The Public Health and Economic Benefits of Taxing SSBs. Roberta R. Friedman, ScM Yale University

Transcription

1 The Public Health and Economic Benefits of Taxing SSBs Roberta R. Friedman, ScM Yale University

2 Today Rudd Center Why target SSBs? public health benefits economic benefits Taxes as part of broader public health strategy Other strategies to reduce consumption What to expect from industry

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4 Strategic science Food marketing to kids School and pre-school initiatives Weight bias Legal and economic approaches Food and addiction Policy resources

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6 Evaluating Sugary Drink Nutrition and Marketing to Youth

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8 Definition: Any beverage with added caloric sweetener

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10 SSB Tax Proposal Penny per ounce Any beverage w. added sugar or Penny per teaspoon added sugar Incentive to reduce sugar Revenue for obesity prevention

11 Impact of price changes 10% price increase = % consumption decrease Penny per oz = approx 20% increase Enough to reduce net caloric intake and obesity Andreyeva, AJPH, 2010; Smith, USDA ERS, 2010; Chaloupka, CCHSS, 2011

12 Also looking for Decreased diabetes incidence Reduced obesity-related health care costs

13 Andreyeva et al. Prev. Med. 2011

14 would reduce consumption by 15 percent among adults ages Wang et al. Health Affairs, 2011.

15 Why target SSBs? Largest source added sugar

16 Sources of added sugars, 2-19 yr, NHANES

17 Sources of added sugars, 2-19 yr, NHANES

18 Why target SSBs? Science is strong and growing

19 Since then, more studies Sept 2009

20 Child/adult overweight & obesity Committee on Nutrition, Council on Sports Med and Fitness, Pediatrics, 2011 Fiorito et al., Am J Clin Nutr, 2009 Lim et al., Obesity, 2009 Sichieri et al., Pub Health Nutr, 2009 Woodward-Lopez et al., Pub Health Nutr, 2011 Hu et al., Physiol Behav, 2010

21 Elevated risk of type 2 Diabetes dekoning, AJCN, 2012 Malik et al., Circulation, 2010 Malik et al., Diabetes Care, 2010

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23 CVD in adolescents and adults Pollock et al., J Nutr, 2012) Bernstein et al., AJCN, 2012 dekoning et al., Circ., 2012 Aeberli et al., AJCN,2011 Brown et al., Hypertension, 2011 Duffey et al., AJCN, 2010 Welsh et al., JAMA, 2010 Fung et al., AJCN, 2009

24 Dental caries, erosion Committee on Nutrition, Council on Sports Med and Fitness, Pediatrics, 2011) Buyer, J IN Dental Assn, 2009 Warren et al, Commty Dent. Oral, 2009

25 NO association: Industry-funded Meta-analyses Vartanian et al. AJPH, 2007 Lesser et al., PLoS Med, 2007 Industry funding increased the likelihood of a finding favorable to the sponsor by 4-to 8-fold.

26 Why target SSBs? Consumption trends

27 Soda down slightly Beverage World Data, 2011 Gallons/year per capita

28 Sports drinks up Beverage World Data, 2011 Gallons/year per capita

29 RTD teas up Beverage World Data, 2011 Gallons/year per capita

30 Energy drinks up Beverage World Data, 2011 Gallons/year per capita

31 Why target: Intake

32 Average US intake = 45 gallons/yr Andreyeva, et al., Prev. Med, 2011

33 16% 12% 11% 11% 6% 5% Chaloupka, CCHHS, 2011

34 Ogden et al., NCHS Data Brief, No. 71, 2011 Daily Calories

35 Ogden et al., NCHS Data Brief, No. 71, 2011 By Race/Ethnicity

36 Ogden et al., NCHS Data Brief, No. 71, 2011 By Income

37 The calories are empty junk detrimental nutrition-less whatever (bad thing) you want to call them.

38 Rudd Center tax calculator, Maine is drinking

39 Why target SSBs: Marketing to Kids

40 Sugary Drink FACTS 644 products, 61 brands, 14 companies $29 billion estimated sales Share of sales in 2010: Source: Symphony IRI

