health & science

Sugar tax: unfair or the only way forward?

One leading public health expert says a sugar tax would quickly become as normal as wearing seatbelts, but his University of Auckland colleague is arguing taxation would just increase inequity. Teuila Fuatai reports.

The debate over whether a sugar tax would effectively combat New Zealand’s obesity problem is back in the spotlight, and two University of Auckland professors squared-off over its merits at a public lecture this week.

Politics and international relations professor Martin Wilkinson, who is in the final stages of completing a research paper on the topic, argued it was wrong to use “better health outcomes” as justification for “preventive regulation” like taxes on soft drinks at his on-campus lecture on Thursday.

“The intent of all these things is to try and make it harder to consume obesogenic food and drink,” he said.

“The thought goes that if we have policies that raise the price of these obesogenic items, in particular, it’s the people who are relatively poor who are going to change their behaviour and they will therefore be either thinner or less fat than they would otherwise be.”

Wilkinson, who has a special interest in public health ethics, said while that may be the case, it did not automatically result in people being better-off.

Only individuals are able to say, and determine, whether they are better-off, he argued. It is a personal choice, and “it’s not enough just to say that you make people healthier - you’ve got to show that health is, all things considered, worth the cost to them”.

Professor Martin Wilkinson is dubious around health equity arguments supporting a tax on unhealthy foods. Photo credit: Teuila Fuatai. 

Sitting in the audience was leading public health expert Professor Boyd Swinburn.

Swinburn, whose focus is on childhood and adolescent obesity, believed Wilkinson had taken a “fairly narrow view” of the problem. The health gains that would result from a tax on unhealthy food and drink through its decreased consumption (particularly in poorer communities which are over represented in obesity and obesity-related disease statistics) proved that people would be better-off, he said.

“People value their health. They don’t particularly want to die, they don’t want to get diabetes and they don’t want to lose a leg from something like diabetes - they want to be healthy.”

“If your reducing of health equity makes the worst-off 'worse-off' than they’d otherwise be, than there’s something wrong with your view of equity."

While Wilkinson agreed, he reiterated that reasoning was insufficient to base a tax policy on. He also said that by making unhealthy food and drink more expensive, it also reduced the overall choices of those who were less well-off, and instead increased inequity along socio-economic lines.

“It’s not really surprising that people without much money or time eat processed food that makes them fat," he said. "You go to the greengrocers then you can see that broccoli this week is about $5. You can’t have a meal out of broccoli, and you have to cook the damn thing as well. So you have to have time, and have more ingredients,” he said.

“For the same amount you could go to a takeaway and get a burger, which would fill you up.”

“If your reducing of health equity makes the worst-off 'worse-off' than they’d otherwise be, than there’s something wrong with your view of equity."

Swinburn, who has more than 25 years experience in public health, pointed out Wilkinson’s argument failed to take into account the gravity and reality of the situation.

“[In terms of how] public health progressed over centuries - quite a lot of it has been taking away choice," he said. "You don’t have a choice when you have a car about what speed you can go and whether you put a seatbelt on - that’s actually law that dictates your behaviour,” Swinburn said.

“Judgments” that determined what was better for a person’s quality of life were made all the time in public health.

“Most of the gains have come about with sets of rules that actually have a direct effect on our behaviour,” Swinburn said of his field.

“There is no single policy that I can think of - apart from maybe banning particular foods in schools - that says you must eat this or you must not have that, or you must go for a walk or you must not.

“[Furthermore], in the obesity space, policies and regulations cannot directly influence behaviour like laws on seatbelts,” he said. “They can only indirectly do it by influencing the environment - so the policies and laws are actually relatively weak in obesity, and relatively less restricting of choice, than they are in many other places where we have implemented public health things which are now just part of life.”

Swinburn then asked his colleague what he would do if he was Minister of Health.

“Provide more money for the worst-off,” Wilkinson said.

“I’d rather just give them money - because then they could just buy what they want,” he said to a much-amused room.

Swinburn smiled in response, and remarked about his potential popularity as an MP.

“What I’ve always done is always buy the easiest and buy the cheapest, and the tastiest," Swinburn said of people's general consumer choices. 

“If that environment changes and I keep buying the easiest, and the cheapest and the tastiest, then I end up with a changing diet because the environment changes."

Raising the price of sugary food and drink through a tax, as has been done in Mexico, would make it harder to access in poorer communities, reduce its consumption, and increase overall health outcomes, he said. 

Currently, the Government appears to be steering away from a possible sugar tax, relying instead on food and drink manufacturers to voluntarily reduce the sugar content of their products. If that does not work, Health Minister David Clark has said regulatory change is possible. 

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Read more: Cut sugar content or we’ll regulate

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