangblog Says:

    Thanks for bringing in this interesting post! I also firmly support the idea that Maryland increase sugar-sweetened beverage taxes to reduce consumption and maintain government earnings. Changing consumer behavior through introducing taxes on goods sold has proven to be effective in tobacco control (http://www.medicalnewstoday.com/releases/137936.php) and alcohol consumption (https://www.ncbi.nlm.nih.gov/pubmed/19149811). Moreover, this post reminds me of my RA work at the JHSPH Injury Research Unit, which has been making efforts to ensure that academic institutions and NGOs not to receive funding from the alcohol industry. In fact, multiple studies have shown that the alcohol, tobacco and sugar-sweetened beverage industries who often use channels like sponsoring events and monetary donations to non-profits as an indirect way of advertising their products. Unlike tobacco and alcohol whose negative impact on population health can be fatal, immediate and obvious (lung cancer, stomach cancer, road traffic crashes, severe mental disorder, etc.), the negative impact on health from sugar-sweetened beverage takes much longer time to see, so it would be harder for public health professionals and policy makers to implement stringent rules like high tax and limited (or banned) direct advertisement towards consumers.

  7. drrakshagupta Says:

    Thanks for this blog post and raising a key issue in the public health world. Sugar consumption in the form of SSB has been in the notice for quite some time and I have come across many emerging policies and backlashes regarding this. Although I agree that consumption of sugar products is alone of the major causes of early onset obesity and diabetes, and raising taxes might solve some aspects of this issue. But I strongly advocate that raising taxes along with stringent ban or limit in the sale of these products in regions where they are readily available to kids might help more. I have observed in the grocery stores and recreational parks, that the most popular aisle or most frequently taken paths have big hoardings or sections of SSB. That makes them so visibly available and also in the aisle during wait times many kids and also adults just buy them because they just can’t abstain from the sudden urge for sugar load. These tactics are exploited by SSB companies and there should be stringent steps taken in this issue.
    Also I think, health is not something you can give or offer to someone, so there is a need to provide healthy options and safe walking pavements so that it is easy to acquire these habits.
    Rest I loved reading the post.

  8. tamiloreareola Says:

    Very interesting post. I noted you mentioning how the existing 6% tax has not decreasing SSB consumption. This might have to do with varying price elasticities with different tax percentages. The lack of past success might suggest a need for evidence-based decisions that consider price elasticities.

  9. zcatanz Says:

    I agree that the negative health consequences associated with excess sugar consumption- and therefore products like SSBs- are major contemporary health concerns. However, I disagree with the method of increasing taxation, and thereby cost, in order to achieve this end. The reason I disagree with this method, sometimes called a “sin tax,” is not because it is ineffective. There appears to be sufficient evidence from the tobacco industry that such increased taxation can result in decreases in consumption (although there may be some harmful displacement, such as people switching from premium pre-rolled cigarettes to cheaper filter-less “loose” tobacco).
    The primary reason I disagree with the “sin tax” method is that it violates human rights by disproportionately affecting the poor. Some may regard this as providing greater benefit for the poor, arguing that the poor are more strongly affected by the tax and therefore tend to show the greatest decrease in consumption (naturally). However, this disregards a number of factors. First, the poor are not necessarily willful participants and are, essentially, being coerced. Second, although increased cost may be associated with decreased consumption, this may not result in a decrease in expenditure but rather simply having fewer goods.

    In addition, it would seem the case of sugar is quite distinct from tobacco. First, sugar is a basic commodity and certain sugars and certain amounts of these sugars are essential for health, unlike tobacco. Second, the sugar industry is much less easily regulated. Does an increased tax on SSBs also come with an increased tax on sugar generally? This is a slippery slope especially when we considered sugary drinks that are sold dry and how easily sugar can be added to a beverage. Moreover, while it may be true that SSBs are primary drivers of the negative consequences of excess sugar, a great many products include what many professionals might consider excess sugar. Do we stop at sugar? Saturated fat is also a major cause of obesity, heart disease, and other negative health consequences. What about a fat tax? Applying reductio ad absurdum, we find this logic leads us to a place where only the rich can afford options while the poor must meet strict dietary standards.

    Ultimately, this is a punitive capitalist approach that, were it the only effective solution, might be appropriate. However, this is not only not the only option but I believe that a seemingly minor, yet all important, twist in the logic can be applied that steers policy in a better direction. Rather than increasing the cost of the “bad” through a punishment approach, why not consider decreasing the cost of the “good” through a reward approach? If economic attractiveness is believed to be the mechanism of change then it would seem we could be equally effective by making healthier options more affordable. Although funding methods may have to be more creative, tax incentives that redistribute from the wealthy to poor would be capable of both addressing the primary issue- negative health outcomes associated with poor diets- while simultaneously generating greater equity rather than lesser.

  10. Emad Rajih Says:

    Thanks! Great Post! I like the topic and the way of policies from the different area in the state. I think applying tax only will be an easy decision and easy to implement. But working in different other adjunctive legislations alongside the tax payment could help the consumption rate. And this is not easy to sort how it is important and what is the degree to intervene because it has some elements of controversial. These policies even may not fully eliminate the risk, but even a small reduction in soda consumption will make a difference over long term. So, working in soda with other risk factors for obesity could contribute to dramatic results like other lifestyle and education dripline. As you mentioned, public will try to compensate their caloric intake from another source. And this will complicate the solution. And it is so difficult to act on the other polices other than tax. In my opinion, polices should be adjusted according the behavioral aspect of the community. For that reason, we saw different results from different states.

