Can taxing sugar stunt a global diabetes epidemic?



By Tom Walsh

Taking a lesson from the anti-tobacco playbook, public health officials worldwide are suggesting huge taxes on food and drink products containing added sugar as a means of responding to the grim news that diabetes is now a bigger killer globally than HIV, tuberculosis and malaria. Combined.

Globally, diabetes caused 4.9 million deaths in 2014.

Diabetes comes in two flavors: Type 1 and Type 2. Both are related to the circulatory blood system’s ability to process and deliver insulin, a hormone critical to providing every cell in the human body with food-generated energy. Type 1 is an auto-immune disease in which the pancreas fails to produce the insulin required to meet the body’s needs, a chronic affront that requires Type 1 diabetics to inject insulin on a daily basis. Type 2 diabetes is related to the body’s inability to properly process insulin, a situation exacerbated by obesity, which not unlike Type 2 diabetes is a global epidemic in developing countries ranging from the United States to India.

Type 1 accounts for a mere 5 percent of the total diabetes census, which now includes 29.1 million Americans, according to the U.S. Centers for Disease Control and Prevention. In Maine, the rate is one in eight people, while the median rate for all 50 states is now one in nine, up from one in four 20 years ago. Globally, there are an estimated 387 million people living with diabetes, including 46.3 million who have yet to be diagnosed.

The International Diabetes Federation (IDF) offers a grim forecast for diabetes incidence, predicting the 52 million diabetics now living in Europe will increase to 69 million by 2035, while the 39 million diabetics now living in North America and the Caribbean will increase to 50 million within 20 years. The Federation’s predictions for Asia and the Middle East are equally grim. The largest number of diabetics worldwide now live in China, a trend expected to continue as the newly affluent Chinese embrace the Western (translates: American) high-fat, high-sugar, all-you-can-eat approach to what passes for nutrition.

So what? By 2040, one in every 10 adults on the planet can expect to be diabetic, with cases projected to reach 642 million against 415 million in 2015 and annual healthcare spending on treating diseases related to diabetes rising to $802 billion from $673 billion. The IDF estimates that most countries already spend between five and 20 percent of their healthcare budgets on the disease. Diabetes-related healthcare costs now amount to at least $612 billion within the United States in 2014, which translates to 11 percent of total health care spending on adults.

Diabetes puts not only patients but whole economies at risk, according to Petra Wilson, chief executive of the IDF, the umbrella organization of more than 230 national associations worldwide. Wilson’s immediate focus is getting governments to back a tax on sodas and other sugar-sweetened beverages. While she’s seen plenty of political pushback, including resistance from the food industry, she argues politicians need to protect public health by learning the lessons from tobacco. “It is very well established that heavy taxation on tobacco and relentless reinforcement of the message that tobacco is unhealthy has had a very good effect,” she recently told the Reuters news service. “It is time now we adopted a similar approach with sugar. It is, of course, more difficult with sugar. (While) people can live entirely without tobacco, they can’t live entirely without sugar but (they) can live without added sugars.”

Some countries, including Mexico, Chile and France, already have experimented with different variations of sugar taxation. Mexico, for example, has seen calls by some lawmakers for a halving in the country’s 10 percent sugar tax. British Prime Minister David Cameron recently came out against such a tax, despite a high-profile UK campaign for a levy on sugar-laced drinks and food.

Mexico has been something of a proving ground for the sugar tax concept. An estimated 33 percent of Mexicans are obese, making it the country with the biggest weight problem in the world, according to the United Nations’ Food and Agricultural Organization. The impact on the health of Mexicans has been serious, as 14 percent of the population has diabetes.

While there is not yet any conclusive evidence that raising the price of sugar-sweetened drinks will affect obesity or diabetes incidence, the Mexico experiment is being conducted on an unprecedented scale. Although the tax is set at 10 percent per liter rather than the 20 percent campaigners wanted, it affects a huge number of people as Mexico’s 118 million people drink 163 liters of sugar-spiked soda each, or nearly half a liter a day.

Can state or federal governments regulate health? Ultimately no, as there’s no known cure for stupid. People who jeopardize their health through addictive immersion in tobacco, alcohol and sugar bring potentially deadly health consequences upon themselves. Unfortunately, they also bring them upon the rest of us.

Tom Walsh of Gouldsboro is a medical and science writer.

 

Tom Walsh

Walsh, a Gouldsboro resident, is an award-winning medical and science writer.

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