Irish Heart Foundation

Pre-Budget Submission Investing in children’s future health

September 2014

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The Irish Heart Foundation’s asks for Budget 2015:

1. The establishment of a Children’s Future Health Fund to promote a healthier

future for all Irish children and particularly for disadvantaged children who are

disproportionately affected by obesity, food poverty, smoking and alcohol

misuse.

2. Reduce consumption and gain revenue through a tax on sugar sweetened

drinks.

More Irish children are overweight than in most European countries.1 Our children are drinking

alcohol from a younger age and drinking more than ever before. 2 Irish children take up

smoking at a lower age than any other EU country3.

1 P. 18, Layte, R. and McCrory, C. (2011) Growing up in Ireland - Overweight and obesity among 9-year olds. Dublin: The

Stationary Office. 2 Department of Health (2012) Steering Group Report on a National Substance Misuse Strategy. Dublin: The Stationary

Office.

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Our vision of a Healthy Ireland

Every child is active and has a nutritious diet.

Every child is a healthy weight.

Every child enjoys a smoke-free Ireland.

Every child is protected from alcohol.

The Irish Heart Foundation’s is focused on three areas that affect children’s health – obesity, tobacco and alcohol.

3 European Commission (May 2012) Special Eurobarometer, Attitudes of Europeans to Tobacco.

4 CSO (2012) Profile 2: Older and Younger.

http://cso.ie/en/media/csoie/census/documents/census2011profile2/Profile2_Older_and_Younger_Entire_Document.pdf 5 See Irish Heart Foundation (2012, in press) Childhood nutrition guidelines and food related behaviour for preventing

cardiovascular disease. 6 Layte, R. and McCrory, C. (2011) Growing up in Ireland - Overweight and obesity among 9-year olds. Dublin: The

Stationary Office. 7 Growing Up in Ireland (September 2013) Development from birth to three years.

http://www.growingup.ie/fileadmin/user_upload/documents/Second_Infant_Cohort_Reports/ES_Development_from_Birth 8 Self-reported by children & young people surveyed. Kelly, C., Gavin, A., Molcho, M. & Nic Gabhainn, S. (2012). The Irish

Health Behaviours in School-aged Children study (HBSC) study 2010. Dublin: Department of Health.

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9 Kelly, C., Gavin, A., Molcho, M. & Nic Gabhainn, S. (2012). The Irish Health Behaviours in School-aged Children study

(HBSC) study 2010. 10

Self-reported by children & young people surveyed. Office for Tobacco Control (Nov. 2006). Children, Youth and Tobacco: Behaviour, Perceptions and Attitudes. Dublin: OTC. 11

Kelly, C., Gavin, A., Molcho, M. & Nic Gabhainn, S. (2012). The Irish Health Behaviours in School-aged Children (HBSC) study 2010. Dublin: Department of Health. 12

Self-reported by children & young people surveyed. Kelly, C. et al. (2012). The Irish Health Behaviours in School-aged Children (HBSC) study 2010.

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CHILDREN’S FUTURE HEALTH FUND

To prevent childhood obesity

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To stop a new generation of smokers

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To end underage drinking

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Food poverty and health inequity

Food poverty affects 10% of the population.

1 in 5 children go to school or to bed hungry because there is not enough food

in the home.17

1 in 6 children never have breakfast on weekdays.18

Health inequities are those which are unnecessary, avoidable, unfair and unjust.

Poor people get sick more often and die younger than those who are better off.

People in the most deprived areas have the lowest life expectancy.19

Coronary heart disease is almost 2.5 times more prevalent and stroke 2.2 times

more prevalent in the most deprived areas than in the least deprived areas.20

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Food Safety Authority of Ireland (2011) Scientific Recommendations for Healthy Eating in Ireland. Dublin: FSAI. 14

An, Ruopeng (2012) ‘Effectiveness of subsidies in promoting health food purchases and consumption: a review of field experiments’. Public Health Nutrition, 16 (7), 1215-1228. 15

Madden, D. (2013) ‘The poverty effects of a ‘fat-tax’ in Ireland’. Health Economics, DOI: 10.1002/hec.3006. 16

Carney, C. and Maître, B. for Department of Social Protection (2012) Constructing a Food Poverty Indicator for Ireland, Technical Paper. Available at: http://www.socialinclusion.ie/documents/2012-10-15_DSPFoodPovertyPaper_001.pdf 17

Kelly, C., Gavin, A., Molcho, M. & Nic Gabhainn, S. (2012). The Irish Health Behaviours in School-aged Children (HBSC) study 2010.Dublin: Department of Health 18

Ibid. 19

Life expectancy is correlated with a person’s social class, the affluence of the area in which they live and educational attainment. People with disabilities and carers also die younger, as do single persons and those who are widowed and divorced. CSO (2010) ‘Mortality Differentials in Ireland’ http://www.cso.ie/en/media/csoie/census/documents/Mortality_Differentials_in_Ireland.pdf 20

Balanda, K. et al. (2010). Making Chronic Conditions Count: Hypertension, Stroke, Coronary Heart Disease and Diabetes. Dublin: Institute of Public Health in Ireland.

