TAXES WORK?

Yet it was one of the first na­tions to in­tro­duce such a tax. What has been the ef­fect there, and what could that mean for the fu­ture of Bri­tain’s drinks in­dus­try – and for our waist­lines?

The Daily Telegraph - Telegraph Magazine - - Just Williams - Pho­to­graphs by Jordi Ruiz Cir­era

Moises Sanchez has in­tel­li­gent, hu­mor­ous eyes, but as he takes out his phone and brings up a pic­ture of Mer­ari, his eight-year-old daugh­ter, they are pinched with sad­ness. ‘As you can tell, she’s not thin,’ he says. ‘We’re tak­ing her to dance classes and have given her an eat­ing sched­ule to con­trol her diet. The other kids have started to bully her – I tell her to try not to get sad.’

Moises, a lawyer spe­cial­is­ing in cor­po­rate fraud, is a dot­ing fa­ther but an un­cer­tain role model. He him­self weighs 26 stone and is ad­dicted to sug­ary food and drink. In a som­bre apart­ment above a garage in the mod­est Mex­ico City sub­urb of Tla­co­tal Ramos Mil­lán, he tells a late-night meet­ing of Tragones Anón­i­mos (roughly trans­lated as ‘Guz­zlers Anony­mous’) about the times when things get re­ally bad. He’ll quite often drink four litres of Co­ca­cola in a day. ‘Tech­ni­cally, it’s sugar that trig­gers sat­is­fac­tion be­cause it is the sub­stance pro­cessed quick­est by the body,’ he ex­plains with grim an­i­ma­tion. ‘I look for im­me­di­ate sat­is­fac­tion, with car­bo­hy­drates in their purest form. Give me car­bo­hy­drates – they’re de­li­cious!’

If it isn’t Coke, then it’s gummy bears; if not fast food, then ex­tra tacos. In Fe­bru­ary, un­able to con­trol his diet, Moises de­clared a ‘cri­sis’ and went to live at Tragones Anón­i­mos, where his eat­ing switched in favour of veg­eta­bles (cab­bage is a sta­ple) and non-pro­cessed food, com­bined with reg­u­lar weigh­ings and a strict daily calo­rie limit. There are no fizzy drinks on the premises.

The great fear, says Moises, is type 2 di­a­betes, which af­flicted his par­ents, cost­ing his fa­ther both legs. Obe­sity has taken a large enough toll as it is. His mar­riage failed – ‘I didn’t feel at­trac­tive… we had trou­ble in the bed­room’ – mean­while, at work Moises be­lieves he has lost busi­ness be­cause his ap­pear­ance calls his pro­fes­sion­al­ism into doubt. ‘They think, “If he can­not con­trol his eat­ing, he won’t be able to con­trol my case and I will end up in jail”.’

Moises is an ex­treme case, but his story is be­com­ing less and less un­usual in a so­ci­ety en­joy­ing rel­a­tive pros­per­ity and whose tra­di­tional diet is un­der siege from for­eign pro­cessed food and, above all, sug­ary drinks; a coun­try that elected a for­mer top Coca-cola ex­ec­u­tive as its pres­i­dent, and in whose schools the com­pany paints vast mu­rals boast­ing of the drink’s ben­e­fits.

Es­tab­lished 35 years ago along sim­i­lar lines to Al­co­holics Anony­mous, the self-funded Tragones move­ment has grown in re­cent years as Mex­ico as­cended the world obe­sity rank­ing – it was fifth last year. Like Moises, those who join – of­fice work­ers, stay-at-home mums, IT en­gi­neers – tend to have acute prob­lems. But in one cru­cial re­spect, he and his com­padres are ahead of their fel­low Mex­i­cans: at least they ac­cept they have a prob­lem.

They are in the mi­nor­ity. A re­cent sur­vey es­tab­lished that 80 per cent of the Mex­i­can pop­u­la­tion is aware of the dan­gers as­so­ci­ated with sug­ary drinks. Nev­er­the­less, Mex­ico is the sec­ond thirsti­est con­sumer of such prod­ucts in world, with peo­ple de­riv­ing, on av­er­age, around 70 per cent of their to­tal added sugar in­take from fizzy drinks. Ac­cord­ing to Dr Pablo Kuri-mo­rales, Mex­ico’s un­der­sec­re­tary of preven­tion and health pro­mo­tion, most Mex­i­cans more or less un­der­stand what con­sti­tutes a bad diet, they just don’t be­lieve the risk ap­plies to them per­son­ally. Ap­prox­i­mately 40 per cent of Mex­i­cans told they may have di­a­betes fail to turn up for a fur­ther con­sul­ta­tion.

