The hard questions soft drinks raise

InMarch, the British government announced that it intends to impose a tax on sugary drinks from 2018 to tackle childhood obesity. Whether the tax, which will be debated this summer, achieves its publichealth goals depends on the details, and on rigorous evaluation of its effects.

TheUnited Kingdom is not alone in worrying about the global rise in obesity-related ailments like diabetes and cardiovascular diseases— costly conditions that can lead to significant disability and early death. Many countries have, or are considering, imposing taxes on unhealthy foods and drinks— especially those to which sugar has been added. For example, Chile has an 18 percent tax on high-sugar drinks, France taxes drinks with both added sugar and artificial sweeteners, and Hungary taxes food and drinks with high sugar, salt and caffeine content. And Philadelphia in Pennsylvania recently became the largestUS city to impose a tax on sweetened drinks.

These food taxes are one of the most effective behavioral-change levers available to policymakers: price. But it would be premature to conclude that higher prices necessarily lead to lower consumption and thus better health outcomes. The effectiveness of a tax depends on how it is designed, and how consumers and the food industry respond to the incentives it creates.

The imposition of taxes on sugary drinks inMexico and Berkeley in California, has demonstrated the industry’s willingness to fight legislation that might lower its profits. And evidence suggests that these taxes, once implemented, did indeed result in a change in price for customers, who subsequently bought fewer sugary drinks.

Unfortunately, however, little is known about the effect of these taxes on public health. Obesity and its related ailments take a long time to develop, and isolating the effects of food taxes from changes caused by other health policies and cultural trends is challenging. However, both mathematical modeling and simple logic suggest that these taxes will improve health. And detailed evaluations have been launched inMexico and elsewhere to quantify the effect.

Interestingly, all taxes on sugary drink, whether in France, Hungary, Mexico or Chile, are sales taxes; they lead directly to increases in point-of-sale prices, often in proportion to the volume of the drink. InMexico, for example, the tax is a peso per liter, which raises the price by about 10 percent. This is where the proposed UK scheme differs. Former chancellor of the UK Exchequer George Osborne announced a two-tiered levy, with the explicit aim of encouraging the industry, rather than consumers, to change behavior. The proposed tax has been widely welcomed by public health organizations and campaigners. But since placing the burden on industry is a different approach than has been implemented elsewhere, the effects are not entirely predictable. For example, there is nothing to stop a company from raising prices across its product range, thereby erasing any price difference between high-sugar drinks and low-sugar alternatives. The possibility of the reformulation of existing offerings and new entrants into the market are other important uncertainties. In 2014, Coca-Cola introduced its low-sugar alternative, Coca-Cola Life. With its distinctive green packaging and wholesome image established through advertising campaigns, the new product captured more than 2 percent of total Coca-Cola sales in the first year after its introduction. However, it is unclear whether these additional sales came from consumers who would otherwise be drinking fullsugar Coca-Cola, the diet version of the soft drink, or other beverages, such as fruit juice or water.

If industry responds to the tax by reformulating products and changing its marketing strategy, and if this leads to a reduction in sugar intake in the UK, then the tax will have been a success. But accomplishing this will require policymakers to get the legislation right and to ensure that its effects are properly assessed. Adam Briggs is aWellcome Trust Research Training fellow at the BritishHeart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Mike Rayner is a professor of PopulationHealth at the Nuffield Department of PopulationHealth and director of the BritishHeart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, and Peter Scarborough is a senior researcher at the BritishHeart Foundation Centre on Population Approaches for NonCommunicable Disease Prevention. Project Syndicate

The Dutch seem pleased with a recent announcement that King Willem-Alexander’s daughter Amalia, the 13-year-old heir to the throne, will learn Chinese during the upcoming school semester. Some have even called it the royal family’s “smartest investment” given the deepening relationship between China and theNetherlands.

The Dutch royalty is not alone in embracing the Chinese language. In neighboring Belgium, Princess Elisabeth, the first child of King Philippe born in 2001, was already studying Chinese in a Dutch-medium school in Brussels. When King Philippe acceded to the throne in 2013, the princess became the duchess of Brabant, a title reserved for the heir apparent, which means she could become a Chinese-speaking queen of a European country.

In fact, the older generations of royal families in Europe have had an interest in Chinese culture for long. Although Britain’s Queen Elizabeth II, who celebrated her 90th birthday this year, doesn’t speak Chinese, she has enormous interest in Chinese philosophy, especially Taoism.

This month, the University ofWales Trinity Saint David, partly supported by Britain’s Royal Family, established the Academy of Sinology with the aim of encouraging doctorate students to study ancient Chinese religions, texts, language and history.

The Danish monarchy, too, has shown keen interest in Chinese language and culture. Apart from Danish, French and English, the royal family’s website has been using Chinese since 2014. QueenMargrethe II of Denmark, King Willem-Alexander of the Netherlands and King Philippe of Belgium have already visited China after Xi Jinping became China’s top leader. And in return, Xi has visited the Netherlands, Belgium and Britain.

Studying Chinese is becoming popular across Europe. When I was interviewing parliamentarians in Greece during the country’s sovereign debt crisis, one of them even arranged for his 16-year-old daughter, who was learning Chinese at the time, to be present during our conversation.

For sure, European institutions are increasingly offering Chinese-language classes to young officials. On July 21, while I was walking with participants in the BelgianNational Day parade, a retired Belgian stopped me to say that in his youth he studied Chinese in Taiwan for a fewyears and spent more than 10 years on the Chinese mainland. I was amazed at his fluent Chinese.

All these are proof of the trend of Chinese becoming popular across the world, partly because of the attractions of Chinese civilization and China’s growing economic clout.

In recent years, China has initiated several projects to better connect with the rest of the world. One is the Belt and Road Initiative, which is aimed at improving connectivity in Eurasia through infrastructure construction, growing trade flow and increased people-topeople exchanges. The other is the establishment of the Asian Infrastructure Investment Bank that offers funds to countries to improve connectivity among Asia, Europe and Africa.

China therefore needs to innovatively respond to this trend to spread its language and culture, in order to meet the rising demands in Europe and other continents.

Although China has already helped set up Confucius Institutes in many universities in countries across the world, and Chinese language and culture classes have become part of primary and secondary schools in many countries, more needs to be done to spread the real values of Chinese culture. It’s time China intensified its cooperation with other countries to turn some of the schools into bilingual or trilingual institutions, where Chinese language and culture can be taught at least one day a week. Britain, the US, Canada, Japan, France and other countries have set up many schools in China with their own curriculum.

China can follow their examples to set up similar schools in other countries. And this should also be part of the mission for China’s newMinister of Education Chen Baosheng.