'Coz I'm the tax man

I get asked a lot about whether taxing soda is effective. There has been a lot published on taxing food and beverages that are deemed bad for us. So what gives? Does taxing soda have any impact on our health? This is my take on the science, but first, let this jig run through your head….

Should five percent appear too small
Be thankful I don't take it all
'Cause I'm the taxman
Yeah, I'm the taxman

I'll tax the street
(If you try to sit, sit) I'll tax your seat
(If you get too cold, cold) I'll tax the heat
(If you take a walk, walk) I'll tax your feet

TAXMAAAAAAAN!!!

Sugar-sweetened beverages (SSBs) are nonalcoholic beverages containing added caloric sweeteners. In addition to carbonated soft drinks or sodas, SSBs include energy and sports drinks, less-than-100-percent fruit or vegetable juices, ready-to-drink teas and coffees, sweetened waters, and milk-based drinks. SSBs are widely consumed worldwide, and the retail sales of these beverages have been increasing over the last decade. Their consumption has been associated with obesity, diabetes, heart disease, and other detrimental non-communicable diseases (NCDs). Because of their unhealthy nature, the World Health Organization has included a range of policy priorities, including SSB taxes, to help countries combat NCDs and improve the overall health of the global population.

Taxes on SSBs have been introduced in 118 countries, with 105 at the national level and 13 at the subnational level, covering 51% of the world’s population. Most SSB taxes are implemented using excise taxes (88%), with a handful of other countries implementing them through mechanisms such as import taxes, differential Value-Added Tax (VAT), Goods and Services Tax (GST), or regional sales tax (see the figure below). These excise taxes occur mainly as tax pass-throughs, in which the price increase of the taxed product falls on the consumer. In the U.S., for example, 70% of SSB taxes are passed onto consumers through higher-priced SSBs.

Types of SSB taxes being implemented around the world

In a systematic review and meta-analysis of 62 empirical studies of SSB taxes across 45 countries, the majority of SSB taxes were implemented as a tax pass-through. While the impacts were heterogeneous across the countries, the demand for SSBs was sensitive to tax-induced price increases, with a mean reduction in sales of SSBs by 15%. The sales resulted in no substitution towards healthier, untaxed beverages (e.g., bottled water). Another review argued that SSB taxes provide no substantive changes to dietary or purchasing behavior due to the lack of substitution towards healthier alternatives. Another study found that while SSB taxes modestly reduced the purchases of some taxed beverages in the taxing jurisdiction, consumers respond to the taxes by increasing cross-border shopping, in which they go outside the taxing jurisdiction and buy those same taxed beverages at a lower cost. However, taxes may spur downstream effects on other industry responses and policies, including reformulating products to reduce sugar consumption in those beverages, as was seen with the graduated sugar tax implemented in the UK.

Of the tax policies around the world, 73% are implemented in low- and middle-income countries (LMICs), with the highest in South Asia. However, LMICs face many challenges in implementing SSB taxes, including a lack of political will and resources, weak national capacity to implement policies, large informal food sectors, and substantial influence of the food and drink industry on policy development.

The question remains whether SSB taxes can result in healthier dietary patterns and reduce the health implications accompanying excess consumption of these products – particularly NCDs. Most of the evidence — particularly from  Nakhimovsky et al., 2016; Niebylski et al., 2015; Teng et al., 2019; and Thow et al., 2014 — suggests that SSB taxes have impacted the purchases of taxed products to varying degrees, but not necessarily long-term and impactful behavior change towards healthier diets and improvements in health. One potential reason may be that the SSB taxes translate to only a 5 to 22-kilocalorie reduction per capita daily. This is insufficient to have a meaningful impact on disease outcomes. Some researchers suggest that one way to deal with this is to raise the current tax rates from the current approximate 5% to 20%. This would also be aligned with the WHO’s recommendation for at least a 20% tax on SSBs. Several countries, such as Qatar and Saudi Arabia, have substantive (50-100%) excise taxes on SSBs, which are more in line with the taxation rates of tobacco.