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Supporting healthy eating for children and families with low incomes

Children

Families with low incomes

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Details of School Meals Programme available at: http://www.welfare.ie/en/Pages/School-Meals-Programme.aspx 22 Government of Ireland (2014) Better Outcomes Brighter Futures – The national policy framework for children and young people 2014-2020. 23

For further information about Community Food Initiatives see safefood (2013) Demonstration Programmes of Community Food Initiatives 2010-12 Evaluation. http://healthyfoodforall.com/wp-content/uploads/2013/11/safefoodCommunityFoodInitiatives20102012Evaluation.pdf

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The public supports a tax on sugary drinks

Following years of austerity, the public are understandably weary of taxation, yet there

is a majority in favour of a tax on sugary drinks. An Ipsos MRBI poll carried out for the

Irish Heart Foundation25

in May 2014 shows that the public expects the government to

exercise its role as a protector of public health:

52% supported the introduction of a tax on sugary drinks.

Almost 90% agreed that sugary drinks contribute to obesity among children and

agreed that Irish children and young people consume too many sugary drinks.

In addition, a 2014 poll by safefood26

found that 86% of the public supported the

introduction of subsidies for fruit and vegetables.

Health impacts of sugary drinks

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Brownell, K.D. and Frieden, M.D. (2009) ‘Ounces of Prevention – the public policy case for taxes on sugared beverages’. New England Journal of Medicine, 360 (18), 1805-1808. 25

Ipsos MRBI nationwide poll of 1,008 adults for the Irish Heart Foundation, May 2014. See http://www.irishheart.ie/iopen24/irish-public-supports-sugary-drink-obesity-rate-n-467.html 26

safefood (2014) Attitudes of the public towards policies to address obesity. http://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Publications/Research%20Reports/Safefood-Attitudes-Report-Final.pdf 27

For e.g., Chaloupka, FJ, Powell, LM, Chriqui, JE. ( 2009) Sugar-sweetened Beverage Taxes and Public Health. A research brief. Robert Wood Foundation. wwwrwif.org 28

de Ruyter et al. (2012) ‘A trial of sugar-free or sugar-sweetened drinks and body weight in children’. New England Journal of Medicine. DOI: 10.1056/NEJMoa1203034. 29

Ebbeling et al. (2012) ‘A randomized trial of sugar-sweetened drinks and adolescent body weight’. New England Journal of Medicince. DOI: 10.1056/NEJMoa1203388 30

Qi et al. (2012) ‘Sugar-sweetened drinks and genetic risk of obesity’. New England Journal of Medicine. DOI: 10.1056/NEJMoa1203039

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Evidence in favour of a sugar drinks tax

There is compelling evidence that consumption of sugary drinks is related to increased risk of obesity.

There is convincing evidence from randomised control trials that reducing intake of sugary drinks decreases risk of weight gain and obesity in children and young people.

There is a dose-response relationship between sugary drinks and weight gain – as sugary drink intake increases, the amount of weight gain also increases.

For a discussion of the evidence, see: Hu, F.B. (2013) ‘Pro v Con debate: role of sugar sweetened beverages in obesity. Resolved: there is sufficient scientific evidence that decreasing sugar- sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases’. Obesity Reviews, 14, 606-619.

What is Ireland drinking?

Counting the calories and the sugar

The WHO is developing new guidelines on sugar consumption, proposing that sugars make up less than 5% of total energy intake per day for adults and children. 5% of total energy intake is approximately:

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Institute of Public Health (2012) Proposed Sugar Sweetened Drinks Tax: Health Impact Assessment (HIA) Report. Dublin: Institute of Public Health. 32

Estimated by Dr Adam Briggs and presented at Irish Heart Foundation Seminar ‘20% tax on Sugar Sweetened Drinks’,

Monday 23rd June 2014, The Gibson Hotel, Dublin 1. 33

Consumption details provided in Institute of Public Health (2012) Proposed Sugar Sweetened Drinks Tax: Health Impact Assessment (HIA) Technical Report. http://www.publichealth.ie/document/iph-report/proposed-sugar-sweetened-drinks-tax-health-impact-assessment-technical-report

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7 teaspoons of sugar per day for an adult of normal Body Mass Index (BMI).

