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Episode 3 - The Case for a Tax on Sugary Drinks
71 Plays11 days ago
AMA Senior Policy Adviser Sally Witchalls joins Dr Omar Khorshid and Dr Chris Moy to discuss the AMA's proposal for a tax on sugary soft drinks.
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Transcript
Introduction to The Waiting Room
00:00:00
Speaker
Welcome to The Waiting Room, the podcast where we unpack big issues in Australian healthcare. care
00:00:07
Speaker
You're listening to The Waiting Room, a podcast by Australian Medical Association, with your hosts, Dr Omar Khorshid and Dr Chris Moy.
Dr. Omar Khorshid on Healthcare Advocacy
00:00:28
Speaker
I'm Dr Omar Khorshid, an orthopaedic surgeon from way out west in Perth, but also former president of the AMA during the pandemic and a time when we really had to work hard to push ah public health interests ah of Australians with government, a topic that we're going to go through a little bit more today.
00:00:48
Speaker
G'day, it's Chris Moy. I'm a GP from Adelaide and former sidekick to Omar. um and It's interesting for us to be looking at this topic, given the fact we were doing a lot of advocacy, but very focused on on COVID a
What is the AMA's Sugar Tax Proposal?
00:01:02
Speaker
long time ago. But now now it's actually really interesting to turn that lens onto a subject which I think has ramifications for our community, which go far into the future, and not only for for us, but but our children as well.
00:01:16
Speaker
So today, of course, we're talking about the AMA's proposal for a sugar tax, a big idea that that Chris and I are on the record supporting pretty strongly from our time leading the AMA, but an idea that, to be frank, doesn't have too many friends in Canberra.
The Impact of Obesity on Healthcare
00:01:31
Speaker
We'll be joined shortly by Sally Whitchell, Senior Policy Manager at the AMA and one of the key architects of the AMA's Sickly Sweet campaign. But before we hear from Sally, let's have a little look at the problem.
00:01:42
Speaker
that the average Australian is no longer bronze swimmer leaping into the waves on the Gold Coast, but actually bit pasty, a bit overweight. Two-thirds of us are overweight and a third obese. And, of course, we have rocketing rates of chronic disease.
00:01:59
Speaker
Is that what you're saying and in general practice, Chris? I think yeah one of the um measures of this is the amount of money that is being spent on these weight loss medications at the moment, which are you know enormous at at compared to the health budget at the moment. And and you know if it if it was paid for by the government, would actually bankrupt the country.
00:02:20
Speaker
um I think it just gives you an idea that not not only do you know the the epideal epidemiologists and and and and the health sector understand that this is a ah huge problem and that sugar is a huge factor in in contributing to this, but in fact the community actually do understand that this is a problem.
00:02:39
Speaker
um and And we really do need to, on their behalf, ah start to ah focus on it as something we can prevent and and improve over time.
Research and Political Challenges of Sugar Tax
00:02:49
Speaker
And it's just amazing that obesity is now the leading cause of preventable death in our community. and to To have gone from a situation where smoking was by far and away ah the leader in terms of preventable death and now having not quite won the war, but made a huge impact through public health measures on smoking.
00:03:08
Speaker
We're now in a situation where obesity is taken over and of course sugar is a big part of the obesity story, but also other chronic diseases like diabetes and of course obesity and diabetes lead to all sorts of other health problems.
00:03:22
Speaker
Now, the AMA first proposed a sugar tax in 2021. I was very pleased to launch a scientific study looking at what a sugar tax could look like, the impact on health, the financial impact on Australia's health system, but also the amount of money would raise for the government.
00:03:40
Speaker
And really, it was a really positive story. It was a win-win-win. And yet, frustratingly, No progress, you know, that there was literally no interest from ah politicians from the left or the right in our country.
00:03:53
Speaker
And we knew that when we launched it. But I guess this is one of those fights that we've just got to keep ah keep working on in order to make a difference. I think what's really interesting in this is that smoking is um as as something that that Australia to a great degree has has led the world It is something we have a great deal of pride in what we've done.