Speak­ing in his el­e­gant gov­ern­ment of­fice near Bosque de Cha­pul­te­pec, the Mex­ico City show­piece park where jog­gers are con­spic­u­ous by their ab­sence, Kuri-mo­rales sums up the prob­lem. ‘Most adults per­ceive them­selves as healthy,’ he says. ‘They don’t want to change their di­ets: they don’t care.’

The same self-delu­sion ap­pears to take place in Bri­tain. Re­search by the Of­fice for Na­tional Statis­tics in 2017 found that, on av­er­age, peo­ple in the UK un­der-re­port the num­ber of calo­ries they con­sume per day by more than a third. Jack Win­kler, emer­i­tus pro­fes­sor of nu­tri­tion pol­icy at Lon­don Metropoli­tan Univer­sity, says, ‘The ma­jor­ity of the pop­u­la­tion is not in­ter­ested in healthy eat­ing. They’ve got other things on their minds. They know what’s right but they’re not in­ter­ested in act­ing on it for a whole host of good and bad rea­sons.’ While nei­ther ex­pert could be ac­cused of de­spair, they share the same de­spon­dency.

As well they might. Af­ter all, pub­lic health and nu­tri­tion bod­ies have spent decades ad­vo­cat­ing ed­u­ca­tion as the best prac­ti­cal means of fight­ing un­healthy liv­ing – yet world­wide obe­sity has al­most tripled since 1975.

With nearly two bil­lion adults found to be over­weight as of 2016, of which 650 mil­lion were obese, the fail­ure of leav­ing healthy eat­ing to cit­i­zens’ good judge­ment is clear.

Last Oc­to­ber, NHS data re­vealed the high­est-ever pro­por­tion of obese English chil­dren leav­ing pri­mary school – one in five – while 63 per cent of Bri­tish adults are classed as over­weight (BMI 25-29.9) or obese (BMI 30-plus). An abun­dance of sugar in the diet is also sus­pected to be be­hind the rock­et­ing to­tal of un­der-18s need­ing teeth re­moved in hospi­tal: 170 a day.

With more peo­ple sur­viv­ing the ill­nesses that used to kill them, en­abling long and ex­pen­sive re­tire­ments, health sys­tems do not have the cash to spare on what Si­mon Stevens, chief ex­ec­u­tive of NHS Eng­land, eu­phemisti­cally refers to as ‘mod­i­fi­able’ risk fac­tors. Or, in plain English, self­in­flicted wounds. Gov­ern­ments around the world are fed up; they can no longer af­ford to wait for their cit­i­zens to mimic Moises and ad­mit, ‘I have a prob­lem’.

Yes­ter­day, the man­i­fes­ta­tion of the UK Gov­ern­ment’s im­pa­tience, the Soft Drinks In­dus­try Levy, came into force. Even be­fore its an­nounce­ment by Ge­orge Os­borne in the 2016 bud­get, the leg­is­la­tion was ubiq­ui­tously dubbed a ‘sugar tax’.

‘My mother would give me a bot­tle filled with Coke when I was a baby’

That, how­ever, has man­darins gnash­ing their teeth, as the mea­sure is not a levy on sugar per se, or even on all high-sugar drinks – fruit juice and milk­shakes are ex­empt – but specif­i­cally on so­das or fizzy drinks: cer­tain brands of Coca-cola, Pepsi, Irn Bru etc. Im­porters and man­u­fac­tur­ers are now sub­ject to a multi-tier regime, pay­ing 18p per litre if the drink has five grams or more of sugar per 100ml, and 24p per litre if it con­tains eight grams or more. In bring­ing in the levy, Bri­tain joins 30 coun­tries where a tax has or will be in­tro­duced, in­clud­ing France, South Africa and the United Arab Emi­rates.

On the face of it, ‘sin’ taxes such as these have three po­ten­tial ben­e­fits. Either the higher cost of pro­duc­tion is passed on to the con­sumer, who, de­terred by the in­creased price of the soft drink, makes a health­ier choice. Al­ter­na­tively, to avoid pay­ing the tax, com­pa­nies can take steps to make their drinks health­ier, a process known as re­for­mu­la­tion. Fi­nally, the tax may en­able a gov­ern­ment to bring in more rev­enue which can then be spent on fight­ing obe­sity, such as on school ex­er­cise pro­grammes, although this only ap­plies if re­for­mu­la­tion does not take place.

It is fair to say the soda com­pa­nies, pub­licly at least, do not see things the same way.

