Monthly Archives: July 2017

What Health Professionals Need to Know about Sugar Taxes

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Calls for taxes on sugar-sweetened beverages (SSB) by health professionals and advocates continue to occupy news headlines. Many of these commentaries rely extensively on emotional justifications for implementing these taxes as a public health measure to prevent weight gain, diabetes and cavities.

Taxes on sugar sweetened beverages are not new and have been implemented in many areas in many different ways. In theory, this sounds like a great idea, but what is the actual evidence that they meaningfully impact public health?

Theoretically, given a large enough excise tax on SSB, consumption levels decrease, leading to significant improvements in weight and obesity rates. In Mexico for example, one analysis estimates that a SSB excise tax may have resulted in a 7.5% average reduction in SSB consumption, with the greatest decrease among households at the lowest socio-economic level, while an analysis of 15 cities in the United States that have implemented an excise tax on SSB estimates that the incidence of diabetes could potentially decrease by 6% within a year of the tax reaching its full effect. However, the estimates from these economic models only predict a decrease of less than one pound of body weight, with no real improvement in health. Furthermore, empirical evidence of self-reported soda consumption did not significantly change after Berkeley, CA, implemented its tax on SSB as people shifted their purchases to neighboring counties or online vendors. This may be because demand for sugar-sweetened beverages tends to be slightly inelastic among the general population when prices increase, meaning that price does not significantly influence a consumers decision to purchase them.

But at what cost? Are the actual changes in consumption or health outcomes substantial enough to be considered worthwhile? How sustainable or long-lasting are these improvements? And are there other programs or policies that would lead to more significant health outcomes and have a societal or individual cost that is equivalent to or lower than a sugar tax?

It is important to remember that while sugar taxes may be associated with improved weight status at the population level, there is no evidence that they cause improvements in actual health status. One reason may be because lifestyle choices contribute to less than a quarter of one’s of current health status and sugar-sweetened beverage consumption is just one of many lifestyle variables. A greater proportion of an individual’s health risk is due to social determinants of health such as one’s social environment, physical environment/total ecology, and health services/medical care.

Focusing the health conversation on taxing sugar-sweetened beverages may actually be distracting efforts to take action in addressing more substantial causes of poor health like low wages, poor housing conditions, access to affordable healthy food, violence and trauma, systemic oppression, and quality healthcare. Increasing the price of SSB may deter consumption of these products, but it does nothing to increase access to affordable healthy food or healthcare services in the communities that are affected most by food insecurity and diet-related health issues. Policy alternatives, like subsidizing the cost of fruits and vegetables, and investing in community-based food systems would do more to improve access to healthy choices–without the need to penalize people for taking pleasure in a sugary beverage now and then.

While the case of Mexico shows that a SSB tax may reduce consumption of the taxed beverages, they also estimated a 2.1% increase in purchases of un-taxed beverages due to the substitution of SSB with other products like juice, milk, diet soda, and even alcohol. While certain substitutions may be beneficial, a focus on decreased consumption of SSB and changes in BMI are too narrow to be meaningful. Without empirical evaluations of the SSB tax impacts on actual health outcomes, it is difficult to determine if the tax is actually worthwhile in achieving anything more than imposing administrative costs on society and placing an unnecessary burden on the individual autonomy of both healthy and unhealthy individuals.

Unfortunately, few studies have empirically evaluated the effects of taxes on sugar-sweetened beverages and the evidence that they improve public health measures is limited. Many studies in this area rely on econometric modeling rather than measuring peoples’ actual behavioral response to the tax. Before getting on the SSB tax band-wagon, health professionals should advocate for more extensive empirical research in this area as a way to promote evidence-based policy decisions in public health.

Related: Junk-food Taxes: Do They Work?

Self-determination and Resiliency: The Case for Community-based Food Systems

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There are no unicorns, and there are no unicorn foods. This was the analogy given by an agricultural economist speaking on a panel about the future of our food system in reference to the fact that we as humans have multiple, and sometimes conflicting, values and needs that cannot be met by one perfect food. Since no one food, or one food system, is likely to live up to meet all of our needs, we ultimately need to make decisions and prioritize what is most important to us. Personally, I have oscillated through periods of shopping at farmers’ markets and supporting local food systems, and also periods of relying on grocery store chains to deliver the most convenient and economical source of daily sustenance. After the book Dark Money, by Jane Mayer, landed on my reading list this past summer, my commitment to community-based food systems once again strengthened as I reflected on the themes of self-determination and economic diversity.

Dark money is a detailed history that tells the story of a wealthy network of capitalists who have organized and funded a strategy to promote a neoliberal policy agenda aiming to capture the state and impose a new order around corporate interests. This strategy is designed by powerful business leaders to influence public opinion in support of policies that seek to privatize public goods, erode environmental and safety regulations, and suppress wages and labor rights, ultimately boosting corporate wealth and power at the expense of the public. Organizations, like the Koch Foundation, use their tax-exempt foundations to channel money to tax-exempt non-profits that champion their cause through research, advocacy, and public education. Or, as Kari Polanyi Levitt and Mario Seccareccia put it in their erudite commentary on the subject, these foundations foster the “proliferation of neoliberal think-tanks and other such lobby groups, often masquerading as research institutes that can hijack government policies at the local and national levels and end up almost as in camera advisors to elected representatives.”

