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Follow the Data Podcast: Everybody eats – obesity prevention in three nations

Nearly every nation is experiencing rising rates of overweight and obesity and no country has successfully reversed these trends.  This poses a serious threat to people’s health and wellbeing; the significant healthcare costs associated with treating obesity and related conditions, such as diabetes heart disease and certain cancers, have the potential to undermine economic development across the globe.

A major cause of the obesity epidemic is easy access to unhealthy, ultra-processed foods and beverages that are inexpensive and marketed heavily—especially to children. We need leaders who can stand up to the food and beverage industry and fight for communities where healthy foods are the norm, not the exception.

Dr. Neena Prasad of Bloomberg Philanthropies’ Public Health team spoke with three public health experts who are doing just that: Paula Johns, Director of ACT Health Promotion in Brazil; Professor Karen Hofman, Director of Priceless South Africa; and Deborah Chen, Executive Director of the Heart Foundation of Jamaica. They describe the food environments in their countries and highlight some of the successes and challenges of their work.

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TRANSCRIPT

KATHERINE OLIVER: Welcome to Follow the Data, I’m your host, Katherine Oliver.

Over two billion people – approximately 30 percent of the world’s population – are overweight or obese, which is a risk factor for diabetes, heart disease, and certain types of cancer. The Bloomberg Philanthropies’ Public Health team is supporting researchers and advocates to identity, implement, and evaluate obesity prevention policies – employing strategies proven effective in tobacco control work.

Obesity prevention partners gathered in New York to discuss lessons, best practices and challenges facing their work across the world. We took the opportunity to learn about country-specific food environments and the strategies they employ to make progress.

Doctor Neena Prasad of Bloomberg Philanthropies’ Public Health team spoke to three experts:

  • Paula Johns, Director of Act Health Promotion in Brazil, who outlines the deceptively simple dietary guidelines that have become a beacon for other nations;
  • Professor Karen Hofman, Director of Priceless South Africa, based at the Wits School of Public Health. Priceless is a research team that provides information on the best buys for health in South Africa;
  • And Deborah Chen, Executive Director of the Heart Foundation of Jamaica, who identifies the industry tactics undermining a campaign to adopt a sugary beverage tax in the island nation.

Bloomberg Philanthropies Obesity Prevention partners convening

Through promotion of policies such as taxes on sugary beverages and junk food, warning labels on the front of packaged foods, and policies to get healthier food served and sold in schools, our partners are aiming to reduce consumption of foods high in calories, sugar, sodium, and saturated fat and ultimately reduce and prevent obesity and non-communicable diseases (NCDs).

Listen now to hear more about their work on the ground.

DR. NEENA PRASAD: We have with us a longtime partner and, Paula Johns. Paula is cofounder and general director of ACT Health Promotion, which is a Brazilian coalition of over 1,000 members that works to address risk factors for NCDs [Non-communicable diseases] like tobacco, unhealthy diets, and alcohol.  ACT Health Promotion is a key partner of the Bloomberg Philanthropies obesity prevention program.  Paula, can you start off by telling us about yourself and what your organization does?

PAULA JOHNS:  I’m an advocate working for health promotion, as mentioned.  I’m a social scientist myself, so I started working with health promotion through the Framework Convention on Tobacco Control [FCTC].  I participated in the global negotiations, co-created the Brazilian coalition.  In the beginning we focusing only on tobacco control policy issues. That was an incredible learning experience by all means.  And as a social scientist, I was much more worried how we promote products in a society rather than in the individual behavior.  I think the Framework Convention on Tobacco Control, it’s an excellent example of a successful global policy that gives very clear guidelines and recommendations on what to do to change the environment and to shift away the blame from the individual into the environment.

Building on that experience, that’s why I also became involved in food policy issues and understanding the similarities among those risk factors because they have some very, very similar dynamics. I think there’s a lot of discussion going on about evidence and whether we have enough evidence or not.

DR. PRASAD: Paula, for our listeners that don’t know what the Framework Convention is, could you describe it?

