Generating Political Commitment for Regulatory Interventions Targeting Dietary Harms and Poor Nutrition: A Case Study on Sugar-Sweetened Beverage Taxation in Australia

Document Type : Original Article

Authors

1 Public Health, School of Medicine, Griffith University, Gold Coast, QLD, Australia

2 Institute for Physical Activity and Nutrition, Deakin University, VIC, Geelong, Australia

Abstract

Background 
Sugar-sweetened beverage (SSB) taxes are an effective public health policy intervention for improving nutrition and public health. Although implemented in over 50 jurisdictions worldwide, this intervention remains vastly underutilised, and in Australia political commitment for such a tax is low. The aim of this study is to understand the politics of SSB taxation in Australia, what factors have constrained political commitment for a tax, and what might enable such commitment in future.

Methods 
We adopted a case study design, guided by a theoretical framework developed from the political economy of nutrition literature. Data were collected from 16 interviews with informants from multiple sectors, supported by media articles, journal articles, and grey literature. Data were coded and organized by thematic analysis, and synthesised into the final results.

Results 
Nutrition actors have made significant progress in generating commitment for a SSB tax by producing relevant evidence, raising awareness, advocating for action, employing resonating frames, collaborating with civil society organisations, and forming coalitions increasing their overall cohesion. Nevertheless, political commitment for a SSB tax is low and was found to be impeded by the powerful influence of the food, beverage, and sugar industries, opposition from both major Australian political parties, ideological resistance to regulation, a low quality monitoring and surveillance system for food and nutrition, and limited public advocacy. The influence of nutrition actors was also impeded by weak connections to key policy-makers and missed collaborative opportunities with pro-SSB tax organisations.

Conclusion 
The identification of several impediments provides an explanation for why political commitment for a SSB tax is low in Australia and reveals several opportunities for how it might be generated in the future. Political commitment may come about through, for example, actions to limit the influence of industry in policy decision-making, and by strengthening the existing pro-SSB tax coalition.

