Nobody disagrees that we should tax harmful substances like tobacco and alcohol to discourage their consumption. But there is one substance - which can also be addictive - that seems to have got away lightly when it comes to taxation, and that is sugar.
Sugar is already present in a natural form in many foods. But food and beverage makers add extra sugar to what they produce, to make it tastier. Supermarket shelves are laden with products that contain added sugar, including soft drinks and juices, canned foods, soups, sauces, syrups, spreads, dairy products, breakfast cereals, cakes, breads, biscuits, confectionery and more.
For the longest time, added sugar was considered relatively harmless; it was simply calories, we were told. For decades, the sugar lobbies - food and beverage associations, for instance - suppressed or debunked research which exposed the harmful effects of sugar.
An eye-opening account of the dirty politics of the sugar business can be found in Prof John Yudkin's 1972 book Pure, White and Deadly. Persecuted for his findings at the time, he has now been vindicated.
In recent years, there has been a revival of research on the dangers of sugar, led by Robert Lustig, Professor of paediatrics at the University of California, San Francisco, whose YouTube video, "Sugar: The Bitter Truth" ( https://www.youtube.com/watch?v=dBnniua6-oM ) is one of the most watched health videos of all time, with more than 6 million views.
The evidence is now strongly established. Sugar is not only a health hazard, but its effects are much worse that earlier thought. Many health experts agree that sugar is in fact the single most harmful ingredient in the modern diet. It contributes to not just diabetes - the illness most popularly associated with sugar - but also heart, liver and kidney disease, cancer, memory loss and more. Much of the added sugar in foods and drinks takes the form of high fructose corn syrup, which is even more harmful than plain sugar.
As for calories, the research shows that not all calories are equal. Those that come from plain sugar are "empty calories" - unlike naturally occurring sugars in fruit, they are not accompanied by any nutrients but by molecules that damage health.
One of the early manifestations of sugar consumption is childhood obesity, the incidence of which has been increasing worldwide at an alarming rate. A report released last week by the World Health Organisation (WHO) that covered more than 100 countries described childhood obesity as "an exploding nightmare." In 2014, 41 million children under 5 years of age (6.4 per cent of the total) were overweight, a one-third increase from 1990, when 4.8 per cent of under-fives were overweight. Almost half of these children are in Asia.
In Singapore, obesity (which often starts in childhood)is a serious problem. In March 2014, Senior Minister of State for Health Amy Khor revealed that around 1.7 million Singaporeans (more than one third of the population) are at risk of obesity-related diseases. Six in 10 of them are either pre-diabetic, or suffer at least one chronic condition such as diabetes, high blood pressure or high cholesterol.
Diabetes in Singapore is already a scourge, affecting more than 11 per cent of people aged 18 to 69 (among the highest in the developed world), compared to the world average of 8.5 per cent. Even some children as young as 10 years of age who suffer from obesity have diabetes. In 2012, Professor Chia Kee Seng, the dean of the Saw Swee Hock School of Public Health predicted that one in three Singaporeans will develop diabetes by the time they are 69. This will lead to all manner of health complications on a mass scale, with huge cost implications.
One of the big preventive health care challenges facing governments is how to reduce sugar consumption. So far, most have relied mainly on education and persuasion, by trying to encourage food manufacturers to develop healthier foods and educating consumers - for example, through the use of the "Healthier Choice" symbol in Singapore.
Consider tougher measures
But if the incidence of obesity and diabetes are any guide, such approaches have not produced results. It is time to consider tougher measures. The WHO report also suggests that it is no longer sufficient to reply on food labelling. It supports the idea of a tax on sugar. "The rationale for taxation measures to influence purchasing behaviours is strong and supported by the available evidence," it points out, adding that "there is sufficient rationale to warrant the introduction of an effective tax on sugar-sweetened beverages". It notes that low income groups and children, who face the greatest risk of obesity, "are the most influenced by price".
Taxes on sugar have already started to be introduced. In 2013, Mexico introduced a tax of 1 Mexican peso per litre on sodas (sugared drinks). Norway has an excise tax on refined sugar products, including soft drinks. In 2015, the city of Berkeley in California implemented a "soda tax" of one cent per ounce on the distributors of sugar-sweetened beverages like sodas, sports drinks, energy drinks, and sweetened ice teas (but excluding milk-based beverages, meal replacement diet drinks, fruit juice, and alcohol). Seventy-five per cent of Berkeley's voters approved the measure. Earlier this month, the UK's National Health service announced that it will impose its own sugar tax in all its hospital cafes and vending machines across England. More countries are likely to introduce sugar taxes.
Although taxation alone is not enough - other restrictions on marketing and sale are also advisable - it will go a long way towards reducing consumption of sugared products, which, given their health-damaging effects, are underpriced and therefore overconsumed. It is scandalous that some fast food outlets are permitted to provide unlimited helpings of sugared drinks at a low fixed price. It is also remarkable that in Singapore, two litre bottles of sweetened fizzy drinks - which are unhealthy even in moderation - are at least ten times cheaper than a bottle of wine.
It's time to bring sugar into the tax net. The additional revenue that this may bring is not the point. The point is people's health, and the likely savings in health care costs in the years to come.
This article was first published on February 1 2016.
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