With skyrocketing rates of overweight and obesity facing Caribbean nations, policymakers are increasingly being challenged to find solutions for this public health emergency. This challenge was significantly responded to this year in January when the Government of Jamaica (GoJ) implemented guidelines to restrict the sale of sugary beverages in Jamaican schools. This bold move aimed at modifying the drinking habits of young Jamaicans who may be ‘drinking themselves sick’, helped to underscore Jamaica’s leadership role in the Caribbean in implementing progressive health policies, however, more is needed. The World Health Organisation (WHO), the Pan American Health Organisation (PAHO), the Caribbean Public Health Agency (CARPHA) and the Healthy Caribbean Coalition (HCC), have all recommended a complete package of policy interventions to effectively halt and reverse obesity.
In the past year, the Heart Foundation of Jamaica (HFJ) in partnership with the Ministry of Health, implemented a massive obesity prevention public health campaign built around a likeable Jamaican personality “Rosie” who challenges Jamaicans to consider the amount of sugar they are consuming in sugary drinks and the negative health effects. The nationwide mass media campaign has dramatically increased public awareness and dialogue around the dangers of excessive sugar consumption and links with obesity and NCDs. This combined with the Jamaica Moves campaign, which has inspired significant numbers of Jamaicans to get active, suggests that the public may in fact be ready for the next step in the implementation of a complete package of policy interventions – namely the imposition of a tax on sugary drinks.
The WHO has identified excessive consumption of sugar in sugar sweetened beverages (SSBs) as a major contributor to obesity and NCDs and recommends a levy on SSBs which raises their price by at least 20% as one of the key policy measures to curb sugar consumption and combat obesity and NCDs(1). In 2016 Caribbean leaders, recognizing the challenges posed by obesity, pledged to elevate taxes on foods high in sugar; and in 2017 they expressed concern that obesity in children represented the greatest threat to the health of future generations. Furthermore many regional leaders have recognized and expressed the view that a failure to address the health challenges posed by obesity and related conditions is likely to slow or reverse socioeconomic progress.
There is clear evidence that taxation of sugary drinks works (2)(3). Sugary beverage taxes have led to reduced consumption of SSBs and increased consumption of healthier alternatives globally(3) and in the Caribbean(4). In Mexico the SSB taxation introduced in 2014, resulted in a 9.7% decline in purchases of sugary drinks(5); and in Berkeley, California, SSB taxation triggered a similar decline in SSB purchases and a 15% increase in bottled water sales(6). The Barbados sugary drink tax resulted in a 4.3% decline in sales of SSBs and a 7.5% increase in sales of bottled water in its first year(4).
Barbados was the tenth country in the world and the first country in the Caribbean to implement a tax on sugary beverages(7)(8) in 2015. Dominica followed closely behind, and a few months later implemented a 10% excise tax on sugary drinks. Four years later against the background of increasing recognition of a global and regional epidemic of obesity and mounting evidence demonstrating that taxation reduces SSB consumption – over 36 countries across the globe now tax sugary beverages in an effort to combat obesity and overweight(9) (8). By contrast, in the Caribbean, despite growing waistlines, chronically underfinanced health systems and mounting economic instability, only two of the 20 CARICOM Member and Associate Member states had implemented this measure at the beginning of 2018. However, the tide may be changing. In October 2018 Bermuda introduced a 50% SSB tax which will rise to 75% in April 2019(10); and in the latter part of 2018 and early 2019, a number of CARICOM countries indicated a warming towards taxation.
In January this year, PM Gaston Browne announced Antigua’s plans to begin taxing sugary drinks in 2019 in order to address the growing social and economic burden of NCDs. A sugar tax also seems to be on the horizon for Trinidad and Tobago, which implemented a nation-wide ban on the sale of SSBs in schools in 2017. In January this year, the St. Kitts and Nevis National Commission for Universal Health Care revealed that a range of new taxes, including SSB taxes, will be used to finance universal health care(11). In The Bahamas, one of the key recommendations emerging out of a public consultation led by the National Health Insurance Authority on a roadmap for universal health coverage, was the introduction of a tax on sugary drinks, the revenue from which would be used to fund the universal health care scheme(12).