4 teaspoons of sugar per day for a 5 year old child.

A 500 ml bottle of cola can contain up to 12.5 teaspoons of sugar. A 500ml energy drink can contain up to 21.5 teaspoons.34

Revenue from a sugary drinks tax

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Irish Nutrition and Dietetic Institute (2014) ‘Factsheet – Understanding sugars and how they affect your health.’ https://www.indi.ie/fact-sheets/fact-sheets-on-food/708-this-fact-sheet-will-help-you-to-understand-how-sugar-might-affect-your-health-and-wellbeing.html 35

Presentation by Dr Micheál Collins, 23rd

June 2014 to Irish Heart Foundation Seminar, ‘A SSD Tax: Revenue & Income Distribution implications’. This estimate does not account for the reduction in consumption which the tax is intended to achieve. 36

Bahl et al. (2003) ‘The uneasy case against discriminatory excise taxation: soft drink taxes in Ireland’. Public Finance

Review, 31 (5), 510-533. 37

Department of Jobs, Enterprise and Innovation, Ireland’s Trade Performance 2004-Q1 2012, http://www.djei.ie/trade/bilateral/tradeperformancetables2012q1.pdf 38

Parliamentary Question to the Minister for Environment, Community and Local Government, 16th

July 2013 – Tax Yield.

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Job loss arguments by the beverage industry are overstated for 3 reasons:

1. They do not fully account for the increased consumption of non-sugary drinks, which are often produced by the same companies.

2. They do not include the increases in jobs created elsewhere in the economy as consumers reallocate their spending to non-sugary drinks goods.

3. The economic activity the tax revenue generates is not accounted for.

Source: Powell, L.M., Wada, R., Persky, J.J. and Chaloupka, F.J. (2014) ‘Employment impact of sugar-sweetened beverage taxes’. American Journal of Public Health, 104 (4), 672-677.

Employment effects in Ireland

Research on the Irish market40

indicates that the employment effects of a tax on sugary drinks

and a subsidy on fruit and vegetables are likely to be neutral at worst and maybe even

positive, because the fruit and vegetable sector is more labour intensive than the beverage

sector.

If a tax is revenue neutral the impact on employment will depend on the employment intensity

of the goods involved in the reform. The Census of Industrial Production (2010) gives

measures of gross turnover and number of persons employed. The inverse of turnover per

worker is a rough measure of employment intensity. This shows that the fruit and vegetable

sector in Ireland is more labour intensive than the beverage sector.

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Powell, L.M., Wada, R., Persky, J.J. and Chaloupka, F.J. (2014) ‘Employment impact of sugar-sweetened beverage taxes’. American Journal of Public Health, 104 (4), 672-677. 40

Professor David Madden, School of Economics, University College Dublin, Presentation and ‘Food, Fat and Fiscal Measures’ Irish Heart Foundation Seminar, 20

th March 2013. Presentation available at:

http://www.irishheart.ie/media/pub/foot_fat_and_fiscal_measures__some_observations__david_madden.pdf

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Employment intensity of sectors in Ireland

If, however, the effect of the tax is not neutral then the size of the tax increase is relevant. The

size of the sugary tax as proposed is unlikely to lead to major employment effects. Further it is

unlikely that the sugary drink tax would influence multi-national beverage companies to

relocate, given that they tend to respond to corporation tax and non-marginal changes. There

is also scope for expenditure switching by consumers to other equally employment intensive

goods.

Impact of sugary drinks tax on people with low incomes

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For example, see Layte, R. and McCrory, C. (2011) ‘Growing Up in Ireland – overweight and obesity among 9 year olds, report 2’. Dublin: Department of Children and Youth Affairs. http://www.growingup.ie/fileadmin/user_upload/documents/Second_Child_Cohort_Reports/Growing_Up_in_Ireland_-_Overweight_and_Obesity_Among_9-Year-Olds.pdf

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Looking at the impact of a sugary drinks tax on poorer households in Ireland

Research using Irish expenditure data44

finds that while taxes on high fat/sugar goods on their own will be regressive, a tax-subsidy combination can be broadly neutral with respect to poverty. The research shows that it may be possible to construct a tax / subsidy package that would have a limited, or perhaps even a beneficial impact on poverty.

