sugary drink policy – 2017...• taxing sugary drinks is a progressive public policy: o no one has...

Sugary drink policy – 2017 State of Play

JIM KRIEGER, MD, MPH

JUNE 2, 2017

HEALTHY FOOD AMERICA

o Primary source of added sugar in U.S. diet o Major source of added calories fueling the obesity epidemic o Consumption higher among low income and minority populations o Cause obesity, diabetes, dental decay, liver, and heart disease o Do not affect appetite o Heavily marketed (and youth and minorities targeted) o No nutritional benefits

A reminder: Why focus on sugary drinks?

ACTION FOR HEALTHY FOOD


How much sugar is in that drink: QUIZ TIME!

And for a bonus: What is the recommended daily limit for sugar intake?

11 oz 20 oz 32 oz 16 oz

12 tsp 15 tsp 13 tsp 8 tsp

DGA: <10% daily calories, ~12 tsp/day AHA: 6-9 tsp/day


16 oz

13 tsp

Sources: (1954-2003): Beverages Table. United States Department of Agriculture, Economic Research Service Food Availability (Per Capita) Data System Website. Updated February 1, 2015. Accessed September 9, 2015. (2004-2014): Beverage Digest annual estimates; Caloric CSDs based on estimate that 70% of CSDs are caloric and 30% are non-caloric/diet.

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lons

of S

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Regular soft drinks

Availability triple what it was 60 years

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Dramatic increase in sugary drink availability


http://www.ers.usda.gov/datafiles/Food_Availabily_Per_Capita_Data_System/Food_Availability/beverage.xls

http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/.aspx

Progress, but the decrease may be stalling…


Half of adults and two-thirds of youth

consume at least one sugary drink on a given day

↓ Availability ↓ Acceptability/Appeal

↓ Affordability

Reducing sugary drink consumption


What are the most active sugary drink policies? o Current

• SSB tax • Kids Meals • Procurement • Schools, out-of-school, and childcare nutrition standards

o In the wings • Warning labels • SNAP subsidies and incentives • Marketing restrictions in schools • Portion sizes?


Acceptability & Appeal


Increase awareness of sugary drinks


Building Public Awareness: Countermarketing Campaigns



Warning labels



Board of Health Resolution


Availability


Kids meals A third of all US children and adolescents aged 2–19 consume fast food on a given day. Kids who eat at fast food drink more SSBs and less milk.

o Ban soda as default beverage option or ban completely

o Stockton, Davis, Perris, Santa Clara County (CA) have adopted bills.

o More being considered in CA, Vermont, Montgomery Co, PG Co, NYC, NY, Lafayette.

o Many fast food chains are voluntarily removing SSBs from kids meals



Changes in kids meals beverage offerings from 2008-2016


Source: CSPI, 2017

Procurement: Government o Vending o Cafeterias o Government programs:

• Parks and Recreation Sites

• Child care and before/after school programs

o Government contracts

Procurement: Hospitals

o In 2006, 99% of hospital cafeterias sold SSBs

o Partnership for a Healthier America: 150 hospitals now serve healthier drinks

o Healthier Hospitals: 500 hospitals committed to healthier foods

o UCSF: Eliminated the sale of sugar sweetened beverages and removed from menus

o Santa Clara County: Ban sales at county health facilities



Schools o Much progress through Healthy,

Hunger Free Kids and Smart Snacks

o Work remains: • Assure implementation • Seek total elimination (HS vending, after-school hours, events, fundraisers) • Address in-school marketing • Fully implement school wellness policies

o No “pouring rights”

“After listening carefully to the concerns and information I received from our students, faculty, and staff, I have decided not to move forward with the process of establishing a partnership with a beverage company.” - SF State president Les Wong



Child care and out of school

o Need to follow the Child and Adult Care Food Program guidelines, but these don’t limit sugary drinks/sweetened milk

o Food quality can be improved through:

