Imagine if the real cost to society of the food you buy at the grocery store was built right into each product's price. Everything with added sugar would cost a whole lot more, according to University of Alberta researchers in a new study in The Canadian Journal of Public Health.
They peg the economic burden of excessive sugar consumption in Canada at $5 billion a year, thanks to the direct and indirect costs related to 16 chronic diseases. They call on governments to use a combination of taxation, subsidies, education and other measures to encourage healthier eating habits, saying it is "an area of urgent need for action" in the post-COVID-19 pandemic era.
"This pandemic has brought us more unhealthy choices — on the nutrition side, on the physical activity side and on screen time for kids. If we do not act now, we should expect more chronic diseases such as Type 2 diabetes in the years ahead," said principal investigator Paul Veugelers, professor in the School of Public Health.
"Health-care costs for chronic diseases are ballooning," Veugelers said. "We not only need to make our health-care system more efficient, we should also act on the demand side by investing in primary prevention to ensure we have fewer patients with chronic diseases. Addressing sugar consumption is one strategy to achieve that."
Two out of three Canadians eat too much sugar
Canada's Food Guide advises modest use of sugar and the World Health Organization recommends that less than 10 per cent of our daily energy intake should come from "free sugar", which is the sugar added to many processed foods as well as the naturally occurring sugar found in fruit juices, honey and syrup. For additional health benefits, less than five per cent is recommended.
Using data reported in the 2015 Canadian Community Health Survey on nutrition, the researchers found that two out of three Canadians eat more sugar than recommended. They then established risk estimates for 16 diet-related chronic conditions, including diabetes, cardiovascular diseases, cancer, kidney disease and low back pain. They calculated avoidable direct health-care costs such as doctors, hospitals and drugs, along with indirect costs like productivity losses due to illness and disability.
They concluded that if Canadians had followed the 10 per cent recommendation in 2019, an estimated $2.5 billion could have been saved, and $5 billion in costs could have been avoided by following the stricter five per cent recommendation.
Treatment and management of chronic diseases accounts for 67 per cent of all health-care costs in Canada, they reported, with an annual price tag of up to $190 billion.
They estimated that limiting free sugar consumption to less than 10 per cent of energy intake could reduce the prevalence of diabetes by 27 per cent, and that benefit could reach 44.8 per cent if Canadians limited their sugar consumption to less than five per cent.
"Diabetes is just a very expensive condition to manage and to treat. It can occur at an early age, and you can live with it for a long, long time. Kidney issues, dialysis, amputation, those are just a few gruesome examples of where that disease trajectory can go," said Veugelers. "Patients require lots of health-care interactions that drive the costs of chronic diseases."
Pricing strategies could curb consumption
Forty countries and cities around the world have already introduced a special tax on sugar-sweetened beverages such as pop as a disincentive to consumption, building on lessons from tobacco control measures. Newfoundland and Labrador recently introduced Canada's first such tax and similar policies have been suggested elsewhere, but in this study the researchers push for a broader approach, because they found that only 17 per cent of sugar consumption comes from sugar-sweetened beverages.
Instead, they advocate for higher taxes on all sugar-added products, and to put the tax revenues towards subsidies for healthful foods, education programs, limits on advertising to children, and better product labelling.
"The tax level would be adjusted based on the sugar content. For example, if you buy breakfast cereals they may be taxed less than jumbo-sized pop," said first author Siyuan Liu, a graduate research assistant and PhD candidate. "I think it's better to combine a sugar tax with specific interventions to help low-income groups to buy healthy foods."
Liu will continue her research by running economic simulations of the impact of various levels of taxation in combination with other measures.
In another recently published study, Veugelers estimated that Canadians spend roughly $1 on chronic disease-related health care for every $10 spent on food. He said it just makes sense for a country with a publicly funded health-care system to promote healthy eating to avoid future health-care costs.
"When you go to a restaurant, rather than only tipping the server, you should also tip the government 10 per cent, because they will need to take care of your health sometime in the future," he said.
The research on the economic burden of excess sugar consumption was supported by the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, the Canada Foundation for Innovation, Statistics Canada and the Stollery Children's Hospital Foundation through the Women and Children's Health Research Institute.
