A Call for Global Sugar Reduction
“This unprecedented meeting—the first ministerial conference on non-communicable diseases—is evidence of a new and positive trend: the world is paying attention to non-communicable diseases as never before…Chronic illnesses influenced by diet, tobacco consumption and other individual behaviors were long thought to be diseases of affluence. That is clearly not the case. The World Health Organization estimates that nearly 9 out of 10 people who die from non-communicable diseases under the age of 60 live in the developing world. They have less protection from the risks and consequences of these diseases than people in the developed world.”
—U.N. secretary-general Ban-Ki Moon, to the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control, Moscow, April 28, 2011
It Tolls for Thee…
On September 20, 2011, in New York, the UN secretary-general lowered the boom. The world is dying. Not of the plague, not of influenza, not of Ebola, not of AIDS. Noncommunicable disease (i.e., heart disease, diabetes, cancer, dementia—in other words, the metabolic syndrome) is now a greater threat to the developed and developing world than is infectious disease. This is quite a paradigm shift. The reality is that every country that has adopted the Western diet (now the industrial global diet) has witnessed rising rates of obesity and metabolic syndrome. Furthermore, economic development means that the populations of low- and middle-income countries are living longer (which is a good thing), but are therefore more susceptible to these diseases (which is a bad thing). Currently, there are 30 percent more obese than undernourished people on the planet. And 80 percent of deaths from heart disease and other noncommunicable diseases occur in low- and middle-income countries.1
The Rationale for Targeting Sugar
The UN announcement targets tobacco, alcohol, and diet as the central risk factors in noncommunicable disease. The first two, tobacco and alcohol, by everyone’s estimation, are the most prevalent and dangerous chronic exposures on the planet. Both are regulated by governments around the world to protect the public health—not just for the abuser, but for the innocent bystander as well. Alcohol has a long history of governmental control, extending back to ancient China, when an attempt was made to curb alcohol’s promotion of unruly behavior and property damage. More recently, the efforts of MADD (Mothers Against Drunk Driving) and other advocacy groups have promoted efforts to curtail drunk driving, more to protect the innocent bystander than the drinker himself. Public outcry works. Tobacco is more recently regulated, not just because of lung cancer, but also to curtail the dangers of secondhand smoke. But what, if anything, about diet should be targeted? And why? This is a little more complicated. Unlike with tobacco and alcohol, we need food. What aspect of the Western diet should be targeted for intervention?
Denmark took the first plunge, despite the fact that obesity isn’t a huge problem there. The Danes first chose to tax foods high in saturated fat, even though most medical professionals no longer believe that fat is the primary culprit (see chapter 10). After all, look where such a belief has gotten us. But now Denmark is ready to tax sugar as well, which, as you will see, is a much more plausible and defensible step.
Do we really need to restrict sugar? After all, sugar is fun. Sugar is family. Sugar is pleasure. Coke’s 2009 tag line is “Open Happiness.” Now, that’s going a bit too far. Maybe pleasure, on a good day. But there’s nothing “happy” about sugar, and this book documents the unhappiness that sugar has wrought worldwide.
In 2003 a landmark book called Alcohol: No Ordinary Commodity2 laid out the four criteria that the public health community established to justify the regulation of a substance: unavoidability, toxicity, abuse, and costs to society. Alcohol and tobacco easily meet these criteria. But what about sugar? My colleagues Laura Schmidt, Claire Brindis, and I evaluated these effects.3
Unavoidability
Sugar is now the most ubiquitous foodstuff worldwide, and has been added to virtually every processed food, limiting consumer choice and the ability to avoid it. Approximately 80 percent of the 600,000 consumer packaged foods in the United States have added caloric sweeteners. The only way you can avoid it is if you grow your own. Many schools have removed soda from their vending machines but they still serve juice and chocolate milk. When you were five, would you opt for water over chocolate milk? And in 40 percent of schools in California there are no drinking water fountains, so again, your children don’t get to choose, and can’t avoid the sugar.4 Daily sugar intake in many countries now tops 400 calories (see chapter 11).
