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Right: Rearguard action; shoppers in an American supermarket are targeted by anti-sugar tax literature and point-of-sale advertising.

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Arguments in favour of a sugary drink tax

1. Excessive sugar consumption harms health
Those who support a sugary drink tax do so because excessive sugar consumption is associated with major ill health. Sugar consumption promotes obesity, diabetes, cardio-vascular disease, and tooth decay. These sugar-related health issues affect Australian children and adults.

Excessive unhealthy food and sugar-sweetened soft drink consumption has been linked to weight gain. In 2010, the World Health Organisation commissioned a literature review to clarify the effects of sugars on excess weight. The review analysed the findings of 110 published studies. It found that sugar intake is a major determinant of body weight. The high calorie concentration found in sugars make them an easy source of excess energy. Laboratory studies have also found that diets high in sugar, high in fat, or both trigger changes in gut bacteria that contribute to obesity. In addition, the review found that a positive correlation between sugar consumption and obesity is only apparent when sugar is overconsumed. Therefore, it did not recommend that sugars be removed from the diet. It concluded they should be consumed at safe levels. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959843/

The link between excess sugar consumption and overweight is concerning because overweight and obesity is linked to many diseases. Overweight and obesity is the second leading risk factor contributing to ill health and death in Australia. Overweight and obesity is linked to 30 diseases, including 17 types of cancers, four cardiovascular diseases, three musculoskeletal conditions, type 2 diabetes, dementia, asthma, and chronic kidney disease. https://www.aihw.gov.au/reports/overweight-obesity/overweight-and-obesity/contents/overweight-and-obesity 2018 data shows that 67 percent of Australians are overweight or obese. Health authorities are concerned that Australian children are also affected by overweight and obesity. In 2017-18, one in four (25 percent) Australian children and adolescents aged 2-17 was overweight or obese. According to results from the Longitudinal Study of Australian Children, the prevalence of overweight and obesity generally increases with age. By the age of 16-17 nearly a third (31 percent) of Australian adolescents were overweight or obese. https://www.aihw.gov.au/reports/overweight-obesity/overweight-and-obesity/contents/overweight-and-obesityhttps://www.aihw.gov.au/reports/overweight-obesity/overweight-obesity-australian-children-adolescents/summary

Increased weight is a contributory factor in developing diabetes and sugar plays a direct part in this causal link. Too much sugar in the diet leads to insulin resistance, inflammation, and weight gain. These are all major risk factors for Type 2 diabetes. https://redcliffelabs.com/myhealth/diabetes/sugar-consumption-and-diabetes-unraveling-the-sweet-connection/ In 2021, one in 20 Australians had diabetes and the incidence of the disease is increasing. In 2021 5,400 Australians died directly because of diabetes, while diabetes contributed to the deaths of another 19,300. Currently, 11 percent of all deaths in Australia are associated with diabetes. https://redcliffelabs.com/myhealth/diabetes/sugar-consumption-and-diabetes-unraveling-the-sweet-connection/https://www.aihw.gov.au/reports/diabetes/diabetes/contents/summary Clinicians have only recently begun to track cases of Type 2 diabetes (a condition traditionally only seen in midlife) in children and those under 24 and have discovered an alarmingly high incidence. In Darwin, childhood presentations of Type 2 diabetes have increased 20-fold in the last ten years, with children as young as four diagnosed. http://tinyurl.com/326t47p6

Similarly, excess weight contributes to cardiac disease and strokes. Recent studies have found that weight gained from sugar consumption elevates the risk of heart disease and stroke more than weight acquired from other food sources. The people with the highest risk of heart disease or stroke consumed about 95 grams of free sugar per day, or 18 percent of their daily energy intake. https://www.nbcnews.com/health/heart-health/high-sugar-intake-risk-heart-disease-stroke-study-rcna70406 The maximum recommended sugar level in Australia is less than 10 percent of daily energy intake. https://www.nbcnews.com/health/heart-health/high-sugar-intake-risk-heart-disease-stroke-study-rcna70406https://www.healthdirect.gov.au/sugar#:~:text=Adults%20and%20children%20should%20reduce,per%20day%20for%20an%20adult.

