Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
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
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
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.
0
5
10
15
20
25
30
35
40
45
1954
1956
1958
1960
1962
1964
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
Gal
lons
of S
oft D
rink
Regular soft drinks
Availability triple what it was 60 years
ago
0
1
2
3
4
5
6Juice drinks Sports drinks
Dramatic increase in sugary drink availability
HEALTHY FOOD AMERICA
Progress, but the decrease may be stalling…
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
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?
HEALTHY FOOD AMERICA
Acceptability & Appeal
HEALTHY FOOD AMERICA
Increase awareness of sugary drinks
HEALTHY FOOD AMERICA
Building Public Awareness: Countermarketing Campaigns
HEALTHY FOOD AMERICA
HEALTHY FOOD AMERICA
Warning labels
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
Board of Health Resolution
ACTION FOR HEALTHY FOOD
Availability
HEALTHY FOOD AMERICA
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
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
Changes in kids meals beverage offerings from 2008-2016
HEALTHY FOOD AMERICA
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
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
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
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
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
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
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
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
SNAP demonstration projects
o Exclude sugary drinks and add healthy food incentives
o Farmers Market subsidies o Minimum stocking standards
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
Working with industry: reformulation
HEALTHY FOOD AMERICA
Affordability
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
Sugary Drink Tax Policy Trends Across the United States
Implemented
Enacted
Philadelphia Boulder
Cook County
HEALTHY FOOD AMERICA
San Francisco Oakland
Albany
Berkeley
Under consideration
Seattle
Multnomah County
Navajo Nation
US Adopted Taxes 8.3 million people
benefitting $342 million per year
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
Berkeley: November 2014
HEALTHY FOOD AMERICA
HEALTHY FOOD AMERICA
• 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
HEALTHY FOOD AMERICA
HEALTHY FOOD AMERICA
• 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
HEALTHY FOOD AMERICA
2016 Tax campaign spending
Philadelphia $11.1M $2.5M Boulder
$954K $822K
Bay Area $30.2M $22.5M
Cook County $80K $95K
HEALTHY FOOD AMERICA
San Francisco Oakland
Albany
> $42 million spent by industry
and counting Source: CSPI
> $26 million spent by advocates and
counting
HEALTHY FOOD AMERICA
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.
HEALTHY FOOD AMERICA
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
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
HEALTHY FOOD AMERICA
HEALTHY FOOD AMERICA
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.
HEALTHY FOOD AMERICA
Effective implementation
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
Contact us! • Get answers to your questions • Technical assistance and support • Tools and resources • Media and communications help
www.healthyfoodamerica.org 206-451-8196
HEALTHY FOOD AMERICA
Extra slides
ACTION FOR HEALTHY FOOD
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.
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
Trends in consumption: Mexico
HEALTHY FOOD AMERICA
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
A 20 ounce soda has 16 tsp sugar -equal to:
Alex
luki
n/Bi
gsto
ck.c
om mikeledray/Bigstock.com
Duplass/Bigstock.com
= =
=
HEALTHY FOOD AMERICA
What are sugary drinks?
Energy Drinks
Fruit Drinks
Sweet Iced Tea & Coffee
Soda Sports Drinks
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
[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
HEALTHY FOOD AMERICA
Even the youngest children consume too much
31% of toddlers age 12-23 months consume sugary drinks on any given day.
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
Black and Hispanic and low-income adults consume more sugary drinks
HEALTHY FOOD AMERICA
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).
ACTION FOR HEALTHY FOOD
HEALTHY FOOD AMERICA
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)
HEALTHY FOOD AMERICA
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)
HEALTHY FOOD AMERICA
Median quartile
HEALTHY FOOD AMERICA
The evidence: Taxes decrease sugary drink consumption Impact of a 1 cent per ounce tax in Berkeley
HEALTHY FOOD AMERICA
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
HEALTHY FOOD AMERICA
Taxes decrease sugary drink sales Impact of a 1 cent per ounce tax in Berkeley
HEALTHY FOOD AMERICA
Silver, et al. PLoS Med. 2017 Apr 18;14(4):e1002283
Taxes decrease sugary drink sales Impact of a 10% tax in Mexico
HEALTHY FOOD AMERICA
Colchero. Health Affairs 2017