Johanna Ralston, CEO, World Heart Federation
With the introduction on 1 October of a “fat tax” in Denmark – a surcharge on foods with more than 2.3 per cent saturated fats – we asked our member organizations to give their reaction to this new law.
I am delighted to introduce this first guest blog, written jointly by the Danish Society of Cardiology and the Danish Heart Foundation, and congratulate their efforts on a national level to reduce the burden of cardiovascular disease (CVD).
Dr Inge Vestbo, MD, Managing Director, Danish Heart Foundation
Dr Christian Hassager, President, Danish Society of Cardiology
Obesity and overweight continues to increase in Western Europe as a result of unhealthy diets and low physical activity. Healthy diets are characterized by a high intake of fruit, vegetables, legumes, fibre, whole grains, nuts, vegetable oils, and fish; whereas unhealthy diets are characterized by a high intake of salt, red meat, processed meat, saturated fat, trans fat, refined grains, and refined sugars. Unhealthy diets greatly increase CVD incidence and premature mortality. Key problems are high salt intake, sugar sweetened beverages and saturated fat, each accounting for 10–15% of calories consumed by youth. Campaigns and public education programmes have not yet succeeded in changing these unhealthy lifestyles.
Changing dietary patterns from unhealthy to healthy will substantially lower cardiovascular risk. The causal linkage between consumption of saturated fat and risk of CVD is beyond discussion; the question is how to reduce consumption of saturated fat in the general population as well as those at increased cardiovascular risk. For those at increased cardiovascular risk, individual measures are needed but it is well recognized that small changes in risk of disease in the whole population can lead to greater reductions in disease burden than large shifts among those persons already at risk. Taxation is a widely used measure to regulate population behaviour: its efficiency has been shown in tobacco consumption, where fiscal measures are the most efficient in preventing smoking uptake in adolescents and reduce smoking in the less affluent. Although tobacco does not compare directly to food, taxation of unhealthy food content has the potential to modify food habits in a healthier direction. For this reason The Danish Society of Cardiology and the Danish Heart Foundation welcome this new tax on saturated fat.
Taxation of unhealthy food has been estimated to have the potential to reduce CVD deaths in the UK by 2%. Taxation of salty foods and sugar, including soda taxes, are already implemented in some countries. No substantial knowledge of the effect on consumption or obesity exists but tax is often lowered due to lobbying from industries. It is well recognized that the current “default” dietary patterns are pushed in the unhealthy direction by a number of conditions, including the ease of access to junk food, healthy choices being more expensive, marketing by the food industry and EU agricultural policy. Opponents to taxation of unhealthy food allege that taxation and other legislation will lead to a “Nanny state” that hinders the free choice of people but the fact is that free choice remains for the individual. Taxation of saturated fat just helps make the healthier choice the easier choice.
Inequality in health is increasing. Cardiovascular risk factors tend to accumulate in the disadvantaged. Whereas fiscal measures are more efficient in changing behaviour among the disadvantaged, the burden of the tax is also unequal. This is a paradox that has not been sufficiently addressed.
For now the Danish tax is mainly of symbolic value – it will result in relatively small increases in the price of meat, more in fatty meat, less in lean. It may have some impact on consumption of dairy products high in fat content, which the Danes still use a lot of when preparing traditional food. It will not hit whole milk, as only products with more than 2.3 per cent fat will be taxed. However, Danes use only 5 per cent of their income on food so the effect on their dietary habits and thus consumption of saturated fat is likely to be minimal. For taxation to have a real impact and translate into measurably reduced CVD and saved lives, the taxation has to be heavier. However, a principle has been established with wide political support and this is an important step in the right direction
Dr Inge Vestbo MD & Dr Christian Hassager
Managing Director, Danish Heart Foundation President, Danish Society of Cardiology
Should the global CVD community push for taxation of unhealthy food as a key source of revenue for addressing NCDs within health systems?
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Should we emphasize taxes on unhealthy foods as a means of changing personal behaviour around dietary choices, alongside our continued efforts to prioritize increased budget allocations for NCD prevention and control?
I believe that, as with the FCTC, taxation is surely one of the measures that have to be taken – certainly without evidence specifically at each unhealthy element there needs to be research conducted and saying this might be a generalization. However, my feeling is that it certainly would be help. We do have to take into consideration though that advocating for this is not enough. Action should be taken in educating people and especially young children in terms of healthy lifestyles, eating healthy and exercising. On a last note, if major social determinants aren’t tackled I doubt that a poor (for example) family will give too much effort in trying to educate their child(ren) on healthy lifestyles in general. There is a lot of work to do!
Thank you for your comments and this topic is certainly a great one to have open for discussion. Taxation policies have to be supported by public education and awareness campaigns, as taxes alone cannot lead to a change in dietary habits. Healthier food options also have to be made more affordable and accessible and I totally agree with you, a lot more work has to be done in addressing the social determinants of health. However, this is a step in the right direction and one that should help avoid the millions of unnecessary deaths caused by cardiovascular disease each year. We look forward to the day when it is not the world’s number one killer.