Finally, sugar consumption is linked to tooth decay. The World Health Organisation has noted that sugars are the essential dietary factor causing dental caries (tooth decay). Dental caries develops when bacteria in the mouth metabolize sugars to produce acid that demineralizes the hard tissues of the teeth (enamel and dentine). The acid ultimately wears away the hard outer surface of the tooth. http://tinyurl.com/4r3jzf2n The Australian Dental Association has stated, 'Tooth decay is Australia's most common chronic illness and is largely preventable. Diet is the most prevalent factor in the cause of tooth decay, with sugary foods and drinks the largest risk factor.' https://www.teeth.org.au/tooth-decay#:~:text=Summary,drinks%20the%20largest%20risk%20factor. More than one third (34.3 percent) of Australian children have experienced tooth decay in their primary (baby) teeth by as early as age 5 to 6. http://tinyurl.com/4r3jzf2nhttp://tinyurl.com/y6zr8pck

2. Australians consume huge quantities of sugary drinks
The average Australian consumes large quantities of sugary drinks on a regular basis. Advocates for a sugary drink tax want to change this dietary habit. They are especially concerned that sugary drink consumption is highest among young people and that the high glucose content of the sugar used in Australian drinks increases the risks.

Australians consume excessive amounts of sugar by international standards. Australians, on average, consume about half a kilo of sugar each week. https://hw.qld.gov.au/blog/sickly-sweet-sugar-consumption-and-our-health/ Australian Health Survey data shows that more than half of Australians aged two years and older exceeded the World Health Organization's recommended limits on energy from free sugars in 2011-12. Free sugars are sugars added to foods by manufacturers or consumers, and those naturally present in honey, syrups, and fruit juices. Australians consume more than twice the amount of free sugar recommended by the WHO for optimal health outcomes. The average Australian's free sugar consumption per day is 14 teaspoons; the amount recommended for best health is 6 teaspoons or 5 percent of daily energy intake. https://hw.qld.gov.au/blog/sickly-sweet-sugar-consumption-and-our-health/https://www.obesityevidencehub.org.au/collections/prevention/the-case-for-a-tax-on-sweetened-sugary-drinks

Sugary drinks are a major contributor to the amount of added sugar in the Australian diet. 81 percent of Australians' free sugar consumption comes from sugary drinks and discretionary foods (snacks). https://hw.qld.gov.au/blog/sickly-sweet-sugar-consumption-and-our-health/ . In January 2023, the Australian Medical Association (AMA) revealed data showing Australians consume more than 2.4 billion litres of sugary drinks every year. The AMA's press release highlighted, 'That's enough to fill 960 Olympic sized swimming pools.' http://tinyurl.com/4bypkz9t The AMA has further warned, 'Sugar-sweetened beverages contain 8-12 teaspoons (33-50 grams) of sugar in the average 375 mL can of soft drink. This is more than the daily recommended amount of sugar in just one drink, delivering a high number of liquid calories but providing almost no nutritional benefit.' https://hw.qld.gov.au/blog/sickly-sweet-sugar-consumption-and-our-health/https://www.ama.com.au/articles/why-tax-sugary-drinks