JOHNS:  Sure.  The Framework Convention on Tobacco Control, it’s a global health treaty, the first of its kind negotiated under the World Health Organization [WHO] by all member states. It clearly put out a set of policies that countries should implement in order to decrease smoking.

In the case of food, I think it’s a bit more complex in the sense that many things that we call food, they are not real food. There are formulations made lots of additives and sugar, fat, and sodium, which actually do not nourish us, we should regulate this category of products. There are some products that nourish us, and there are some other things that are really not helping us to become healthier. We can apply the same four core policies to this challenge as a global community.  And now we have the new recent data saying that well, actually all forms of malnutrition, which includes obesity and undernutrition and other dietary risks, they are the leading cause of diseases in the world today. Everybody eats — which is different than tobacco, right?  I mean coming from the tobacco field, it’s much easier in a way to mobilize people around food because everybody eats, that’s the upside.  The downside is that the industries behind the food policy issues, they are much stronger, and they are much bigger.

One of the most important lessons learned around the Framework Convention on Tobacco Control was to acknowledge that industry interference is a major issue, but I think the progress is so slow if we think about what we should already know about it borrowing from the experience from tobacco control. I think we can do a lot better.

DR. PRASAD: Tobacco control is our flagship program at Bloomberg Philanthropies. As Paula said, we have noted many parallels between food and tobacco, both on the policy side and what’s possible, and also in terms of how these industries behave to delay, obstruct, present regulation. They don’t want to be regulated.  They offer themselves up as part of the solution and promote voluntary measures, which we know don’t work. This is an issue where we, and I know you as well Paula, are feeling a sense of urgency.

Obesity and overweight is growing everywhere.  The health impacts are very well documented, causes premature death, cancer, diabetes, heart disease.  And the economic impacts are staggering.  A recent estimate from the World Obesity Federation put the treatment costs alone, just the treatment at $1.2 trillion by 2025.  And really, no government can afford this, and particularly developing countries.  So this is very much a development issue, and we have been partnering with a number of organizations who are really leading the charge, like your organization, to put in place policies and evaluate them.  Can you talk to us about the policy environment in Brazil and what you see as the opportunities there?

What are you hoping for?

JOHNS:  Just to say something about the clear message that we need to send out to the rest of the globe and as international partners, I think Bloomberg Philanthropies has a big role to play there. The message about the solutions. What solutions can we develop for food policy issues so that we actually tackle that challenge?  I mean treatment, I don’t know an equivalent expression in English, but it’s just like drying ice, right?  We will never go anywhere if we do not really have some real powerful prevention policies.  In addition to surveillance, to know the data, to know the information, to know the trends because what’s happening in the world is a transition in the dietary patterns which are causing the problems that I spoke about before. I’m thinking here about the MPOWER for tobacco that could be used for diets as well.

DR. PRASAD: Can you tell us what MPOWER is?

JOHNS:  Yes, MPOWER, it’s a group of policies developed to tackle the tobacco epidemic. We are going through the epidemic of diets, right? Of malnutrition in all its forms.  And we could have the same set of policies adjusted for the food policy area, like monitor and surveillance, for example, the data from Brazil. We have an overweight rate of almost 70%, an obesity rate of 20% among adults.

And if trends continue the same way, we will very, very soon be like the US or like Mexico.  They are kind of the worst ones, right?  So we are going in the same direction. So we need to do something to stop that transition in dietary patterns. And we have to protect children because childhood obesity is a real issue.

DR. PRASAD: Paula, one of the things that I think really put Brazil on the map were the dietary guidelines. At the time they were considered radical, but they’re so logical and they’re so beautiful, and they’re easy. A number of countries have followed this. Can you tell us what is in the Brazilian dietary guidelines, and I think it really captures the vision of how we should all be eating.

JOHNS:  Yes.  And they’re so beautifully simple.  A sustainable diet, which is the major challenge that we when you talk about food, you’re also talking about climate change.  And they talk about, eat food, forget about these pyramids, forget about counting nutrients.  And it moves away from the notion of food as a nutrient-specific thing.

DR. PRASAD: So you’re not counting carbs, calories, sugar.