The question is whether other foods, particularly red meat, should be taxed due to their significant implications on the environment and contributions to climate change. While consuming red meat in high amounts can contribute to NCDs, red meat is also a source of important nutrients. If a tax on red meat makes them prohibitively expensive for those who already struggle to afford these foods, it could put these nutrient-dense foods even further out of reach for the world’s poor. Thus, a “carbon tax” on red meat might be appropriate in wealthy countries with strong social protective measures and in countries with disproportionately high levels of red meat consumption.

Soda, Celebrities and Sell Outs

I wrote this piece two years ago on my urwhatueat blog, but I feel it needed to be updated and resurfaced.  So here it is.

A few years ago, Mark Bittman wrote: “Why Do Stars Think It’s O.K. to Sell Soda?” This was in response to Beyonce’s TV ad selling Pepsi to the masses. I couldn’t agree more. It is maddening actually. With the current culture being so obsessed with all-things celebrity, you would think that actors, musicians, and athletes would use that position, an enormously powerful one, to make positive change in the world. I was really surprised and disappointed to see one of my favorite actors, Steve Carell (with Cardi B and others), doing a Pepsi commercial during the 2019 Super Bowl yelling that Pepsi is “okay!” But is it Steve?

One out of every 4 people are overweight or obese globally – approximately 2.1 billion people. This “globesity” pandemic touches everyone including young children and teenagers. Obesity has more than doubled in children and quadrupled in adolescents in the past 30 years and now more than one third of children and adolescents were overweight or obese.

So what does obesity have to do with soda? Well…the evidence is pretty cut and dry at this point. Some would argue, and are often “paid” to do so, that soda doesn’t make a dent as a contributor to our waistlines but that is just hogwash. Much of the deleterious effects are due to the high content of sugar in these products. One single 12-ounce can of soda contains three-quarters of the daily added sugar the World Health Organization deems as safe. We know three things about soda and other sugar-sweetened beverages (SSBs such as soda, energy, sports drinks, sweetened teas):

1. Serving sizes have increased: Before the 1950s, standard soft-drink bottles were 6.5 ounces. Now, 20-ounce to 42 ounce bottles are the norm.

2. People everywhere are drinking more soda: In one decade, calories from sugary beverages increased by 60% in children ages 6 to 11, and sugary drinks (soda, energy, sports drinks) are the top calorie source in teens’ diets.

3. Soda does contribute to obesity and diabetes: Frank Hu at Harvard outlined the studies that make the case. Recent meta-analyses show that higher intake of SSBs among children was associated with 55% higher risk of being overweight or obese; A meta-analysis showed that one to two servings per day of SSB intake was associated with a 26% greater risk of developing type 2 diabetes compared with occasional intake (less than one serving per month); Two large randomized control trials showed that reducing consumption of SSBs significantly decreases weight gain and adiposity in children and adolescents.

Convinced yet? Unfortunately, some of the top-selling artists and athletes are clearly not convinced or just don’t care. Instead, they have sold their souls to the soda companies. Not that some scientists are any better. This whole fiasco of soda companies funding science and pushing the product in emerging economies is just beyond me. With all the commoditization of everything on the planet, isn’t there anything that remains pure and of sound truth? Science should remain untouched, un-monetized: an “immuno-priveleged” place where you just don’t tamper with evidence. Marion Nestle, professor at NYU, has written a whole book on the poltics of soda aptly entitled “Soda Politics” highlighting the perverse tactics used by soda industries to fund and push their products on the public. But I digress…

Selling products with saccharin-sweet pop music is so ubiquitous in our culture that you can even take quizzes on which celebrity sold Coke or Pepsi. Not sure the point of that but indeed a good time waster.

The 1980s saw pop music come to life (and further exploited) through our TV, not just our record players (cassette tapes in those days) thanks in large part to MTV. Commercials or mini videos followed. As an 80s teenager, the first massive star I remember selling soda was Michael Jackson and he took a pretty decent pop song, Billy Jean, and changed its lyrics from “Billy Jean is not my lover” to “You’re the Pepsi generation.” Swell. But it all didn’t work out so well for Mike. Remember the hair catching fire incident not to mention other controversies…Next up. Madonna aka self-proclaimed #rebelheart. Dancing in lingerie in front of burning, Catholic crosses and kissing a black Jesus proved to be a bit too racy for Pepsi in which her ad was banned. Mamma mia.