The analysis presented here has confirmed the conjecture of the Report of the National Task Force on Obesity that fat/SSB [sugar sweetened beverage] taxes on their own are likely to be regressive in their effect. However, if such taxes were to be combined with a subsidy on various ‘healthy’ foods, then it is possible to put together a package whose impact on poverty would be negligible

...in terms of the narrower issue of the distributional impact of a fat/SSB [sugar sweetened beverage] tax, what this paper has demonstrated, for Ireland at least, is that such taxes are generally regressive but that this regressivity can be almost completely mitigated by choice of an appropriate accompanying subsidy

Madden (2013) ‘The poverty effects of a ‘fat-tax’ in Ireland’. Health Economics.

This analysis relates purely to the economic effects of taxes and subsidies and does not address the additional health benefits that would be likely to accrue over time.

Even if there was no accompanying subsidy the state could decide to directly target those families who were negatively impacted by a sugary drinks tax. Expenditure of approximately €4 million would be required to compensate the poorest households for a 10% tax.

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Sales are by Big Soda

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Presentation by Dr Michael Collins, 23rd

June 2014 to Irish Heart Foundation Seminar, ‘A SSD Tax: Revenue & Income Distribution implications’. 43

See pg. 10 Social Justice Ireland (2014) Budget Choices http://www.socialjustice.ie/content/budget-2015-should-protect-vulnerable-invest-social-housing-and-disability-services-and-roll 44

Madden, D. (2013) ‘The poverty effects of a ‘fat-tax’ in Ireland’. Health Economics, DOI: 10.1002/hec.3006. 45

Presentation by Prof. David Madden, 23rd

June 2014 to Irish Heart Foundation Seminar, ‘The distributional impact of a tax on SSBs – some observations’. 46

Institute of Public Health (2012) Proposed Sugar Sweetened Drinks Tax: Health Impact Assessment (HIA) Technical Report. http://www.publichealth.ie/document/iph-report/proposed-sugar-sweetened-drinks-tax-health-impact-assessment-technical-report

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o

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Implementing the tax

o

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Sharma, A. et al. (2014) ‘The effects of taxing sugar-sweetened beverages across different income groups’. Health Economics. 48

See page 20, National Heart Forum (2012) ‘What is the role of health-related food duties? A report of the National Heart Forum meeting, 29

th June 2012. http://www.worldobesity.org/site_media/uploads/UKHF_duties.pdf

49 Finkelstein et al. (2010) ‘Impact of targeted beverage taxes on higher- and lower-income households’. Archives of

Internal Medicine, 13 (27), 2028-2034. 50

Ng et al. (2012) ‘Patterns and trends of beverage consumption among children and adults in Great Britain, 1986-2009’. British Journal of Nutrition, 108 (3), 536-551. 51

Brownell, K.D. and Frieden, M.D. (2009) ‘Ounces of Prevention – the public policy case for taxes on sugared beverages’. New England Journal of Medicine, 360 (18), 1805-1808. 52

Andreyeva,T. et al. (2011) ‘Estimating the potential of taxes on sugar sweetened beverages to reduce consumption and generate revenue’. Prev. Med.

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Food industry arguments

Putting a price on obesity The annual cost of obesity in the Republic of Ireland is estimated to be €1.13 billion. Some 35% of the costs (€398m) are direct healthcare costs, €728m are indirect costs in reduced productivity and absenteeism.

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A 2012 study57

estimated the impact of overweight and obesity on use of particular healthcare services (GP services; hospital inpatient; and hospital day-case services). It conservatively estimated that primary healthcare costs are €17 million higher and secondary healthcare costs approximately €24 million higher as a result of overweight and obesity in adults.

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Smith et al. (2010) Taxing calorific sweetened beverages: potential effects on beverage consumption, calorie intake, and obesity. Economic Research Report, 2010 No. (ERR-100). 54

Mytton et al. (2012) ‘Taxing unhealthy food and drinks to improve health’. BMJ. 55

Ng et al. (2012) ‘Patterns and trends of beverage consumption among children and adults in Great Britain, 1986-2009’. British Journal of Nutrition, 108 (3), 536-551. 56

Safefood and Dept. of Epidemiology and Public Health (2012) The cost of overweight and obesity on the island of Ireland. 57

Doherty, E., Dee, A. and O’Neill, C. (2012) ‘Estimating the amount of overweight and obesity related health-care use in the Republic of Ireland using SLAN data’. The Economic and Social Review, 43 (2), 227-250.

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Conclusion

Big decisions and a new approach are needed

A small role for industry

“... It is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics”.

Margaret Chan, Director-General, World Health Organisation, June 201358

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Chan, M. (2013) ‘Opening address at the 8th Global Conference on Health Promotion Helsinki, Finland’ http://www.who.int/dg/speeches/2013/health_promotion_20130610/en/

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