The Sugar Tax Success – How Global Policies Are Actually Improving Public Health Outcomes.

The shelves in an Oakland corner store today are essentially the same as they were ten years ago. rows of vividly colored cans, the crisp green of Sprite and the recognizable red of Coke. What people are aiming for and leaving behind has changed. Purchases of sugary drinks decreased by almost 27% since the city’s one-cent-per-ounce tax went into effect in July 2017 when compared to comparable cities that never imposed the tax. Policymakers lean forward in their seats when they see a figure like that, which was published in PLOS Medicine.

Observing this across continents gives the impression that something has actually changed. Concerned about its diabetes epidemic and a population that consumed more Coca-Cola per person than almost any other country in the world, Mexico launched it in 2014. In 2018, the UK followed suit with a tiered levy that shocked nearly everyone by subtly pressuring manufacturers to change their recipes before the tax even applied. Ribena was altered. Lucozade was transformed. Fanta was altered. Maybe that’s the point—consumers hardly noticed.

There isn’t a consensus among academics, and there shouldn’t be. Although the amount varied greatly depending on design, a 2022 meta-analysis published in JAMA Network Open that covered more than 45 countries consistently found reductions in SSB purchases after taxation. Higher prices don’t always translate into better health outcomes, according to the Tax Foundation, which is consistently skeptical of excise measures. They point out that consumers occasionally switch to less expensive store-brand alternatives or untaxed sugary snacks. It’s a valid criticism. Any sincere analysis of the data must acknowledge the existence of substitution effects.

The Oakland study did, however, provide something unique. No evidence of people driving to Richmond for their soda or stockpiling candy bars instead was discovered by the researchers. Despite its modest size, the tax appeared to actually lower consumption without causing the workarounds that critics had anticipated. According to health economist Justin White, the cost-effectiveness is comparable to smoke-free workplace regulations, which is a serious comparison considering how revolutionary those laws have been.

Beyond the numbers, the political economy of this is what makes it intriguing. In 2018, California lawmakers effectively froze new local SSB taxes due to pressure from the American Beverage Association. The only places that were grandfathered in were Oakland, Berkeley, San Francisco, and Albany. As a result, these cities have turned into an unintentional laboratory where the people who live there are the subjects of a natural experiment that no one fully agreed to.

It is also important to acknowledge the regressivity argument. Families with lower incomes do spend a larger portion of their income on sugar-filled beverages, which makes the tax more noticeable to them. In response, supporters point out that those same households also have the highest rates of diabetes and heart disease, and that money spent on community clinics and school nutrition is meaningfully reinvested. Depending on where you live, how much you make, and what’s in your fridge tonight, that trade-off may or may not seem fair.

It’s difficult to ignore how frequently the tobacco parallel is brought up in these discussions. Cigarettes weren’t taxed to extinction. Over several decades, they were gradually forced into retreat. Sugar might have a similar trajectory, less dramatic than supporters anticipate and less worthless than detractors assert. The question of whether any of this significantly reduces global obesity is still unanswered as the evidence continues to mount and reformulations continue to be implemented. But for the time being, something is actually happening in Oakland, Mexico City, and Manchester.