It is valuable for Ni Mhurchu and colleagues to have demonstrated the potential positive impact on health outcomes and equity of taxation on sugar-sweetened beverages in the New Zealand context.1 However, an emphasis on the taxation of carbonated soft drinks alone detracts from the need to consider the wider soft drink market.
The soft drink market includes products other than carbonated drinks, that can contain significant amounts of sugar, and make up about a quarter of the sales of Coca Cola Amatil, the premier seller in New Zealand.2,3Artificially sweetened drinks also act as an appropriate substitute product for sugar-sweetened soft drinks and so it is important that a tax on soft drinks is applied to sugar-sweetened drinks alone.
How a tax is applied can impact its effect. A duty applied to volume or sugar content rather than as a percentage of value reduces the potential of consumers to respond by purchasing cheaper brands or buying in bulk.4
The use of fiscal measures to reduce the consumption of simple sugars to improve nutrition and health is warranted as health education has a limited effect on behaviour5 and non-regulatory measures alone are considered to be insufficient.6 However, the impact of taxation should be enhanced with concomitant education,7 as the awareness of health harms reinforces the impact of taxation on food consumption.8 The earmarking of the funds raised, for health programmes as the authors suggest, may improve societal acceptability9 and would be similar to the taxation of alcohol.10
In two Pacific nations taxes on sugar drinks were initiated expressly for health reasons and to generate revenue to enact preventive health interventions.8 Let’s hope that this option gains traction in New Zealand as it has done in other parts of the World.
Public Health Physician and General Practitioner
Wellington, New Zealand