Supporters of a sugary drink tax are concerned that these drinks are frequently consumed by children and young people. Research has shown that in 2019-20 36 percent of adults and 41 percent of children consumed sugar-sweetened beverages at least weekly, with nine percent of adults and seven percent of children consuming them daily. https://www.ama.com.au/articles/why-tax-sugary-drinks Children aged 2-17 years who are daily consumers of sugar sweetened drinks consume on average 2.4 cups per day (equivalent to 1.6 cans of soft drink or one 600mL bottle). The average intake for boys aged 2-17 who consume sugar sweetened beverages daily is higher than girls (2.8 cups per day compared with 1.6 cups). http://tinyurl.com/y2tc8b4b Sugary drink consumption is a major problem among teenage males. Research released in 2017 showed almost 17 percent of teenage boys consumed a litre of sugary soft drink a week, or 52 litres a year. https://www.ama.com.au/articles/why-tax-sugary-drinkshttps://www.cancer.org.au/media-releases/2017/1-in-6-teenage-boys-consume-at-least-52-litres-of-soft-drink-each-year Energy drinks are a high source of sugar for adolescent consumers. A 2021 national survey of just under 9,000 students aged 12 to 17 found that 24 percent consumed sugar-sweetened energy drinks at least weekly. 83 percent of the regular adolescent consumers were male. Australian Cancer Council nutrition expert Clare Hughes warned, 'Sugary drinks contribute the most added sugar to Australians' diets and the news that one in six teens consume more than 5kg of sugar each year through sugar-sweetened beverages alone is alarming.' https://www.ama.com.au/articles/why-tax-sugary-drinkshttps://www.cancer.org.au/media-releases/2017/1-in-6-teenage-boys-consume-at-least-52-litres-of-soft-drink-each-yearhttps://www.kidsnews.com.au/health/survey-finds-aussie-teens-still-drinking-too-much-sugar/news-story/1933cf11ad9731d232bfd40ce2822082

The sugar used to sweeten Australian soft drinks and other beverages is particularly dangerous. Australian sugar has a higher glucose level than sugar produced in other countries. This elevated glucose presents a greater risk for the development of diabetes and other metabolic diseases. http://tinyurl.com/y8nntme7 Australian sugar is refined from sugar cane; however, sugar in the United States comes from corn syrup and sugar in Europe is produced from beets. Research has shown that cane sugar has significantly higher glucose than the other common sugar sources. https://thewest.com.au/lifestyle/health-wellbeing/aussie-soft-drinks-found-to-have-more-sugar-than-rest-of-the-world-ng-b88498356z The result is that Australian soft drinks have a 22 percent higher total glucose concentration than United States formulations. http://tinyurl.com/y8nntme7http://tinyurl.com/y8nntme7 Professor Bronwyn Kingwell, from the Baker Heart and Diabetes Institute, has warned, 'This means blood glucose will go up higher when we consume our Australian sugary drink, and this will increase blood insulin [a risk factor in disease development].' https://thewest.com.au/lifestyle/health-wellbeing/aussie-soft-drinks-found-to-have-more-sugar-than-rest-of-the-world-ng-b88498356zhttps://thewest.com.au/lifestyle/health-wellbeing/aussie-soft-drinks-found-to-have-more-sugar-than-rest-of-the-world-ng-b88498356z

3. Sugary drink taxes reduce sugar consumption
Supporters of sugary drinks taxes stress that they succeed in reducing consumption of beverages containing excessive amounts of sugar.

Critics of sugar taxes claim that they do not reduce consumption of sugar-sweetened beverages. For example, in Britain, between 2015 and 2019 the sale of sugar-taxed beverages rose by 14.9 percent. (The tax was introduced in April 2018.) https://assets.publishing.service.gov.uk/media/60953c63e90e0735727c80be/Sugar_reduction_progress_report_2015_to_2019-1.pdf

Defenders of the taxes argue this is a misleading simplification. Though the quantity of these drinks bought by British purchasers increased, the amount of sugar consumed dropped by 34.5 percent. It appears that consumers were choosing to buy beverages with a lower sugar content that avoided the tax. The tax is graduated so that sugary drinks become more expensive as their sugar content increases. Here is no levy on soft drinks containing less than 5g of sugar per 100ml. An 18p per litre tax is charged on soft drinks containing between 5g and 8g of sugar per 100ml. While there is a 24p per litre tax on soft drinks containing more than 8g of sugar per 100ml. https://www.instituteforgovernment.org.uk/article/explainer/sugar-tax The total sugar consumed per household from taxed drinks has decreased across all socio-economic groups. The reduction is largest in households where the main wage earner is in a skilled manual occupation where the drop was 38.5 percent and then is similar across all remaining socio-economic groups (between 32.7 percent and 35.1 percent reduction). https://www.instituteforgovernment.org.uk/article/explainer/sugar-taxhttps://assets.publishing.service.gov.uk/media/60953c63e90e0735727c80be/Sugar_reduction_progress_report_2015_to_2019-1.pdf

