Taxation of beverages as strategy against heart disease – Part 2
The implementation of a tax on these sugar sweetened beverages has emerged as a key target for policy intervention among economic and health advocates. The endpoint in the strategy for SSB tax proponents is the passage of a SSB tax-law by the National Assembly through formal lobbying, leveraging on scientific evidence, and with understanding of the political context; borrowing experience from the challenging process of passage of the tobacco law and eventual approval of a tobacco fund in Nigeria by the legislature.
For public health promotion, taxation of SSBs is internationally recommended as priority component of a comprehensive approach to preventing and controlling obesity and diet-related non-communicable diseases. Accordingly, the World Health Organization recommends that governments impose taxes on SSBs to raise retail prices by at least 20% to reduce consumption and improve population health. There is international momentum supporting SSB taxes which are now in place in more than 40 countries globally, mostly in high economic countries, and more recently in sub-Saharan Africa especially in Mauritius in 2016 and South Africa in 2018. Taxes have been imposed in countries with some of the highest SSB consumption and obesity rates though there are countries with high or rapidly rising SSB consumption rates that are yet to introduce SSB taxes.
With rapidly growing upsurge of NCD epidemic in Nigeria, there is growing need for government to emphatically put in place a multi-sectoral, whole-of-government response to tackling NCDs. The health sector alone cannot bear the burden of both treating and preventing NCDs when many of the practices and policies that influence NCDs risks, and their social determinants, reside outside the health sector. A first step is to build awareness around the linkages between NCDs risks and key sectors outside health such as agriculture, finance, environment, trade, and transportation. Research on the health-related impact of taxation of sugar sweetened beverages is emerging and the evidence points to positive changes in consumption patterns as recently demonstrated in Mexico where 6% decline in the purchase of taxed beverages was observed.
The consequences of food cost and its impact on health are likely to be amplified among the poor in the lowest income groups as they spend a greater proportion of their income on food. This, therefore, makes them more vulnerable to financial and other stresses than those in middle- or higher-income groups, as diet quality varies with socioeconomic status which is a significant contributor to health inequalities. Available evidence reiterates that in some settings, a healthy diet is largely unaffordable to those most at risk of obesity and associated NCDs such as cardiovascular diseases, diabetes, and cancers. Furthermore, the increasing cost of both healthy and unhealthy foods reduces consumption. Thus, the Nigerian Government must also focus on measures to reduce the cost of healthy foods, such as fruits and vegetables, in addition to reducing consumption of SSBs through increased taxation.
A similar proposition to the focus on SSBs is the high prevalence of smoking of tobacco among the poor in the lowest income groups, and the positive effects of increase in tobacco excise tax is immeasurable. Therefore, implementation of the 10% taxation of sugar sweetened beverages (SSBs) by the Nigerian Government should be seen as one of the key strategies at reducing consumption of SSBs. This would be a positive measure at lowering the costs of health care, improve the health of the population, and a source of increased revenues for government. It is hoped that this increased revenue would be dedicated to funding of health programmes, especially non-communicable diseases, as is the practice in most developed countries where taxation on SSBs has been effectively introduced and implemented.
Dr. Akinroye is the Executive Director, Nigerian Heart Foundation.