The financial impact of obesity and its associated illnesses are significant due to not only to the direct costs of provision of treatment and care, but also due to indirect costs related to decreased productivity. An estimate of the costs related to cardiovascular disease CVD and diabetes complications alone in Jamaica between 2017 and 2032 is a staggering 77.1 billion JMD (US$ 607 million). Taxing of SSBs offers the double benefit of providing additional revenue to offset these costs while contributing to the anticipated decline in consumption and resulting decrease in the prevalence of obesity, a major NCD risk-factor.
There is increasing momentum across the region as the ‘Caribbean Moves’ towards policy measures which build healthy food environments such as taxation of sugary drinks. The Government of Jamaica has made tremendous strides in this arena and stands poised to become one of the first countries in the region to check multiple policy boxes in the fight against childhood obesity. The HCC and our 120+ members across the region, and our regional and global public health partners, congratulate the Government of Jamaica on the progress made thus far and encourage them to continue to lead boldly by implementing a tax of at least 20% on SSBs in 2019.
Sir Trevor Hassell,
President, Healthy Caribbean Coalition
Maisha Hutton, Executive Director
Healthy Caribbean Coalition
- WHO | Fiscal policies for diet and the prevention of noncommunicable diseases [Internet]. WHO. [cited 2016 Oct 11]. Available from: http://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/
- World Cancer Research Fund International (2018). Building momentum: lessons on implementing a robust sugar sweetened beverage tax. Available from: www.wcrf.org/buildingmomentum
- Fiscal and pricing policies: evidence report and framework [Internet]. GOV.UK. [cited 2019 Feb 17]. Available from: https://www.gov.uk/government/publications/fiscal-and-pricing-policies-evidence-report-and-framework
- Alvarado M, Unwin N, Sharp SJ, Hambleton I, Murphy MM, Samuels TA, et al. Assessing the impact of the Barbados sugar-sweetened beverage tax on beverage sales: an observational study. International Journal of Behavioral Nutrition and Physical Activity. 2019 Jan 30;16(1):13.
- Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016 Jan 6;352:h6704.
- Silver LD, Ng SW, Ryan-Ibarra S, Taillie LS, Induni M, Miles DR, et al. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study. PLOS Medicine. 2017 Apr 18;14(4):e1002283.
- HCC Brief: A Closer Look, The Implementation of Taxation on Sugar-Sweetened Beverages by the Government of Barbados [Internet]. Healthy Caribbean Coalition. 2016 [cited 2016 Dec 12]. Available from: http://www.healthycaribbean.org/hcc-brief-taxation-sugar-sweetened-beverages-barbados/
- World Cancer Research Fund International Nourishing Framework. Use Economic Tools. [Internet]. Available from: http://www.wcrf.org/int/policy/nourishing-framework/use-economic-tools
- Tax on sugary drinks will make children and the budget healthier [Internet]. [cited 2019 Feb 17]. Available from: https://www.who.int/malaysia/news/commentaries/detail/tax-on-sugary-drinks-will-make-children-and-the-budget-healthier
- 50% – First Phase Of Sugar Tax In Effect Today. Bernews [Internet]. 2018 Oct 1 [cited 2019 Feb 17]; Available from: http://bernews.com/2018/10/first-phase-of-sugar-tax-to-come-into-effect/
- story-editor. Wage deductions, increased new taxes to sustain Universal Healthcare [Internet]. The St Kitts Nevis Observer. 2019 [cited 2019 Feb 17]. Available from: https://www.thestkittsnevisobserver.com/featured/wage-deductions-increased-and-new-taxes-to-sustain-universal-healthcare/
- Jones R. NHIA: Research indicates sin taxes are effective revenue sources [Internet]. The Nassau Guardian. 2018 [cited 2019 Feb 18]. Available from: https://thenassauguardian.com/2018/10/25/nhia-research-indicates-sin-taxes-are-effective-revenue-sources/