00:04:14
Speaker
um and And, you know, obviously I think there there has been, if if I could put it this way, perceived big bad enemy in the world. cigarette industry that has been easy to
Industry Pushback and Consumer Influence
00:04:25
Speaker
focus on. But it is interesting the contrast in in the lack of focus on obesity and the contributors to obesity, which are now looking as much bigger as as big as bigger problems, not bigger problems, and we are completely oblivious or blind to it. So we might bring Sally in at this point.
00:04:43
Speaker
Sally, could you take us through what the AMA's proposal is and what do you expect the impact to be? Hi Chris and Omar, thanks so much for having me. um The sugar tax in our sickly sweet work is something I love talking about because it's a preventive health policy that as you've said before, does have win-win-wins, but also has a lot of enemies across industry and government.
00:05:07
Speaker
And I think some of that is due to a lack of understanding of what the tax would be able to to ah So the AMA's tax comes from 50 cents per 100 gram of sugar model, which is something that's recommended by the World Health Organization, and that's per product.
00:05:23
Speaker
And that means that it's a bit of a sliding scale. So industry can reformulate and they're not paying as much of that tax. But it also still shows a cost um incentive for consumers that there's a cost going up on this sugary drink and perhaps I shouldn't purchase it or drink it. And and what are what are the what are the numbers that we're looking at in terms of effect on the health system, but also um reduction in health costs and and potentially revenue raised
Global Success Stories and Challenges
00:05:51
Speaker
from this?
00:05:51
Speaker
There's some really big wins. um We're looking at the fact that Australians drink 2.2 billion litres of sugar-sweetened beverages. um And so there's savings of billions in chronic health savings if this was implemented.
00:06:08
Speaker
um But it's not just those savings to the health system, but actually the revenue that could be raised through this as well. um That means there's two sides of the coin. There's first that um health system saving and preventive health angle, but there's also a revenue that then can be spent on other public health programs as well. And um as you've alluded to, there's a real increase in a lot of chronic disease conditions at the moment. And so anything that can be done to tackle with these both at a preventive level with initiatives, but also through then helping a health system to respond to these increases as well is important. Now Sally, this isn't a new idea, it's one that's actually been implemented all over the world. i understand it's now over a hundred countries have done this, so we certainly wouldn't be leading the world if we went down this path. Yeah, there's heaps and heaps of research across 130 jurisdictions and
00:07:01
Speaker
The AMA's recently crunched a map of all of these jurisdictions that do have a tax, whether it's for preventive health reasons or for revenue-raising reasons, um and they can be found on our Sickly Sweet website.
00:07:12
Speaker
But there's case studies that are happening in similar countries to Australia. So we look at England and the daily sugar intake fell by 11 grams, which is the equivalent to 2.5 teaspoons in adults in the year after they introduced their tax.
00:07:29
Speaker
um and similar trends were seen for children in the UK as well. And then we look at places like Mexico and they found that when the sugar, sweetened beverage tax that they introduced um happened, there was a 16.2% increase in water purchased.
00:07:43
Speaker
So it's not just looking at those lessening of sugary drink consumptions, but it's also changing in consumer attitudes as well that's really important, um especially for those households that were in ah low to middle income households where the water purchase was even higher for these places as well.
00:07:59
Speaker
And then there's lots of other case studies of The SSB tax being one of a number of preventive health measures that were implemented and there have been reductions in chronic health conditions across the board there as well. So taxes obviously are never popular things. you know, is this a kind of a nanny state thing, you know government in impeding, stepping on our toes, stopping us being able to choose what we want to do? Yeah. As as a public health expert, I say no. um However, it's the pushback that we get all the time with this.
00:08:32
Speaker
um How dare you stop our consumptions and our consumer choice? um How dare you put another tax on us in a time of cost of living? And that's where the narrative has really changed in the last 12, 18, 24 months.
00:08:46
Speaker
to when this policy was first um introduced and backed by the AMA. There's this really strong cost of living narrative now, which means that you often get health departments um pitted up against treasury departments and it becomes an economic versus preventive health question, um which means that it's hard to find supporters However, we are really lucky that we're seeing a shift in ah governments now to have doctors in their inner circles and with that comes a real health support for this.
00:09:18
Speaker
um But there's still a lot of work to do in reframing this to um an option of policy that industry and government are happy to consider. um But, yeah, we've seen we've really seen some big moves in how government respond to this with where it would be a blanket no there's now recommendations in parliamentary inquiries and doctors sitting on committees suggesting that it's a good way forward I mean, a lot of lot of advocacy is won and lost on who the losers are and and how loud they are.