Keywords


  1. Murray CJL, Aravkin AY, Zheng P, et al. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-1249. doi:1016/s0140-6736(20)30752-2
  2. Lyn R, Heath E, Dubhashi J. Global implementation of obesity prevention policies: a review of progress, politics, and the path forward. Curr Obes Rep. 2019;8(4):504-516. doi:1007/s13679-019-00358-w
  3. World Health Organization (WHO). Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases: Report of the 2019 Global Survey. Geneva: WHO; 2020. https://www.who.int/publications/i/item/ncd-ccs-2019.
  4. Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393(10173):791-846. doi:1016/s0140-6736(18)32822-8
  5. World Health Organization (WHO). Report of the Commission on Ending Childhood Obesity. WHO; 2016.
  6. Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. 2013;14 Suppl 2:159-168. doi:1111/obr.12098
  7. World Bank. Taxes on Sugar-Sweetened Beverages: International Evidence and Experiences. Washington, DC: World Bank; 2020. https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y.
  8. Ruanpeng D, Thongprayoon C, Cheungpasitporn W, Harindhanavudhi T. Sugar and artificially sweetened beverages linked to obesity: a systematic review and meta-analysis. QJM. 2017;110(8):513-520. doi:1093/qjmed/hcx068
  9. Imamura F, O'Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015;351:h3576. doi:1136/bmj.h3576
  10. Valenzuela MJ, Waterhouse B, Aggarwal VR, Bloor K, Doran T. Effect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis. Eur J Public Health. 2021;31(1):122-129. doi:1093/eurpub/ckaa147
  11. Roache SA, Gostin LO. The untapped power of soda taxes: incentivizing consumers, generating revenue, and altering corporate behavior. Int J Health Policy Manag. 2017;6(9):489-493. doi:15171/ijhpm.2017.69
  12. Teng AM, Jones AC, Mizdrak A, Signal L, Genç M, Wilson N. Impact of sugar-sweetened beverage taxes on purchases and dietary intake: Systematic review and meta-analysis. Obes Rev. 2019;20(9):1187-1204. doi:1111/obr.12868
  13. Cullerton K, Donnet T, Lee A, Gallegos D. Playing the policy game: a review of the barriers to and enablers of nutrition policy change. Public Health Nutr. 2016;19(14):2643-2653. doi:1017/s1368980016000677
  14. Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N. The politics of reducing malnutrition: building commitment and accelerating progress. Lancet. 2013;382(9891):552-569. doi:1016/s0140-6736(13)60842-9
  15. Hagenaars LL, Jeurissen PPT, Klazinga NS. The taxation of unhealthy energy-dense foods (EDFs) and sugar-sweetened beverages (SSBs): an overview of patterns observed in the policy content and policy context of 13 case studies. Health Policy. 2017;121(8):887-894. doi:1016/j.healthpol.2017.06.011
  16. James E, Lajous M, Reich MR. The politics of taxes for health: an analysis of the passage of the sugar-sweetened beverage tax in Mexico. Health Syst Reform. 2020;6(1):e1669122. doi:1080/23288604.2019.1669122
  17. Le Bodo Y, Etilé F, Gagnon F, De Wals P. Conditions influencing the adoption of a soda tax for public health: analysis of the French case (2005–2012). Food Policy. 2019;88:101765. doi:1016/j.foodpol.2019.101765
  18. Thow AM, Quested C, Juventin L, Kun R, Khan AN, Swinburn B. Taxing soft drinks in the Pacific: implementation lessons for improving health. Health Promot Int. 2011;26(1):55-64. doi:1093/heapro/daq057
  19. Mosier SL. Cookies, candy, and coke: examining state sugar-sweetened-beverage tax policy from a multiple streams approach. Int Rev Public Adm. 2013;18(1):93-120. doi:1080/12294659.2013.10805242
  20. Carriedo A, Koon AD, Encarnación LM, Lee K, Smith R, Walls H. The political economy of sugar-sweetened beverage taxation in Latin America: lessons from Mexico, Chile and Colombia. Global Health. 2021;17(1):5. doi:1186/s12992-020-00656-2
  21. Fuster M, Burrowes S, Cuadrado C, et al. Understanding policy change for obesity prevention: learning from sugar-sweetened beverages taxes in Mexico and Chile. Health Promot Int. 2021;36(1):155-164. doi:1093/heapro/daaa045
  22. Purtle J, Langellier B, Lê-Scherban F. A case study of the Philadelphia sugar-sweetened beverage tax policymaking process: implications for policy development and advocacy. J Public Health Manag Pract. 2018;24(1):4-8. doi:1097/phh.0000000000000563
  23. Hagenaars LL, Jevdjevic M, Jeurissen PPT, Klazinga NS. Six lessons from introducing sweetened beverage taxes in Berkeley, Cook County, and Philadelphia: a case study comparison in agenda setting and decision making. Health Policy. 2020;124(9):932-942. doi:1016/j.healthpol.2020.06.002
  24. Lacy-Nichols J, Scrinis G, Carey R. The politics of voluntary self-regulation: insights from the development and promotion of the Australian Beverages Council's Commitment. Public Health Nutr. 2020;23(3):564-575. doi:1017/s1368980019002003