But com­mer­cial opposition to the tax in Bri­tain, while cer­tainly present, has hardly been deaf­en­ing. This may be be­cause the cru­cial bat­tle was fought, and ar­guably won, more than four years ago.

To un­der­stand just how deep and firm a grip soda com­pa­nies, and par­tic­u­larly Coca-cola, have over Mex­ico, you have to go there. Any­where. Even in Chi­a­pas, the most im­pov­er­ished state in the land, vil­lages com­pris­ing just a few hun­dred res­i­dents will nor­mally sup­port six or seven abar­rotes, tiny con­ve­nience stores awk­wardly em­bla­zoned with the gar­ish Coca-cola liv­ery, more often than not hum­ming to the sound of a gen­er­a­tor pow­er­ing the prom­i­nent bright-red fridges with their ranks of glis­ten­ing bot­tles.

The de­cay­ing moun­tain roads, de­void of any real traf­fic, nev­er­the­less thun­der as the com­pany’s lor­ries sport­ing the slo­gan ‘Dis­fru­tala!’ (‘En­joy!’) churn their way up and down the hair­pin bends to re­stock the agrar­ian com­mu­ni­ties. When one of them breaks down, its driver, 20-year-old Lorenzo Perez, squint­ing in the mid­day sun, ex­plains he is on his way to visit a few of the abor­rotes in his home town of Zi­nacan­tán. To keep even this hand­ful of out­lets in stock, it is a jour­ney he must make two or three times a week.

Fur­ther into the Chi­a­pas cen­tral high­lands, in the vil­lage of Cruztón, Jose Jimemes, 47, slouches against one of the fridges in his store as he re­counts how drink­ing habits in the re­gion have changed. ‘Coke be­came re­ally big around here in the ’80s, but even be­fore that my mother would give me a bot­tle filled with it when I was a baby,’ he says.

‘Peo­ple used to fill them­selves up on po­zol [a drink made from fer­mented corn dough] be­fore they worked in the fields but they switched to Coke and drank it in the same way, think­ing it would fill them up. Now peo­ple are be­com­ing more aware that Coke has noth­ing good in it, but they’re still drink­ing it.’

In some of the re­moter set­tle­ments, Coca-cola has be­come al­most a par­al­lel cur­rency, as Ger­ard Bravo, who runs a taco stand in Tene­japa town square, ex­plains. ‘If you are go­ing to ask a girl to marry you, you wouldn’t dream of go­ing to her fa­ther’s house with­out a big crate of Coke. It’s the same if you need to raise an is­sue with one of the lo­cal au­thor­i­ties: bring Coke.’

In the town of Chamula, about 20 miles away through the hills, the role of Coca-cola is taken some­what fur­ther. From the out­side, the Igle­sia de San Juan looks like any other Latin Amer­ica Catholic church. But to step in­side is to con­front a baf­fling three-way hy­brid of iconog­ra­phy: stat­ues of Chris­tian saints, an­cient Mayan mys­ti­cism and nods to US con­sumer culture. Iden­ti­fy­ing the plain-clothed ‘sac­ristans’, the peo­ple who look af­ter the church, is not im­me­di­ately ob­vi­ous, un­til you work out what to look for. Hang­ing from each of their belts are not rosary beads or the chains of an in­cense-burn­ing thuri­ble, but bot­tle open­ers.

They shuf­fle be­tween par­ties of par­ish­ioners, each kneel­ing be­fore their rows of can­dles amid lit­tle clear­ings in the sea of pine nee­dles that coat the floor (there are no pews), wait­ing for the ‘shaman’ to give her sig­nal that it is time for the Coca-cola. Mur­mur­ing in her in­dige­nous Tzot­sil, the shaman will by then al­ready have saluted the saints and spat a good mea­sure of the

lo­cally dis­tilled, rum-like spirit ‘posh’ on to a cou­ple of eggs be­fore run­ning them up and down the parish­ioner wait­ing to be ‘cleansed’. A lib­eral swig or two of Coke will con­clude a cer­e­mony, which can be re­quested for any­thing from in­fer­til­ity to de­pres­sion.

De­pend­ing on the type of cleans­ing re­quired, a bunch of basil may be rubbed over the parish­ioner’s face to ward off evil spir­its; the con­fig­u­ra­tion of the can­dles – white to rep­re­sent a corn-based of­fer­ing to God, tal­low for meat – may change; some­times a chicken is slaugh­tered. But Coca-cola al­ways plays a part.

The shamans are cagey about why the drink is used. Maria San­tis, 48, who learnt ‘heal­ing’ at her mother’s knee, sim­ply says with a twinkle in her eye: ‘Coke fixes every­thing.’