JOHNS:  You are not counting carbs, calories.  You’re not looking at how much of each food I need to eat.  You’re talking about a combination of foods and about eating foods.  You’re talking about having meals, it talks about having meals together with other people or for family and friends, and it talks about giving time for preparation of meals and for sitting to eat and not eating running the streets or sitting in the car.

And it talks about sustainable food systems, where the food comes from, how it was produced.  It talks about all those elements. The real farmers, the ones that are producing the healthy foods, there’s no marketing for that.  There’s no money for that, right?

So it’s so simple because it’s just says: go back to eating real food, stop worrying about what to eat or not to eat based on so-called “healthy recommendations.”  What are the local foods?  What type of foods are accessible in your region?  What can be grown there? I mean in Brazil, we should be more manioc than wheat, for example.  Being more sensitive about the connection between the production of food and the consumption of food, bringing closer together producers and consumers, it’s simple.  Eat food, go back to the kitchen, cook and eat food.

DR. PRASAD: I think it was Michael Pollan that said, “You should eat food that your grandmother would recognize as foods.”

JOHNS:  Yes, yes.  It comes from this fantastic view of like nutrition.  It was a very strong criticism of looking at food, just at the nutrients that are inside some foods and look in of the combination of these nutrients.  That’s how they have an impact in our body.  You cannot take away a nutrient from a bean and think that you’ll have the same effect if you put it in a pill.  It doesn’t work that way.

DR. PRASAD: And it’s not nearly as delicious.

JOHNS:  No.

DR. PRASAD: It seems to me that there is almost a direct association between how much the industry fights something and the public health impact it could potentially have. So the more they fight it, the more useful it will be for public health.

JOHNS:  Absolutely.  That was our golden rule in tobacco.  If the industry fights really hard against it, that’s a very big hint that is a very effective policy.

DR. PRASAD: That it works.

JOHNS:  And if they industry promotes it, probably doesn’t work very much.  And the industry is promoting physical activity, which is an incredibly important risk factor in its own.  Let’s make that point clear.  But it’s not the remedy for obesity.  I think we need to be really strong in separating physical activity from recommendations around diets.

DR. PRASAD: There’s overwhelming evidence that unhealthy diet is the much bigger driver of this epidemic than lack of physical activity. We are not going to be able to exercise our way out of this epidemic, as you said.  And we live in unhealthy food environments, and we need to change those environments with things like front-of-package warning label and marketing restrictions so that healthier options become the default for people.

JOHNS:  Let’s make another thing clear for the general public.  Healthy options are not Diet Cokes, for example, okay?  It’s amazing because in the past, people would smoke in bars and restaurants, and we would think it was normal, and it has been normal for many decades.  And nowadays when people are having a Coke or a Diet Coke in a restaurant, we find it normal.  It’s so naturalized as a part of a meal and we need to denaturalize it because you could never, you could never run away a can of soda. It doesn’t work that way.  I mean it’s a completely different impact on your body, and we should go back to drink water.

DR. PRASAD: Thank you Paula. This has been a great discussion and really appreciate you making the time to be with us.

JOHNS:  Thank you.  This is a great opportunity.

DR. PRASAD: We’re really pleased to have with us Professor Karen Hofman, director of Priceless South Africa, based at the Wits School of Public Health. Priceless is a research team that provides info on the best buys for health in South Africa.  Recently, Priceless was approved as the medical research council of South Africa’s Center for Health Economics and Decision Science.  Congratulations on that Karen.

PROFESSOR KAREN HOFMAN:  Thank you so much.

DR. PRASAD: And thanks for being with us.

PROFESSOR HOFMAN:  Sure.

DR. PRASAD: Karen, can you take us to South Africa and talk to us about the food environment there? It’s a country that has simultaneously a big burden of undernutrition and over-nutrition and often in the same household, which presents some unique challenges. Talk to us about what you’re seeing and why this is.

PROFESSOR HOFMAN:  So we’ve got the situation where we are dealing with this double burden of undernutrition, 20% of children in South Africa are stunted — still — in 25 years following the dawn of democracy in South Africa, and at the same time we have, close to 70% of South African women are either overweight or obese, and 13% and climbing of children are overweight or obese.