  25. Mialon M, Swinburn B, Allender S, Sacks G. Systematic examination of publicly-available information reveals the diverse and extensive corporate political activity of the food industry in Australia. BMC Public Health. 2016;16:283. doi:1186/s12889-016-2955-7
  26. Ojeda E, Torres C, Carriedo Á, Mialon M, Parekh N, Orozco E. The influence of the sugar-sweetened beverage industry on public policies in Mexico. Int J Public Health. 2020;65(7):1037-1044. doi:1007/s00038-020-01414-2
  27. Cullerton K, Donnet T, Lee A, Gallegos D. Using political science to progress public health nutrition: a systematic review. Public Health Nutr. 2016;19(11):2070-2078. doi:1017/s1368980015002712
  28. Baker P, Gill T, Friel S, Carey G, Kay A. Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study. Soc Sci Med. 2017;177:141-149. doi:1016/j.socscimed.2017.01.047
  29. Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. Lancet Diabetes Endocrinol. 2016;4(2):174-186. doi:1016/s2213-8587(15)00419-2
  30. Weighing the Cost of Obesity: A Case for Action. 2015. https://www.pwc.com.au/pdf/weighing-the-cost-of-obesity-final.pdf.
  31. Obesity Policy Coalition and Global Obesity Centre. Tipping the Scales: Australian Obesity Prevention Consensus. 2017. https://www.opc.org.au/downloads/tipping-the-scales/tipping-the-scales.pdf.
  32. Hutchens G. Malcolm Turnbull Rejects Calls for Sugar Tax to Tackle Obesity. The Guardian. September 19, 2017. http://www.theguardian.com/australia-news/2017/sep/19/malcolm-turnbull-rejects-calls-for-sugar-tax-to-tackle-obesity. Accessed February 16, 2021.
  33. Whelan M. No plans for Australian tax on sugary drinks, says Ballarat MP and Labor health spokeswoman Catherine King. The Courier website. https://www.thecourier.com.au/story/5373430/no-plans-for-sugar-tax-king/. Accessed February 16, 2021. Published May 1, 2018.
  34. Brandon I, Baker P, Lawrence M. Have we compromised too much? a critical analysis of nutrition policy in Australia 2007-2018. Public Health Nutr. 2020:1-11. doi:1017/s1368980020003389
  35. Lee AJ, Cullerton K, Herron LM. Achieving food system transformation: insights from a retrospective review of nutrition policy (in)action in high-income countries. Int J Health Policy Manag. 2020. doi:34172/ijhpm.2020.188
  36. Sainsbury E, Magnusson R, Thow AM, Colagiuri S. Explaining resistance to regulatory interventions to prevent obesity and improve nutrition: a case-study of a sugar-sweetened beverages tax in Australia. Food Policy. 2020;93:101904. doi:1016/j.foodpol.2020.101904
  37. Crammond B, Van C, Allender S, et al. The possibility of regulating for obesity prevention--understanding regulation in the Commonwealth Government. Obes Rev. 2013;14(3):213-221. doi:1111/obr.12004
  38. Yin R. Case Study Research and Applications: Design and Methods. 6th ed. Los Angeles: SAGE Publications; 2018.
  39. Baker P, Hawkes C, Wingrove K, et al. What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Global Health. 2018;3(1):e000485. doi:1136/bmjgh-2017-000485
  40. Clarke B, Swinburn B, Sacks G. The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis. BMC Public Health. 2016;16(1):1084. doi:1186/s12889-016-3639-z
  41. Sabatier PA, Weible CM. Theories of the Policy Process. 3rd ed. Boulder, Colorado: Westview Press; 2014.
  42. John P. Analyzing Public Policy. 2nd ed. New York: Routledge; 2012.
  43. Gillespie S, van den Bold M. Stories of Change in Nutrition: A Tool Pool. Washington, DC: International Food Policy Research Institute; 2015. http://ebrary.ifpri.org/cdm/ref/collection/p15738coll2/id/130077.
  44. Bryman A. Social Research Methods. 4th ed. New York, United States: Oxford University Press; 2012.
  45. Commonwealth of Australia. Select Committee into the Obesity Epidemic in Australia, Final report. 2018. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Obesity_epidemic_in_Australia/Obesity/Final_Report.
  46. Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Liamputtong P, ed. Handbook of Research Methods in Health Social Sciences. Singapore: Springer; 2018:844-858. doi:1007/978-981-10-2779-6_103-1
  47. Sara S. Health Minister rebuffs Australian of the Year’s sugar tax push. The World Today. 2020. https://www.abc.net.au/radio/programs/worldtoday/health-minister-rebuffs-australian-of-the-years-sugar-tax-push/11902914.
  48. Veerman JL, Sacks G, Antonopoulos N, Martin J. The impact of a tax on sugar-sweetened beverages on health and health care costs: a modelling study. PLoS One. 2016;11(4):e0151460. doi:1371/journal.pone.0151460
  49. Lal A, Mantilla-Herrera AM, Veerman L, et al. Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: a cost-effectiveness and equity analysis. PLoS Med. 2017;14(6):e1002326. doi:1371/journal.pmed.1002326