With each decade, the hits and the soda sales just escalated. Britney Spears, Beyonce, One Direction for both Pepsi and Coke (isn't that a conflict of interest?), Selena Gomez (sipping the slurpy stuff from a Coke bottle with a straw got over 7 million likes!) and Taylor Swift, to name a few. But Taylor is okay because she promotes diet soda. Taylor – don’t you know about the implications of diet soda on the profile of the microbiome? Sigh…

Biggie in da Bronx

CSPI, a DC nutrition watchdog, published a list of celebrities, what they promote, and twitter feeds like Pittbull’s elegant tweets of poetry: “Hanging out at Club23 with Dr. Pepper.”  Nas and Drake for Sprite – Obey your thirst. In the ridiculous video, showing lots of young African American men drinking soda, Drake actually credits Sprite with his success. Maybe he should give himself more credit instead of belittling his talent to something so nutritionally deficient. Even the dead cannot RIP. I saw the below ad in the Bronx. Who gave Sprite permission to use Biggie’s image? His estate? Is that even legal?

Kendall Jenner, one of the Kardashians, did a Pepsi ad last year, that infuriated the #blacklivesmatter (BLM) movement. At the end of the commercial, Kendall walks to the front of the protest line, and hands a police officer a Pepsi. There is an exchange of peace, love and understanding. The crowd cheers on Kendall, who has saved the day, ending any resentment and policy brutality. Indeed art imitates life with this ad taking inspiration from a photo of a specific black woman, Leisha Evans, bravely standing up to riot gear adorned police at a BLM protest in Baton Rouge.  Live bolder, live louder, live for now. "Pepsi was trying to project a global message of unity, peace and understanding. Clearly, we missed the mark and apologize." Um…yah.

What makes this so infuriating is that they are targeting young, African Americans. But African Americans are not untouched by the obesity epidemic and often, suffer significantly more than other races due to poor access to healthy foods, poverty and inequity. Some stats in case you don't believe me:

• African American adults are nearly 1.5 times as likely to be obese compared with White adults.

• 47.8% of African Americans are obese compared with 32.6% of Whites

• More than 75% of African Americans are overweight or obese compared with 67.2% of Whites

• 35.1% of African American children ages 2 to 19 were overweight, compared with 28.5% percent of White children

#BlackLivesMatter – indeed they do. And if we continue to push junk food and soda on populations, racial health inequities will continue to persist.

On one hand, I understand the pull of profit. Celebrities make bank with these commercials. We could equally criticize all the sports players who promote equally unhealthy sugar sweetened beverages (Gatorade etc) and movie stars promoting fine Japanese whiskey (for a relaxing time, make it Santori time), but picking on pop stars is fun. And they earn so much money already. One Direction, a British pop boy band, was the highest grossing band in 2017 due to touring, which of course is always sponsored by somebody. Do they need to sell Toyota, Coke, and everything else that comes along, to sell their songs and get teenagers to come to their concerts?

I am not judging them. Well, maybe I am. I bet they are all great human beings and many have promoted important causes. One Direction is pushing Action 1 which is getting the young generation to take action and raise their voices to what future they want in the post 2015 development agenda. Commendable. Taylor Swift in her own right is empowering young women #GirlPower! The millennial generation, which Taylor and others are 'labeled' as, is impressive. I know. I teach them every day. What bothers me is the selling of their songs – their “art” – to sell soda. Why? They should really start thinking about their fans. If they want them to continue buying their records, going to their movies, and going to their shows, they should want their pre-pubescent and adolescent fans to be healthy. Especially our girls who are particularly vulnerable to obesity, with life-long repercussions.

We know celebrities care about their own health. They gotta look good with 25million+ Twitter and Instagram followers watching their every move. Most popstars are on special diets, have brutal trainers, do yoga and soul cycle. They probably don’t drink soda or for that matter, consume any sugar. Because well, that is what their personal nutritionist advised them to do…And advice given by "nutritionists to the stars" is ALWAYS of sound scientific evidence (Think Beyonce + Cleanse).

