The Soda Tax: Down, But Not Out

NY Gov. David Paterson proposed a tax on sugary and high-caloric beverages, including soda, as a simultaneously fiscally responsible and good for public health proposal months ago.  But it never got off the drawing board, nor did it even have a formal public debate, before being dropped from the state budget.  But that's OK - as a recent New England Journal of Medicine article shows, it's such a no-brainer public health idea that someone somewhere will eventually move ahead with it.

To say that what little debate there was ephemeral and bubbly - much like soda itself - is an understatement.

As the NEJM article puts it, "Sugar-sweetened beverages (soda sweetened with sugar, corn syrup, or other caloric sweeteners and other carbonated and uncarbonated drinks, such as sports and energy drinks) may be the single largest driver of the obesity epidemic. A recent meta-analysis found that the intake of sugared beverages is associated with increased body weight, poor nutrition, and displacement of more healthful beverages; [and] increasing consumption increases risk for obesity and diabetes."  Obesity also links up to increased instances of some of the most expensive chronic conditions - not just diabetes, but hypertension, heart disease and a host of others.  Obviously, there are many other factors that contribute to obesity, particularly among children in poor and disadvantaged neighborhoods, including fast food, high caloric snacks, lack of opportunities for exercise, etc.  But soda is the most obvious one to target - no one's nutritional intake will be disrupted if they stopped drinking soda.  It's not a necessity, and it displaces a whole host of other options - not just the obvious diet soda, but water, milk, fruit juices with actual fruit in them - that have far more nutritional value.  Consumers wouldn't need to entirely quit, just think twice about their beverage selection.  The payoff is huge:  "Even if one quarter of the calories consumed from sugared beverages are replaced by other food, the decrease in consumption would lead to an estimated reduction of 8000 calories per person per year - slightly more than 2 lb each year for the average person."

But aside from a great homemade video by Dr. Richard Daines, New York State Health Commissioner, the public health benefit was scarcely mentioned in the public debate.  In a public meeting with my Assemblywoman in which she solicited feedback on the tax, she rhetorically shrugged, "Why are we taxing soda?  Why not potato chips?  Why not Twinkees?"  Well, that's an idea for another time, but the short answer is no matter which inner-city neighborhood I've ever been in, the local corner stores and bodegas have a Coca-Cola alternative.  They might not have options for diet soda, but they have water, milk and juice.  They often do not have good substitutes for Twinkees and potato chips - fresh fruits and vegetables can be hard to come by in some neighborhoods.  That doesn't mean we shouldn't tackle the influence and marketing of snacks and fast food, too.  The fact that we'd solve one problem, not all problems, is not actually a reason not to solve what we can.

The second argument is that the tax is regressive - and it is.  A 12 cent tax on a can of Dr. Pepper hits families on a limited budget much worse than the more affluent.  But it also disproportionately benefits those same communities, as the articles point out:  "But the poor are disproportionately affected by diet-related diseases and would derive the greatest benefit from reduced consumption; sugared beverages are not necessary for survival; Americans consume about 250 to 300 more calories daily today than they did several decades ago, and nearly half this increase is accounted for by consumption of sugared beverages; and though no single intervention will solve the obesity problem, that is hardly a reason to take no action."  It's also worth mentioning that over 40 states already tax sugar and snack foods lightly - but more is needed if it's actually to cause consumers to pause and think through their choices more carefully.

Someone somewhere is going to be smart enough to give this a shot and, much like how smoking bans in restaurants caught on once someone tried it and the sky didn't fall, the benefits will speak for themselves and convince other states to try it.  It's worth mentioning one of the authors of the NEJM article is Dr. Tom Frieden - the New York City Health Commissioner who introduced the smoking ban, the transfat ban, and the calorie display regulations that are working so well.  Obesity is a tough nut to crack, because so much of the remedy is tied to public health education and wellness programs - two areas of our health care system that are chronically underfunded.  A soda tax dedicated to funding the fight against obesity, however, would be a - dare I say - refreshing way to tackle a drain on our health care system.

(Photo credit:  vox_efx on Flickr.)