Almost half of Canadians support the idea of a "fat tax" on high-fat foods such as chips, soft drinks and snack cakes, a new poll suggests.
And four in 10 people surveyed recently by Ipsos-Reid for The Globe and Mail and CTV said they believe there should be tax breaks for those who maintain a healthy lifestyle.
Over all, the majority of Canadians disapprove of such heavy-handed measures as a way to tackle the country's growing obesity problem. But there is widespread support for investing as much money promoting healthy lifestyles as has been spent fighting smoking, and almost universal backing for making physical-education courses an integral part of school curriculum. Public-health experts tend to agree.
"We don't need to be health Nazis, because that won't work," said David Butler-Jones, president of the Canadian Public Health Association, speaking against a fat tax.
"We don't need to ban the Big Mac. We need to make it easier to choose alternatives to the Big Mac and other unhealthy foods."
For Dr. Butler-Jones, that means education programs to promote healthy eating and perhaps subsidizing healthy foods, or at least the transport of healthy foods to areas where they are not accessible such as the Canadian north, rural areas and low-income neighbourhoods.
He notes that, in most provinces, liquor-control boards subsidize transport so that beer and alcohol are sold at a uniform price, "but the same isn't true for milk and fresh vegetables."
Dr. Butler-Jones said that, as with a fat tax, the idea of subsidizing individuals for being healthy seems attractive at first blush but he believes Canadians would ultimately reject the approach.
"What it amounts to is punishing the sick and, in Canada, that would never fly," he said.
Larissa Roux, a Calgary sports physician who is working on a PhD in health economics, was equally dismissive of the idea of a new tax, particularly a regressive tax that would disproportionately hit the poor.
"We should deal with the underlying poverty, the inability of people to make good nutrition choices, not make it worse," she said.
Dr. Roux said a parallel is often drawn between taxing cigarettes (which, in combination with public-health campaigns, has been quite successful) and taxing fatty and sugary foods, but she said the comparison is a stretch.
"You can tell people to stop smoking, but you can't tell them to stop eating," she said. Further, there is an assumption that cutting consumption of fat will eliminate obesity, but that is not necessarily the case, especially if people do not increase their levels of activity.
"From a purely scientific point of view, there are too many missing links to even consider a fat tax," Dr. Roux said.
But she agreed that as much effort should be put into tackling the dual epidemic of inactivity and poor nutrition as into fighting smoking. In the Globe-CTV poll, 86 per cent of respondents endorsed that level of action.
The poll also suggested that 96 per cent of Canadians believe physical- education courses and nutritional-education courses should be compulsory in primary and secondary school. Most primary students now get less than one hour of PE weekly, and in many high schools the course is optional. A number of health groups are lobbying governments to have a minimum 30 minutes daily of physical education incorporated into the core curriculum.
In a paper published last year in the British Medical Journal, Tom Marshall, a professor in the department of public health and epidemiology at the University of Birmingham, said that taxing fatty foods would prevent hundreds of premature deaths each year, and cut the incidence of heart disease by about 10 per cent.
"There is a clear economic rationale for this approach," he said. As in Canada, most food in Britain is not taxed. But Dr. Marshall said that extending the value-added tax, currently set at 17.5 per cent, to foods that are the principal sources of dietary saturated fat would quickly push consumers to make healthier food choices.
Dr. Marshall also said that, because a tax on food is regressive, it should be coupled with an increase in welfare rates and increases in other forms of fixed income.
Martin Collis, a retired professor of physical education from the University of Victoria who now works as a motivational speaker, said he backs the idea of taxing unhealthy foods, albeit reluctantly.
"Nobody likes taxation but the reality is that we have to find a way of promoting healthy lifestyles, and this is a pretty obvious way to raise money," he said.
Dr. Collis said that rather than tax fatty foods, he would impose a lifestyle tax on a full range of products that encourage and exacerbate the sedentary lifestyle that is the root cause of the obesity epidemic. Even a minimal tax could raise hundreds of millions of dollars, he said.
The products Dr. Collis would target include fast foods, soft drinks, snack foods, as well as automobiles, gas, video equipment and video rentals. He would allocate all the revenues to a group such as ParticipAction to promote activity and good nutrition.
"McDonald's alone spends more than $1-billion a year advertising. We spend nothing on promoting a healthy lifestyle. It's not a level playing field out there," Dr. Collis said.
A report released this month by the Dalhousie University Medical Research Foundation also suggested that the carrot is a better approach than the stick.
A forum of 24 academics proposed that healthy behaviour should be rewarded with tax rebates or credits. For example, obesity-reduction programs (most of which must be paid out-of-pocket) could be tax-deductible. The report also called for taxes to be dropped on healthy foods.
