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2 October 2019updated 09 Sep 2021 3:39pm

Boris Johnson should understand that sin taxes work

When it comes to healthcare, prevention is better than cure.

By Michael Escudier

Brexit may have dominated the news for three years, but as a general election approaches the NHS will once again be a critical factor as people cast their votes. When Matt Hancock took the stage at Conservative Party conference today, he paid the standard tributes to how valued the service is, and talked as ever of the investment needed.


His announcement of capital funding for new hospitals is welcome, but to prepare for the 2020s, a radical shift of emphasis is required. The NHS needs to undergo a transformation from a sickness service – focused on treating illness in hospital – to a true health service focused on prevention in the community. In her final days in office, Theresa May’s government set out in a green paper the crucial necessity of the prevention agenda for securing the long-term sustainability of the NHS, and Hancock himself has previously been an advocate for prevention.


The taxpayer presently spends hundreds of millions each year treating preventable disease. A primary example is the 32,500 hospitalisations last year – 89 every day – of children under the age of 10 to treat tooth decay. Almost unbelievably, this is the leading cause of hospital admission amongst five to nine year olds, and more or less every single one could be avoided. A widespread public health programme to promote supervised tooth brushing would save children a great deal of pain, and return £3 for every £1 invested according to official estimates.


Part of the picture is also sugar consumption, which is now widely acknowledged as a major driver not only of dental problems but of wider health issues like obesity and diabetes. Boris Johnson’s two immediate predecessors both recognised this, and moved to announce and introduce the soft drinks industry levy. Often casually labelled the “sugar tax”, its purpose is not to raise revenue but to encourage drinks manufacturers to reformulate their products, reducing the sugar content.


According to a recently published evaluation, the levy has been enormously successful. The sugar content of fizzy drinks fell by 29 per cent between 2015 and 2018. As a public health measure, the initiative has been ten times more effective than the voluntary target set by government for the food industry, which has achieved only a 3 per cent reduction in sugar during the same period. The evidence indicates that “sticks” are working far better than “carrots” when it comes to product reformulation.

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Before he entered Number 10, Boris Johnson expressed scepticism about “sin taxes”. His reaction reflects a wider choice that all governments face about how “interventionist” they should be in citizens’ lives. As healthcare professionals, we are likewise acutely conscious of the need to take people with us on the journey to better public health. But it is our responsibility to lead rather than follow public opinion. Huge changes in attitudes on smoking could not have been achieved without leadership from clinicians, and nor could the positive changes in policy which have been secured as a result.


A similar shift is now underway in our relationship with sugar, with rising public demand for action. The soft drinks industry levy is a shining example of how to make progress without undue interference: nobody is asking people to stop drinking soft drinks altogether; the levy, instead, makes them less harmful to consume. Polling commissioned by the Health Foundation think-tank last year found that 62 per cent of UK adults support it, and 68 per cent back stronger restrictions on advertising for unhealthy food and drink. 


A potent combination of logic, a strong evidence base and a supportive public mood now gives the government a chance to give real meaning to the adage “prevention is better than cure”. The Secretary of State needs little persuasion, but his speech today gave us an early indication that his boss has yet to be convinced.

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Professor Michael Escudier is Dean of the Faculty of Dental Surgery at the Royal College of Surgeons.