If you look at both of those things, certainly in the same household, it’s impacting the economy of South Africa. Non-communicable diseases that relate to obesity and smoking are costing the country close to 7% of GDP. We’ve got a situation where breastfeeding is low.  Certainly fulltime breastfeeding for three to six months is really unheard of.

We have also a very high diabetic rates and growing, with 60% of them being undiagnosed, and many of the diabetics and hypertensive dying very young, prematurely.  In order for that to happen, something must be going on.  So what’s going on?  We have the consumption of sugary beverages by nine and ten-year-olds in South Africa as number two in the world.  We are consuming on average 31 kg of sugar per South African per year, and 2 teaspoons a day of salt.

DR. PRASAD: For our listeners, what are the recommendations for sugar and salt?

PROFESSOR HOFMAN:  So the sugar amounts should not exceed six teaspoons a day, and the salt should not exceed one.  Recently we had salt regulations enacted, and of course our sugary beverage tax, which was enacted in April of 2018.

DR. PRASAD: Karen, can you talk to us about the work that Priceless did to bring about the tax? You were a force in in bringing that about.  Tell us what you did to make it happen.  It wasn’t easy.

PROFESSOR HOFMAN:  It wasn’t easy.  We’re trying to move the needle in terms of population health in South Africa.  We strongly believe in prevention. We realize that often the road to health is through the legislature or through the fiscus, through the Treasury.  It’s not always through the health systems. We decided to do some modeling and looked of course to other countries as to what was going on in other countries.  So we actually asked for 20%.  There was a lot of back and forth and a lot of industry trying, well they did influence the Treasury.

DR. PRASAD: And in fact didn’t the Treasury’s own analysis at first have a 20% tax?

PROFESSOR HOFMAN:  Yes it did.  It did have a 20% tax.

DR. PRASAD: And it ended up being around 11%.The idea is you really have to bring the public along with you. You can’t go in and say, raise taxes.  The public needs to understand why you’re doing it.

PROFESSOR HOFMAN: The public are critical.  We need to continue to work with them.  I would say that it’s a complicated political economy space in South Africa because there’s extremely high unemployment.  There was a lot of using of statistic misleadingly, exaggeratedly to try and show that there would be something like 72,000 job losses, which of course had to be then revised downwards to the point where it became negligible somewhere in the region of 1,000 at the most, if at all. That was critically important.

DR. PRASAD: It’s almost a reflex. We’ve been seeing around the world that if you talk about sugary beverage taxes, they say well this is going to destroy the economy; it’s going to kill jobs.

PROFESSOR HOFMAN:  Right.

DR. PRASAD: And in South Africa because unemployment is high, it was a real politically hot button issue. I would like to say for our listeners that the evidence so far, in where it’s been studied, Mexico, Berkeley, California, and Philadelphia, is that there has been no impact on employment and/or unemployment as a result of these taxes. The industry does this, they make claims that just aren’t backed up by the evidence. I think we need to keep studying it to build up and consolidate this evidence even further.

PROFESSOR HOFMAN:   It’s a serious matter.  I agree with you; I think it’s very unlikely to affect the employment rates.  But because employment is, I would say the biggest policy issue in the entire country, it’s the issue of the day in South Africa.  There is approximately 30%, unemployment.  In some areas of the country, it’s close to 70 %.

DR. PRASAD: Wow. You and others around the world are really at the forefront of these policies to improve the food environment.  Talk to us about what that’s like, to be creating something that there is no guidebook, you’re making the guidebook, which, and I imagine that that’s both simultaneously a really exciting thing, but it’s also daunting.

PROFESSOR HOFMAN:  It is; it is. It is uncertain, but nerve-racking let me say, I think that our group at Priceless also understands quite well the political environment.  I think there is somewhat of a playbook in the sense that this is very similar to tobacco. I would say that if we had unlimited funds, we would be responding on a more regular basis.

DR. PRASAD: And what would that look like?

