April 09, 2019
As a primary care doctor working in a safety net clinic in North Philadelphia, what is the largest health threat facing Philadelphians today? Obesity. The cause is consuming a surplus of calories (eating or drinking too much) with a relative deficit in calorie expenditure (too little exercise).
Many people know the increase risk of diabetes or heart disease, but less people are aware of the higher risk of joint pains, breathing problems, pregnancy complications, cancers, and depression. Unfortunately, our city suffers from some of the worst health statistics in the country among major metropolitan areas. From the last city health assessment, Philadelphia has higher rates of obesity, diabetes, early cardiovascular disease, and infant mortality as compared to the national average. In fact, in a recent index of overall fitness, Philadelphia ranked 82nd out of the 100 largest cities in the country. Our city has an uphill battle to improve our health, and the soda tax is an important measure to help combat obesity.
When my patients and I discuss diet, one of my first questions is usually, “What do you drink?” Soda provides no nutritional value; it contains “empty calories” which expand our waistline without satiating hunger or providing sustenance. I consider dramatically reducing sugar-sweetened beverage consumption to be the lowest hanging fruit for weight loss. My clinic sits in the district with the second highest rate of obesity and the highest rate of sugary drink consumption – almost half of the adults drink a sugary beverage every day. The city health data shows clear differences between zip codes and ethnic groups within our city which reflect disheartening trends – our poorest communities suffer the worst health consequences and drink the most sweetened beverages.
In 2018, the American Beverage Industry spent $1.5 million lobbying in Philadelphia. Consider this mathematical exercise: assume a 20-ounce bottle of Coke (230 calories) is worth $1.50 in revenue for Coca-Cola, and there are 3,500 excess calories in a pound of fat. This means Coca-Cola earns $22.82 when we consume enough Coke to make one pound of fat. Industries lobby for their interests (protecting revenue), and not for individuals to avoid taxation. Therefore, the beverage industry must project losing at least $1.5 million, which if consumed in Coke bottles would generate 65,714 pounds of fat for Philadelphians. If you consider the two-liter bottles are even cheaper, that is many more pounds!
A Harvard researcher estimated the Philadelphia tax would prevent more than 2,200 new cases of diabetes each year.
Many of my patients admit that while soda is now more expensive, they still buy it. Most overweight patients I see want to lose weight to improve their health, and many who drink soda would like to stop. One of my patients tries hiding cans in different cabinets of her house so she does not drink it all at once. These individuals assume twice the burden – the financial one imposed by the city and the associated health risks from their personal choice. The soda tax is not meant to further punish them, but to positively influence their behaviors. My patients live in an already complex environment of direct-to-consumer marketing, product availability, and their own culture, which while powerful is not static.
Since the tax passed in 2017, other patients demonstrate the influence of positive incentives when they tell me, “I don’t buy soda anymore, it’s too expensive.”
Now let’s consider regressive taxation, or taxes which disproportionately affect the poor. We should be cognizant of the financial impacts on vulnerable populations, who buy proportionally more soda. At the same time, a quintessential regressive tax is one of public health’s biggest success stories: tobacco taxation.
After decades of experience, data, and even some villainization of the tobacco industry, our society overcame powerful lobbying tactics and passed a tobacco excise tax. Each pack of cigarettes costs our society $19 in health care costs and lost productivity. When Minnesota raised the price of packs by $1.60, sales dropped by 54 million packs, or almost a quarter. Most of the Minnesotans who quit smoking said the increase in price helped them, and the biggest behavior changes took place among the poorest group.
Sweetened beverages should be no different. A Harvard researcher estimated the Philadelphia tax would prevent more than 2,200 new cases of diabetes each year, which can be a costly diagnosis for patients in medication co-pays, doctor visits, and decreased productivity.
There are many reports of stores suffering because of the soda tax, most recently a West Philadelphia supermarket closing. If this is true, we must rethink our business models so they are not propped up on one powerful, unhealthy industry. Let’s encourage innovative businesses that support healthy habits in our communities.
Entwined in this debate is the issue of funding early childhood education, which should be a separate discussion. Earmarking the revenue from the soda tax was a political tactic to help pass the legislation since it was easier to garner support for our children’s well-being. It complicates the current debate, diverting attention from the merit of the soda tax itself.
Since the tax came into effect, the largest published consumer survey showed daily consumption of sugary soda fell 40 percent within two months. The city of Berkeley, California passed a similar sweetened beverage tax in 2014, and by 2017 consumption of sweetened beverages was halved. Moreover, decreases were sustained across diverse neighborhoods. It will take time until we can show the long-term health effects in studies because these consequences occur over decades.
Last month, on March 14, Philadelphia Council introduced a bill to phase out the soda tax. The bill’s sponsor, Councilwoman Maria Quiñones-Sánchez, expressed her concerns, “Are there any unintended consequences we need to pull back so we don’t hurt the most vulnerable constituents?”
I fear we are overlooking the intended consequences: the Philadelphia Beverage Tax promotes behaviors which positively impact our city. I believe it should be treated as what it is at its heart – a measure that improves the health and saves the lives of Philadelphians most at risk.
Emi Okamoto is an internal medicine doctor working in Philadelphia.