One could argue that there are efforts underway to counter these ads - companies are reformulating sodas to get the sugar content down or using alternative sweeteners, and national and municipal governments are taxing soda at the point of sale. Is this enough? I will write on these topics in some detail at a later date.

And maybe it is all just a bit unethical to be pushing soda on children? Marketing junk food and soda to children is generally considered pretty immoral in some circles, and wreaks of the same tactics used by tobacco to get kids to smoke. Check out this Coke 2018 ad called The Wonder of Us that promotes “the diversity of youth” and “there is a different coke for all of us.” Rafael Acevedo, the group director for Diet Coke in North America said “Millennials are now thirstier than ever for adventures and new experiences, and we want to be right by their side. We're making the brand more relatable and more authentic.”

Maybe celebrities need to be held accountable to what they are selling and to who?Young popstars should take a page from the songbook of Neil Young. Or at least watch "This Notes for You" and his rip on the commercialism of rock and roll.

 Ain't singin' for Pepsi


Ain't singin' for Coke


I don't sing for nobody


Makes me look like a joke


This note's for you.

Well sung Neil Young.          

Food bytes: Weekly nibbles from Feb 18 - Feb 24

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Since the publication of the Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems,” there have been some thoughtful critiques on the paper. Lawrence Haddad of GAIN and some other GAIN colleagues published what they felt were omissions but also the opportunities for more research, dialogue and debate. Over at the New Food Economy, Sam Bloch tried to eat the planetary health diet for one week. He struggled. He cooked almost all his meals, and he found the diet more expensive. I think he was a bit extreme, forgoing coffee and spices, which is not really recommended, but A effort in at least trying to take the lofty goals of the report and giving some practical insights into whether one can consume this diet on a daily basis. But don’t throw the baby out with the bathwater just yet. There are many attempts to ensure plant-based diets and vegan cuisine are tasty to our picky palates. Restaurants and food companies are trying new recipes and using new technology to ensure that vegetables make our mouths water just as much as those pavlov-dog-drooling juicy steaks do.

Another Lancet journal commission report was published last week on the “Global Syndemic of Obesity, Undernutrition, and Climate Change.” What is a syndemic one might ask? It is a synergy of pandemics that co-occur in time and place, interact with each other, and share common underlying societal drivers. Oh. Sounds serious. Well, in this case, it is. The pandemics are climate change and malnutrition - that being undernutrition and obesity. All three affect most people in every country. They give this example:

“Food systems not only drive the obesity and undernutrition pandemics but also generate 25-30% of greenhouse gas emissions (GHGs), and cattle production accounts for over half of those. Car-dominated transportation systems support sedentary lifestyles and generate between 14-25% of GHGs. Underpinning all of these are weak political governance systems, the unchallenged economic pursuit of GDP growth, and the powerful commercial engineering of overconsumption. The outcomes of obesity, undernutrition, and climate change interact. For example, climate change will increase undernutrition through increased food insecurity from extreme weather events, droughts, and shifts in agriculture. Likewise, fetal and infant undernutrition increases the risk of adult obesity. The effects of climate change on obesity and vice versa are currently uncertain.”

The Commissioners argue that double and triple duty actions are necessary to address The Global Syndemic. This figure below shows some options of triple duty actions. Some are very similar to what was recommended in the EAT Lancet Commission like reducing meat consumption and more sustainable dietary guidelines. Seems, most scientists are somewhat on a similar page on these recommendations. They do rip into both governments and food and beverage industries for not governing and not having public health concerns in mind respectively.

Triple duty actions to address the “global syndemic”

Dark cuisine. Copyright: NYT

Of course, as part of these global conversations is the issue of meat production and consumption and the potential future technologies that could save the planet, animals and humanity. One report just released argues that lab-grown meat could accelerate climate change, more so than current cattle production. Shwoops. Not sure about the authors assumptions, but they do acknowledge the limitations of their modeling of different types of gases and the energy calculations to come up with such a sweeping conclusion. The podcast Freakonomics breaks down the potential future of meat - weighing the pros and cons. It is worth a listen. One thing they discuss in the podcast that I had not heard of is “finless foods” - where fish are produced from stem cells. With 33% of fish stocks overly fished, this could be a game changer. That is, if people want to eat cultured meats and seafoods….