A United States study has also noted declines in sugar consumption linked to sugar taxes. The recent study examined consumer behaviour in five American cities with sugar taxes. It found that retail prices of sugar-sweetened beverages increased by 33.1 percent over the two years following tax implementation in each city studied, and that there was a corresponding decrease in purchases of 33 percent over the same timeframe. At the same time, there was no evidence that consumers were traveling to bordering areas without sweetened beverage taxes to make purchases there. https://publichealth.berkeley.edu/news-media/research-highlights/taxes-on-sugar-sweetened-drinks-drive-decline-in-consumption/

Success in reducing sugar consumption has occurred in other countries. Mexico introduced a sugary drinks tax in 2014. The results of a survey and questionnaire comparing pre-tax sugary drink consumption with consumption up to 2018 found that after the implementation of the tax, the probability of becoming a non-consumer increased by 4.7 percent, and the probability of being a low consumer increased by 8.3 percent. In addition, the probability of being in the medium and high levels of soft drink consumption decreased by 6.8 percent for medium consumers and 6.1 percent for high consumers. These results remained consistent across the three years of the survey. https://www.bmj.com/company/newsroom/mexicos-sugary-drinks-tax-has-helped-cut-consumption-after-just-three-years/ In June 2022, the results of a literature review of 86 studies examining the effect on consumption of a sugar tax were examined. The literature review found that imposing a sugar tax resulted in a 15 percent drop in the sale of sugar sweetened beverages. The review concluded that 'consumers respond to economic interventions...[and] SSB (sugar-sweetened beverages) taxes were associated with higher prices of taxed beverages and lower sales.' https://www.bmj.com/company/newsroom/mexicos-sugary-drinks-tax-has-helped-cut-consumption-after-just-three-years/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9161017/ Unlike in Britain, this worldwide survey suggests that consumers do not simply swap to beverages with a lower sugar content, many stop consuming sugar-sweetened beverages altogether. The way the tax is imposed may affect this.

The Australian Medical Association (AMA) has examined the reduction in sugar consumption that could result from a sugary drinks tax in Australia. The Association is proposing a tax rate of 40 cents per 100g of sugar. This would increase the retail price of the average supermarket sugary drink by 20 percent. Computer projections predict that this tax would reduce sugar consumption from sugary drinks by 12 to 18 percent per year. https://www.ama.com.au/sickly-sweet/why-a-tax AMA President, Dr Omar Khorshid, has explained how the sugary drinks tax works to discourage consumption. He has stated, 'The tax on sugary drinks sends a clear price signal to consumers that a product is unhealthy and makes it less affordable.' https://www.ama.com.au/sickly-sweet/why-a-taxhttps://www.ama.com.au/media/sugar-tax-will-cut-disease-and-save-lives

The increased price is claimed to make potential consumers more aware that the drink is unhealthy. Matthew Parks, Master of Laws candidate at the University of Melbourne, has explained that these taxes have a 'signalling effect'. They make the customer aware that sugary drinks pose a health risk. He claims that this helps to influence all buyers, but especially those less effected by a price rise. https://taxpolicy.crawford.anu.edu.au/sites/default/files/uploads/taxstudies_crawford_anu_edu_au/2022-03/complete_policy_brief_1_2022_m_parkes.pdf

4. Sugary drink taxes encourage manufacturers to produce healthier products.
Some supporters of sugary drink taxes hope they will prompt drink manufacturers to redesign their product with lower sugar contents that will avoid the tax.

