The Academy of Medical Royal Colleges recently issued a report which called for a trial 20 per cent tax on sugary drinks. Whilst the potential (dental and general) health benefits of such a tax appear obvious I think there certainly are question marks over the proposal.
Necessary?
According to the British Soft Drinks Association the consumption of soft drinks containing added sugar has fallen by nine per cent already over the last 10 years, and already nearly two-thirds of soft drinks now contain no added sugar. That begs the question - is a tax necessary?
Effective?
As a non-smoker I have to say I am surprised at the number of people who still do have the habit (one in five in 2010). Whilst it is true the numbers have fallen considerably over a period of 40 years, this has been due to a number of factors, a quite substantial price increase, better and earlier education, and changing regulations (in terms of advertising and limiting where people can actually smoke). After all that, a good number of people still smoke – so how effective will a tax on soft drinks actually be in terms of changing habits? Eamonn Butler, director of the Adam Smith Institute, said that international studies have shown for taxes of this kind to be effective they have to be very large. How effective would a tax of 20 per cent actually be?
Enough?
If sugary drinks are so bad for the health of the public then why are they allowed at all? Wouldn’t a ban be more effective than a tax? Hard drugs aren’t taxed to dissuade people from becoming users, they are banned (this in spite of the fact a tax on drugs could raise significant funds). When it came to tooth whitening regulations there wasn’t a tax on whitening treatments using over six per cent hydrogen peroxide – there was a ban. If sugary drinks are so bad for the health why not ban them and only allow the sale of drinks with a lower sugar/calorie content?
The bigger picture
If the proposed tax did prove effective in dissuading people from consuming sugary drinks, and no sugary drinks were consumed at all, what sort of a difference would it make to obesity and oral health? According to the National Diet and Nutrition Survey only two per cent of the average adult’s calories comes from soft drinks (not low calorie) so will it actually achieve its primary aim? Though there are oral health benefits, are these not secondary to the fight against obesity?
Rights
Perhaps most importantly though is a more fundamental question over the right of the Government to impose such a tax and the question of personal freedom. Yes, someone’s oral and general health may be improved by consuming fewer sugary drinks. Yes, obesity and poor oral health can negatively affect self-esteem. Does it automatically follow that action should be taken though? In philosophical terms - does the ‘ought’ follow the ‘is’?
In terms of diet, the people of Britain were healthiest during World War II, when there was strict rationing of food. Of course, as soon as it was possible, rationing was dispensed with because though obviously health is important, luxuries and the freedom of choice was valued more. Denmark introduced a ‘fat tax’ in 2011 but the scheme was abolished after just one year because it was so unpopular.
Whilst it can be argued being obese and having poor oral hygiene isn’t nice surely people are free to choose how to live their own life, and their own path to happiness. Is eating fatty food and drinking sugary drinks not a lifestyle choice people should be free to make?
The idea of informed consent is crucial in healthcare, and dentists will have to gain this before they can proceed with any treatment. This is because though a dentist may be an authority on dental disease, as it is in the patient’s mouth the disease is the patient’s responsibility. If a patient is not mentally capable of making an informed decision then their legal guardian or carer will do so on their behalf.
The same applies with dental advice, you can advise all you want but ultimately it is down to the individual how to act. You can tell patients about the importance of brushing twice a day and flossing, but getting them to actually adopt such a routine is quite difficult. Patients can be in possession of the facts and fully comprehend the issues, and yet be still unmotivated to act. It may be frustrating for you as a professional, but ultimately it is up to the patient to decide how to live their life and whether or not to practise an effective oral health regime.
Whilst I think there is a good argument for educative campaigns, and making sure people have the information needed to make a decision, beyond that the case for action is weaker. People have a right to make their own decisions – even ones we don’t like. Whether that’s getting a tattoo on their face, smoking, eating fast food, listening to loud music or sitting too close to the television, it is up to them.
Trying to influence that decision by using financial manipulation is not giving people due respect or dignity as citizens. Yes sugary drinks, along with smoking and not brushing twice a day may be bad for one’s health, in that sense their actions are ‘wrong’; but on a fundamental level do people not have the right to be wrong?