The fizzy drink tax: can it halt the diabetes epidemic?

The International Diabetes Federation is calling for taxes on sugary drinks – with the hope of holding back the rise of type 2 diabetes.

The battle to halt the global epidemics of obesity and type 2 diabetes is entering a new chapter, as governments, health bodies and charities around the world consider new taxes on unhealthy food and drink.

In the war against obesity, some have declared sugary and carbonated drinks to be the new Public Health Enemy Number One.

Calls for new legislation to impose taxes on carbonated colas and other sugary drinks are gaining ground rapidly - something that even just a few years ago would have seemed improbable.

"Mexico has now surpassed the US as the fattest country in the OECD group"

Mexico's soda tax

Mexico has blazed a trail in public health by becoming the first ever country to introduce a tax on carbonated soft drinks - known as 'soda' in the country and in North America, the heartland of top-selling brands such as Coca-Cola and Sprite.

The tax was introduced in January 2014, adding one Mexican peso (eight US cents) per litre to the cost of drinks.

Mexico's government decided to act because of a monumental obesity problem: seven of 10 adults and one-third of children in the country are overweight or obese. Mexico has now surpassed its neighbour the US as the fattest country in the OECD group of countries.

The country's weight problem has led, inexorably, to a rapid rise in cases of Type 2 diabetes. An estimated 15 per cent of Mexicans over the age of 20 now have the condition, the highest levels of any country with more than 100 million inhabitants.

Crucially, the new soda tax is not an isolated gesture, but is part of a comprehensive National Strategy for the Prevention and Control of Overweight, Obesity and Diabetes, launched in the second half of 2013. The policy has three pillars: strengthened public health and surveillance; better medical care for people with chronic diseases; plus new regulation and taxes.

Mexico has also tightened laws on food advertising to children, labelling of processed food, availability of food in schools and taxation of unhealthy food.

Finally the government has also launched a media campaign aimed at raising public awareness of obesity and related chronic diseases.

While there is little global consensus on how best to tackle the epidemic of obesity and diabetes, there is agreement that changing attitudes to food and drink and exercise is the only way real progress can be made.

Doctors across the country are also piloting new technologies and non-economic incentives to help increase uptake and compliance to medical prescriptions for people with diabetes, high blood pressure and other related chronic diseases.

Fear of the nanny state

The rest of the world is looking to Mexico to see what kind of impact the new measures will have – both in terms of public health terms, and its popularity with voters.

In the UK, the issue is also gaining ground among public health advocates. In February 2013 the Academy of Medical Royal Colleges launched Measuring Up, a report calling for urgent action to help avert a public health disaster caused by obesity.

It had 10 key recommendations to address the growing public health problem of obesity, including:

• banning junk food advertising on TV before the 9pm watershed

• reducing the proximity of fast food outlets to schools, colleges and other places were young people gather

• a one-year trial of a 20 per cent tax on sugary drinks, to evaluate its effects

Professor Sir Neil Douglas, the chair of the Academy of Medical Royal Colleges, said: "This report does not pretend to have all the answers. But it does say we need together to do more, starting right now, before the problem becomes worse and the NHS can no longer cope."

"A 20 per cent tax could cut obesity by around 1 per cent"

So just how much of an impact can Mexico's soda tax have? The UK proposals, if introduced, would raise the cost of the drinks more significantly than the tax in Mexico. One study published in the BMJ concluded that a 20 per cent tax on sugar sweetened drinks would reduce the number of UK adults who are obese by 180,000 (1.3 per cent) and who are overweight by 285,000 (0.9 per cent).

The authors conceded that this was a modest effect, but said that people aged 16-29 years – the biggest consumers of fizzy drinks – would gain the greatest benefits.

Despite support from public health experts, most UK politicians are distancing themselves from the proposals, wary of accusations that taxes on fast food and sugary 'pop' would infringe personal freedoms and impose a 'nanny state'.

Voluntary measures not working

One influential charity, the International Diabetes Federation (IDF) is adding its voice to the calls for new taxes on sugary drinks.

Speaking earlier this week at the Westminster Health Forum's seminar on diabetes care, John Grumitt, vice president of the IDF said:

"We will be driving very hard for legislative intervention. We don't have a view that one intervention is the right thing to do, but we do think legislation is needed."

He stated that Mexico's government had been bold in pushing through its new laws despite concerted opposition from the drinks industry. Commenting on the contrasting picture in UK politics, he said: "We face an issue politically – all parties say it is about individual ownership."

He conceded that it "goes against the political grain" in UK politics to propose legislation in this area.

Andy Burnham is the man who might take over as health secretary if Labour emerge as the party with the most votes in the general election next May.

He has already indicated that his party doesn't favour a sugar tax. Instead, he is putting forward plans to regulate for maximum levels of salt, fat and sugar, particularly in children's food.

Also speaking at the Westminster Health Forum meeting, Robin Hewings, head of policy at Diabetes UK said: "It is not a policy that is ready to go for implementation", adding that it would create complications for Diabetes UK.

"There is one group of people for whom having a fizzy drink is very helpful – people with type I diabetes," he explained, referring to their use as rapid glucose supplies when type 1 sufferers have a hypoglycaemic episode.

He added, however: "We are much more relaxed about going further on junk food marketing."

Responsibility Deal

The IDF's John Grumitt stated that his organisation supported new laws because current voluntary agreements between the UK government and the soft drinks industry were not working.

The Responsibility Deal is a voluntary agreement under which a number of food and drinks companies agree to cut sugar levels in their products. However, earlier this year, it emerged that sugar content in Coca-Cola had remained the same – the company electing to meet its commitment by cutting sugar in its less popular Sprite drink instead, in order to retain Coke's popular taste.

In the absence of action to match Mexico's tough measures, the UK's health service looks set to struggle to contain the obesity and diabetes epidemics. The NHS in England is committed to changing its services from fragmented ones built around the different disciplines, to an integrated one, built around patient needs and outcomes, and this could help it make some headway against the deadly epidemic.