Campaigners for a sugar tax in Australia have suggested it will lead producers to reduce the sugar content of their drinks. The Australian Medical Association has suggested, 'You also...encourage the companies that make sugary drinks to reformulate - that is, make drinks with less or no sugar, so they can have their products avoid the tax.' https://www.ama.com.au/sickly-sweet/why-a-tax Most believe a tax is necessary to force a healthy change in soft drink products as manufacturers are reluctant to risk customer attachment to their brand by altering the taste. An industry food magazine 'What's new in food' commented on the response of British sugary drink manufacturers to the imposition of a tax. It noted, 'For two years soft drinks companies have debated whether to reformulate their products and risk jeopardising consumer loyalty or change nothing and risk pricing consumers away with tax-imposed...increases.' https://www.ama.com.au/sickly-sweet/why-a-taxhttps://www.foodprocessing.com.au/content/business-solutions/news/how-should-manufacturers-respond-to-sugar-taxes--229195109

Supporters of sugary drink taxes point to many drink companies that have changed their products after a tax was implemented. A study conducted in Britain and Ireland in 2019, after sugar taxes came into operation, found most manufacturers decided to alter what they produced. The survey examined products in 2014 and 2018. 83 of 464 products were the same in both years. However, the mean sugar content of products decreased by 42 percent. Manufacturers of the reformulated products in our study have either reduced the total sugar or reduced sugar by replacing it with non-caloric sweeteners without changing the product name. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883278/ These figures reflect British Institute for Government findings published in 2021. The total sugar sold in soft drinks by retailers and manufacturers decreased by 35.4 percent between 2015 and 2019, from 135,500 tonnes to 87,600 tonnes. Over the same period, the sales-weighted average sugar content of soft drinks declined by 43.7 percent, from 5.7g/100ml to 2.2g/100ml. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883278/https://www.instituteforgovernment.org.uk/article/explainer/sugar-tax Following the sugar tax in Britain, Coca Cola Great Britain is now using their new low-sugar formulas as part of their promotions. They claim, 'Today, 67 percent, or two-thirds, of the drinks we sell at Coca-Cola Great Britain are either low or no calorie products. We have reformulated 43 products and launched 100 new low and no-sugar drinks. This has enabled us to reduce the sugar content of our portfolio by over 52,000 tonnes, representing a 30 percent reduction in the amount of sugar we contribute to shopping baskets across Great Britain.' https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883278/https://www.instituteforgovernment.org.uk/article/explainer/sugar-taxhttps://www.coca-cola.com/gb/en/sustainability/how-coca-cola-gb-is-offering-low-sugar-alternatives-to-offer-peo

Tax supporters note there is a large international trend toward reducing the sugar content of drinks to avoid a sugar tax. Ireland-based food manufacturer Kerry have examined the impact of sugar taxes in fifty countries and noted, 'Many manufacturers are reformulating sugar sweetened beverages-which are often the primary target of sugar taxes-creating products with sugar volumes that fall below the taxation threshold. After some initial hesitation, consumers are now actively embracing low- and no-sugar products, due in part to technological advancements that deliver the full flavour and mouthfeel of sugary beverages, without the sugar content.' https://www.kerry.com/insights/kerrydigest/2018/the-state-of-sugar-and-health-taxes-around-the-world.html Kerry has commented on specific instances of products being reformulated, and observed some cases where changes have been that exceed what regulations require. Kerry notes, 'In Brazil, the food and beverage industry agreed to voluntarily reduce sugar in over 1,100 products by 2022. Some participating manufacturers have also made voluntary commitments to the reduction of sodium, suggesting that overall nutrition optimisation is an increasingly popular goal.' https://www.kerry.com/insights/kerrydigest/2018/the-state-of-sugar-and-health-taxes-around-the-world.htmlhttps://www.kerry.com/insights/kerrydigest/2018/the-state-of-sugar-and-health-taxes-around-the-world.html

5. Sugary drink taxes would improve the health of Australians, reduce pressure on health services and boost revenue for public health
Those who support a tax on sugary drinks argue that this measure would improve the health of the Australian community. They also claim it would relieve pressure on hospitals and other health services. They recommend that the tax revenue contribute to funding public health.

