By Sir Henry Fraser From CARIBBEAN360

If it were totally up to me, I would raise the cigarette tax so high the revenues from it would go to zero. – Michael Bloomberg (New York mayor)

BRIDGETOWN, Barbados, Monday July 20, 2015 – In an effort to help fight the obesity epidemic in Barbados, the Government announced in the recent budget debate that a 10 per cent tax will be imposed from August 1, on “sweet drinks” – carbonated soft drinks, sports drinks, juice drinks and fruit juices with added sugar. “Beverages containing intrinsic sugars only, such as 100 percent natural fruit juice, coconut water, plain milk, evaporated milk will not be subject to the excise tax.”

The response to this proposal has been interesting. There’s no doubt that Barbadians love sweet drinks – indeed some may well be addicted. There has been little public criticism, although one commentator said it wasn’t going far enough, and that far, far more needs to be done. There has been nothing but praise from the medical and nursing profession and the Healthy Caribbean Coalition. We can’t agree more with that, because our people, like the proverbial lemmings rushing for the cliff, are largely eating themselves to death!

The Associated Press had the remarkable opening statement in a report: “The government of Barbados plans to impose a 10 per cent tax on sugary drinks despite widespread objection from the public.” Where is this widespread objection from the public? Most people have praised it – it’s perhaps the best move since establishment of National Insurance, since so many people seem determined to maim, disable or kill themselves, and are costing the country and their families hundreds of millions of dollars a year to treat the chronic non-communicable diseases (CNCDs).

Taxing unhealthy habits has an impressive track record for taxation on alcohol and tobacco. A large body of research literature provides evidence that raising taxes on these two substances reduces consumption, in many countries, especially in young people and in preventing development of the habit. A thorough review is available by Pacula and Chaloupka in “The effects of macro-level interventions on addictive behaviour” in the journal Sustance Use/Misuse, 2001, Volume 36, pages 1901 – 22. These authors, reviewing the impact of prices and public policies on the demands for tobacco, alcohol and illicit drugs, conclude: “The findings from these studies clearly demonstrate that even addictive behaviours are sensitive to changes in the price of substances being abused. When the full price of the addictive good rises, consumption falls, even among abusers. Therefore, public policies that raise the full price of a drug to a consumer, particularly youth, are likely to result in long run reductions in rates of addiction.”

The crisis of the obesity epidemic and the consequent CNCDs is much talked about today, 35 years after the medical profession tried to get our people to recognise and do something about it. My first research study in Barbados, in 1977, studied the problem of obesity in health care; we found that the prevalence of obesity in female medical outpatients at the Queen Elizabeth Hospital reached 83 per cent in sixth decade women. In a PAHO sponsored conference in 1978, organised by Sir Frank Ramsey, Founder Director of the National Nutrition Centre, Sir Trevor Hassell spoke on the high prevalence of hypertension, Dr. Oscar Jordan on the high prevalence of diabetes, and I on the obesity epidemic.

In spite of increased public health education and comprehensive health care provision, things have got worse, as indicated by repeated studies of the situation. Cathy Foster’s Wildey study in the ’80s, our International Comparative Study of Hypertension (ICSHIB) in 1991-92, the last National Nutrition Study and the recent Health of the Nation Study all confirm the increasing crisis, with more victims among teens and younger adults. The logical response is therefore to take note of the evidence and focus far more on prevention and on public health interventions such as taxation.

The Health of the Nation (HotN) study is a partnership between our Ministry of Health and the Chronic Disease Research Centre, to study the prevalence and social determinants of risk factors for CNCDs. Data were collected from more than 1200 adults over 25, and weighted to balance the age/gender distribution of the 2010 population census. Results have been reported, but here are the key findings:

The most alarming fact is that two out of every three adults, and three out of every four women, are overweight and/or obese. Also, more than one in three adults, and more than half of those aged 45 and over, are hypertensive, while one in five or 20per cent have diabetes! This figure rises to half of those 65 and over. And one in three of those with known high blood pressure or diabetes, receiving treatment, had poor control – hence the distressing fact of nearly two strokes occurring every day!

Daily tobacco use was only reported by one in 10 men (thanks to years of advocacy by Dr. Tony Gale) and one in 50 women. Reported excess weekly alcohol intake was similar, but binge drinking in men was much more common – one in three men aged 25 to 44.

Finally, fruit and vegetable intake was low, while half of the sample reported low levels of physical activity – similar to the previous National Nutrition study. Education and exhortation has not improved that either!

As a nation, we are not learning to look after our health. Which leads to another question: Are we learning anything at all about our economic health? Are we learning, with our increased debt, from the Greek crisis? The causes of their bankruptcy are the usual – low productivity, non-payment of taxes and alleged corruption. How different are we? Are we learning? And has anyone calculated the economic cost of last week’s disruptions, and the potential cost to the nation of a national shut-down? Are we happy with “junk status” or will we all work harder, party less, import less, and reduce, re-use and re-cycle?

Sir Henry Fraser is past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine. Website: profhenryfraser.com

For more on this story go to: http://www.caribbean360.com/opinion/sweet-drinks-tax-and-the-health-of-a-nation-sir-henry-fraser#ixzz3gXD6u8H1