Toxicity
If “a calorie is a calorie” were true, and obesity and metabolic syndrome were a result of “empty calories,” the mantra of “eat less, exercise more” would stand. But sugar is not “empty calories.” The fructose component is a toxin by itself—a chronic one, a dose-dependent one—but a toxin nonetheless.5 We know about the ill effects of smoking and prolonged alcohol usage. Every single disease or condition of metabolic syndrome is driven by fructose, including hypertension, through increases in uric acid; high triglycerides and insulin resistance, through synthesis of fat in the liver; diabetes, via increased liver glucose production combined with insulin resistance; accelerated aging, due to damage to lipids and protein; likely cancer, due to DNA damage, high insulin levels, and the fact that some cancers seem to use fructose preferentially for energy; and likely dementia, through insulin resistance in the brain.
Sugar acts on the reward center6 to encourage subsequent intake (see chapters 5 and 11). Whether it fits the criterion for addiction is irrelevant; the stuff is abused. You get hooked at an early age, and it’s harder to kick the habit after years of prolonged usage. There are now numerous human studies examining the dependence-producing properties of sugar.7 By reducing dopamine signaling in the brain’s reward center, the pleasure derived from food is reduced (increasing tolerance), compelling the individual to consume more. And when the sugar is stopped, symptoms of irritability (withdrawal) become apparent.
Costs to Society
Society acknowledges that alcohol abuse (driving under the influence) and smoking (effects of secondhand smoke) can injure the innocent bystander. But how does your sugar consumption affect me? An extra $274 million in jet fuel to cart the obese around the skies? Discomfort on the subway? Sinking of boats due to the weight? In 2003 the Ethan Allen, a tour boat, capsized in Lake George, New York, because it was certified to carry 48 people at 140 pounds, yet the average person aboard was 25 percent over that weight. The diseases of metabolic syndrome are bankrupting the medical care systems of our country and the world at large.8 In the United States, we’re talking $150 billion annually in health care expenditures and $73 billion in lost productivity due to obesity in full-time employees.9 This amount is expected to increase to $192 billion by 2030. And because 27 percent of military applicants are now rejected for obesity-related reasons, the past three U.S. surgeons general and the chairman of the U.S. Joint Chiefs of Staff have declared obesity a “threat to national security.”
Why Alcohol Is So Relevant
The appropriate analogy to draw for sugar is with alcohol (see chapter 11). Let’s recap.
1. Alcohol is derived from the fermentation of sugar.
2. Both are metabolized by the liver, bypassing insulin regulation to overload the mitochondria and cause metabolic abnormalities.
3. Both act as an energy source, but with a clear health cost.
4. Both are legal substances that produce harm when overused.
5. Both cause the diseases of metabolic syndrome.
6. Both are addictive, acting at the reward center of the brain, with bingeing, craving, tolerance, and withdrawal.
7. Both bring with it a stigma from overuse.
8. Both are abused by the lowest socioeconomic strata, almost certainly to stimulate pleasure, and the overwhelming burden of harm falls on them.
9. Both are treated as market commodities.
10. Both have generated powerful industry lobbies and vested interests, and have co-opted the objectivity of many government officials.
Unfortunately, moderating your sugar intake is nearly impossible given our current sugar glut. Sugar is in nearly everything you eat or drink, and you’re hooked on it from childhood. Given all the metabolic, hedonic, and societal similarities to alcohol, doesn’t it make sense to use the lessons learned from alcohol control policies and apply them as a template for societal approaches to sugar reduction?
Does Education Change “Behavior” for Addictive Substances?
There’s no question that public health campaigns can help change attitudes, which can help change disease risk. For instance, education increased condom use to reduce HIV rates. But for alcohol, tobacco, and street drugs, most of the popular approaches to public health education don’t work to curtail abuse for two reasons: because they do not do anything to reduce availability of the substance in question, and because those substances are addictive. For instance, school-based education programs have little effect on reducing alcohol consumption.10 School-based obesity education programs to date also show limited success,11 in part because our kids’ food preferences are formed before they ever get to school and because their home environment remains constant. Teaching the child won’t fix her environment. Necessary, but not sufficient. Ask the kid who returns from fat camp and gains all his weight back within three months.
