Public Health Leaders Propose Soda Tax

Sept. 17, 2009— -- Several of the nation's leading health experts are calling for a tax on soda as a means of curbing America's obesity-epidemic.

Their paper, appearing in the most recent issue of the New England Journal of Medicine, calls for a tax on "sugar-sweetened" drinks in order to reduce the consumption of the drinks and lower health costs as well as fund government-run health programs.

"A tax on sugar-sweetened beverages is really a double-win," said Dr. David Ludwig, a co-author of the paper and director of the Optimal Weight for Life program at Children's Hospital, Boston.

"We can raise much-needed dollars while likely reducing obesity prevalence, which is a major driver of health care costs, the paper states. "Ultimately the government needs to raise more money to cover the deficit, and in terms of ways of raising that revenue, a tax on sugar sweetened beverages is really a no-brainer."

Such a tax has been proposed in the past. In a perspectives article in the New England Journal this past April, Kelly Brownell of Yale University, one of the current paper's authors, along with then-New York City health commissioner Dr. Thomas Frieden, co-authored an article advocating a tax on "sugared beverages."

Frieden has since become head of the Centers for Disease Control and Prevention. A spokesman for the CDC noted that taxing sweetened beverages is not part of the current administration's position. However, in at a conference on obesity in July of this year, Frieden responded to a question on the issue saying:

"I think anything that increases the availability and decreases the relative price of healthy foods and anything that decreases the availability and increases the price of unhealthy foods is likely to be effective. The challenge, I think, is a political one of getting that approved as well as there are very important administrative and operational issues with implementation of such a tax."

Frieden's successor in New York, Dr. Thomas Farley, is one of the authors of the current paper.

Ludwig noted that the authors focused exclusively on beverages that contained sugar, and not diet substitutes for sugar.

"The evidence is much stronger for sugar sweetened beverages than diet beverages," he said. "It's not to say that the question of diet beverages isn't interesting and important, and there is much research going on."

But while many public health advocates support a sugared-beverage tax, the idea has drawn concern and outright opposition.

"If your goal is to reduce obesity, this won't work, because most people won't stop drinking soda," said Richard Williams, managing director of the regulatory studies program and government accountability project at the Mercatus Center at George Mason University. "You can't change people's taste buds."

While acknowledging the cost difference, he said he didn't think it was likely that people would turn away from soda as quickly as hoped.

"I don't think it's necessarily true that the poor haven't heard that water's cheaper than soda," said Williams.

Martin Binks, director of behavioral health and research director of the Duke Diet and Fitness Center, expressed skepticism that a taxation and health education program would achieve its goals.

"I would fear that without a concentrated commitment to educating the public about healthier options that the choices made may shift away from high caloric beverages -- yet land on equally unhealthy alternate choices," he said in an e-mail to ABC News.

Noting that "fast food, candy bars and countless other snack foods are likely equally culpable," Binks concluded that "Of course, any approach would require careful thought and planning -- but it seems that focusing discouraging single food classes is not the answer to such a multifaceted issue."

Is Drinking Coke Like Smoking?

Most doctors contacted by ABC News expressed approval of the idea of taxing sugary drinks.

"I strongly agree. It will clearly take public health measures with some teeth to tame the obesity crisis," said Dr. Ken Fujioka, director of nutrition and metabolic research at Scripps Health in San Diego.

"I think it's a fine idea," said Dr. Meir Stampfer, a professor at the Harvard School of Public Health, although he noted some of the authors are colleagues and friends. "The head of Coke likened this to the Soviet Union, but there is plenty of precedent for taxation like this."

The most common analogy drawn by advocates and opponents of the measure is to smoking, which has been taxed heavily.

Doctors affiliated with the study say the beverage industry has manipulated public opinion to oppose a tax.

"I think the main opposition comes from the sugar and soft drink industry, which has apparently engaged in a multimillion-dollar lobbying campaign to oppose this effort," said Ludwig.

The beverage industry has countered that such taxes undermine personal choice.

"A tax will cause real harm to hard-working American families at a time when they are already struggling to stay afloat during a recession," said Susan Neely, president and CEO for the American Beverage Association, in a statement issued Wednesday. "The American public views it as an over-reach when the government tries to tell them what to eat and drink."

Some researchers argued that tobacco is not an apt analogy.

"I think steep taxes on foods are problematic, because even 'bad' food is not tobacco," said Dr. David Katz, director of medical studies in public health at Yale University. "Tobacco can be avoided altogether -- and indeed, should be -- and thus, steep taxation is justifiable. Food cannot be avoided, so it comes down to choices -- and taxing people into choices is fraught with challenges and hazards."

While many states currently have taxes on sugary drinks, the authors of the paper say that such taxes are not high enough to effect change in dietary patterns.

Taxes on sugary beverages appear to be favored by a slight majority of Americans. In a Kaiser Family Foundation poll in August of this year, 53 percent of respondents favored an increased tax on soda and sugary drinks, while 44 percent were opposed to such a measure.

A Small Part Of A Larger Problem

Despite some support for the tax, other researchers questioned whether it would work at all.

"I don't see how anyone would go with attacking the beverage industry and taxing a single food, and I don't think the evidence is there to support taxing a soft drink," said Theresa Nicklas, an epidemiologist at the Baylor College of Medicine. "Why are we targeting sweetened beverages? What about Twinkies, what about happy meals, what about chocolate candy?"

Instead, she said, efforts needed to be focused on education and self-responsibility.

"We should spend our money on educating the public on ways in which they can maintain a healthy weight, teach our children how to live a healthy lifestyle. Certainly taxing soft drinks is not a way to teach our children how to live a healthy lifestyle," said Nicklas. "Where does self-responsibility come in? Why can't people take some of the responsibility for their health and making healthier choices?"

Nicklas said drinking soda and other sugar-containing beverages only accounted for a small part of what makes a person obese.

On that point, she had some agreement with doctors who supported the tax, but said it was just one step.

"It is not the only solution, but as for smoking, it is one part of the effective plan," said Madelyn Fernstrom, director of the University of Pittsburgh Medical Center's weight management center.

She disagreed with Nicklas, however, on the role of sugary drinks in obesity.

"There is ample evidence that liquid calories contributes to the obesity epidemic -- not the only cause, but one of them," said Fernstrom. "So, a plan to try to alter change 'in the wallet' is a good one. In our country, people seem to respond to that kind of plan."

Katz agreed that taxes would help, but only provide part of the solution to obesity.

"Note that just as taxes are at best a small part of the solution, soda is, at worst, a small part of a very pervasive problem, often referred to as the 'typical American diet.'"