The sit­u­a­tion in Chi­a­pas is ex­treme: Coca-cola op­er­ates a large bot­tling plant out­side the main city of San Cristóbal de las Casas and has for many years been a very vis­i­ble pres­ence in the com­mu­nity. But it is a story re­peated to vary­ing de­grees across Mex­ico, re­gard­less of class, in­come or ge­og­ra­phy. The com­pany is deeply wo­ven into the fab­ric of ev­ery­day life and it has been com­mon for schools to dis­play any­thing from sub­tle lo­gos to vast ad­ver­tis­ing mu­rals, a legacy of cash-strapped head teach­ers ea­gerly tak­ing up of­fers of ‘pro bono’ re­pairs to class­rooms or bas­ket­ball courts.

At a na­tional level, Coca-cola has been spon­sor­ing youth sport­ing events for nearly 20 years and in the po­lit­i­cal sphere the firm’s in­flu­ence is pro-

found. Not least with Vi­cente Fox, the pres­i­dent of Mex­ico from 2000 to 2006, who had served as pres­i­dent of Coca-cola Mex­ico and head of the com­pany’s Latin Amer­i­can op­er­a­tions. Mean­while Jaime Zablu­dovsky Ku­per, the coun­try’s deputy chief ne­go­tia­tor at the NAFTA (North Amer­i­can Free Trade Or­gan­i­sa­tion) talks in the early 1990s, which did much to im­prove the ac­cess of US com­mer­cial gi­ants, went on to lead the Mex­i­can Coun­cil of the Con­sumer Goods In­dus­try.

Also strik­ing has been the at­ti­tude of sig­nif­i­cant parts of the med­i­cal estab­lish­ment, which for years ar­gued against co­er­cive mea­sures to tackle poor diet. When in 2013 pres­i­dent En­rique Peña Ni­eto took ev­ery­one by sur­prise by propos­ing a 10 per cent flat tax on sug­ary drinks, the mea­sure was pub­licly op­posed by Dr María Guadalupe Fabián San Miguel, the med­i­cal direc­tor of the Mex­i­can Di­a­betes Fed­er­a­tion, as well as by Dr Mercedes Juan López, the coun­try’s then health sec­re­tary.

How­ever, the tax was a prod­uct of Mex­ico’s fi­nance min­istry, where the soda in­dus­try en­joys less in­flu­ence, and, to the as­ton­ish­ment of the in­ter­na­tional pub­lic health com­mu­nity, it be­came law in Jan­uary 2014.

The at­ten­tion of health of­fi­cials around the world is now trained on Mex­ico – the fat­test and most pop­u­lous na­tion to have in­tro­duced such a tax – to find out whether it works. Ac­cord­ing to Dr Pablo Kuri-mo­rales, it will take years to gather the data to re­li­ably an­swer that ques­tion. Nev­er­the­less, in 2017 cam­paign­ers were en­cour­aged by a joint study by the Univer­sity of North Carolina and the Mex­i­can Na­tional In­sti­tute of Pub­lic Health, which found there had been a 5.5 per cent drop in sug­ary-drink sales in the first year af­ter the tax was in­tro­duced, fol­lowed by a 9.7 per cent de­cline in the sec­ond.

Scep­tics have ques­tioned the method­ol­ogy and pointed out the re­search was funded by Bloomberg Phi­lan­thropies, which has long sup­ported the in­tro­duc­tion of fizzy drink taxes, although most sci­en­tists agree that, while im­per­fect, the data is the best avail­able. The ques­tion is: to what ex­tent do the re­sults ap­ply to Bri­tain?

Pro­fes­sor Jack Win­kler, who sup­ports the Soft Drinks In­dus­try Levy, points out that the am­bi­tion be­hind the two laws is fun­da­men­tally dif­fer­ent. Mex­ico’s is a flat-rate tax de­signed to in­hibit con­sump­tion, whereas the UK’S tiered tax – which any­way is roughly dou­ble the Mex­i­can levy – is de­signed to stim­u­late re­for­mu­la­tion.

As far as he is con­cerned, it is al­ready hav­ing an ef­fect. ‘On the face of it, in Bri­tain the soft drinks in­dus­try be­haved ut­terly like you’d ex­pect them to: “Why are you sin­gling out sugar? Why don’t you fo­cus on ex­er­cise?” etc, etc. They were staunchly against it.