What about public service announcements (PSAs) or counter-advertising? The recent anti-tobacco ads with amputees and tracheostomy patients are pretty stark, but they don’t change tobacco availability. Thus far, alcohol PSAs have demonstrated only modest effects with respect to total alcohol consumption.12 Despite numerous ad campaigns to combat obesity, such as those in New York City,13 there are no data that show that PSAs alone are effective in reducing sugar consumption. Necessary, but not sufficient.
How about the latest hot idea, menu labeling? New York City was the first to require in-store labeling for consumer education. The results show that, for adults, average calorie consumption did not change with the advent of labeling changes alone—828 versus 846 calories—only 15 percent of adults altered their choices based on caloric knowledge.14 One study compared a New York City sample population exposed to labeling with a Newark, New Jersey, sample population exposed to no labeling.15 Guess what? No difference! Worse yet, none of the current menu-labeling initiatives even measure sugar—it’s just total calories, fat, and salt. Necessary, but not sufficient.
This goes for food labeling as well. Remember “Smart Choices,” the green checkmark that the food industry placed on products to indicate compliance with USDA food standards? Cocoa Krispies and Froot Loops bore the Smart Choice insignia. Froot Loops qualified because it met standards for fiber and vitamins A and C; and because it did not exceed limits on fat, sodium, and sugar (only 12 grams per serving—or 41 percent of the product, that’s all). The program was scrapped in 2009 due to the outcry of citizens incredulous that Froot Loops was on the list. The Environmental Working Group in 2011 published Sugar in Children’s Cereals,16 which documented the sugar content of eighty-four breakfast cereals (and while they were at it, the lack of fiber). Table 22.1 shows the worst. Incredibly, Froot Loops is only number ten! Perhaps the biggest travesty is that this information is not squarely placed on the label for all to see.
Table 22.1: The Ten Worst Children’s Breakfast Cereals (from among 275)
1. Kellogg’s Honey Smacks: 55.6 percent sugar by weight Ingredients: Sugar, wheat, dextrose, honey, contains 2 percent or less of vegetable oil (hydrogenated or partially hydrogenated soybean), salt, caramel color, soy lecithin, BHT for freshness. |
| 2. Post Golden Crisp: 51.9 percent sugar |
| 3. Kellogg’s Froot Loops Marshmallow: 48.3 percent sugar |
| 4. Quaker Oats Cap’n Crunch’s OOPS! All Berries: 46.9 percent sugar |
| 5. Quaker Oats Cap’n Crunch Original: 44.4 percent sugar |
| 6. Quaker Oats Oh!s: 44.4 percent sugar |
| 7. Kellogg’s Smorz: 43.3 percent sugar |
| 8. Kellogg’s Apple Jacks: 42.9 percent sugar |
| 9. Quaker Oats Cap’n Crunch’s Crunch Berries: 42.3 percent sugar |
| 10. Kellogg’s Froot Loops Original: 41.4 percent sugar |
Then there are government guidelines. The 2010 Dietary Guidelines Advisory Committee suggested an upper limit of 25 percent of daily calories allotted to added sugar (remember, Nutrition Facts gives you only total sugar, not added sugar). However, a recent adult study showed that when 25 percent of calories were due to added sugar, people developed worsened LDL, triglycerides, and insulin resistance within two weeks.17
Bottom line, although lots of effort and money have been thrown at various methods of obesity prevention at the individual education level, the results are downright disappointing.18 When it comes right down to it, you can’t change behavior with information alone, especially when you’re talking about addictive substances. Necessary, but not sufficient. Because the biochemical drive will eventually overcome any cognitive attempt to control it. Nope, it’s going to be all about changing the environment, and that means changing availability.
Changing Marketing to Children: Not Much Better
There is plenty of evidence that the cumulative effect of alcohol advertising alters young people’s perceptions, and encourages pro-alcohol attitudes and greater consumption.19 While population studies find some small effects for alcohol advertising bans, individual studies of short-term impacts on alcohol consumption find no effect.20 Worse yet, industry-sponsored efforts are even less efficacious for the public health—“Don’t drink and drive,” by Budweiser, has become “Drink Budweiser and then let someone else drive.” Government-imposed regulations on the marketing and promotion of alcohol products have mainly targeted youth, with varied results.
