A Coke, a smoke and policing behaviour: When taxes and public health collide

This week's Newfoundland and Labrador budget contained two tax measures the provincial government is making that connect to public health.

One was quite controversial, with angry reactions that had people accusing the Liberal government of attacking or shaming the poor.

The other caused barely a ripple.

The difference in reaction may have something to do with the difference in attitudes about policing particular behaviours, and how much or not the public understands about the dangers of particular behaviours.

The first measure is the brand new tax on sugary drinks, which quickly got dubbed the "Pepsi tax." The government will charge 20 cents on every litre of sugar-sweetened beverages, although exactly how that is going to work has not yet been worked out. We also don't know which beverages will fall into that tax, as there are plenty of products out there why hello, Tim Hortons Iced Capp or Starbucks Frappuccino that have sugar in them, beyond a tin of Pepsi to die for.

Well, that one got people going. Any new tax will raise someone's dander, but this one really annoyed people. Words like "elitist," "classist" and "anti-poor" flooded social media.

The second measure, though, didn't create much of a stir at all. The government hiked the cost of cigarettes by three cents each. (Tobacco by the pouch is up six cents a gram.)

Whereas the sugar tax won't kick in until the next fiscal year it's going to take a while to figure this one out the tobacco hike is already in effect.

That's because governments have been taxing tobacco, and aggressively, for many years. We're so used to it that a new change doesn't matter.

Sugar taxes, though, are relatively new at least in terms of what governments are doing to curb the intake. Not many governments have introduced such a tax yet, which means there is not a lot of data yet to prove whether it's effective.

But the idea of a sugar tax is far from new. I know this, because I've worked on stories about it for years. In 2003, Iand colleagues in St. John's launched a show called Food Chain, which aired on the CBCdigital channel then called Country Canada, now called Bold. (Never heard of the show? Don't worry; we joked that we were in the witness protection program, because no one knew where we were.)

In any event, proposals for sugar taxes were already in the air, as many nations were staring at skyrocketing rates of childhood obesity and similar health crises, and clinical experts were calling for actions to turn around a problem that seemed to be out of control.

A generation later, all those problems not only still exist, but have gotten worse.

Excess sugar 'a health hazard': MD

Dr. Tracey Bridger is blunt about this.

"I definitely consider excess sugar consumption a health hazard, and there's great evidence to support that," she told CBC's St. John's Morning Show on Friday.

A pediatric endocrinologist in St. John's, Bridger has patients with serious sugar-related issues who are not yet in school. (Think about that.)

Warnings from experts have been heeded in different jurisdictions, but there's conflicting evidence on whether they work.

Finance Minister Siobhan Coady said the move was made to "position Newfoundland and Labrador as a leader in Canada and will help avoid future demands on the health-care system."

Still, it's important to note that N.L. is introducing this measure during a fiscal crisis, when any and every way of raising revenue is likely being considered. The province is dealing with an escalating debt and year-over-year deficits that it is trying to bring under control.

Also, there's no (pardon the pun) sugar-coating the fact that a new tax on sugary drinks is regressive. That is, unlike an income tax where higher incomes pay more, a consumption tax inherently eats up a higher proportion of cash in lower-income households.

Josh Smee, executive director of Food First NL, is worried about that impact.

"At first blush, there's always the worry about the equity of these kind of taxes because they're not just regressive in the sense that that they're hitting low-income households harder," Smee said in an interview earlier this week.

"They're actually sometimes doubly regressive because sugar-sweetened beverages make up a bigger portion. The per capita consumption can often be higher in low-income households because it's sometimes the only available treat or sweet thing that folks can afford."

If there's going to be a sugar tax, Smee and Bridger both want it to not exist in isolation. That is, they both want concrete action to address public health, using the very money that will be collected.

Bridger noted pediatricians and others are OK with the tax, "with the provision that the money goes towards expanding health programs, subsidizing healthier drinks [and] food choices, ensuring clean, safe drinking water, that sort of thing."

• Weekend Briefing: Read earlier editions of this column

Smee wants to see what else the government has in mind.

"Where these taxes have been introduced, some of the best practices that you see around the world is that the revenue that they generate is reinvested to improve healthy food access," he said. "We don't know exactly how that's going to work here yet."

Back to cigarettes for a moment

Cigarette taxes are regressive too, by the way. We seem to tolerate them because we have seen over a long period of time a dramatic change in public smoking habits, and a product that is a notorious carcinogen.

But there is also clear data that cigarettes pose a greater threat to our poorest citizens. According to Statistics Canada's Canadian Community Health Survey, about 12 per cent of the richest fifth of Canadian households have a smoker. In the poorest group, smoking rates are at 22 per cent.

That says something about a powerful addiction, and that smoking, despite the cost, still happens, even after decades of evidence that it kills people, shortens lives, wrecks families and so on.

The same research also proved a correlation between food insecurity the inability to afford a nutritious diet and cigarette use. In other words, smoking remains a health problem that's stubbornly difficultto solve.

Smoking rates have been falling steadily in Canada for years, although it's not just because governments have been hiking taxes. Other measures include education campaigns, laws against smoking in public places, making workplaces smoke-free and bans on tobacco advertising.

For Bridger, sugar is also a top-level health crisis.

We don't know yet if the provincial cabinet has other measures in mind to curb sugar consumption.

But as Bridger puts it, "The drinks are a good place to start."

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