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Part 1: The UK promotes oral and systemic health through its soft drinks industry levy

In this two-part interview with the British Dental Association, learn about the soft drinks industry levy that aims to promote healthier dietary choices and enhanced health for all.

Soft drinks

The United Kingdom (UK) announced the Soft Drinks Industry Levy (SDIL) in 2016, and introduced it into law in April 2018. The levy applies to sugar sweetened beverages (SSBs), seeking to encourage industry stakeholders to reduce their sugar content and provide healthier choices for consumers.

In this two-part interview, FDI Member, the British Dental Association (BDA), delves deeper on the impact of the levy and highlights its importance to curve the burden of oral diseases.

Can you tell us about the SDIL and the history behind its introduction?

The SDIL was introduced as part of the government’s initiative to tackle childhood obesity, by encouraging manufacturers and retailers to reduce the sugar content in their drink products.  Whilst the initial discussion of a sugar tax took place in the UK Parliament in 2011, it was several years before SDIL legislation was proposed (2016) and introduced into law (2018).

In 2011, the UK Government launched a public-private partnership – the Public Health Responsibility Deal – which sought to encourage the food industry to undertake voluntary measures to help tackle obesity, which did not involve fiscal or legislative action. A review of this strategy in 2015 demonstrated it had little impact on public health.

From 2011–2016, calls for a sugar tax persisted, and were further strengthened by the failure of the UK Government initiative – the Public Health Responsibility Deal.  Several campaigns by key organizations and stakeholders, including the BDA, led the charge, and were supported by celebrities such as Jamie Oliver which further raised the profile of the campaigns.

Alongside campaigns, the publication of the Scientific Advisory Committee on Nutrition (SACN) 2015 report, Carbohydrates and health, which evaluated the evidence on sugar intakes and health further made the case for action. It noted that higher consumption of sugars, sugar-containing foods and sugar-containing beverages is associated with greater risk of dental caries in deciduous and permanent dentitions. The report concluded that reducing the intake of sugar would lower the risk of consuming excess calories and therefore, weight gain, as well as benefitting dental health.

In October 2015, Public Health England published a report entitled “Sugar reduction: the evidence for action,” which reviewed the evidence on possible interventions to reduce sugar intakes and recommended the introduction of a structured and transparently monitored sugar reduction programme as well as placing restrictions on advertising and promotions, and the imposition of a tax or levy on, high sugar food and drink. All this momentum eventually led to development and implementation of the SDIL.

Can you give examples of the types of “soft drinks” that are being taxed under this law.

There are two rates of tax, depending on the sugar content of the beverage: the “standard rate” (18p per litre) applies to drinks with a total sugar content of between 5g and up to, but not including 8g per 100ml; and the “higher rate” (24p per litre) applies to drinks with a total sugar content equal to or great than 8g per 100ml.

There is no tax applied to drinks with a sugar content of less than 5g per 100ml. Examples of drinks included in the SDIL would be non-diet versions of colas and ginger beer.

Can you explain SDIL’s importance for oral health and general health?

Whilst the levy was introduced to support efforts in tackling childhood obesity, and whilst sugar is a contributor to that, it is also the main cause of dental caries. Tooth decay remains the leading cause of hospital admissions for young children, and a World Health Organization (WHO) and SACN report made recommendations on sugar reduction particularly based on the evidence that it causes caries, and on the level of consumption required to benefit oral health.

Dental caries are largely preventable and the SDIL is part of a package of measures needed to address the complex problem and over-consumption of sugar and its effects. For example, a recent research published in BMJ Nutrition, Prevention & Health in November 2023, suggests that 22 months after it was implemented, SDIL was associated with a 12% reduction in hospital admissions amongst children, aged 0 to 18 years.

Whilst SDIL is not a silver bullet, measures to tackle sugar consumption and tooth decay are still needed – statistics for 2022/23 hospital admissions show a 17% increase in the number of episodes of decay-related tooth extractions in hospital for 0 –19 year olds from the previous year. In addition, the decay-related tooth extraction episode rate for children and young people living in the most deprived communities was nearly 3 and a half times that of those living in the most affluent communities.

The most recent figures of cost to the NHS of hospital admissions for decay-related tooth extractions (2022-23) was £40.7million.

Can you provide details about BDA’s activities to support the implementation of the SDIL?

The BDA strongly advocated for the SDIL and carried out a number of activities to support this, including its Make a meal of it campaign, which was launched in 2013 and called for a sugary/acidic drinks tax, the removal of foods high in fat, sugar and salt (HFSS) from supermarket checkouts and provided template letters calling for cinemas, hospitals and other settings to cut retailing/portion size of sugary products.

The BDA also expressed support for using some proceeds of the sugar levy to improve oral health. We also measured the ‘human cost’ of disease prevention, utilizing tooth extraction data for children.

Alongside the SDIL, the BDA supported several measures which would support the aims of SDIL, and which would encourage a reduction in sugar consumption. These included:

  • Clearer food and drink labelling with regards to sugar
  • Supporting SACN’s recommendation to adopt the “free sugars” definition
  • Supporting the SACN/WHO recommendation to reduce maximum sugar intake to 5% of daily calories.
  • Action on Sugar’s call for a ban on promotion/marketing of unhealthy foods to children.
  • A ban on product placement of HFSS food/drink in broadcast media aimed at both children and adults.

Want to learn more?

Read the second part of this interview to learn about the impact of the SDIL and measures that other National Dental Associations can take to address noncommunicable diseases caused by excessive sugar consumption.

Access Part 2

Editor’s note: this article was submitted by an external party and has been edited according to FDI’s editorial guidelines. The views expressed are those of the original author.