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Extensive research has demonstrated the negative impacts of sugary drink intake. While the impacts of high sugary drink intake are far-reaching and include health, social and economic burdens, what is missing from the discussion by Riediger and Bombak (1) is the consideration of the further inequity and additional economic burden that inevitably arises from the evolving poor health outcomes of our pediatric patients.
While the authors acknowledge the link between sugary drinks and obesity, they minimize the other associated chronic diseases and they do not discuss how these diseases lead to greater health disparity. The authors also fail to account for how the disproportionate burden of disease among people with low-incomes impacts an individual’s quality of life. The growing rates of chronic disease burden our publicly funded health care system, which will be doubly burdened by an aging population and increasing rates of chronic disease among children at younger and younger ages.
Working with vulnerable populations in a pediatric tertiary care hospital, we observe first-hand the impacts that unhealthy diets have, including sugary drink consumption, and the resulting chronic disease they cause to our patients. With current sugary drink use and trends, it is estimated that more than 2 million new cases of obesity, almost 1 million cases of type 2 diabetes, over 100,000 cancer cases and almost 300,000 cases of cardiovascular disease will develop over the next 25 years (2).
A vulnerable subset of the pediatric population, youth/adolescents are among the highest consumers of sugary drinks (2). Research shows upwards of 80% of youth have consumed at least one sugar-sweetened beverage (SSB) in the previous day, while more than 40% have consumed 3 or more (3). This consumption represents 7-8% of daily energy intake within this age group and puts them well over the recommended daily limits for sugar intake, increasing their risk for numerous metabolic conditions (4,5). Canadian youth have disposable income and are making a lot of their own decisions – the primary challenge though is their difficulty assessing the long-term health consequences of their decisions (6). This group and other low income individuals are the most price sensitive consumers. The taxation of tobacco and alcohol arose out of a need to reduce consumption. While consumption and use may still occur, it is in lower quantities, overall reducing population risk. We should be able to do the same for sugary drinks, with the same long term benefits.
As clinicians, our aim is to diagnose and treat all patients who come through the doors of our medical practice. While we diagnose, treat, and aim to educate our patients about their overall health and risk reduction, we know education can only go so far. While taxation and food voucher programs have not been federally implemented in Canada, certain jurisdictions in British Columbia and The Maritimes have provided such supports, with individuals noting increased fruit and vegetable intake, improved ease of making healthy food choices, and greater accessibility to healthy food options (7,8). Preliminary research has shown that programs which subsidize fruits and vegetables for diabetic patients have led to improved diabetes control and reductions in the need for medication (9). Population-based policy interventions, including taxation of sugary drinks will not only lead to reduced consumption of these harmful products but also their negative health consequences. It is time for Canada to take a stand and introduce a sugary drink tax. Leveraging such revenues to make healthy eating more affordable has additional benefits of increasing protective health factors. Overall, these complimentary measures will reduce the burden of chronic disease and improve population health. Our hope is that children in Canada benefit from these actions sooner, rather than later.
Dr. Matthew Feldman
Pediatrics Resident
Dr. Catherine Pound
Pediatrician
References
1. Riediger ND, Bombak AE. Sugar-sweetened beverages as the new tobacco: examining a proposed tax policy through a Canadian social justice lens. CMAJ 2018;190(11):E327-E330.
2. Jones AC, Veerman JL, Hammon D. The health and economic impact of a tax on sugary drinks in Canada. March 2017.
3. Vanderlee L, Manske S, Murnaghan D, Hanning R, Hammond D. Sugar‐Sweetened Beverage Consumption Among a Subset of Canadian Youth. January 2014. Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1111/josh.12139
4. Coalition québécoise sur la problématique du poids. Sugar-Sweetened Beverage Marketing Unveiled. Volume 2 - Price: A Paying Argument. Montreal; 2012. Available from: http://www.cqpp.qc.ca/documents/file/2012/Report _Marketing-Sugar-Sweetened-Beverage_Volume2- Price_2012-03.pdf
5. Taxation and Sugar-Sweetened Beverages: Position of Dieticians of Canada. February 2016. Available from: https://www.dietitians.ca/Downloads/Public/DC-Position-SSBs-and-taxation...
6. Adolescent Risk and Vulnerability: Concepts and Measurement. https://www.ncbi.nlm.nih.gov/books/NBK223741/
7. BC Association of Farmers’ Markets. (n.d.) Coupon program. Retrieved from http://www. bcfarmersmarket.org/coupon-program/about-program
8. Brown, Stephanie. (2016, July). How the Charlottetown Farmers' Market connects local food to families in need. CBC News. Retrieved from http://www.cbc.ca/news/canada/prince-edward-island/ charlottetown-farmers-market-families-in-need-1.3678507
9. Hess, A. (2018). The Fresh Food Pharmacy: A Novel, Replicable Program to Address Food Insecurity. World Health Care Congress: Connecting and Preparing Leaders for Health Care’s Transformation. Washington, D.C.