Sugar-sweetened beverages as the new tobacco: examining a proposed tax policy through a Canadian social justice lens

Equity

Stigma

The current public health approach to smoking assumes, among other things, that once Big Tobacco’s unscrupulous marketing tactics and the health effects of smoking are demonstrated, people will either quit or decide not to smoke through a sense of personal responsibility.16 This has strong moralistic undercurrents, ignores the context of the smoker and pleasure derived from smoking, and may stigmatize some already-marginalized populations.16^,17 For example, a recent qualitative study found that smokers in low-income groups in New Zealand felt victimized by increases in tobacco taxes that pressured people to quit smoking in the face of inadequate provision of cessation supports.18 A qualitative study found that socially marginalized Canadian youth who smoke — but not privileged youth who smoke — had feelings of shame about their behaviour.19

Taxation on sugar-sweetened beverages is positioned as a strategy to reduce obesity.4 Like smoking, obesity is associated with pronounced stigma, in part because it is framed as a matter of personal responsibility.20 As a result of personal responsibility framing, excess weight can become conflated with laziness and sloth, and public health measures that are framed in this way may exacerbate well-known physical and mental health–damaging effects of obesity stigma.20 Recent “anti-soda” public health campaigns, including the “Berkeley v. Big Soda” campaign, have been criticized as stigmatizing for individuals with low income or obesity.21

Furthermore, a sweetened beverage tax aimed only at regular soft drinks may carry classist and racist overtones that could exacerbate stigma directed at already-marginalized groups. For example, it is interesting to note which beverages are discussed as “tax targets.” Sweetened coffee sales increased 579% in Canada from 2004 to 2015;3 coffee was already the most frequently consumed beverage, after water, in 2004.22 Taxing (nonbottled) sweetened coffee is not currently included in any tax on sugar-sweetened beverages; nor has it been proposed. US data indicate that consumption of store-purchased sweetened coffee and tea intake is significantly higher in regions of higher socioeconomic categorization and in those in which a higher proportion of the population identifies as white.23 In other words, economically advantaged people may continue to drink their frappuccino, untaxed, while less wealthy people are taxed for their cola, despite similar added sugar content.

Effects of taxation policies on Indigenous populations

Canada, as a country, has so far failed to develop effective and acceptable strategies in collaboration with First Nations communities to address smoking; smoking prevalence among First Nations is triple that of settler populations.24 In some communities, the prevalence of current smoking is increasing.25 For the federal government, taxing tobacco is the primary strategy to reduce tobacco use. However, tobacco taxes are complicated by jurisdictional differences related to taxation on reserve. First Nations communities have the authority to tax tobacco products, but less than 2% of bands tax tobacco.26 Tobacco has cultural significance for First Nations, but it is also an issue of sovereignty; it is one of the few areas in which First Nations communities can exercise control independent of the federal government. The lack of tobacco taxes on reserve has been used to blame First Nations communities for the illicit trade of contraband cigarettes in Canada.27 Such finger pointing further undermines harmonious collaboration between First Nations communities and other peoples — driving a lack of respect and partnership with First Nations people in policy development — and it contributes to further stigmatization for an already-marginalized population.

In light of these observations, it is important to consider the potential that a tax on sugar-sweetened beverages may negatively affect reconciliation between Indigenous and other peoples in Canada. Water quality on First Nations reserves remains an intractable problem in Canada. As of August 2017, there were 103 long-term drinking water advisories in First Nations communities,28 some in place for more than a decade. This number does not include the many communities with intermittent drinking water advisories or potable-but-not-palatable water. Many remote communities rely on purchased beverages for hydration. A 4L jug of milk costs more than Can$10, even after subsidies through Nutrition North Canada (a federal food subsidy program for remote Northern communities, which aims to improve access to perishable foods).29 Communities frequently rely on sugar-sweetened beverages for hydration, as these beverage types are not perishable. Because of ongoing water safety issues, First Nations people are likely to have legitimate concerns over policies that aim to increase water consumption by making other beverages more expensive.

Contributing to dietary patterns among First Nations people and the associated high rates of diabetes are factors related to colonialism, which include historical loss of land, introduction of market foods, and hunger at residential schools, among others.30 Indeed, concerns related to colonialism and taxation on sugar-sweetened beverages are magnified when agricultural subsidies and the historical context of farming are taken into consideration. This occurs because in Canada, sugar-sweetened beverages are most commonly sweetened with high-fructose corn syrup;31 corn growers therefore benefit from government subsidies, and farmers may have inherited family farms that were established on free land for settlers at the expense of limiting land for Indigenous people. These ties between sugar and colonialism, formed by bitter history, may cast any proposed tax on sugar-sweetened beverages as part of ongoing subjugation of Indigenous peoples and the ahistorical, depoliticized and paternalistic concern of more privileged groups. Such concerns must be taken into account when formulating a policy that may well affect Indigenous peoples negatively and disproportionately. Indigenous communities must be engaged in the policy process. It is crucially important to incorporate insights from communities when developing policies that affect those communities.

Conclusion

Proponents of a tax on sugar-sweetened beverages are quick to emphasize positive aspects of a tobacco tax; however, a thorough comparison analysis reveals other lessons about exacerbation of inequity and stigma, including racial stigma, in already-marginalized populations. True economic and health reform will require more thoughtful policies than trying to “nudge” people to make “more appropriate” choices.