41 Evaluating Sugary Drink Nutrition and Marketing to Youth

42 Higher exposure significantly associated with higher consumption

43 Voluntary policies not working CFBAI Began companies No ads to kids under 12

44 Industry fighting voluntary stds sensiblefoodpolicy.org

45 Coke s CEO We are laser-focused on targeting the right consumers.to target aging and affluent consumers globally, we are actively exploring new ingredients, new functionality and new occasions. At the same time, we are creating new strategies that are winning over a massive new generation of teens to drive growth of Trademark Coca- Cola. Businesswire.com, November 16, 2009

46 Targeting Youth Especially Black and Hispanic Despite pledges to market fewer SSBs, industry is targeting youth with more

47 TV ads increased overall 3 companies doubled advertising Children Teens

48 Black children/teens view 80-90% more TV ads than whites

49 Product placements

50 YouTube Coke: 23 million upload views Red Bull: 158 million Monster: 11 million

51 Facebook 30 million fans, #1 brand on Facebook

52 Banner ads Mobile advertising Text messages From My Coke Rewards, 3/4/11: Want to boost ur balance? It s easy to do. Enter 3 codes in the next 10 days and u ll get 20 Bonus Points on us.

53 Mobile apps Downloaded by 40,000 teens (25-40% of users)

54 Company websites Visitors per month 2-11 years years Minutes per month MyCokeRewards.com 42, , Coca-Cola.com 3,800 32, MyCoke.com 6,200 28,

55 Banner ads on 3rd-party websites

56 Twitter 300,000 10/19/10: Smiles, laughs, bubbles. What else do you associate with Coca-Cola? ^OP

57 Even Barbie

58 Why target SSBs: Caffeine

59 Gratuitous addition of caffeine Coupled with calories Supposed taste enhancer AAP: Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Brownell, Griffiths, & Gold 2008; Keast & Riddell 2007; Griffiths & Vernotica, 2000

60 Economic benefits

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62 Study: Obesity adds $190b in health costs The startling economic costs of obesity, often borne by the non-obese, could become the epidemic s second-hand smoke. Reuters, 4/30/2012,msnbc.msn.com

63 Estimated adult obesity-attributable percentages and medical expenditures for Maine (2003 dollars) Total population: 5.6% $357m Medicare pop: 5.7% $66m Medicaid pop: 10.7% $137m Finkelstein et al, Obes Res, 2004

64 Earmarking School-based interventions Access to real food/subsidize real food Public education campaigns Community interventions Health care

65 Tax as part of a broader approach

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67 How best to make change? Educate Knowledge Medicate Operate The Individual Less Obesity? Implore Motivation

68 Economics Legislation Optimal Defaults The Individual Less Obesity? Regulation Environment

69 Change Environment: Optimal Defaults 69

70 SSB Environment 70

71 Default: Encourages healthy behavior

72 Default: supports responsible behavior?

73 Default: normalizes

74 Obesity Prevention Strategies Schools: food/p.a. Marketing Built environ Access to real food Pricing strategies

75 SSB strategies Taxes/price strategies Orgs lead by example Education. campaigns Fast food default kids meals Expose, monitor marketing Supermkts SNAP?

76 Education: Portland, ME

77 Education: Youth campaigns YO! Youth Outlook, California

78 Education: other School curricula Health care professionals Discuss with patients

79 Lead by example: Healthy cities

80 Lead by example: Hospitals

81 Lead by example: Churches Seattle

82 Lead by example: no soda

83 Monitor/Expose Marketing

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85 Brownell, JAMA, Sept 2011

86 Supermarkets no SSBs in checkout aisles no SSBs on endcaps better beverages at eye-height signage: water is better for you water is cheaper sugar amounts

87 Other pricing strategies Differential pricing Minimum pricing Discount better bevs

88 Calls for reducing added sugars, SSB consumption American Academy Pediatrics American Heart Assn American Medical Assn CDC Institute of Medicine USDA World Health Organization

89 What to expect from the industry

90 Millions spent lobbying by industry Congress considers 1 per oz tax Reuters, April 29, 2012

91 Industry Defense Many things drive obesity It won t solve obesity Consumption is down, obesity is up Sugar isn t special all calories are equal It s about physical activity The science isn t clear People will lose jobs Tax would hurt the poor True True False False False False False False

92 We re part of the solution

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94 Clear on Calories

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96 Issue overview and fact sheets Tax information Revenue calculator Legislation Public opinion data Study synopses Supporting statements of nat l orgs Additional resources

97 Thank you!