The World Health Organization is backing a controversial remedy to reverse the global rise in obesity and type 2 diabetes — a 20% to 50% soda tax.
The recommended tax should not be limited to soda, the WHO said Tuesday. It should apply to all sugar-sweetened beverages, a category that includes sports drinks, energy drinks, fruit punch, sweetened iced tea, vitamin waters and lemonade.
"If governments tax products like sugary drinks, they can reduce suffering and save lives," Dr. Douglas Bettcher, director of the WHO's Department for the Prevention of Noncommunicable Diseases, said in a statement.
The World Health Organization, the public health agency of the United Nations, said the reasons to act were clear. More than half a billion of the world's adults are now obese, including 11% of men and 15% of women. Those rates are more than double what they were in 1980. In the United States, 34% of men and 38% of women are obese, which is defined as having a body mass index of 30 or above.
People who are obese have an increased risk of heart disease, the leading cause of death in the U.S. They also are more likely to develop certain types of cancer, including breast cancer, colorectal cancer, renal cell cancer, esophageal adenocarcinoma, endometrial cancer, gallbladder cancer and thyroid cancer. The risk of stroke and type 2 diabetes also rises with BMI.
The WHO cited the steady rise of diabetes as a primary reason for a sugary drink tax. Worldwide, an estimated 442 million people live with the chronic disease, which caused 1.5 million deaths in 2012. More than 76,488 Americans died of diabetes in 2014.
In a report released Tuesday, WHO officials say that consumption of added sugar is the root of these ills. This includes not just table sugar but the honey, syrups and fruit juice concentrates that find their way into processed foods.
"Nutritionally, people don't need any sugar in their diet," Dr. Francesco Branca, director of the WHO's Department of Nutrition for Health and Development, said in the statement.
With this in mind, global health officials have been calling on people to limit the amount of added sugar in their diet to less than 10% of total calories. Even better would be to keep it below 5% of total calories. For an adult with a healthy weight, that works out to about six teaspoons of sugar per day. (To keep that in perspective, a 12-ounce can of Coca-Cola contains the equivalent of nearly 10 teaspoons of sugar.)
A soda tax would help people meet this goal, the WHO argued in a 36-page report. When sugary drinks are more expensive, people will buy less of them. That means they'll consume less, too.
Economic research suggests that a tax would have to raise the price of sugar-sweetened beverages by 20% to 50% in order to make most people unwilling to buy them, according to the report. In coming to this conclusion, the authors reviewed studies of food and drink taxes implemented in Denmark, Ecuador, Egypt, Finland, France, Hungary, Mauritius, Mexico, the Philippines, Thailand and the United States.
"The greatest impact was on lower-income, less-educated younger populations and populations at greatest risk of obesity," the authors wrote.
The most effective taxes are likely to be excise taxes, which are levied on a specific amount of a certain product or ingredient. This would eliminate the incentive for manufacturers to simply switch to less expensive sweeteners in order to shield consumers from higher prices, according to the report.
The report also recommended the use of subsidies that would reduce the price of fresh fruits and vegetables by 10% to 30% to encourage people to buy them.
Implementing soda taxes won't be easy, the report authors acknowledged.
"The beverage industry will do everything it can to avoid taxes, using the same well-financed — and well recognized — scare tactics used by the tobacco industry," they wrote. In particular, they cited the industry's efforts to fight proposed taxes on sugar-sweetened beverages in San Francisco and Berkeley in 2014, pouring more than $10 million into their campaign and outspending tax proponents, 18-1.
Advocates for soda taxes should expect arguments related to fairness (consumption taxes are a bigger burden for poor than rich people), freedom (the government shouldn't interfere with your personal choice of what to drink), trust (officials won't spend the tax revenue the way they say they will) and economics (small business will be harmed if taxes discourage sales). But the report authors emphasized that this onslaught "can be overcome with a well-planned campaign involving a broad coalition of supporters … and sufficient resources."
Consider Berkeley, where a tax on sugary drinks passed with 75% of the vote. A study this summer in the American Journal of Public Health found that five months after the penny-per-ounce tax passed, consumption of sugar-laden drinks had fallen 21% among low-income Berkeley residents. Meanwhile, consumption rose 4% in neighboring Oakland and San Francisco, where there was no such tax.
Places like Berkeley "are showing that taxes on sugary drinks are effective at driving down consumption," said Michael Bloomberg, who tried to implement a ban on super-sized sugary drinks when he was mayor of New York and now serves as a WHO global ambassador for noncummunicable diseases.
"The World Health Organization report released today can help these effective policies spread to more places around the world, and that will help save many lives," Bloomberg said in a statement.
The International Council of Beverages Assns., on the other hand, said soda taxes were "discriminatory" and too simplistic to address "the very real and complex challenge of obesity."
As the authors of the WHO report predicted, the industry group argued that such taxes pose an unfair burden on poor people.
"The committee members have lost sight of the real-world implications of these type of recommendations," the association said in a statement. "In Mexico, for example, 10,000 jobs were lost and those who could least afford it carried the burden of the tax, all for a minimal decrease of fewer than 6 calories per day out of a diet of 3000 calories."
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2:55 p.m.: This article has been updated to include reaction from the International Council of Beverages Assn.
Oct. 12, 2:40 p.m.: This article has been updated to reflect the report's discussion of barriers to implementing a tax on sugar-sweetened beverages. It also includes comments from Michael Bloomberg.