1st September 2017, Volume 130 Number 1461

Tiffany Parmenter, Charlotte Jordan, Ishika Jayasinghe

In June this year, as part of our undergraduate medical training, we were asked to devise a public health programme to improve the obesogenic environment in New Zealand. Our team interviewed several stakeholders, and reviewed the scientific evidence relating to potential programmes. Through the week, we developed a strategy to garner political and public support for a sugary drinks tax. We were inspired by the project and decided to seek philanthropic funding to make this project a reality. This letter outlines our reasons for choosing this programme and the resources we seek to get it off the ground.

In recent decades, increasing obesity prevalence has become a major public health issue.1 In New Zealand, 10.7% of 2–14 year-olds are considered obese.2 Moreover, there are significant ethnic and socioeconomic disparities in obesity rates, with 14.7% of Māori and 29.8% of Pacific children aged 2–14 years classified as obese.2 The singular focus of the Government’s Child Obesity Plan (ChOP) is on lifestyle behavioural change at the individual level.3 For this reason, we believe it is unlikely to work. Sustainable change is more likely to succeed when a broader synergistic package of population-level, settings-based and individual-level interventions is adopted.4

According to the World Health Organization’s Commission on Ending Childhood Obesity,1 this should include the regulation and taxation of obesogenic beverages. Acknowledging this, we propose to lobby for a sugary drinks tax. A number of our community and non-government organisations we spoke to supported this idea, but were unable to do so publicly due to financial dependence on government or private companies with conflicting financial interests.

Sugary drink intake is now widely recognised as an important cause of childhood obesity. Sugar drinks are a uniquely harmful product because of their contribution to increased energy intake, their limited nutritional value and because they bypass food intake regulatory systems.4 The high sucrose and fructose content of such drinks is also linked with a range of important health and metabolic disorders, such as diabetes, raised blood pressure, gout, dental caries as well as weight gain.5

Sugary drinks taxes implemented in other parts of the world have led to reduced purchasing and intake of the targeted products. In 2014, Mexico imposed a 10% tax on sugary drinks as part of a wide-ranging strategy to combat obesity. The first evaluation of its effects reported a higher than expected drop in intake of sugary drinks, while intake of untaxed drinks, mainly bottled water, rose.6 The changes were greatest in poorer households and accelerated over time. Similar results followed policy change in several other countries, including France, Denmark, Hungary and Ireland. In New Zealand, an important consideration is whether or not the public support such a policy. A recent New Zealand Herald poll reported 83% support for a sugary beverage tax from 11,700 respondents,7 suggesting that such a strategy has potential for success.

Social media campaigning was cost effective in similar campaigns overseas.8 In New Zealand, 88% of people aged 10 years or older use the internet at least weekly, and 88% access social media.9 However, a social media campaign alone is unlikely to be sufficient.8 Thus, our strategy will also directly lobby for policy change and will involve collaborating with health organisations.

We propose a focused short-term campaign that will take place in the lead up to the New Zealand election. This is a particularly sensitive time for political activity, given the potential for government change. The campaign will operate with input from the established Fighting Sugar in Softdrinks (FIZZ) group and consists of two approaches: one aimed at convincing policy makers and organisations, and another aimed at raising awareness with the general public.

Policy makers and health organisations

This will involve lobbying:

  1. Politicians and policy makers to get a sugary drinks tax on the agenda in the run up to the New Zealand election.
  2. Health organisations and professionals to build collaborative effort and support in this area. Recent work has suggested an important role for health professionals in reducing SSB consumption and childhood obesity.10

General public

This will primarily involve a social media-based marketing campaign. We intend to:

1. Drive social media campaigns aiming to:

a. Raise awareness and gain support among key target population segments through social media marketing/competitions.

b. Gain signatures for a citizens-initiated referendum to force the issue into the political forum.

2. Develop relationships with public personalities who endorse the campaign. As an example, Dame Tariana Turia and Nigel Latta have already expressed support.

3. Generate visibility of our campaign through a variety of print and internet media sources.

Two individuals could conduct this work, each working full time, for the equivalent of one full-time equivalent salary (approximately NZ$60,000 for the next three months, including the weeks leading up to and following the September election).

We believe that a sugary drinks tax is among the most effective interventions to address the burden of obesity in this country. Many other countries and regions have decided to adopt such a strategy, and the timing of this election raises the impetus for focused action to elevate the issue in the minds of politicians and the voting public.

Author Information

Tiffany Parmenter, University of Auckland School of Medicine, Auckland; 
Charlotte Jordan, University of Auckland School of Medicine, Auckland; 
Ishika Jayasinghe, University of Auckland School of Medicine, Auckland.

Correspondence

Dr Tiffany Parmenter, University of Auckland School of Medicine, Auckland.

Correspondence Email

tiffanyparmenter@gmail.com

Competing Interests

Nil.

References

  1. Adair LS, Kumar Arora N, Azizi F, Baur L, et al. Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: Report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. Geneva, Switzerland: World Health Organization; 2016.
  2. Cox S. Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington: Ministry of Health; 2016.
  3. Ministry of Health. Childhood Obesity Plan [Internet]. Wellington, New Zealand: Ministry of Health; 2015 [Updated 2017 April 13; cited 2017 June 28]. Available from: http://www.health.govt.nz/our-work/diseases-and-conditions/obesity/childhood-obesity-plan 
  4. Gortmaker S, Swinburn B, Levy D, Carter R, et al. Changing the future of obesity: science, policy, and action. Lancet. 2011 Aug 27; 378(9793):838–47.
  5. Thornley S, Tayler R, Sikaris K. Sugar restriction: the evidence for a drug-free intervention to reduce cardiovascular disease risk. Intern Med J. 2012 Oct; 42 Suppl 5:46–58.
  6. Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016 Jan 6; 352:h6704.
  7. Herald on Sunday. Niki Bezzant: Sugary Drinks Tax - It’s Time. [Internet]. Auckland, New Zealand: New Zealand Herald. 2016 [Updated 2016 Mar 27: Accessed 2017 June 28]. Available from: http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11612259
  8. Jou J, Niederdeppe J, Barry CL, Gollust SE. Strategic messaging to promote taxation of sugar-sweetened beverages: lessons from recent political campaigns. Am J Public Health. 2014 May; 104(5):847–53.
  9. Nielsen Company. New Zealand Media Trends Report 2016 [Internet]. New York: Neilsen Company; 2016. [Updated 2016 June 14; cited 2017 June 28]. Available from: http://www.nielsen.com/nz/en/insights/reports/2016/new-zealand-media-trends-2016.html
  10. Sanghavi A, Siddiqui NJ. Advancing oral health policy and advocacy to prevent childhood obesity and reduce children’s consumption of sugar-sweetened beverages. J Public Health Dent. 2017 Jun; 77 Suppl 1:S88–S95.