The Ministry of Public Health is proposing a tax on sugary drinks, also known as sugar-sweetened beverages (SSBs). This move has been controversial. It shouldn't be.
SSBs are a major contributor to being overweight, diabetes and other serious diseases as well as to tooth decay. By taxing SSBs, the government intends to discourage their consumption which will, in turn, improve public health.
A National Health Examination Survey estimated that 19 million Thais are overweight; this problem is reaching epidemic proportions. In 1991, 8% of men and 16% of women were overweight in Thailand. By 2014, that proportion had increased to 33% and 42% respectively.
Why does this matter? It matters because being overweight increases one's likelihood of having a heart attack, stroke, diabetes or cancer. These non-communicable diseases (NCDs) already kill almost 1,000 Thai people every day. The economic impact from these and other NCDs in Thailand was estimated at 280 billion baht per year -- a staggering amount.
There are two reasons why the proposed tax is on SSBs is important for the health of Thais.
Firstly, SSBs are contributing to the overweight epidemic. A large study of 60,000 Thai university students between 2005 and 2009 found that drinking SSBs led to weight gain. The study noted that the more students drank SSBs, the more weight they gained during the study period. Students who drank SSBs at least once a day gained 0.5kg more than those who consumed SSBs less than once per month.
SSBs are uniquely damaging because they are high in calories and poor in nutrition. A normal sized can of SSB (330ml) contains up to 35 grammes (around nine teaspoons) of "free" sugars; about 140 calories with no nutritional value. Furthermore, consumers generally don't eat less of other foods to compensate for the extra calories consumed by SSBs. This leads to excess calorie intake and weight gain.
In fact, Thais consume on average 26 teaspoons of sugar per day -- much more than the upper limit of 12 teaspoons recommended by the WHO. The proportion of sugars consumed derived from SSBs has increased from 15 to 25% over the past 15 years.
The tendency of children to be overweight is particularly concerning. Being overweight not only can affect a child's immediate health, educational attainment and quality of life, but an overweight child is likely to become an overweight adult who is at risk of chronic illness and premature death. SSBs are inappropriately and aggressively marketed to children and adolescents through such mechanisms as "fortune games", an incentive-based marketing strategy which offers prizes to stimulate higher consumption.
Secondly, we know taxes work to discourage unhealthy consumption of SSBs. Mexico implemented an excise tax of 10% on SSBs in January 2014 and saw sales of taxed beverages fall by an average of 6% by the end of the year. The full impact of this reduced consumption on public health is still being evaluated. However, that has not hindered uptake -- France, Hungary, South Africa and several states in the United States of America have all introduced SSB taxes as well.
By introducing such taxes, the government sends a message to the public that the consumption of SSBs is unhealthy and discouraged. Importantly, SSB taxes can prompt the food industry to reformulate food products thus providing consumers healthier options for beverages. Additionally, SSB taxes generate revenues that the government can use for improving public health.
The Ministry of Public Health's proposed tax on SSBs seeks to introduce a two-tier excise tax on SSBs -- the retail price of drinks containing more than 6g per 100 ml of sugar will go up by 20% of the retail price. Drinks with 10g or more of sugar per 100 ml will go up by 25%. The tax will cover a wide range of packaged and bottled SSBs including carbonated drinks, coffee, green tea, energy drinks fermented milk, soy milk and juices. The proposal also includes a ban on the aforementioned "fortune games".
A multifaceted and multisectoral approach is needed to tackle rising prevalence of overweight in Thailand -- government, parents, caregivers, civil society, schools as well as the private sector all need to take responsibility and action. SSB taxation is an important tool to reduce overweight in the population; other recommended interventions include subsidies for healthy alternatives, raising public awareness on healthier diet and physical activity, food labelling that enables consumers to more informed decisions, and restrictions on marketing of unhealthy food and beverages to children.
Preventable non-communicable diseases are killing Thai people every day. Being overweight is an important contributing factor.
No single intervention can halt the growing epidemic of overweight, but the government's proposed tax on sugar sweetened beverages will firmly ensure Thailand is heading in the right direction.