Although commercials for alcohol (except for beer and wine) have been scaled back since the 1970s, messages about alcohol still pervade the airwaves. Government-imposed regulations on marketing of alcohol to youth have been somewhat effective. The success of regulations that limit how alcohol is advertised and marketed has immediate relevance for sugar reduction.
Can we limit junk food advertising, especially those marketing sugar? Marketing to children is a major goal of the food industry, as it hastens “branding” of specific products, which the child will likely take into adulthood. All this despite the fact that children can’t tell the TV show from the commercial until they are eight years old. A 2007 study showed that the average American child sees thirty thousand TV commercials annually marketing fast food or candy.21 An average of one food commercial is shown every five minutes during Saturday morning cartoons. Advertisers spent more than $10 billion targeting children and youth though TV ads, coupons, contests, public relations promotions, and packaging designed for children. All this advertising translates into purchasing requests22 and, more important to the industry, increased consumption.23
In 2007 the health ministers of fifty-two European nations convened in Istanbul and agreed to ban the marketing of junk food to children.24 Heartened by this effort, in October 2007, I asked Deborah Taylor Tate, then commissioner of the Federal Communications Commission under President George W. Bush, whether this was feasible in America. Her response was “I expect the food industry to police itself.” When left to their own devices, cigarette ads blatantly targeted children until public outcry demanded that the government step in. Metabolic syndrome is currently claiming more lives than lung cancer. Clearly public outcry has to become so deafening that the government has no recourse but to take action. Against all odds, and led by Dr. Guido Gerardi Lavin, a pediatrician and former president of the Senate, the nation of Chile in May 2012 became the first nation to ban junk food marketing to children.
In 2007 the Better Business Bureau produced a voluntary industry agreement called the Children’s Food and Beverage Advertising Initiative (CFBAI), which ostensibly limits advertising and promotion to children in schools, and is set to go into effect in 2014. The standards would apply equally to all companies that participate (currently seventeen), but participation is voluntary. For instance, Nestlé, the world largest food conglomerate, has thus far said, “Go fly.” Here’s an example of what’s okay to market under this initiative: Pepperidge Farm Goldfish, Kellogg’s Apple Jacks, and ConAgra’s Chef Boy-ar-dee canned pastas. Not entirely happy with this response, in 2011 Congress directed the FTC, the FDA, the CDC, and the USDA to establish an Interagency Working Group (IWG) of federal nutrition, health, and marketing experts. The IWG came up with stricter, but still voluntary, guidelines that would limit not only television but also other forms of multimedia advertising (e.g., websites, online games, social media movies). The food industry lobbied Congress so hard that the IWG has withdrawn, and is planning to support the weaker, self-anointed CFBAI. So will Toucan Sam and Tony the Tiger bite the dust? Don’t bet on it.25
Thus far, there are no government-imposed bans on the marketing of high-sugar-content products to children in the United States. Even so, despite vigorous lobbying by the food industry, San Francisco recently instituted a ban on including toys with fast food meals. Why does a toddler need more coercion to eat fast food than the food itself? Since then, the political fallout has resulted in three states banning “toy bans.” Nonetheless, in June 2012 Disney got the memo—they will cease marketing of junk food to children under twelve. Hope springs eternal.
What will it really take to reduce sugar consumption? We can’t get rid of it; rather, like alcohol and tobacco, we will have to learn to “peacefully co-exist” with these substances. Let’s look to the many generations of international experience with alcohol control to find models that do work. Anything that works does so by limiting availability.26 This means upstream strategies that limit supply, rather than downstream approaches that hope to decrease demand, but can’t. Reducing availability can be done at three levels: taxation, restriction, and interdiction. Well, forget interdiction—that’s a non-starter. It didn’t work for alcohol. Criminalizing a substance as widespread or as popular as sugar would be equally doomed to failure; can you imagine sugar prohibition, with candy speak-easys and bathtubs of Coca-Cola? But successful interventions all share a common end point: curbing availability. In other words, control the environment, not behavior.
