- The American Academy of Pediatrics, American Heart Association, and others have called for public policies to reduce consumption of sugar-sweetened beverages
- The Citizens Research Council previously found that a tax on sugar-sweetened beverages was among the viable policy options to improve health in Michigan
- It often takes a major event/catastrophe in combination with intense media coverage to focus the attention of policy makers, and, as a result, some of the biggest threats to health are ignored despite being slow-moving, ubiquitous, and preventable
News of actions by President Trump, Governor Whitmer, and other states’ governors to curb use of flavored vaping products have filled recent headlines; the window for this policy change was opened by a spate of vaping-related lung injuries of yet-unspecified cause(s).
Banning fruit-flavored e-cigarettes will do little to directly address the outbreak of injuries, illnesses, and deaths associated with vaping products. Rather, the ban has been a long-preferred policy for many public health and medical groups. Health experts point to evidence that flavors make these vaping products more attractive to young, first-time users (as opposed to the smaller number of adult smokers who might believe vaping is a viable path to tobacco cessation). I wrote about the seriousness of this trend in a previous blog titled “Much Ado About Vaping,” highlighting the way e-cigarettes are creating a whole new generation of nicotine addicts.
While the prevalence of youth vaping has been growing for years, the recent media fixation on vaping finally focused the attention of politicians and the general public long enough for health advocates to push through one of their preferred policy solutions, even if this particular solution does far more to address the ongoing youth vaping epidemic than the injuries and deaths that caught politicians’ attention in the first place.
But what if I told you vaping wasn’t the only fruit-flavored vice destroying America’s health and harming its youth?
Fruity soft drinks and other sugar-sweetened beverages have long posed immense health risks. Excess consumption of added sugar is harmful (particularly from soft drinks that provide no nutritional value and are the leading source of added sugars consumed in the U.S.). Consumption of sugary drinks contributes to childhood and adolescent obesity, as well as lifelong risks for a variety of health issues, from hypertension, cardiovascular disease, and diabetes to fatty liver disease and dental decay. Recent evidence furthermore suggests that consumption of soft drinks may increase a person’s overall mortality risk even after controlling for other related risk factors like BMI and tobacco use.
American political discourse often finds itself in a catch-22 surrounding consumable goods that have adverse health or environmental consequences, caught in a vicious cycle between admonitions of personal responsibility and the defense of personal freedom of choice (including choices that are ultimately unhealthy). Society has, over time, come down strongly in favor of regulation for combustible tobacco products. However, in a political environment that has seen a lessening of regulation of other potentially harmful substances (e.g., alcohol, and, more recently, cannabis), governments have been reluctant to put safeguards in place for emergent products with harmful side effects (e.g., e-cigarettes). At the same time, sugary drinks (indeed, junk foods in general) have evaded scrutiny, despite being addictive and harmful while providing no nutritional value.
Given the health and fiscal consequences that arise in society from the production, marketing, sale, and consumption of junk foods, it may be time for policy makers to reframe conversations around these products; sugary beverages should be seen as a low hanging fruit for health policy formulation and population health improvement. Regulatory experience with tobacco, alcohol, and other substances could be highly instructive for governments considering interventions targeting soft drinks and other sugary, fruit-flavored beverages.
Earlier this year, the American Academy of Pediatrics and the American Heart Association released a set of policy recommendations to reduce sugary drink consumption by children and adolescents. Recommendations include:
- Increasing price through taxation and directing revenue to reducing existing health and socioeconomic disparities
- Curtailing marketing to children and adolescents
- Discouraging consumption and ensuring access to healthful foods in public nutrition assistance programs
- Improving nutritional labeling, including in restaurant menus and advertisements
- Making healthy beverages the default choice with children’s meals
- Admonishing hospitals and other health facilities to serve as models to limit or disincentivize purchase of sugary drinks
In our 2014 Report, “Addressing Michigan’s Obesity Problem,” the Citizens Research Council presented several of these policy options, including taxes on sugar-sweetened beverages, greater public health funding and attention, improved nutrition standards, and better management of food access in schools.
Some might oppose government interventions to address consumption of junk foods as an infringement on personal freedoms, expressing discomfort with government experts making judgments regarding an individual’s health and life choices. Others would contend that these recommendations do not supersede individual choice, but rather make it easier for individuals to make healthy choices for themselves without preventing them from exercising their right to make unhealthy ones. Interventions targeting nutrition also reflect the understanding that our choices are not purely rational, internal processes, but rather are strongly influenced by our environment and the messages we receive from others (such as advertisements), along with habit and tradition.
Some might also contend that these policies place undue (and unfair) costs and burdens of enforcement on certain groups, such as retailers; indeed, the current patchwork of state tax treatment of groceries is undoubtedly complex, confusing, and cumbersome. Yet, the choice to embrace the status quo and do nothing is not without costs. Consumption of products with potentially negative health consequences (like soda, alcohol, tobacco, or, in many states, cannabis) creates societal costs that are absorbed in the form of higher private health insurance premiums, higher government spending on health care programs, and diminished economic productivity, not to mention the social and emotional toll exacted by resultant morbidity and mortality.
Determining efficient, effective, and equitable ways to share costs and benefits is a central political responsibility. True, some policies do create new costs for certain groups, but the fairness of these costs must be assessed and balanced against the ongoing costs to all members of society from business as usual.
An excise tax on sugary beverages (along with counter-advertising to ensure people fully understand health risks associated with the product they are considering) would nudge people towards making healthier decisions without forcing their hand nor limiting their freedom of choice. The tax could generate much-needed revenue for public health initiatives while also ensuring that people who exercise the choice to purchase another can of pop will simultaneously make a financial contribution to offset the nonconsensual costs this selected transaction imposes upon the rest of society.
Policy analysis is, of course, not the same as politics. The kind of shocking soda pop catastrophe that would be needed to capture the attention of news networks, policy makers, and the general public is unlikely to occur any time soon (if ever). Long-term trends and slow-moving threats only seem to be truly exciting and attention-grabbing for small, wonk-ish groups like ours. That means our fellow Michiganders must continually rely on the tumultuous (yet lugubrious) political process to one day catch up with the science and data. For Michigan’s children and health advocates alike, that day cannot come soon enough.