  11. Gary Adkins Says:

    If taxation is the method that is going to be implemented to reduce consumption and generate revenue, there must be at least some portion of it dictated at federal law in order to avoid disproportionately harming businesses in specific geographic areas.

    Those who want to propose such taxation on Baltimore specifically as a city need only look at what Philadelphia has accomplished. They have caused a number of job losses in both the retail sales and beverage distribution industries. Those who live in the city and are able to travel outside the city to purchase their beverages. The tax has brought in even less than it was forecasted to. The Mayor plainly came out and said the tax was not to effect changes in behavior or health. The primary goal was taxation. To raise money to fund all day kindergarten for the most part.

    To bring health into the discussion on this blog is disingenuous if you want to hold up the Philadelphia model as an argument for your suggestion of a similar tax in Baltimore (or more broadly,Maryland).

    Also, there are many types of foods and drinks that contain sugars, both naturally occurring and added. Juices such as apple and orange are loaded with natural sugars, yet you lose many of the benefits of whole fruit, and you are likely to consume much more juice in a serving than you would if you were instead eating the whole fruit.

    If there is to be a “sugar tax” it needs to be equally levied across all foods and drinks containing what would be seen as an unacceptable level of sugar. You would also have to factor in artificial sweeteners (and perhaps natural ones such as stevia) to not enable companies to avoid the tax by reformulating their products to contain less or no sugar.

    There is also the long-held argument that as a society we have become much more sedentary, which is having a more significant impact on obesity than our diets. We are not working farm or other manual labor jobs, kids are not playing outside as much (due to violent streets, video games, the Internet or other reasons) and exercise and physical education in schools has greatly decreased. Soda consumption has been on the decline for quite some time. As of 2015, overall sales have fallen for twelve straight years, and per capita consumption was the same as it was 30 years prior, in 1985.
    But why have we not seen similar improvements in health?

    There has been an overall effort in the food and beverage industries to reduce/remove sugar and it’s more negatively perceived counterpart, high fructose corn syrup along with removing artificial flavors, artificial colors and other unwanted ingredients.

    But I don’t think we can reformulate or legislate ourselves out of the obesity epidemic. It is going to take major changes at all levels where our governments and communities interact with our health care. We need a committed focus on this as a health crisis. We need real education not influenced by the distortions of the sugar and anti-sugar lobbies. It needs to be real education derived from real research not funded or influenced by anyone who a business “dog in the fight.”

    We need a strong commitment from our school system and partners such as the YMCA and Boys and Girls Club to bring a renewed focus to exercise. Real exercise without “sports drinks,” fancy machines or corporate sponsors (primarily those who can bring unwanted influence).

    We need real, honest, unified communication from all types of health care. We need a team approach. Not doctors/specialists working independent of one another and treating specific diseases or illnesses, but instead coming together to treat the person as a whole being. We need to include behavioral health and dietary health included in this discussion.

    We need properly funded campaigns from our government encouraging us to talk to our doctors, to take better care of ourselves, to learn what to eat and drink to be healthy, and what can be enjoyed “in moderation.” To set up websites linking us with access to exercise instruction if we can’t afford or don’t have access to the instruction in other methods. To provide access to telemedicine so we can still attend a doctor’s appointment, just out of our homes.

    All in all, there is really a lot of work that needs to be done to attack and defeat obesity. Slapping a tax on sodas and calling it a victory rings very hollow with me. Especially if you are modeling it after Philadelphia’s tax.

    We are going to need to educate a lot of people, hopefully with open minds. People will have to make a lot of changes, including ones that often have strong physiological and psychological attachments that must be undone.

    We need buy-in and cooperation from school systems and individual schools. We need buy in from non profits who work with schools or with certain populations in schools. We need buy in from local and state governments who be either accepting grant money from the federal government or using their own money to fund programs.

    Most of all we need buy in from the parents and the kids and their larger families (or “adopt” people into your family). The family will have to set time aside to want to spend time together having fun while losing weight, learning new eating and drinking choices,and supporting each other when difficulties arise and celebrating all the small successes which lead to even bigger successes.

    A grand proposition? Yes. But not unachievable. But we need everyone involved who wants to be involved and who is in it for the long haul. We won’t see overnight success, but there will successes that should be celebrated, not diminished.

    And that we must hold food and beverage producers to a higher standard, to produce foods and drinks that are better for us without loading us up with sugar or artificial sugar. The FDA is now beginning to require that he nutrition box on every food/drink have an added sugar line.

    Food and Beverage companies aren’t sitting on their laurels. They have been developing foods and drinks that are healthier than what we have now. Small start up companies, where a lot of the real research and innovation goes on, are developing new products all the time. The big companies see them grow quickly in sales and reach, and they make steps to acquire these companies and for the most part, leave their current structure intact, but use their own business power and production facilities to be able to produce even more than the small companies could have, and to bring these revolutionary new items to the hands of as many people as they can. One thing that I would point to as an example of this would be kombucha.

    Thanks for your time and I hope you found what I read to be motivational and inspiring.

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