PROFESSOR HOFMAN:  I would say the industry puts out a piece in the press or has since April probably every month.  It would be calling out industry for their incorrect assumptions.  It would be continuing to place the ads that we had before, and the Department of Health has actually asked for that. The social norms about sugar are not well-established. The paid media that was done before was very helpful in helping to establish that.

DR. PRASAD: I think what you’re saying is you need sustained campaigns.

PROFESSOR HOFMAN:  Totally.

DR. PRASAD: Yeah.

PROFESSOR HOFMAN:  This cannot be achieved—

DR. PRASAD: I completely agree.

PROFESSOR HOFMAN:  –without the sustained campaigns.  For example, one of the issues around weight and obesity is confounded in South Africa by HIV.  We have for, however long, 20 years, been the epicenter of the AIDS epidemic, and we still are.  Now, there are many more people who are on medications and who are surviving through into their fifties and sixties.  So that’s really good, okay, but the views of obesity were shaped in the HIV era.

DR. PRASAD: Can you elaborate on that, when you say the views of weight and obesity were shaped in the HIV era? What do you mean by that?

PROFESSOR HOFMAN:  So when people got HIV, and they were not treated, obviously some of them died.  And on their way, they became very thin.  So people who were thin were not considered to be beautiful.  They were considered to be sick.  It’s very difficult to change that now. Being a little bit overweight was good.

DR. PRASAD: It was a sign of health.

PROFESSOR HOFMAN:  A sign of health.

DR. PRASAD: You didn’t have HIV.

PROFESSOR HOFMAN:  At the same time as apartheid was abolished, there was a lot more investment in South Africa by companies food companies and beverage companies that see South Africa as a growth market because in North America and Europe, things are not as good for them.  They have specifically said, in public statements that they are targeting the poor, which feels really awful because the poor are exactly the people who don’t need to be obese, and in fact increasingly, although not exclusively are obese.  There are still a lot of wealthy people who are obese or overweight.

I don’t think just because we have the tax that our work is done.

DR. PRASAD: Absolutely agree. Taxes are not a panacea. It’s going to require a whole host of interventions.

PROFESSOR HOFMAN:  Right, I mean the policymakers have said to me, can’t you tell us exactly how much each intervention will impact?  And of course those are very difficult calculations to do.

I think that we have to involve other sectors because without that multi-sectoral health in all policies approach, we are unlikely to be successful on any one thing.

DR. PRASAD: Tell us what hope you have for South Africa.

PROFESSOR HOFMAN:  I think that policymakers are much more sensitized as a result of all the work that we’ve all been doing and all the funds that have been put into this.  All the resources have made a big difference.

We are frequently requested to serve on panels that deal with food policies, strategic plans.  We continue to do our work on where we can get the best return on our investments for health and particularly for obesity.  I think that South Africa is on its way.  I think we’ve got policies around sugary beverages, which we have to protect.  We’ve got policies around trans fats.  We’ve got policies around salt.

I do think that we can do some more work within large metropolitan areas. We can do some more work on legislative options, and I’m glad to say we now have a lawyer working with us.  We have to expand.  I also think we need to work to get a cadre of students up to speed in terms of their capacity to deal with these things. I’m optimistic actually.  I’m an optimist about South Africa in general, but it does have its challenges.  Thank you very much.

DR. PRASAD: Karen, thank you. This has been a fascinating conversation, thank you so much for all of your insights.

PROFESSOR HOFMAN:  Welcome.

DR. PRASAD: We are really pleased to have Deborah Chen, who is Executive Director of the Heart Foundation of Jamaica here with us today to talk about the food environment in Jamaica and what the Heart Foundation is doing to improve that food environment. Debbie, thanks so much for joining us.

DEBORAH CHEN:  Yeah, it’s a real pleasure to be here.

DR. PRASAD: So Debbie, take us to Jamaica. Transport us there, and talk to us about the food environment.

CHEN:  Well as many people may know, Jamaica is a relatively small island in the Caribbean. Over the last few decades like everywhere else, we have had a transition away from the communicable diseases now to non-communicable diseases (NCDs).  Along with the changing environment has come obesity and other risk factors for NCDs.  Unfortunately we have been moving away from our traditional ways of eating.  Many years ago we used to eat ground provisions, vegetables, fruits.