00:09:50
Speaker
mean, who who are the losers are and and and and and what is the magnitude of of the loss, really? I mean, that's the reality of it. It's true. But I think that we need to consider the consumers in this space as losers as well. They'll lose weight. Well, exactly. They should be losing weight instead of losing money and, in the long run, losing their health outcomes. So, yeah.
00:10:11
Speaker
So, yeah, I think it just takes needs a bit more reframing from a this is a cost on consumers to actually this is a win and a money saving measure for consumers as well. but but Which industries are in fact are the ones that that are really resisting this primarily? and Obviously the manufacturers, but um ah but I mean, what is the magnitude of the the effect on them? Yeah, we've had some really interesting pushback from industry and it's not just the manufacturers, but it's actually links into agriculture as well. yeah,
00:10:39
Speaker
um We make it really quick ah clear that the AMA's tax is on drinks that have no nutritional value. So we've kept ah milk-based drinks out of that. We've also kept 100% fruit juices.
00:10:51
Speaker
um One, because there is some nutritional benefit to that. But also, two, there's a real issue around industry pushback, whether it's the dairy industry or whether it's fruit and veg industry.
00:11:03
Speaker
or even the sugar industry in Australia. So we've got stats saying that the actual sugar industry impact is quite low. ah So it'd be 0.72 to 1.2% impact is where our numbers are sitting on the impact of the Australian industry from an SSB tax.
00:11:22
Speaker
But it's a lot easier to swing that to, oh, you're going at small business here, how dare you put a tax into this and how dare you thwart government on um initiatives where they should really be supporting small business and farmers in um regional Australia as well. So there's lots of narrative changes in this as well.
00:11:41
Speaker
yeah i mean, it's nothing compared with the the changes in sugar price, um you know, due to international, um ah you know, things that go on, the the the changes are vastly bigger than that. And yet the narrative is you're going to hurt farmers, you're going to hurt shop owners.
00:11:57
Speaker
And can you tell us, Sally, how much would a can of Coke go up by in price? can of Coke would only go up by 20 cents um based on the fact that it has 40 grams of sugar. And is a 375 millimetre can of Coke. So the regular one that you normally find on shelves in convenience stores. So it might be a good time to get onto the politics of this because at the end of the day, the idea is pretty good. There's a whole pile of public health bodies who who agree with it. The AMA has joined up ah with um with a number of others in in trying to push this tax.
00:12:32
Speaker
but we haven't been winning so
Political Hurdles and Public Support
00:12:34
Speaker
far. So I guess to start with, we've already covered who's against it but who's who's on our side? And have you got a sense, either Chris or Sally, as to how we we bring those people together to actually achieve change in this area? We saw through the inquiry into diabetes, a real support by the doctors in labour and the doctors sitting as independents, um that they saw an SSB tax as one of a suite of preventive health measures and something that I say is really important is that we don't think the SSB tax is a silver bullet in preventive health.
00:13:10
Speaker
um That's never been um one of the AMA's policy headlines but there's certainly an appetite for the SSB tax to be part of a broader push for for preventive health reform at a federal government level.
00:13:26
Speaker
um And also it comes into play with some of the initiatives happening at a state parliamentary level as well. So we've seen outdoor junk food marketing has been limited in South Australia recently.
00:13:38
Speaker
and other jurisdictions are looking at other measures. So there's ways that um I'm quite optimistic about this policy because there's ways that we can get jurisdictions on board and members on board to see the, um members of federal government on board to see the benefits of this as well. But Chris, I'm interested in your thoughts. I think, you know, when you stand back and look at this, this is a no brainer from the point view. saves lives. It's got public support. It has little effect on industry.
00:14:03
Speaker
um Other countries have done this um and to be honest, I think we'll hardly notice frankly on a day-to-day basis. But and I think the other interesting thing I find very fascinating, if you look at the numbers that that you've indicated, and the the amount of money that is going to be raised from this and the amount that the government are going to save um is in the same ballpark as the amount they're going to raise from this superannuation liy they're putting on.
00:14:30
Speaker
And they are absolutely hemorrhaging at the moment from this. you know and What it tells me, I think, in the politics at the moment is is that they've won an election by such a margin they've actually got some political capital at the moment.
