The obesity crisis is costly. Sustainable Transformation Partnerships (STPs) are currently in the early phases of system-wide transformation of services. They are focusing, amongst other things, on shifting patient activity, financial balance, workforce pressures and new roles and ways of working. Alongside these strategies, prevention has been identified as key to both maintaining the health of the population and reducing long term pressures on the system. One of the key battle lines drawn is in relation to our diets in the bid to fight the increasing prevalence of obesity. Prevention is really the only way to win this expensive fight.
The obesity crisis has been a constant presence in the news and on the agenda of the Government. According to the ONS, 58% of women and 68% of men are overweight or obese. NHS England has said that in 2016 the direct spend on diabetes and other conditions related to being overweight or obese was £16bn – and estimates suggest these numbers are only set to rise. We simply cannot afford not to act.
Did the sugar tax set a precedent for a fat tax?
In 2016, in a bid to combat some of the factors that contribute to obesity – particularly in children – we saw the announcement of plans for sugar tax. This looked to levy an additional charge of up to 24p per litre on fizzy and sugary drinks in an effort to reduce our reliance on these ‘unhealthy’ options. Whilst the tax is set to come into effect in 2018, the drinks industry has already begun to make significant efforts to reduce the sugar content in many of its products.
In August we saw a further declaration in this prevention drive. Public Health England (PHE) announced that targets are to be set to reduce calories in pizzas, burgers and other ready meals as part of the Government's drive to tackle child obesity in England. The measures were needed because health officials believe we on average are consuming 200 to 300 calories a week more than we need – that adds up to 17,000 calories a year!
PHE’s announcement signalled tougher targets and guidelines, yet did not go as far as legislation or taxation. But with the precedent set on sugar, will the next step be a fat tax?
Do taxes and bans work?
Its too early to gauge the impact of the sugar tax as a measure of influencing public health behaviours – it is not due to come into effect until 2018. Tax on tobacco has steadily increased in recent decades and there is general consensus that it has significantly contributed controlling its uptake and use. The public places smoking ban (implemented in 2007) has also helped to continue to drive down the prevalence of smoking but this was a different approach and therefore limited parallels can be drawn.
When assessing the merits of a fat or calorie tax, policy makers need to be aware of potential unintended consequences. In particular, the impact it would likely have on disadvantaged groups, with a stark correlation between those who are overweight and those who are on lower incomes. Conversely, those who are already healthy tend to be better educated and more middle-class, and less likely to be affected financially by the tax.Experts have said that for a fat tax to work, the price of unhealthy food and drinks would need to increase by as much as 20% in order to cut consumption by a sufficient amount. For a typical family this could add up £520 a year to their shopping bill – likely to be a difficult and unpopular measure. The Government will therefore need to be careful to ensure they are not ‘punishing’ those already on lower incomes with a further tax on their lifestyles.
Whilst taxation policy is one way to address the crisis, there is evidence that other measures may be more effective when it comes to childhood obesity prevention in particular. Public Health England recently identified two initiatives that would most support prevention of childhood obesity. These were (1) banning price promotions on junk food, and (2) restricting advertising of unhealthy foods prior to the TV watershed. These would be highly effective in reducing ‘pester power’ and it has been said that restrictions on junk food adverts before the 9pm watershed could more than halve children’s exposure to them. Neither of these two initiatives appeared in last year’s Childhood Obesity Strategy however.
Should we expect a fat tax in the short term?
So far, the Government has proved reluctant to act with a multitude of direct taxes in the fight against obesity, preferring to use ‘carrots’ to softly influence behaviour. It seems likely the Government will use the sugar tax as a test case, monitoring its effectiveness in changing behaviours over time. It will want to wait to understand the reception and impact before looking to further forceful intervention – which would likely be in the next Parliament. Public Health experts will be watching the outcome of the sugar tax closely to see whether it is the pre-cursor to wider tax schemes aimed at reducing calories and fat content consumed. However those claiming this misses a trick and that the real attention should focus on marketing and promotions have a point. The approach needs be to be multi-pronged focusing on taxation, regulation and education. Whether Government will seek to push the regulatory elements through despite opposition from the food and retail industries remains to be seen – it may need to get tougher if it wants to prevail in this battle.
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