Revisiting a tax on sugary drinks

A government report has recommended measures such as a tax on sugary drinks to help tackle the growing burden of diabetes in Australia. There is an important opportunity to link this to oral health.

The House of Representatives Standing Committee on Health, Aged Care and Sport recently handed down their report on the state of diabetes in Australia following an extensive consultation. Although the focus was very much on the prevention, diagnosis and management of diabetes, the scope included the broader impacts of diabetes on Australia’s health system and economy. This is important in the oral health context for a couple of reasons. Firstly, we know there are bidirectional links between diabetes and periodontal disease, so any measures that help to improve diabetic outcomes and in particular glycaemic control will have benefits to oral health. Secondly, reducing sugar consumption is a key driver of diabetes prevention, and that will help reduce the risk of dental caries.

So it was pleasing to see the committee make a number of strong recommendations that, although they are targeted a diabetes, will help to improve oral health.

The first is a proposal for a 20% tax on all sugar-sweetened beverages that have added sugar, including soft drinks, cordial, energy drinks, sports drinks, fruit drinks and flavoured mineral waters, with the levy graduated according to the sugar content. This would bring Australia in line with international best practice on tackling sugary drink consumption.

Not surprisingly the opposition members of the committee did not support this recommendation, and quoted the Australian Beverages Council (the lobby group for the beverage industry) as saying:

“[the UK soft drink industry levy] incentivised many manufacturers to reduce sugar in soft drinks. Some of the cost of the levy to manufacturers and importers was passed on to consumers as higher prices but not always on targeted drinks.’

The opposition view is that a tax on sugary drinks would not have a tangible impact on consumer behaviour. They also argued that this tax would be regressive and therefore have the greatest financial impact on lower income households. However this ignores two key facts – firstly that this is exactly where the greatest burden of disease sits (for diabetes, periodontal disease and dental caries), and so continuing to do nothing is actually contributing to health inequity. Secondly, although sugary drink consumption has broadly been declining over the past few decades, this decline has been slowest in more disadvantaged population groups, with people from low income households and indigenous Australians consuming the most sugary drinks.

Just this week a new study from the UK reported on the impact of a sugary drinks tax on sugar consumption that directly contradicts these claims of ineffectiveness from the opposition and beverages industry. This study found that daily sugar intake for children fell by about 4.8g, and for adults 10.9g, in the year immediately following the levy’s introduction in 2018. This is consistent with other studies in the UK and internationally that have clearly demonstrated that sugary drink taxes shift behaviour and reduce consumption.

There were two other recommendations that would have important benefits in improving oral health. One is to implement food labelling reforms targeting added sugar to allow consumers to clearly identify the content of added sugar from front-of-pack labelling. The other is to regulate the marketing and advertising of unhealthy foods and drinks to children, with a focus on those aged 16 years and under, across television, radio, gaming and online. In addition, there were recommendations to implement a national public health campaign focusing on awareness of the importance of prevention, identification of early signs, and good management of all forms of diabetes. It is important to ensure that these public health messages also include the links to oral health, and the need to include dental care as part of the comprehensive management plan for people living with diabetes.

There is a missed opportunity in not linking some of these issues more specifically to oral health (in the way that the report did link diabetes and obesity) in order to strengthen the case for action, particularly when the report noted that of the $3.4 billion spent on diabetes each year, $555 million could be attributed to dental services – making it the third highest contributor after medication costs and public hospital admissions. Sadly reports like this continue to silo oral health as separate from the rest of the body. A more explicit acknowledgement that tackling diabetes will also improve oral health would have been important.

The ball is now in the government’s court to take action on these evidence-based recommendations to improve health outcomes.

In case you missed it

Have you been listening to the Dental As Anything podcast? You can catch up with previous episodes here (or listen on Spotify or Apple Podcasts), or check-out the top 4 most listened to episodes:

• Episode 4: If in doubt, fill ... dogma, myths and clinical judgement in caries management.

• Episode 5: How will artificial intelligence change dentistry?

• Episode 7: Do we have too many dentists?

• Episode 11: Tongue tied and twisted