‘But be­hind the press re­leases, if you look at what they have done, there has been a sen­sa­tional change, a tri­umph in terms of re­for­mu­la­tion. Be­fore the tax has even come in, we have got rid of a huge amount of the sugar in our drinks. If you look at Coca-cola, the only prod­uct they’re go­ing to have left that is sub­ject to a full tax is Coke red, and that’s go­ing to be sold in smaller por­tions.’

Last month, an Of­fice of Bud­get Re­spon­si­bil­ity re­port – en­thu­si­as­ti­cally tweeted by Ge­orge Os­borne – found ‘pro­duc­ers are re­for­mu­lat­ing their drinks sooner and more ag­gres­sively than pre­vi­ously as­sumed’.

Even if our ‘sugar tax’ is, or al­ready has been, suc­cess­ful ac­cord­ing to its own terms, no one is sug­gest­ing that this alone will turn the tide of obe­sity. Rules ban­ning the ad­ver­tis­ing of un­healthy prod­ucts to chil­dren are in their in­fancy and will take vo­cif­er­ous main­te­nance and im­prove­ment to com­bat the slip­pery char­ac­ter of in­ter­net mar­ket­ing.

Mean­while, although the ar­gu­ments may have been de­ployed cyn­i­cally, the soft drinks com­pa­nies are surely right: the ef­fort should not be just about sugar; there should be a fo­cus on ex­er­cise.

Ul­ti­mately, the bat­tle can only be won if peo­ple un­der­stand the risks and make the right choices, so, yes, pub­lic in­for­ma­tion cam­paigns will con­tinue. As the ex­pe­ri­ence in Mex­ico is prov­ing, it will be dev­il­ishly dif­fi­cult to es­tab­lish how well the tax is work­ing in terms of its real goal, which is to im­prove the na­tion’s di­etary health. When it comes to pop­u­la­tion-wide in­ter­ven­tions, cause and ef­fect is al­most im­pos­si­ble to prove.

Pro­fes­sor Mike Rayner, a pop­u­la­tion health spe­cial­ist at Ox­ford Univer­sity, how­ever, sug­gests watch­ing out for the child tooth-ex­trac­tion statis­tics as a pos­si­ble early in­di­ca­tor of suc­cess. ‘Un­doubt­edly there has been an ef­fect on re­for­mu­la­tion go­ing on as a re­sult of the an­nounce­ment of the tax,’ he says. ‘Whether that’s go­ing to be big enough, we don’t re­ally know.’

One point upon which most cam­paign­ers do agree is that sugar taxes have been suc­cess­ful in re­cast­ing brands like Coca-cola in the pub­lic per­cep­tion. When, last month, the com­pany an­nounced it would be stop­ping school vis­its to its ‘ed­u­ca­tion cen­tres’ in the UK, Richard Kemp, a se­nior Liver­pool coun­cil­lor who has cam­paigned against Coca-cola pro­mo­tions that ap­peal to chil­dren, likened the fizzy drinks in­dus­try to to­bacco: le­gal, but no longer seen as a force for good. ‘They shouldn’t be work­ing with chil­dren,’ he said. ‘It’s three decades since we stopped cig­a­rette com­pa­nies do­ing fac­tory trips, and we are catch­ing up with fizzy drinks.’ In the same vein, Coca-cola’s pro­mo­tional Christ­mas truck tour of Bri­tain last year at­tracted plenty of crit­i­cism.

Per­haps the jug­ger­naut is turn­ing in Mex­ico, too. Up in the Chi­a­pas high­lands, Jose Jimemes is still en­joy­ing a roar­ing trade sell­ing Coca-cola, but he won’t give it to his chil­dren. Back in Mex­ico City, Moises Sanchez has lost 12 pounds and his daugh­ter, Mer­ari, is danc­ing at re­gional level. ‘Thank­fully I haven’t de­vel­oped di­a­betes, and I am here [Tragones Anón­i­mos] be­cause I don’t want to have it,’ he says. ‘But,’ he adds, point­ing to his mouth, ‘it’s a very dif­fi­cult process to un­der­stand be­cause we are given this soft­ware at child­hood.’

Learn more about Global Health Se­cu­rity at tele­graph.co.uk/ global-health-se­cu­rity

One coun­cil­lor likened the drinks in­dus­try to to­bacco: le­gal, but no longer seen as a force for good

A Coca-cola de­liv­ery in the town of Zi­nacan­tán in the Chi­a­pas re­gion A shaman uses Coca-cola as part of a heal­ing rit­ual in Chamula

Moises and fel­low mem­bers of Tragones Anón­i­mos, Mexico City The drinks se­lec­tion at a res­tau­rant in the central mar­ket of San Cristóbal de las Casas

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