Some municipalities have taken up the gauntlet. For instance, in California we have State Bill 19, or “Sodas out of Schools.” In 2008, former president Bill Clinton and former Arkansas governor Mike Huckabee reached an agreement with the beverage industry to get sodas out of schools—but they didn’t negotiate the elimination of the juice and the sports drinks. In 2012 a study showed that in the twelve states where soda had been removed from schools, sugared beverage consumption by teens remained just as high as it had ever been.27
Taxation
Taxation is a simple and effective, if unpopular, way of reducing consumption of virtually anything. Taxation follows the law of supply and demand: adding a tax increases the price of the substance of concern such that consumers can afford to buy less of it. Alcohol taxes are popular worldwide because they are relatively cheap and easy to collect, while causing little market distortion. Alcohol taxation, in the form of special excise duties (taxing the producer), or value added and sales taxes (taxing the consumer), has proven among the most prodigious and effective ways worldwide to reduce the overall volume of drinking and, in turn, alcohol-attributable harm.28
Could taxing sugar help solve obesity?29 This is one of the most incendiary topics on the agenda. Want to stop a dialogue in the United States? Utter the phrase “soda tax.” Soda is not all sugar-sweetened beverages (SSBs)—SSBs are only 33 percent of all added sugar—and SSBs are not the sole cause of the obesity epidemic, so this strategy is incomplete at best.30 Nonetheless, SSBs have several characteristics that make them the most promising target for prevention of obesity and metabolic syndrome31 (see chapter 9). First, SSBs are a clearly defined category, unlike other “junk foods” that might contain some protein, fiber, or micronutrients. There is nothing in an SSB that’s valuable. Oh, some will argue that juice has vitamin C. But the fiber was the good part of the fruit, and vitamin C deficiency (scurvy) is now so rare that cases of it are reported in medical journals.32 Second, SSBs contribute more calories to the diet than any other single type of food or beverage. Third, the evidence supporting an association between SSB intake and obesity is stronger than for any other single foodstuff.
State-sponsored soft drink excise taxes reduced soft drink sales and consumption among children and adolescents, while consumption of whole milk increased. (One downside is that consumption of fruit juice also increased.)33 Another intervention in a hospital cafeteria showed that increasing the price of a soda by 35 percent resulted in a 26 percent reduction in consumption.34 Thus, soda taxation represents a viable public health strategy.35 Already, Canada imposes a GST (goods and services tax), and some European countries impose a VAT (value added tax) on some sweetened foods.
In the United States, the concept of a soda tax has met with a firestorm of antagonism, from everyone from the libertarians claiming consumer freedom, to the ACLU claiming discrimination based on poverty, to the food industry claiming “scientific McCarthyism.” The beverage industry has spent millions of dollars on lobbying against an SSB “sin tax.” It is so desperate to derail this legislation that it offered the city of Philadelphia $10 million, including an obesity professorship at Children’s Hospital of Philadelphia, if the city agreed to abandon its proposed excise tax on soda. While this offer might seem generous, Philadelphia would have raised $77 million in revenues in one year, with $20 million going toward obesity prevention, if the tax had gone through. Money talks, science walks.
A Bad Rap?
Soda taxation has gotten a bad rap for three major reasons. First, how can the poor finance a soda tax? “Regressive” taxes place a greater burden of cost on lower-income consumers.36 The U.S. has a strong tradition of consumer rights protection; taxes that exert unfair constraints on individual choice are bad enough, and those levied on the poor are doomed to fail. Which begs the question—can a “regressive” tax be in the public health interest? Hey, it works for tobacco and alcohol. Of course it can, but with three caveats. First, regressive taxes makes sense only if the substance being taxed causes disproportionate health harms in the poor. This is certainly true for all addictive substances, including tobacco, alcohol and sugar. Remember, fructose is not an essential nutrient, the burden of metabolic syndrome is highest in lower-income minorities,37 and the current loss of productivity and added medical costs associated with metabolic syndrome provide a strong case for widespread taxpayer benefits.
Second, the proceeds of the tax must be diverted back to the public health of the lower-income population, to balance out the regressive nature of the tax. In the case of sugar, tax revenues could be applied toward subsidies on fresh produce. They could also be used to finance commercial loan and development programs encouraging grocery stores and farmers’ markets to relocate to underserved low-income communities or food deserts. By redirecting subsidies to make healthful products accessible to low-income consumers, valid concerns about regressive taxation and government paternalism can be headed off at the pass. Everyone wins (except the beverage industry).