As time has gone along, and I think also with the advent of media where you’re exposed to information from overseas and maybe with travel, our eating habits have been changing for the worse. There’s been, fast foods have been increasingly present.

Of course, coupled with that is a faster pace of life and people wanting food that is more convenient and pre-packaged.  All in all, I’m afraid we’re not going in the right direction.  So at Heart Foundation of Jamaica, along with other agencies, we are trying to see what difference we can make in at least halting the obesity epidemic and then hopefully seeing a reduction.

DR. PRASAD: Can you talk to us about how you’re approaching it, the Heart Foundation of Jamaica?

CHEN:  So at the Heart Foundation of Jamaica, we’ve been established 48 years now.

In recent years have been working more with the Ministry of Health in several areas.  One is tobacco control because of course as we know that affects the NCDs, and more recently in obesity prevention, given the appalling rates of obesity that we see.  In 2000 when the Jamaica Health and Lifestyle Survey was done, are obesity and overweight rate was 45.7%.  And in 2017 it’s now 54%.  Our children overall, it’s at 10.1%.  But the alarming thing is that in the last seven years with the Global School-Based Health Survey, the boys have increased by 94% and the girls by 47%.

Against that background, we were very, very happy and fortunate to receive funding from Bloomberg Philanthropies, which will enable us to work in the specific area of obesity prevention, we have now been able to launch a mass media campaign which has been really, really successful.  We find that the conversation is changing in the homes, on the street, in the schools. People are saying I will drink water instead.

In terms of the schools, we were, we advocated for what the Ministry of Health was working along this line, to restrict sugary sweetened beverages in school as of January 2019.  We would have preferred zero sugar drinks in schools, but you have to work with the environment.  But with the obesity prevention program, we also feel that we need to have a tax on sugary sweetened beverages because as amazing and successful as the media campaign has been, we know that that cannot be continued forevermore.  And in any case, it only will get people to change their behavior at a very small percent.

There was a study that was done in Jamaica that 65% of people who have information and know the information still do not translate that into actual behavior change.  We feel that the tax will create that environment where people will think twice when they take up a sugary sweetened beverage and put it back.

DR. PRASAD: Because the product will be more expensive.

CHEN:  The product will be more expensive, and the poorer people who tend to consume more products and are more impacted by these diseases, are more price-sensitive, so therefore then they would buy less of the product.  Even though the industry will have us believe that it’s impacting poor people and what else are poor people supposed to be drinking, the truth is that they’re actually more impacted than those in the higher incomes.  We’re really, really pushing hard to get that, the tax pass because without it, we don’t want to lose all the work that we have done in the last couple of years.

DR. PRASAD: There’s pretty overwhelming evidence now the taxes have an impact. And I think of all the policy areas that we work on it has the most established evidence base. And since Mexico passed its tax and these really landmark studies on the impact were published, we count over 30 governments covering two billion people, have followed.

This is increasingly being accepted as smart public health policy.  And in Jamaica, you’ve also got the public on your side.  There’s pretty high public support for a tax because through all the communications campaigns you’ve done, the public has come to understand why a tax is needed.  Why don’t you have a tax? What’s going on there?  What are some of the challenges in actioning the data and the evidence to policy change?

CHEN:  Part of it can be political in terms of this current government has campaigned on a policy of no new taxes.  And in fact in the budget debate last year, a placard was held up saying no new tax.  So you can imagine that any tax at all, whether this or another tax, probably would be viewed from a political perspective as not being the most prudent thing to do.

Of course, I don’t doubt industry interference and industry lobbying. In any case, campaigning will start behind the scenes and then more overtly next year.  And of course we have campaign funding to think about, so you always have that in the back of your mind.  Whereas there has been a push in Jamaica for transparency in campaign funding — that has not materialized. So no matter who gives what to who, it’s a big secret.  So of course you’re not really, you’re not really privy to know who gave what and therefore who could be influencing policy — lobbying from the industry who of course are awash with money.  And the industry is quite wide; it’s not one player.