And speaking of weird science, and the future of food, ever heard of stargazy pie? It is a pie made up of herring, half buried in the pie with their heads and eyes peaking up from the buttery crust. Underneath is the rest of their bodies “leaching their brine in a rich custard, larded with bacon and hard boiled eggs.” Yummmm. Welcome to the world of ugly food and “dark cuisine.” These ugly food concoctions are highlighted in the New York Times Fashion section no less.

Food Bytes: Weekly Nibbles from Jan 1 - 7

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

As the world slowly wakes up to a new year, there are already some interesting food nibbles published this week.

Great commentary in Lancet Planetary Health on a new, longitudinal study being led by researchers at the Australian National University to understand the relationship between culture and health of the Aboriginal and Torres Strait Islander people, a group of indigenous peoples who have been discriminated against, underserved and disrespected for too long. The study is actually being designed BY and WITH Aboriginal and Torres Strait Islander people and will gather comprehensive data to explore the links between land, culture, and health amidst the “backdrop of an evolving human civilization and changing state of planetary health.” Looking forward to seeing the results and the transferability of the research to other indigenous peoples.  

In light of the frightening IPCC report on climate change, the Washington Post asked activists, politicians and researchers for 11 climate policy ideas that offer hope. Two involve food. One is about cutting the food we waste in half and is a “win-win-win-win-win for waste mitigation, jobs, economic activity, food security and of course, the climate.” The second is reducing the expansion of CAFOs - concentrated animal feeding operations, and instead, supporting smaller-scale farmers practicing sustainable grazing practices, expanding the infrastructure for grass-fed beef and dairy markets, and enforcing fair market and fair contract rules for the livestock industry.

The Lancet published a very short piece on how digital technologies may revolutionize nutritional sciences. One big gap in the science is that we do not know what people eat, and for everyone who does eat (which is everyone…), we have no way of tracking the health of those foods without going through a very laborious process. Now, with the advancement of technology, we may be able to carry our own personal nutritionist in our pocket, that is, through our smart phones. “By synchronizing various health data types from multiple sources, such as wearable sensors, electronic health records, metabolic profile, gut microbiome, and diet, all analyzable in real-time using machine or deep-learning algorithms, a person’s smartphone has the potential to function as a digital nutritionist.” I am particularly keen to see how the photo-based dietary tracking through automated food image recognition that determines calorie and nutritional content will work.

Gerald Nelson and colleagues published a Nature Sustainability paper and a follow-up op-ed piece in the Washington Post that the global agriculture sector’s narrow focus on feeding the world, in the form of carbohydrate calories (mainly maize, rice and wheat), has led us and will continue to lead us down a dangerous path. In their study, they found that there will be more than enough food per capita to feed 10 billion people by 2050, even with the business as usual climate change pathway. They argue that the focus on carbohydrates has been a contributor to the rising rates of obesity and continued micronutrient deficiencies. They recommend that agriculture shift gears and increase production of major nutrient-rich foods such as fruits, vegetables, nuts, seeds and beans instead of the forty-year focus on staple grains.

Good enough

As we begin a new year, I have noticed a common theme on twitter and newsfeeds -- How rough 2018 was for so many people, and how much they looked forward to its end. The Washington Post wrote, “…around the globe, 2018 was a year of enduring complex conflicts.”

I would agree that sometimes, it seems the world really is on its knees. With the white house in complete chaos, picking fights with everyone from Mexico to China, the looming Brexit, the DRC, Yemen and Syria in disarray, and the “demise of the liberal order” with right wing populist Bolsonaro winning the Brazilian elections, the political climate is alarming to say the least. The violence we do to each other seems never ending – particularly in the U.S. with gun-related injuries and deaths continually plaguing Americans. Climate change is barreling down on us, with natural disasters ramping up, becoming less predictable and more destructive.