Third, what is the purpose of the tax? To prevent obesity or to pay for obesity programs? The fear is that the politicians will abscond with the money as a quick fix to close their budget shortfalls and avoid cuts to critical services such as public safety and transportation. The American Beverage Association says that despite the rhetoric of elected officials wanting to curb obesity, soda taxes are all about filling up public coffers. Larry Young, CEO of Dr. Pepper Snapple and chairman of the ABA, told Goldman Sachs, “You say it’s for obesity. Come on, it’s to fill a budget deficit.” And there’s real reason to be worried about this. The current proposal is for a penny-per-ounce soda tax, which would raise the price of a can of soda by $0.12. While this would generate approximately $13 billion in revenue,38 it is unlikely to have a significant impact on reducing SSB consumption and the diseases associated with metabolic syndrome. Rather, statistical modeling suggests that the price would have to double to reduce soda consumption—so a one-dollar can of soda should cost two dollars.39 And no one is ready for that…yet. But give it time. No one in New York was ready to spend $11.90 for a pack of cigarettes either. Hefty taxes are required to reduce consumption of addictive substances.
Restriction of Access
Throughout this book, I’ve hammered one issue time and again: control the environment. Nothing reduces sugar consumption better than reducing sugar availability. And that means restricting access. Especially to children. We’ve been largely successful with alcohol. Why not sugar?
Successful alcohol control strategies restrict accessibility to purchase, such as reducing the hours retailers are open, controlling the location and density of retail markets, and limiting who can legally purchase alcohol.40 A reasonable parallel for sugar would be tighten licensing requirements on vending machines and snack bars that sell sugary products in schools and workplaces. Many schools have removed soda from vending machines, but usually replace them with juice and sports drinks, which are no better.
Reduction in the number and density of convenience stores that sell alcohol clearly cuts down on consumption, especially in poor neighborhoods.41 Similarly, states could apply zoning ordinances to control the number of fast food outlets and convenience stores in low-income communities, and especially around schools, while providing incentives for the establishment of grocery stores and farmers’ markets. They could also apply zoning ordinances to inconvenience the food trucks that are multiplying like flies outside schools during lunchtime and after the bell rings, targeting our children. Another option would be to limit sales in stores during times of school operation, so kids couldn’t buy a soda on the way home. One would expect that kids who walk to school would have lower BMIs because they exercise. Wrong. My colleague Kristine Madsen showed that kids who walk to school have higher BMIs because they’re stopping to buy soda and chips!42
Lastly, how about an age limit (such as seventeen) in order to purchase drinks with added sugar? Yes, card kids for Coke! You got a problem with that? Store managers already do it for alcohol, and it would cost nothing to implement. If parents want their kids to have a soda, they can buy it for them. Recently, parents in South Philadelphia took this upon themselves. They formed a posse by lining up outside convenience stores and blocking children from entering these stores after school.43 Why couldn’t a public health directive do the same?
Not one to be stymied by the USDA over the 2011 Food Stamp debacle, in June 2012 Mayor Michael Bloomberg unveiled a bold proposal to eliminate Big Gulps from New York City, a move well within his purview. Will this edict really reduce sugar consumption? What’s to prevent people from buying two sodas instead of one? I recall a Bill DeOre cartoon from the Dallas Morning News, showing a kid at a fast food counter. Before downsizing, he orders a large order of fries. After, he orders sixteen orders of fries. Libertarians have gone ballistic decrying Bloomberg’s usurping of personal freedom. Environmentalists are angry as this may mean more plastic waste. Politicians argue this will be unwieldy to administer. But if Bloomberg did nothing else, he sent a loud and clear message: public health is a noble cause, and one worth fighting for.
Curb the Subsidies? Or Curb the Deregulation?
In order to balance the U.S. budget, the Farm Bill needs to lose $23 billion from its ledger. Crop subsidies account for $6 billion per year; of that, $3.5 billion goes to corn, and $1.6 billion goes to soybeans. Diverting money away from subsidies is not without its dangers, especially now that we live in a global economy. One product of our corn subsidy is the production of ethanol as an additive for gasoline, but environmentalists have railed against this practice for years, as it puts more carbon emissions into the atmosphere.
There are two types of subsidies: payments to farmers only when the price of the crop is low (to keep them from going out of business), and payments to farmers based on performance, regardless of price. Over the five years from 2006 through 2011, the price of corn has never been higher44 yet the corn subsidy continues unabated.
