A made-in-Canada sugary drink levy can help reduce intake while being mindful of addressing health disparities
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* Manuel Arango

Riediger and Bombak are correct that we must ensure that any levy on sugary drinks does not create unintended consequences or substantially widen social disparities.1 But the sugary drinks themselves contribute to those exact disparities, because the conditions they can cause — diabetes, heart disease, stroke, cancer and obesity — are highly regressive and disproportionately affect low-income and Indigenous populations.2–4

The reality for many Indigenous and northern communities is that food insecurity is high,5 and healthy options (fruit, vegetables and milk) can be more expensive and less available than energy-dense and nutrient-poor options. A head of cabbage or bunch of grapes can go for as much as $30 or more,6,7 whereas a box of Kraft Dinner is more affordable at $4.8 Cases of water can cost about $100,6,9 whereas a 12-can case of pop can cost $27,10 representing a lower price per unit and a more accessible option for hydration. These price differences are exacerbated by the marketing practices of the manufacturers of sugary drinks, which, as Senator Dennis Patterson of Nunavut has told the Senate of Canada, extend even to very remote areas and to children as young as five years of age.11

We have a responsibility to act urgently and robustly, and a levy could help in a number of ways. In the United Kingdom, in anticipation of the Soft Drinks Industry Levy, manufacturers reduced the sugar content of some beverages even before the levy took effect in April 2018.12 In Mexico, the introduction of a levy was associated with a 10% reduction in sales of sugary drinks in the second year of implementation, with the greatest decline among low-income households. This levy was also associated with increases in the sales of nontaxed healthier products such as water.13

Although we know a levy on sugary drinks can work, it is also critical to ensure that Indigenous communities are meaningfully involved in the development and implementation of a levy and other policies that address the food supply. Indigenous Peoples should be consulted about how the revenues and proceeds from a levy could be used to facilitate an improved food supply, such as improving access to healthy foods and clean water. And in the spirit of self-governance, revenues from sales of sugary drinks on reserves could be given back to the communities to address the health needs they deem most important.

A levy is not the only solution to these challenges; however, if implemented well, it can be important and effective.

## Footnotes

*   **Competing interests:** Manuel Arango is the Director of Health Policy & Advocacy at Heart & Stroke, an organization that has declared its strong support for a levy on sugary drinks in Canada as a tool to reduce their consumption. No other competing interests were declared.

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