Advocates of a tax on sugary drinks claim that this would improve the health of the Australian population. Australian Medical Association deputy president, Danielle McMullen, has quoted the health benefits the Association believes a tax of 40 cents per 100gm of added sugar would produce. Dr McMullen stated, 'Over a 25-year period, we estimate this would result in 16,000 fewer cases of type 2 diabetes, 4400 fewer cases of heart disease and 1100 fewer cases of stroke.' https://www.theaustralian.com.au/nation/politics/doctors-step-up-calls-for-tax-on-fizzy-drinks/news-story/7936d9d434e4ffd326230459ea3ff228

There are similar estimates of public health gains from overseas studies. Researchers in public health in Oakland, California, have calculated the likely health benefits from the 27 percent drop in sugar-sweetened beverage consumption following the imposition of a sugar tax. Using computer modeling they determined that over 10 years this change in consumption habits would add 94 years of quality health per 10,000 residents and save the city more than $100,000 per 10,000 residents in health care costs. https://publichealth.berkeley.edu/news-media/research-highlights/sugary-drink-tax-improves-health/ Similarly, Mexico's 9.7 percent drop in sweetened beverage sales (in the second year after a tax came into operation) is estimated to prevent 189,300 new cases of diabetes over 10 years. Other anticipated health gains are the prevention of 20,400 heart attacks or strokes, and 18,900 deaths among Mexican adults ages 35-94. These public health benefits were estimated to save $983 million in health-care costs. https://publichealth.berkeley.edu/news-media/research-highlights/sugary-drink-tax-improves-health/https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(17)30070-0.pdf

Direct evidence from overseas shows public health benefits that have occurred after a sugary drink tax. A 2013 literature review of nine studies examining the health impact of sugary drink taxes found a correlation between the imposition of the tax and a reduction in obesity in the taxed populations. Six of the studies were in the United States and one was from each of Mexico, Brazil, and France. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1072 Reductions in childhood obesity also occurred in Britain after the introduction of a sugar tax. The Cambridge research team found that 19 months after the sugar tax introduction, there was an 8 percent reduction in obesity levels in year 6 girls, equivalent to preventing 5,234 cases of obesity per year in this group alone. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1072https://www.ukri.org/news/sugary-drinks-tax-may-have-prevented-over-5000-cases-of-obesity/

Supporters of a tax on sugary drinks also argue that the revenue raised should go to the health budget to help prevent obesity. In January 2023, the Australian Medical Association claimed that the federal government could collect $814m annually by taxing sugared drinks at 40c per 100 grams of added sugar. http://tinyurl.com/6c6a6pmj In its pre-budget submission to the government, the AMA outlined a use for the revenue that would be attractive to the public. It stated, 'Australian surveys have consistently shown majority support for a tax on SSBs (sugar-sweetened beverages). Public support is even higher if tax revenue is [to be used] to fund initiatives to tackle obesity. A nationally representative survey undertaken in 2017 found 60 percent of Australians support a tax on sugary drinks. This increased to 77 percent support if the proceeds were used to fund obesity prevention.' http://tinyurl.com/6c6a6pmjhttp://tinyurl.com/363et9ks

Other countries have directed the revenue from a sugar tax toward different targets with a high public value. In 2017, the Seattle City Council, Washington State, passed a law taxing sweetened beverages. Local community advocates negotiated that tax revenue go to expand food and nutrition security and early childhood programs in areas most impacted by sugary drinks, chronic diseases, and health and education inequality. By February 2023 approximately $22 million a year had gone to this community assistance. https://www.seattletimes.com/opinion/sweet-success-seattles-sugary-drink-tax-is-reducing-health-inequities/ The same pattern has occurred across the United States. In 2021 Department of Health officials analysed how sugar tax revenues were being used. They surveyed seven cities with sugar-sweetened beverage taxes, collectively raising $134 million annually. They found early childhood programs received the largest investment of tax revenues at $58 million. Community improvements (e.g., rec centers and libraries) were second largest with $21 million. $17 million went to increasing access to healthy food and beverages. 85 percent of revenues supported projects and programs in impacted communities. https://www.seattletimes.com/opinion/sweet-success-seattles-sugary-drink-tax-is-reducing-health-inequities/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141925/