I would imagine that those are the reasons why it is dragging, even though evidence suggests that would be a win-win situation.  It wouldn’t cost the government to implement the tax.  The other thing is that we have explained to them that there’s many good use for the tax.

DR. PRASAD: Debbie, can you talk to us about some of the industry behavior that you’re observing in Jamaica. How have they responded to some of the communications campaigns that you’ve been promoting?

CHEN:  The industry is quite varied.  So you have the bigger distributors, some who distribute for overseas brand like Pepsi and Coke, and then you have smaller members of that industry locally who seem to be more receptive.  Some of the other industry players surprisingly, not the internationally-based ones, have been not saying much.  And we have seen reformulation taking place.  Slowly but surely we have seen that.  We have seen big ads coming out saying 25% less sugar and so on.  Of course…

DR. PRASAD: Can you describe for our listeners what you mean by reformulation?

CHEN:  Yes, by reformulation we mean reducing the amount of sugar.  In this particular case, we mean reducing the amount of sugar in the drinks, some of our soft drinks have up to 27 teaspoons in a normal bottle.

DR. PRASAD: 27 teaspoons of sugar.

CHEN:  27, there’s one particular brand that has 27.

DR. PRASAD: Wow.

CHEN:  Going down to, the commonest one would be about 17. The reformulation is when the public interest develops and the public are demanding healthier drinks, they are responding, so one outcome is that we have seen reformulation.

The school restriction on sugary sweetened beverage I think has been a big boost to this because if your product is not allowed to be sold in schools, that’s a very big market.

Other than, that I think the industry, through their professional grouping of course, they’re always speaking about it on trying to make out that if you tax the products, then you’re going to lose jobs.  And there was even a recent analogy to the tobacco industry. There was an article by the tobacco industry talking about, how if they continue to put up the taxes, then they’re going to have more illicit trade and the government will lose money and so on, the usual rhetoric from the tobacco industry.

DR. PRASAD: So taxes, raising taxes will result in smuggling, essentially.

CHEN:  That’s what they’re saying.

DR. PRASAD: I mean the tobacco industry way, way, way overinflates the level of smuggling because of tax. There really isn’t a significant relationship.

CHEN:  And it’s my understanding that some other countries with the highest taxes have the lowest smuggling rates, like in the Scandinavian countries, for example, so it doesn’t hold water.  As we know, the tobacco playbook is being used in the beverage industry in terms of how to promote their products and how to counteract advocates.

It is not all gloom and doom.  Some of the manufacturers are genuinely interested.  The smaller ones mainly tend to be quite interested, they’re genuinely trying to make these reformulations.  I don’t want to use a broad brush and say well it’s everybody.  But some are going to be more vociferous, especially those who I think have international connections because sometimes you get the sense that it’s being driven by external forces in terms of what happens in Jamaica. The other thing that we notice happening is that there’s been a lot of marketing to children.

But one of the good things is that there is a school nutrition policy that is being finalized momentarily.  We met with the Minister of Education last week, and it is quite imminent.  And we have seen the draft policy, and we put our input, and that will address the school environment, and it will address what can and can’t be sold in schools in a broader sense, quite outside of the sugary sweetened beverage restriction.  The sugary sweetened beverage restriction is part of that policy, but the wider policy is now being finalized.

DR. PRASAD: So Debbie, it’s really encouraging. We know there’s no one magic bullet here, and this is going to require a package of interventions.  And you’ve clearly got your eye on and you’re working on a number of different policy options to bring to reality this package that’s needed.  Thank you so much for joining us and for all the work that you do at The Heart Foundation.

CHEN:  You’re welcome.

OLIVER: We hope you enjoyed this episode of Follow the Data. Thank you to Paula Johns, Professor Karen Hofman and Deborah Chen for joining us.

If you haven’t already, be sure to subscribe to Follow the Data podcast. This episode was produced by Electra Colevas, Ivy Li, Hagir Elzin, Jean Weinberg, Doctor Neena Prasad and Elizabeth Leonard; music by Mark Piro.

Special thanks to Eric Sheppard and Tim Herro.

I’m Katherine Oliver, thanks for listening.