But when we look at the whole picture and try to not react to the sensationalized news feed that inundates us 24/7, things have actually improved for many people around the world. Just look at the statistics of people living in extreme poverty (number of people living on less than $1.90 a day). In the 25 years from 1990 to 2015, the extreme poverty rate dropped an average of a percentage point per year – from nearly 36% to 10%. That is a massive decline! During the same time period, the mortality rate of children under the age of five has fallen by more than half since 1990 – from a rate of 93 (meaning, 93 children die out of every 1,000 live births) to 39.

While the Rohingya situation in Myanmar is devastating, Steven Pinker, Harvard Professor, and author of The Better Angels of our Nature argues that we are doing better than we did 30 years ago and conflicts and genocides taking place around the world have been on a downward trend since the end of the Second World War. And countries recover from conflict. In Rwanda, at the height of their genocide in 1994, the child mortality rate was 282 children per 1000 live births. Now?  38. What a success story.

Rate of deaths in genocides, 1900-2008 (Source: Our World in Data)

In Martha Nussbaum’s new book, The Monarchy of Fear, she argues the same case. She writes that while the present moment “may look like backsliding from our march toward human equality … it is not the apocalypse” and the world is in a much better place than it was following the Second World War in the 1950s in which women, minorities, and the LGBTQ to name a few, had minimal rights and human injustice was rampant. Nussbaum argues that now is “actually a time when hope and work can accomplish a great deal of good.”

The late and great Hans Rosling also agrees in his book Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think. He argues that by looking at data over time and in the right way, one can see that the world is making huge strides overall. It is just a matter of looking at the bigger picture and the larger trends over time. Yes, children and mothers die, yes there are displaced peoples, conflicts and famines, and yes, the world is very unfair. But at the same time, largely, humans are progressing in positive ways and the news and media, and probably your twitter feed, often does not reflect that.

Because The Food Archive is all about food, let me get to my point. While progress is happening, there has been less success globally in tackling hunger and malnutrition. Those who are food insecure, or hungry, is still too high and we are seeing an increase in the actual numbers and prevalence of people who are hungry over the last two years. However, when looking at the prevalence over a longer period of time, since 2005 those who are hungry in the world have declined from 14.5% in 2005 to 10.9% in 2017. On the opposite spectrum, in 2000, 8.7% of adults were obese, and now, 13%. That 13% equates to 678 million people in the world who are struggling with obesity, or an unhealthy body mass index.  The trends show increases across the board.

Prevalence of obesity is rising among adult men and women over time (Source: Global Nutrition Report)

That said, as reported by the Global Nutrition Report, there are gleams of hope. Stunting, or chronic undernutrition has been declining. In 2000, 33% of children under the age of five were stunted and now, in 2017, 22%. That is almost a 50% decrease. Asia has made significant progress in stunting going from 38% to 23% as has Latin America and the Caribbean declining from 17% to 10% and Africa from 38% to 30%. The question is, why and how? Places like Nepal, Bangladesh and Lesotho have seen significant declines in stunting while still being quite poor. There are many researchers and publications that are trying to understand why these countries have witnessed success, but I think we can argue that it is a combination of interventions from diet, health care, sanitation and hygiene as well as factors not having to do with nutrition at all – like income generation, women’s status, and jobs and remittances.

So what do I hope 2019 looks like? While progress isn't inevitable, and everything doesn’t always get better for everyone all the time, progress is happening in both small and large ways. We need to seek out that progress, learn from what worked, and get into a mindset of problem-solving. We know a lot about what has worked and why, particularly in places where hunger and undernutrition has rapidly come down – look at China, look at Brazil, look at Ethiopia! We also have pockets of success in tackling poor diets, and overweight and obesity. Effective soda taxes in Mexico! Easy-to-read labels on the front of packaged foods high in sugar, fat and salt in Chile! Traditional diets being kept alive in places like Japan and Italy! Obesity rates actually coming down in some states of the U.S. – shocker!

I am well aware of broken resolves, so I refuse to say this year will be better than the last. It is not that I have completely lost faith in humanity and the endeavor it brings, it is just that I think we will need to find the stitched pockets of progress and small glimmers of hope as the basis of our knowledge to move forward. Now, one could argue that seems like a pretty lame new year’s resolution, and instead we need grand-scale, disruptive change. But for me, now, with our current state of affairs, I think that perspective is as good as it gets. And that is good enough.