  50. Sowa PM, Keller E, Stormon N, Lalloo R, Ford PJ. The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia. Eur J Public Health. 2019;29(1):173-177. doi:1093/eurpub/cky087
  51. Cullerton K, Baker P, Adsett E, Lee A. What do the Australian public think of regulatory nutrition policies? a scoping review. Obes Rev. 2021;22(1):e13106. doi:1111/obr.13106
  52. Morley B, Niven P, Dixon H, et al. Association of the LiveLighter mass media campaign with consumption of sugar-sweetened beverages: cohort study. Health Promot J Austr. 2019;30(suppl 1):34-42. doi:1002/hpja.244
  53. Rethink Sugary Drink. Time to rethink sugary drinks. https://www.rethinksugarydrink.org.au/media/time-to-rethink-sugary-drinks.html. Accessed February 2, 2021. Published 2013.
  54. Cullerton K, Donnet T, Lee A, Gallegos D. Exploring power and influence in nutrition policy in Australia. Obes Rev. 2016;17(12):1218-1225. doi:1111/obr.12459
  55. New South Wales Parliament. Standing Committee on Social Issues: Childhood Overweight and Obesity. 2016. https://www.parliament.nsw.gov.au/lcdocs/inquiries/2405/Final%20Report.pdf.
  56. Australian Beverages Council. Annual report: Australian Beverages. 2017. https://www.smh.com.au/cqstatic/gz7s0g/annualreport.pdf.
  57. Coca-Cola Amatil. Making Progress Together: Annual Report 2016. 2017. https://www.ccamatil.com/getmedia/c2807983-4a5e-4828-8ea3-e425931c5856/2016annualreport.pdf.
  58. Victoria’s Citizen’s Jury on Obesity: Insights Report. 2016. https://www.vichealth.vic.gov.au/-/media/ResourceCentre/PublicationsandResources/General/Victorias-Citizens-Jury-on-Obesity-Insights-Report-2016.pdf?la=en&hash=EEBF88790BDA90E3613B09FAB071D9C5EE927D65.
  59. Levy GS, Shrapnel WS. Quenching Australia's thirst: a trend analysis of water-based beverage sales from 1997 to 2011. Nutr Diet. 2014;71(3):193-200. doi:1111/1747-0080.12108
  60. Shrapnel W. Trends in sugar-sweetened beverages: are public health and the market aligned or in conflict? Nutrients. 2015;7(9):8189-8198. doi:3390/nu7095390
  61. Shrapnel WS, Butcher BE. Sales of sugar-sweetened beverages in Australia: a trend analysis from 1997 to 2018. Nutrients. 2020;12(4):1016. doi:3390/nu12041016
  62. Australian Food and Grocery Council. Greens sugar tax (GST) an attack on regional jobs. https://www.afgc.org.au/news-and-media/2016/06/greens-sugar-tax-gst-an-attack-on-regional-jobs. Published 2016.
  63. Backholer K, Martin J. Sugar-sweetened beverage tax: the inconvenient truths. Public Health Nutr. 2017;20(18):3225-3227. doi:1017/s1368980017003330
  64. Dalzell S. Soft drink industry pledges to cut sugar overall, but doctors say it’s a diversion from the real issue. Australian Broadcasting Corporation. https://www.abc.net.au/news/2018-06-25/soft-drink-industry-pledge-to-cut-sugar-criticised-by-ama/9906502. Accessed February 7, 2021. Published June 25, 2018.
  65. Sefiani engaged by the Australian Beverages Council to support agile self-governance agenda. 2019. https://www.sefiani.com.au/2019/12/13/sefiani-engaged-by-australian-beverages-council/. Accessed February 7, 2021.
  66. Australian Electoral Commission. AEC Transparency Register. https://transparency.aec.gov.au/. Accessed February 8, 2021. Published 2020.
  67. Littleproud D. Soft drink tax will not stop infant obesity. Parliament of Australia. https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:%22media/pressrel/6069432%22. Accessed February 16, 2021. Published 2018.
  68. Paterson J. Sugar tax is an argument that carries little weight. Senator James Paterson. https://senatorpaterson.com.au/2017/10/09/sugar-tax-is-an-argument-that-carries-little-weight/. Accessed February 16, 2021. Published October 9, 2017.
  69. Anthony Albanese. Transcript of Television Interview – The Today Show – Friday, 8 June 2018. https://anthonyalbanese.com.au/transcript-of-television-interview-the-today-show-friday-8-june-2018. Accessed February 16, 2021. Published 2018.
  70. Commonwealth, Parliamentary Debates, Senate. 2016. https://parlinfo.aph.gov.au/parlInfo/genpdf/chamber/hansards/548f7e7e-68e6-4e9c-8f40-5e4a56df0b06/0228/hansard_frag.pdf;fileType=application%2Fpdf.
  71. Australian Electoral Commission. Election results: Tally room archive. https://results.aec.gov.au/. Accessed February 16, 2021. Published 2020.
  72. Queensland Economic Advocacy Solutions. The economic contribution of the Sugarcane Industry to Queensland and its regional communities: A report analysing the economic importance of the sugarcane value chain to communities across Queensland. 2019. https://www.bdbcanegrowers.com.au/wp-content/uploads/2019/11/310175_economic-contribution-of-the-sugarcane-industry-to-queensland.pdf.
  73. Lee A. Scoping Study to Inform Development of the National Nutrition Policy for Australia. 2013. https://eprints.qut.edu.au/93234/19/93234.pdf.
