Aggregation of Marginal Gains

See original imageFans of British cycling will understand those words and what they have meant to the performance of British cyclists both in the velodrome and in the Tour de France – sorry French readers, we have been awesome there the last few years!!  David Brailsford used the principle of the ‘aggregation of marginal gains‘.  Very simply, if you can improve everything by just 1%, you can aggregate all those little gains into big successes – by taking each opportunity, however small, enormous success can be achieved.  Keep that thought as I move onto the big topic, my moment on my soap box.

Something that has been featuring quite heavily in my Twitter Feed is the Sugar Tax.  Quite a lot of tweets by People Against the Sugar Tax.  I have been meaning to write a post about the sugar tax since it was announced and I have to say these tweets have got me thinking and sparked me into action.  It will be a long one – a cuppa might be called for. (Then I will move on to the lighter topic of the Maisons-Laffitte cooking round robin – Canada is the next stop if you have been following).

To summarise,  the UK Government have announced that a sugar levy will be introduced on soft drinks to the cheers of health campaigners.  The companies that make soft drinks or import them will have to pay one levy for drinks in the top band of sugar content (including full sugar colas of all the big brands) and a lower levy to the next band of sugar content (which includes many lemonades of big brands).  These levies will not come into place for 2 years to give companies an opportunity to reformulate their products to reduce their tax burden but, more importantly, to help the nation to reduce their sugar consumption.

Obviously, the industry do not like this one little bit.  Anti-tax groups don’t like it very much either – another stealth tax they say and it won’t do anything to reduce obesity they say.  Where will it stop?  Other countries have been cited where a tax has been used – some at the consumers level and others, like this one, at the door of manufacturers.  It has been highlighted that this has little effect on sugar intake from soft drinks.

I just read an article on the soda tax in Mexico and it makes for interesting reading.  It is an example of a soda tax set for for the manufacturers and there are signs that it is making a difference.  In this story, the big soft drinks companies don’t come out of it too well – looking more and more like the tobacco industry in fighting against the link between poor health and their product.

Another country that is cited is France.  The tax here is levied at the point of purchase.  It is applied to all soft drinks regardless of sugar content so it doesn’t encourage a switch to lower sugar alternatives therefore any reduction in consumption isn’t skewed to maximise a reduction in sugar.

There is a clear debate to be had about whether this sugar tax will have its intended result i.e. a reduction in sugar consumption from soft drinks particularly in children.  Only time will tell.  If the tax only results in an increase in soft drink prices across the spectrum, including lower and no sugar soft drinks, then it is unlikely the tax will make much difference to sugar consumption as is the case in France.  It may affect people on lower incomes most.

But, if (and it is quite a big ‘if’) soft drink manufacturers do some reformulation then we could see a drop in sugar intakes from soft drinks and if we see a discrepancy in price between the drinks with the highest sugar content compared with low or sugar free, will we see a shift in consumers purchasing?   It could be a good nudge towards better choices.  When such nudges are carried out openly by governments trying to improve health it is opposed as being nannying or manipulative.  But is it not true that much of the marketing and product placement is using the same nudge tactics to encourage us to buy more product?  We should be equally critical of many of the marketing tactics used to sell food to us.

However, there is no debate among health professionals and scientists that reducing free sugars will help reduce total discretionary calories and that doing so will have a positive effect on health.  Children particularly consume a lot of sugar from soft drinks.  By free sugars or refined sugars I mean those that are not naturally found in milk and fruits and vegetables – once a fruit has been juiced, the sugars have been extracted and are free sugars although they do come with some vitamins.

It is also agreed that sugars found in soft drinks can be particularly detrimental for weight management because they don’t seem to be treated like other calories.  We don’t seem to register them, we don’t then eat fewer calories in the same way as we would if we have consumed the same number of calories in a food.  Additionally, they are particularly bad for our teeth, especially when consumed in between meals.

One point that is repeatedly made about the tax is that it won’t stop people buying soft drinks.  There is no intention to stop people buying fizzy drinks on the back of this tax alone.  It is to push manufacturers to use less sugar and to create an financial incentive to buy drinks lower in sugar.  Taxation is a crude method because how the companies deal with paying the tax is left to them – if they simply pass the cost to the consumer then it may not make a difference.

‘A tax on soft drinks isn’t going to fix obesity’ is the other quote I have seen bandied about by those against the sugar tax.  Tackling obesity is not going to be fixed by any one thing. No one change will get success but pooling lots of changes together can achieve remarkable results.

Can you see where I am going with this?  ‘Aggregation of marginal gains’ principle is needed here.  We all need to be part of the solution.  This defecting the problem away from one thing towards another, laying the problem or the blame at someone else’s door is an easy way of sitting back and doing nothing.  In the end, not enough change will occur.  Obesity will continue to increase along with the ever increasing tide of diabetes.

The soft drinks industry would like all the focus to be on physical activity, and not sugar intake.  But tackling activity alone will not solve obesity.  We hear arguments that it is all about education and personal choice, will power etc etc.  But our surroundings and the obesogenic environments that we live in and other pressures on the choices we make – the quality of food sold to us, lack of time, lack of money, lack of knowledge, confusing information – all have to be addressed.

“There has already been a 17% drop in soft drink consumption” say People Against the Sugar Tax – job done?  But we have to question the data behind that statistic and understand where the majority of this drop was?  Was it in children and adolescents?  How much difference has that made to sugar intake in the highest consumers?  A headline that presents as many questions.  You have to look deeper into the figures.  But think, if we added to this a 1g reduction per serving to every high sugar containing soft drink how much bigger an impact would that then have?  If we then on top saw a 17% shift from the highest band of soft drinks to lower sugar drinks?  If we saw a switch in purchasing from 500mls to 330mls resulting in a drop in total consumption?  Aggregation of marginal gains!

There are serious concerns about taxing foods and it is very important that the poorest don’t suffer adversely.  You could argue that it is this group that benefit most from controlling nutritional quality of food sold at lower price points – just because a family can only afford cheap food why should this be food that is really high in things that we should be eating less off?  And lower in things we should be eating more of like fibre?  There should be a move towards better food.  We should be demanding best practice standards- should energy rich but nutrient poor food be sold at very low prices?

Let us have a debate about tax on other foods by all means.  This levy on soft drinks has been announced and was recommended by independent experts based on evidence, let us not miss the opportunity to make a marginal gain towards better health.  The tax has been announced and it has the potential to make a difference.  Even if it is a small one it is worth fighting for it.

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