Most provinces do not charge sales taxes on food, unless it is junk food, which is, in effect, a sort of hidden fat tax. And the tradition in Canada has been to not target tax revenues to specific initiatives. The issue, however, is increasingly being debated in academic circles and fat taxes are gradually working their way into the public-health armamentarium.
An article published in the American Journal of Public Health last year found that 17 U.S. states already have special taxes on soft drinks, candy and snack foods and estimated that these fat taxes already generate more than $1-billion (U.S.) annually. The Center for Science in the Public Interest estimated that, countrywide, they could raise an additional $1.5-billion. (Similar taxes in Canada would raise up to $250-million.)
The most lucrative measures introduced to date are found in the big U.S. states: New York, California and Texas all have a special tax on soft drinks (ranging from 6.25 to 7.25 per cent) that, by itself, raises more than $600-million. But even smaller states have found the fat tax to be a lucrative way of raising money. Arkansas has used a 2-cent tax on each can of pop to fund Medicaid, a health-insurance program for the poor; West Virginia has used a penny-a-can soft-drink tax to fund its medical and nursing schools.
Michael Jacobson, executive director of the CSPI, said he backs the idea of taxing unhealthy food but only if the revenue is directed at promoting healthy lifestyles.
"With obesity rates soaring and the costs of diet-related diseases in the stratosphere, it is essential that government fund major campaigns to promote healthful diets and physical activity. One way to obtain funding is to apply small taxes to foods that undermine health," he said.
The CSPI estimates that poor nutrition and inactivity kill at least 500,000 Americans annually and costs the health system $71-billion. There are no comparable Canadians studies.
The closest research, produced at York University, found that inactivity alone costs about $3.1-billion and kills 21,000 people annually in Canada.
Over all, it is estimated that obesity and inactivity have about the same impact on the health system as smoking -- each accounting for about four per cent of costs.
The Globe-CTV poll suggested that support for a fat tax was highest in Quebec, where 56 per cent of people endorsed the idea, and lowest in Ontario, where it had the approbation of only 43 per cent.
Quebec respondents were also the biggest supporters of tax incentives for healthy people, at 45 per cent support. Albertans were the least enthusiastic, with only 33 per cent of respondents backing the idea. Interestingly, Quebec is one of Canada's least fit provinces, and Alberta one of the fittest.
Women surveyed were more likely than men to support a fat tax, 53 to 43 per cent. Men, on the other hand, were more supportive of tax incentives than women, 40 to 37 per cent.
Backing also varies markedly by age group and socio-economic status. Only 34 per cent of Canadians in the 18-34 age group backed a fat tax, compared with more than 58 per cent in the 55-plus age group who supported the approach.
At 51 per cent, low- and middle-income households were more likely to back the taxing of unhealthy foods than those with high income, at 44 per cent. The divisions were similar on the question of tax incentives for those who maintain a healthy lifestyle.
But the experts stress that, regardless of the decision that politicians make on taxation, taxes alone cannot begin to address the larger problems -- health-related, economic and sociological -- of a society where half of adults and one-third of children are overweight.
"It would be very naive of us to think that fat taxes or any tax incentives will resolve this complex issue," said Dr. David Lau, the president of Obesity Canada, a non-profit group formed to draw attention to the health burden of obesity.
"We need to sit down and draft an action plan that's as elaborate as the problem. We can't just sit on our duffs and hope it will go away," he said.
Consume at your own risk...
Smoking warnings
The government has printed these two labels, among others, on cigarette packages in the hopes of educating consumers with the dangers of smoking to their health.
Fat warnings?
Should the government print warning labels on the packages of junk food in the hopes of educating consumers on the dangers of obesity to their health? Tell us what you think. Vote in our on-line poll.
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Junk food tax...
Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that high-fat foods such as chips, soft drinks and snack cakes should be taxed at a higher rate than nutritious foods?
Strongly agree 28% Somewhat agree 20% Somewhat disagree 21% Strongly disagree 30% or tax incentives to eat healthier?
Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that there should be financial incentives in the form of tax breaks, for those who maintain a healthy lifestyle?
Strongly agree 17% Somewhat agree 22% Somewhat disagree 20% Strongly disagree 41% Don't know 1% Need more exercise
Do you strongly agree/somewhat agree or somewhat disagree/strongly disagree that just as much effort and money should be invested in promoting physical activity as in fighting smoking?
Strongly agree/Somewhat agree 86% Somewhat disagree/Strongly disagree 13%
Do you strongly agree/somewhat agree, or somewhat disagree/strongly disagree that physical fitness courses should be an integral part of the curriculum for primary and secondary school students?
Strongly agree/Somewhat agree 96% Somewhat disagree/Strongly disagree 4%
André Picard