• Licensing and regulation • Voluntary policies • Quality reporting • Offering technical assistance to

implement healthy practices and policies



Limit portion sizes

Larger portion sizes lead to greater consumption. o Limit portion sizes of drinks

served in restaurants o Limit portion sizes of bottled

SSBs sold in stores



SNAP demonstration projects

o Exclude sugary drinks and add healthy food incentives

o Farmers Market subsidies o Minimum stocking standards



Working with industry: reformulation


Affordability


Sugary drink tax

oReduces consumption o Increases awareness about

adverse health effects oGenerates revenue to support

community health and well-being

oPredicted to reduce disease and health care spending

oMay induce product reformulation HEALTHY FOOD AMERICA


Sugary Drink Tax Policy Trends Across the United States

Implemented

Enacted

Philadelphia Boulder

Cook County


San Francisco Oakland

Albany

Berkeley

Under consideration

Seattle

Multnomah County

Navajo Nation

US Adopted Taxes 8.3 million people

benefitting $342 million per year


Location PopulationEst. annual

revenue ($1,000,000)

Tax rate per ounce

Type of beverage

Use of Revenue Vote

Philadelphia, PA - Council 1,567,442 $91 0.015$ Sweetened Pre-k, parks 13-4Berkeley, CA Measure D 112,580 $2 0.010$ Sugary Health 74%Albany, CA Measure O1 19,735 $0.2 0.010$ Sugary Health 71%Oakland, CA Measure HH 419,267 $7 0.010$ Sugary Health 61%San Francisco, CA Measure V 864,816 $15 0.010$ Sugary Health 62%Boulder, CO Measure 2H 107,349 $4 0.020$ Sugary Health 54%Cook County, IL - Commission 5,238,216 $223.8 0.010$ Sweetened Justice 9-8Total 8,329,405 $342.3


Berkeley: November 2014



• Berkeley Healthy Child Coalition, a diverse, grassroots group of parents, teachers, health professionals, community leaders, and residents

• Endorsed by every local elected official. • Began early - softened the ground with

education. • Focused on children’s health and future. • Used social media • Involved communities most affected

Philadelphia: June 2016



• Mayor Kenney proposed the measure, Council passed it 13-4.

• Strong and diverse coalition supported – ECE support key.

• The American Beverage Association aggressively fighting tax - funded “No Philly Grocery Tax” campaign, filed law suit, trying to repeal.

SODA TAX WARS


2016 Tax campaign spending

Philadelphia $11.1M $2.5M Boulder

$954K $822K

Bay Area $30.2M $22.5M

Cook County $80K $95K


San Francisco Oakland

Albany

> $42 million spent by industry

and counting Source: CSPI

> $26 million spent by advocates and

counting


Lessons learned • Ballot measure and legislative paths are

viable

• Significant financial support has evened the playing field

• Political and grassroots organizing

• Strong communications operation

• Starting first and effective framing to control the debate

• Effective use of community-based messengers and influential champions.


Philadelphia Mayor Jim Kenney

"What we're looking to do is to take some of that profit, to put it back into the neighborhoods that have been their biggest customers, to improve the lives and opportunities for the people who live there."

2) http://www.npr.org/sections/thesalt/2016/04/08/473548273/philly-wants-to-tax-soda-to-raise-money-for-schools HEALTHY FOOD AMERICA

http://www.npr.org/sections/thesalt/2016/04/08/473548273/philly-wants-to-tax-soda-to-raise-money-for-schools



















Big Soda aggressively fighting adopted taxes

• Law suit in Philly

• Earned media

• TV, radio, full page ads – more than $1 .5M in Philly

• Digital media

• Lobbying council to repeal

• Misinformation about tax by storeowners and distributors



Mayor Kenney: “I didn’t think it was possible for industry to get any greedier…They are so committed to stopping this tax from spreading to other cities, that they are not only passing the tax they should be paying onto their costumer, they are actually willing to threaten working men and women’s jobs rather than marginally reduce their seven figure bonuses.”

Howard Wolfson: “Either there are pre-existing problems with the business model, or jobs are being sacrificed to make a political point.”

“Taxes are regressive” • Since when did Big Soda start caring about

poor people except as marketing target?

• Taxing sugary drinks is a progressive public policy: o No one has to pay the tax.

o Low income people now spend more on sugary drinks – the tax will reduce the spending gap between rich and poor.

o In Berkeley, no change in total grocery spending by supermarket customers.

o Low-income communities reap the most health benefits from lowered consumption and from increased investments in their communities.