  74. Public Health Association of Australia. Food and nutrition monitoring and surveillance in Australia. 2018. https://www.phaa.net.au/documents/item/2866.
  75. Australian Bureau of Statistics. National Health Survey: First results, 2017-2018. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release. Accessed February 14, 2021. Published December 12, 2018.
  76. Huse O, Hettiarachchi J, Gearon E, Nichols M, Allender S, Peeters A. Obesity in Australia. Obes Res Clin Pract. 2018;12(1):29-39. doi:1016/j.orcp.2017.10.002
  77. Barclay AW, Brand-Miller J. The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased. Nutrients. 2011;3(4):491-504. doi:3390/nu3040491
  78. Brand-Miller JC, Barclay AW. Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention. Am J Clin Nutr. 2017;105(4):854-863. doi:3945/ajcn.116.145318
  79. Rikkers W, Lawrence D, Hafekost K, Mitrou F, Zubrick SR. Trends in sugar supply and consumption in Australia: is there an Australian Paradox? BMC Public Health. 2013;13:668. doi:1186/1471-2458-13-668
  80. Food Policy Index. Policies for Tackling Obesity and Creating Healthier Food Environments: Scorecard and Priority Recommendations for the Australian Federal Government. 2017. https://6caf7727-1efc-419a-8b13-d58f79d7351f.filesusr.com/ugd/2e3337_ef62a61c075f402ba80bcdd1df8174ae.pdf.
  81. Australian Health Policy Collaboration. Getting Australia’s Health on Track: Priority Policy Actions for a Healthier Australia. 2016. https://apo.org.au/sites/default/files/resource-files/2016-11/apo-nid74893.pdf.
  82. Cancer Council Australia. Position statement - Sugar-sweetened beverages. https://wiki.cancer.org.au/policy_mw/index.php?title=Position_statement_-_Sugar-sweetened_beverages&oldid=7340. Published 2016.
  83. Public Health Association of Australia. Policy-at-a-glance – Health Levy on Sugar Sweetened Beverage Position Statement. 2017. https://www.phaa.net.au/documents/item/2483.
  84. Rethink Sugary Drink. Health levy on sugar-sweetened beverages: Rethink sugary drink position statement. 2017. https://www.rethinksugarydrink.org.au/downloads/health-levy-on-sugar-position-statement.pdf.
  85. Wright S. Australia in recession: Biggest economic contraction since Great Depression, ABS confirms. The Sydney Morning Herald. https://www.smh.com.au/politics/federal/australia-in-recession-biggest-economic-contraction-since-great-depression-abs-confirms-20200902-p55rk4.html. Accessed February 23, 2021. Published September 2, 2020.
  86. Miller C, Braunack-Mayer A, Wakefield M, et al. Qualitative insights into Australian consumers' views for and against government action on sugary drinks. Public Health Res Pract. 2021;31(2):30122003. doi:17061/phrp30122003
  87. Mialon M, Swinburn B, Allender S, Sacks G. 'Maximising shareholder value': a detailed insight into the corporate political activity of the Australian food industry. Aust N Z J Public Health. 2017;41(2):165-171. doi:1111/1753-6405.12639
  88. Wood D, Griffiths K. Who’s in the Room? Access and Influence in Australian Politics. Grattan Institute; 2018. https://grattan.edu.au/report/whos-in-the-room. Accessed February 25, 2021.
  89. Edwards L. Political donations in Australia: what the Australian Electoral Commission disclosures reveal and what they don't. Aust J Public Adm. 2018;77(3):392-403. doi:1111/1467-8500.12283
  90. Fabbri A, Lai A, Grundy Q, Bero LA. The influence of industry sponsorship on the research agenda: a scoping review. Am J Public Health. 2018;108(11):e9-e16. doi:2105/ajph.2018.304677
  91. Duckett S, Swerissen H, Wiltshire T. A Sugary Drinks Tax Recovering the Community Costs of Obesity. 2016. https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/. Accessed February 2, 2021.
  92. O’Brien E, Campbell T. Final Report: Industry Priorities for Value Add & Diversification Opportunities in the Sugar Industry. Lazuli Consulting; 2019. https://sugarresearch.com.au/sugar_files/2019/06/SRA-Final-Report-Diversification-June-2019.pdf.
  93. Australian Trade and Investment Commission. Australia holds world record for longest period of growth among developed economies. https://www.austrade.gov.au/international/invest/investor-updates/2018/australia-holds-world-record-for-longest-period-of-growth-among-developed-economies. Published 2018.
  94. Baker P, Brown AD, Wingrove K, et al. Generating political commitment for ending malnutrition in all its forms: a system dynamics approach for strengthening nutrition actor networks. Obes Rev. 2019;20 Suppl 2:30-44. doi:1111/obr.12871
  95. Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev. 2015;16(7):519-530. doi:1111/obr.12289

Articles in Press, Corrected Proof
Available Online from 22 December 2021
  • Receive Date: 30 June 2021
  • Revise Date: 02 October 2021
  • Accept Date: 20 December 2021
  • First Publish Date: 22 December 2021