This brings me back to our food system. Our predominate, commodity-based, food system has contributed to a dietary pattern disproportionately skewed toward a handful of artificially low-priced foods, namely wheat, corn, and processed meat products. Even within types of foods, variety has decreased. The varieties of cabbage grown, for instance, have decreased from 544 in 1903 to just 28 in 1983. In part, this has to do with innovation in seed production that provides farmers greater certainty in the quality of their product. But it is also the effect of a more highly consolidated food system that demands homogeneity in appearance and transport hardiness. All of this is associated with negative impacts on public health. While this system is arguably highly efficient in delivering calories, it is limited and fragile in its ability to provide workers with a living wage and ensure access to a diverse range of appropriate foods for large segments of the population. Further, its resilience over the long-term is questionable.

Resiliency in the food system consists of three key dimensions: (1) the diversity of the food system’s components, (2) the degree to which the components are connected, and (3) the degree of decision-making autonomy within the food system. Significant consolidation of the food system decreases the diversity of its components, including the varieties of foods grown, production methods, distribution channels, employment options for workers. Alternatively, community-based food systems support a wider base of farmers and value-added producers. These smaller, more diverse, networks increase farmer autonomy while building sustained relationships and shared responsibility for investing in the health and prosperity of the community. For example, the New South Produce Cooperative and Grassroots Farmer’s Cooperative in Arkansas connect members to distribution networks, provide technical assistance, and help small farmers raise capital as a collective. This wider base of producers also leads to more diversity in crop varieties, production methods, and employment options that are adapted to local conditions and cultures.

If degree of decision-making autonomy among a broad base of producers is a key component of a resilient food system, this brings us back to reflecting on the systematic erosion of public voice resulting from the extreme neoliberal agenda described in Dark Money. Because of the substantial wealth large food companies have accumulated in relation to workers and consumers, they now have a more influential political voice than the majority of citizens. Eroding the impact of citizens’ political voice creates a more controlled environment in which farmers and other food producers may find themselves with limited autonomy over their production and distribution decisions. With limited competition in the industry and few places to look for more favorable contracts, more and more decisions are instead dictated by corporate interests (whether or not it is beneficial for the farmer or local community). Operating under such conditions leaves the base of our food system vulnerable to shocks, disincentivizes innovation, and makes it difficult to adopt beneficial practices critical for adaptation.

When an industry becomes too concentrated and competition is diminished, politically powerful companies tend to rely on “special political privileges” rather than invest in the human, social and financial capital creation to build the adaptive capacity required for innovation, ultimately hindering their resiliency and ability to consistently provide stable levels of appropriate foods to the public. Farmers’ markets and locally-owned shops may not prove to be the most efficient way to produce and distribute food. But it can be an efficient way to produce and distribute a portion of our food if we re-define efficiency to account for alternative values like autonomy, civic participation, fairness, and long-term resiliency. So, at least for now, I’ve once again circled back to grocery shopping at farmers’ markets and local shops like my right to self-determination and democracy depend on it.

10 Ways to Connect your Worksite with Local and Regional Foods

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10 Ways to Connect your Worksite with Local and Regional Foods

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Creating a worksite environments that support healthy eating habits by linking employees to their local and regional food cultures is an important multi-level wellness strategy. By making it convenient for employees to choose foods that are both healthy and enhance the economic diversification of their community, your employees and your organization contribute to the overall well-being of your community. Many strategies for encouraging local and regional foods can be easily implemented in worksites of all sizes.

  1. Local Food Atlas: Many regions have created local food atlases to help people identify the farmers in their area. This can be a great resource to hand out at the worksite to help employees learn where they can purchase local foods. For example, check out the Central WI FarmFresh Atlas here.
  2. Cooking workshops and tasting events: Cooking events and workshops that feature local foods are great ways to introduce people to new cooking skills and new foods. If space is limited, try connecting with local farm vendors or organizations to have an off-site lunch and learn.
  3. Volunteer days: Provide employees with volunteer hours that they can use to support local food events in your community
  4. Host Community-Supported Agriculture (CSA) open house: Each spring you could host a farmer meet and greet so employees can meet local farmers, learn about their products, and sign up for a CSA.
  5. List of CSA drop points: Distribute information about CSAs in your area and nearby drop points each spring to encourage employees to sign up.
  6. Become a CSA drop point: Having a CSA drop point within your organization is a great way to make CSAs more convenient for your employees by eliminating “one more stop” from their after-work to-do list.
  7. Farmers’ market walks: If your workplace is within walking distance of a weekday farmers’ market, schedule a break-time or lunch-time walking routine to pick up fresh fruits, vegetables and flowers.
  8. CSA subsidies: Check with your health insurance about offering a rebate for CSA participation, or provide employees with a subsidy to help cover their CSA and increase their fresh fruit and vegetable consumption.
  9. Compost bins, food residuals: Local foods do not end at the plate. Food residuals (often referred to as food waste) are an important part of the local food cycle. There are many great ways to collect food residuals in the office and compost them for use in the organization’s landscaping or returning it to the CSA vendors in your community.
  10. Set up a farmers’ market onsite: Consider if there is a need for a farmers’ market vendor or two in your area during the day. Easy access to a farmers’ market is a convenient way for employees to access local foods and great way to boost morale.