Effective implementation


The evidence is emerging Taxes are working as predicted

• Studies available from Berkeley, Mexico and France

• Consumption and sales of SSBs dropping and water increasing

• Revenues are addressing vital community needs

HEALTHY FOOD AMERICA HEALTHY FOOD AMERICA

Modeling the health impact of a tax

PHILADELPHIA: 1.5 CENTS/OZ. ON SUGARY & DIET DRINKS

SAN FRANCISCO: 1 CENT/OZ. ON SUGARY DRINKS

1.5 2


Contact us! • Get answers to your questions • Technical assistance and support • Tools and resources • Media and communications help

www.healthyfoodamerica.org 206-451-8196


Extra slides


Philadelphia: the legal challenge

• Industry argues that beverage tax duplicates sales tax, rendering it illegal.

• City argues that it is taxing distribution, not sale.

• Lower court rejected industry suit in December.

• Appellate court heard case in April.

• Stay tuned – and note any ruling is specific to Pennsylvania law.


Evaluating taxes o Published – Berkeley, Mexico, France o Currently in field

• Philadelphia, Oakland, Cook County • And more in the works

o Key questions • Price and pass-through • Sales/purchases • Consumption (including substitution) of

taxed and non-taxed beverages • Effects on total dietary intake • Economic impacts – jobs, revenues,

regressivity • Cross border effects • Norms/attitudes • Implementation experience


Trends in consumption: Mexico


A can of soda: more than a day’s worth of sugar relative to AHA guidance

Adult Men

Adult Women

Children 2-18 years

Children <2 years

6 tsp/day 9 tsp/day HEALTHY FOOD AMERICA 6 tsp/day 0 tsp/day 10 tsp


A 20 ounce soda has 16 tsp sugar -equal to:

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What are sugary drinks?

Energy Drinks

Fruit Drinks

Sweet Iced Tea & Coffee

Soda Sports Drinks



[VALUE]%

[VALUE]% [VALUE]%

[VALUE]%

Black White Overall Hispanic

High School Youth Risk Behavior Survey 2007-2013: 38 states

Black youth consume frequently: two or more sodas per day


Even the youngest children consume too much

31% of toddlers age 12-23 months consume sugary drinks on any given day.



Black and Hispanic and low-income adults consume more sugary drinks


NHANES: NCHS data brief, no 270. January 2017 BRFSS 2013

[VALUE]% [VALUE]

% [VALUE]% [VALUE]

%

<$25,000 $25,000–$49,999 $50,000–$74,999 ≥$75,000

Income Disparities

Percent drinking one or more sugary drinks on a given day

Sugary drinks cause chronic diseases 2 sodas/day for just 2 weeks:

− LDL cholesterol & triglycerides by 20%.

2 sodas/day for 6 months:

− Visceral fat, fatty liver disease.

1 soda/day:

− Risk of overweight/obesity by 55% (children).

− Risk of diabetes by 26%.

− Risk of dying from heart disease by almost 1/3.

− Risk of stroke by 22%.

− Risk of tooth decay by 30% with daily consumption (adults).



Schools in California

o Sale of SSBs at elementary and middle schools prohibited (SB 667 - 2003)

o Sale of SSBs at high schools prohibited (SB 965 -2005)

o Must provide access to free, fresh drinking water in food service areas (SB 1413 – 2014)

o Sale of full calorie sports drinks prohibited (SB 1169 – 2016)


Sugar Reduction Expert Conference: Assessment of 36 sugar reduction strategies

Feas

ibili

ty

Low

Hi

gh

Impact Low High

Source: HFA Summit survey, March 2015 (n=22)


Median quartile


The evidence: Taxes decrease sugary drink consumption Impact of a 1 cent per ounce tax in Berkeley


Falbe et al. Impact of the Berkeley Excise Tax on Sugar-Sweetened Beverage Consumption. AJPH 2016.

-21%

4%

Percent change in consumption among low income five months after tax

Oakland/ San

Francisco

Berkeley


Taxes decrease sugary drink sales Impact of a 1 cent per ounce tax in Berkeley


Silver, et al. PLoS Med. 2017 Apr 18;14(4):e1002283

Taxes decrease sugary drink sales Impact of a 10% tax in Mexico


Colchero. Health Affairs 2017

sugary drink policy – 2017...• taxing sugary drinks is a progressive public policy: o no one has...

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