00:14:47
Speaker
ah They're willing to take this battle on. um But it would seem to me that if they really stood back and looked about the effect not only on finances but on the actual community, this would be as big, if not bigger, than what they're proposing for the superannuation levy for the high level.
00:15:12
Speaker
high totals which I think is very interesting and it's something we should probably be pushing really because I think i think it's that magnitude, if and it's a win-win-win and plus people actually going to be healthier which God forbid might be result out of this.
00:15:30
Speaker
Now I recall having a chat with a health minister once talking specifically about a floor price on alcohol, another one of these friendless ideas that makes a whole lot of ah sense from a health point of view, but just seems very difficult to get over the line.
00:15:45
Speaker
But he said to me, if you can make this popular with the public, then I'll do it. Can you do that for me? ah Now, in a way, that's kind of what Sickly Sweet was about, a social media campaign from the AMA, something that we hadn't done before.
00:16:01
Speaker
um Do you have any sense of whether that's been successful so far? And are there lessons for us for the future for public health campaigns? Yeah, there definitely is. So um recent studies suggest that there's a 58% support rate and now for this policy if the revenue is being used to go back into public health initiatives and um obesity tackling initiatives.
00:16:25
Speaker
um But I think this campaign is important for more than just getting a yes or a no and it legislated or at not. I think the health literacy benefit to this sort of campaign is huge, getting consumers to know what they're actually consuming.
00:16:38
Speaker
um But also it comes up against an industry playbook that is exactly what was being seen with tobacco and we'll see it with alcohol and gambling as well. It's something that public health is innately aware is happening, the public health issue.
00:16:55
Speaker
Evidence suggests that industry flips and flips and flips again. So if we find a way to tackle one narrative they're putting up, they'll find another one, which is why it's so important that Sickly Sweet as a campaign has evolved over the years.
00:17:08
Speaker
um And it's still reminding consumers how much sugar they're consuming. And as the numbers change, we'll keep putting in reports, we'll keep doing budget submissions and we'll keep making really tangible and easy to understand resources for the general public
Conclusion and Call to Action
00:17:24
Speaker
as well. And one of the questions we do sometimes here is is why is the AMA, the so-called Doctors' Union, getting involved in in public health campaigns? Why are we spending members' money on public-facing campaigns or on lobbying on on topics that are not in the interest of our members. you know You might argue that we want more people to be sick and overweight so that we can go and treat them.
00:17:46
Speaker
But of course, that's not what what doctors are about. It's not what the AMA is about. But you like Chris, maybe you can tackle this one for me. Are our members getting value for money out of our public health advocacy at the um IMA? Advocacy is about legitimacy in the eyes of the public ah because the public ultimately have the power because um and if the public is interested,
00:18:10
Speaker
um then we'll be the first one to be called um as an organisation. And if we are the first one to be called, um then politicians will listen.
00:18:22
Speaker
um And so really being ah legitimate and having legitimacy on all topics in health, not just about matters of funding and funding individual doctors and and things that may have specific interests for doctors.
00:18:37
Speaker
and having um strong advocacy positions and being well-rounded in areas such as public health and are ethical matters matters a lot in the eyes of the public and actually creates the the the the power and the um It really puts us in the position of getting that first phone call, which is the thing that makes the difference.
00:19:04
Speaker
um At the end of the day, it makes politicians want to listen. So it sounds like a tax on sugar-sweetened beverages is not just a win for the public, a win for government, ah but it's also a win for doctors. um And maybe that's a message for Health Minister Mark Butler if he's listening to this podcast, saying,
00:19:23
Speaker
that here's a great idea to actually improve Australia's health, to raise some extra revenue for government, to do even more good in the public health space, and it'll be popular with the public, ah unlike some of the other taxation ah measures that are on the table at the moment.
00:19:40
Speaker
ah Look, I'd like to really thank Sally, our special guest for today, as well as Chris for their time ah today chatting about the sugar, sweet and beverage tax, the AMA Sickly Sweet campaign.
00:19:53
Speaker
ah Thank you for joining us and I'll see you guys again very soon. Thanks for listening to The Waiting Room.
00:20:02
Speaker
Learn more about the AMA, including how to become a member, at ama.com.au. dot a