NCD commission split over sugar tax

Members of the World Health Organization Independent High-level Commission on NCDs meet in Geneva on May 7. Photo by: © WHO

BRUSSELS — More involvement from heads of state, a “fresh relationship” with certain industries, and a possible “multi-donor trust fund” to catalyze financing, are among the recommendations in an expert report on combating noncommunicable diseases such as cancer and diabetes. The group stopped short of backing a tax on sugary drinks, a reflection of the rifts between members.

Time to Deliver, released today, is the first report from the Independent High-level Commission on NCDs, a group comprised of four heads of state, several ministers, academics, and philanthropists. The commission was brought together by the World Health Organization last year to offer “bold” and “practical” advice on reducing premature mortality from cardiovascular disease, cancer, diabetes, or chronic respiratory disease by one-third by 2030.

Another idea in the report is the creation of an investors’ health forum uniting “individuals, institutions, investment companies, money managers, and financial institutions to encourage shifts towards investments in healthier portfolios.” And the commission encouraged WHO to “explore the possibility of establishing an international code of conduct” to restrict the advertising of unhealthy products to children.

Despite “broad agreement in most areas,” the commission’s five co-chairs, including the presidents of Finland, Sri Lanka, and Uruguay, wrote that “some views were conflicting and could not be resolved.”

“As such, some recommendations, such as reducing sugar consumption through effective taxation on sugar-sweetened beverages and the accountability of the private sector, could not be reflected in this report, despite broad support from many Commissioners,” the co-chairs wrote.

Ilona Kickbusch, director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, and a member of the commission, told Devex that she wanted a much tougher stance on taxation as well as the dangers of alcohol.

On taxing sugar-sweetened beverages, Kickbusch said, “some member states like Uruguay are very supportive, [and] member states like Mexico, who’ve introduced the sugar tax, already have significant experiences with it. Other member states like the United States felt there was not enough evidence on the impact of such taxes and therefore the commission should not recommend them.”

The report argues governments should “implement fiscal measures, including raising taxes on tobacco and alcohol, and consider evidence-based fiscal measures for other unhealthy products.”

“It is very frustrating because the reference to evidence is of course a political game,” Kickbusch added. “You can always say ‘there is not enough evidence, it needs more research.’ The other side of things is that given the extent of the obesity epidemic, public health needs to be courageous.”

Caitlin Oakley, spokesperson for the U.S. Department of Health & Human Services, wrote in an email to Devex: “The terms of reference for the Commission said recommendations should be bold to enable countries to accelerate progress on NCDs. Taxes on sugary drinks is not new, bold, or innovative. More importantly, evidence is lacking that such a tax produces positive health outcomes, specifically reducing the burden of NCDs.”

Each year, 15 million people between 30 and 69 years old die from an NCD — more than 85 percent of whom live in low and middle-income countries. The report found a global rate of decline in premature mortality from NCDs — 17 percent between 2000 and 2015 — not enough to meet the one-third reduction target in the Sustainable Development Goals.

At the United Nations in 2014, states committed in the two subsequent years to set national NCD targets, develop a national plan, reduce risk factors — such as tobacco consumption and harmful alcohol use — and strengthen health systems. Instead, by 2017, the commission found “83 countries had made poor or no progress on the four time-bound commitments … No country has fully achieved all 19 indicators.”

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Advocates are putting their hopes in a high-level meeting at the U.N. in September, where they want to rally heads of state to their cause. For now, the report found: “National investments remain woefully small and not enough funds are being mobilized internationally. There is still a sense of business-as-usual rather than the urgency that is required. Plenty of policies have been drafted, but structures and resources to implement them are scarce.”

The NCD Alliance, a civil society group, welcomed the report overall, including the recommendation for an NCD countdown to the 2030 goals, modeled on a similar initiative for maternal, newborn, and child survival.

However, the alliance, whose Chief Executive Officer Katie Dain sits on the commission, said the report failed to adequately address the need to scale up taxation and regulation on the marketing and sale of alcohol, as well as the “well-documented history of [big tobacco, alcohol, and food] infiltrating public health organizations, subverting science, and interfering with and undermining public policy that would promote health.”

When it comes to the food, nonalcoholic beverage, catering, technology, transportation, and media industries, the commission argued that “a fresh relationship should be explored” after previous efforts to engage the private sector saw “limited” progress.

“Those are some of the formulations that I probably wouldn’t have chosen,” Kickbusch said.

“I had made the point that actually it should be the other way around. It reads as if it’s the responsibility of governments to be nice to the producers. I think it’s up to the producers to show social responsibility.”

The NCD Alliance also took issue with the decision not to endorse taxing sugar-sweetened beverages.

“High body mass index is estimated to claim at least 4 million lives each year,” Dain told Devex.

“And there is promising evidence from many countries to demonstrate that taxation on sugar-sweetened beverages, whilst not a magic bullet, is an important policy measure to reduce consumption.”

Sandro Demaio, an NCD expert and CEO of the EAT Foundation, a multistakeholder platform for food systems transformation, who was not on the commission, commended the “ambitious and timely recommendations,” especially given the short time since the panel’s creation.

Demaio said what’s needed now are “tough conversations that rebuild trust; nuanced and responsible, multistakeholder engagement; innovative approaches prioritizing shared win-wins outside health [such as in the energy sector, to address air pollution]; and strategic, highest level leadership beyond only government.”

This article has been updated to include comment from the U.S. Department of Health & Human Services.

For more coverage of NCDs, visit the Taking the Pulse series here.

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    Vince Chadwick

    Vince Chadwick is the Brussels Correspondent for Devex. He covers the EU institutions, member states, and European civil society. A law graduate from Melbourne, Australia, he was social affairs reporter for The Age newspaper, before moving to Europe in 2013. He covered breaking news, the arts and public policy across the continent, including as a reporter and editor at POLITICO Europe.