Sweet makes sick

Last month the Government took a crucial step to making Sri Lankans healthier by introducing a colour labelling system for sugary drinks that is targeted at reducing consumption. Expected to go into effect at the beginning of August, officials are struggling to get companies to comply with even this basic measure. Elsewhere around the world countries have stepped up the fight against sugar, but studies show comprehensive policies are the most successful. Should a sugar tax be the next step?

Unfortunately it is human nature to want what is bad for us, so few people will take the initiative to be healthy. Locally as much as 85% of ill-health can be traced back to Non Communicable Diseases (NCDs) such as diabetes, cancer, high blood pressure and kidney diseases among others, mirroring a developed country. Also there is indication that poorer people are more likely to be affected by poor diet choices then wealthier members of society.  

Sugar is widely available and cheap. Over the last decade, global sugar consumption has grown from about 130 to 178 million tonnes as companies use sugar in pretty much any food item. The World Health Organization’s (WHO) sugar guideline, issued in March 2015, recommends that adults and children restrict their sugar intake to less than 10% of total energy intake per day, which is the equivalent of around 12.5 teaspoons of sugar for adults, and suggests a further reduction to below 5% of total energy intake per day.

Effective, feasible policy actions are available for governments to reduce the availability and affordability of sugar and sugary products, influence the acceptability of alternatives and raise awareness about the sugar contained in products in an effort to move towards meeting the WHO sugar guideline.

Examples of actions which have had these effects include school nutrition standards in Queensland, Australia; a vending machine ban in France; a front-of-package symbol that led to product reformulation in the Netherlands; soda taxes in France and Mexico; a programme targeting retail environments in New York City, USA; a programme promoting increased water consumption in schools in Hungary; school fruit and vegetable programmes in Netherlands and Norway; a healthy marketing campaign in Los Angeles County, USA and a comprehensive nutrition and health programme in France.

Experience from officials implementing these policies and pilot programmes provides important insights for governments to help them design more effective policies to reduce sugar intake in the context of broader dietary improvements. Insights include the need for measurable indicators of change; engagement, incentives, and/or clear standards for entities involved in the manufacture and delivery of food; actions to inform stakeholders about the broader benefits of reduced sugar consumption; clear and understandable messages for consumers, and synergistic, complementary actions.

A comprehensive approach is needed to reduce sugar consumption at a population level. Part of this comprehensive approach should be dialogue with stakeholders in the sugar supply chain to identify what ‘upstream’ actions can be taken to reduce the supply and demand for sugar, taking into consideration the economic impact of such actions. 

Given the relatively low health spending of 4% of GDP, NCD care in Sri Lanka is increasingly financed by out of pocket spending by the general public. Tackling NCDs in South Asia early on with better prevention and treatment would significantly spare poor people from the crushing burden of poor health, lost earnings, deepening poverty and the risk of disability and premature deaths. Clearly the Government has to sweeten the deal in more ways and apply the stick when needed.