Propping up consumption of specific foodstuffs with price subsidies is a great way to cause market distortion. If supply and demand work their magic, then stopping a subsidy should raise prices, and our food should get more expensive. Is that good or bad? Advocates for the poor would lobby immediately. So would Iowa. But the government and the poor would ultimately save on the subsidy, in medical costs and improved worker productivity. One problem with removing these subsides is that they are unlikely to make a significant difference in the price of junk food. Furthermore, as the poor frequently have limited access to healthy alternatives, they will have to buy junk food even if the price goes up marginally. Taxation proponents favor an excise tax concept because it passes the cost on to industry, which can well afford it. The question is whether it would alter industry’s practices.
A different line of reasoning suggests that it’s not the subsidies that overproduce commodity crops, and overproduction is not the cause of obesity. Unlike with other industries, agricultural producers do not respond to price signals by reducing the amount of a crop when prices are low. 45 Producers may reduce hired labor, but not production. In an agricultural policy dating back to President Roosevelt’s New Deal, the USDA paid farmers not to grow certain crops to prevent overproduction. To keep farms from going out of business, Congress recently approved an annual $20 billion payment to farmers as a direct subsidy, despite the increase in price of all commodities from 2006 through 2011. And no Midwest state will put the brakes on this gravy train. If the United States completely eliminated all commodity protection and subsidy policies, very few foods would change in price. But the one food that would be affected would be sugar, with a reduction in production of 33 percent (because of the elimination of the corn subsidy) and a reduction in price of 15 percent (because of the end of the sugar tariffs).46 The point is that even though we pay more for sugar because of the sugar tariffs, we still consume more, because of sugar’s abuse potential. Again, standard economic principles do not apply to addictive substances.
There’s only one answer that the farmers, the food industry, and the populace can live with: differential subsidization. Instead of subsidizing corn and soy (commodity crops that are storable), why can’t we subsidize something green? We have the technology to do this. When broccoli and carrots are cheaper than potato chips, then Michael Pollan’s thesis on the price of a calorie can be turned around for everyone’s benefit. Promotion of high-fiber foods in U.S. low-income programs such as WIC, SNAP, and NSLP would be the obvious place to start. Furthermore, growing green food means growing local. It would also make tariffs on imported goods a less important concern, because they wouldn’t be subsidizing “commodities.” They would be subsidizing real food.
Differential subsidization goes for water as well. In the developing world, inhabitants have three choices—drink the dangerous water, buy an in-home chlorination system, or buy “safe” sugared beverages made locally by Coke or Pepsi. If the water chlorination system is provided for free, usage is at 80 percent. If people have to buy it, they drink the sugared beverages instead, which costs more in the long term, both in money and in medical costs.47 Until potable water is free, the developing world will continue to suffer at the hands of the food industry as well.
Like a Phoenix out of the Ashes…
Any of these interventions would of necessity require a new business model—one that supports real food over processed food. After all, we need the food industry; we just don’t need their current fare. Because high-fiber foods have a limited shelf life, such interventions would have to support local food production and reduced use of antibiotics and pesticides, which would have implications for mitigating global warming and environmental pollution. These interventions would require allocating new farmland around the country that could be adapted to grow real food, with minimal technological prowess. However, this would of necessity require new delivery and distribution systems, and new pricing strategies. It would also require changes in marketing, especially to children. As distasteful as it is, such upstream societal interventions can be accomplished only with governmental support. (There’s just no way around it.)
Reducing sugar consumption will not be easy—particularly in the emerging markets of developing countries, where soft drinks are cheaper than milk or potable water. Societal intervention is needed to reduce the supply and eventual demand for sugar. Despite the obvious medical, social, and economic benefits, we face an uphill political battle against a powerful sugar and food processing lobby, and against those in government who are already corrupted. Any change will require active engagement from all stakeholders. And that means you. Especially you. With enough public clamor, tectonic shifts in policy do become possible. Take, for instance, bans on smoking in public, the use of designated drivers, airbags in cars, and condom dispensers in public bathrooms. All unfathomable thirty years ago. Your voice changed the world. It can be a new world…yet again.