India is also witnessing a growing prevalence of diabetes, a disease now affecting millions of Indians. India has the second-highest number of diabetes sufferers in the world, with over 77 million cases, as per the International Diabetes Federation (IDF). With an aging population, urban life, changing diets, and a lack of physical activity, diabetes is becoming a public health crisis in India. One of the major causes of this growing epidemic is the excessive consumption of sugar, which permeates all food and beverages consumed by Indians on a daily basis. It has given rise to arguments on whether taxation should be applied to restrict the spread of diabetes and promote public health outcomes.

The growing burden of diabetes in India

Diabetes is a strong predictor of many chronic conditions such as heart disease, renal failure, and stroke. The increase in the prevalence of diabetes in India is mainly due to the interaction between the genetic predisposition, lifestyle changes, and poor dietary habits, with high consumption of sugar in particular. Consumption of sugar-sweetened drinks, processed foods, and confectionery is high in India, resulting in an energy-dense, nutrient-poor diet that is conducive to insulin resistance and type 2 diabetes.

According to a 2020 report published in The Lancet Diabetes & Endocrinology, the prevalence of type 2 diabetes has been increasing steadily in India, with particularly concerning growth seen among young people. The research estimated that nearly 10% of India's adult population suffers from diabetes and is expected to increase further. Overuse of sugar, especially from processed food and sweet drinks, is among the prominent causes of this trend.

What is a sugar tax?

A sugar tax is a fiscal policy that aims to reduce the consumption of sugary foods by levying added-sugar products with taxes, such as sugary beverages, processed foods, and sweet foods. The tax is usually levied on producers, who will most likely pass the burden on to consumers, thus making sugary foods inaccessible and healthy foods more attractive. The purpose of a sugar tax is to reduce the overall intake of added sugars, improve public health outcomes, and reduce the incidence of diet-related diseases, primarily diabetes.

Various countries, including the United Kingdom, Mexico, and South Africa, have implemented sugar taxes with varying levels of success. These taxes have contributed to declines in the consumption of sweetened drinks and a rise in the consumption of healthier substitutes, such as water and low-sugar beverages. The revenue generated by sugar taxes can also fund public health interventions, thereby serving as a solution to the increasing health burden of diabetes and other non-communicable diseases (NCDs) in India.

Scientific evidence supporting the sugar tax

There is more and more evidence that sugar consumption plays a major part in the causation of obesity, insulin resistance, and type 2 diabetes. A landmark study in 2021 in JAMA Internal Medicine found that high consumption of sugar-sweetened beverages has a direct relationship with cardiovascular disease and type 2 diabetes risk. The study found that for each additional serving of a sweet drink per day, there is a 13% higher risk of contracting diabetes. The study further indicated that reducing the consumption of sugary drinks can significantly lower the risk of diabetes and overall health outcomes.

Evidence from nations that have had sugar taxes in place in the past supports that the taxes reduce the consumption of sugary products. For example, a study conducted in Mexico after the introduction of a sugar tax in 2014 reported that it had 12% fewer purchases of sweetened beverages in the first year alone. The taxation was associated with a decline in the consumption of sugary drinks, and that reduced the prevalence of obesity and possibly reduced the cases of diabetes in the long term. Similarly, in the UK, the imposition of a sugar tax in 2018 was a resounding success, with a reduction in the level of sugar found in soft drinks and an overall reduction in the consumption of sugary drinks, pointing to the efficacy of such policies to bring down excessive sugar intake.

Potential benefits of a sugar tax in India

  • Reduction in sugar consumption: the initial benefit of a sugar tax would be to reduce sugar-sweetened food and drink consumption and processed foods that are amongst the primary causes of obesity and diabetes. Since the prices of sugary food would rise, shoppers would be willing to embrace healthier alternatives, such as unsweetened beverages and low-sugar snacks.

  • Public health initiative revenue: the revenue generated through a sugar tax can be used for public health campaigns and programs promoting healthier eating habits. It can also be used to improve the availability of healthy foods among low-income groups, thus tackling diet and lifestyle disease causes at their root.

  • Improved public health: a tax on sugar can help reduce the incidence of obesity, type 2 diabetes, and other NCDs in the long run. By addressing one of the main causes of these diseases, a tax on sugar has the potential to reduce India's overall health cost burden, saving on the expenses of treating diabetes and its complications.

  • Industry reform: a sugar tax would push food and drink manufacturers to reformulate products, reducing sugar content in processed foods and beverages. This could be complemented by a broader, industry-prompted change towards healthier options to make healthier food more available to consumers.

Challenges and concerns

Though the idea of a sugar tax in India is espoused, there are certain challenges and concerns that need to be addressed:

  • Impacts on low-income populations: the concern is that a sugar tax could disproportionately hit low-income families, who would rely on inexpensive sugary foods and beverages as their principal source of energy. Policymakers would need to ensure the tax does not disproportionately affect them, and revenue is directed towards access to healthy, affordable food.

  • Cultural preferences: Indian food is famous for its overabundance of sweets and desserts, the majority of which are highly sugary. A sugar tax might be culturally intransigent, particularly where sweets form a major part of festivities, celebrations, and daily life. Public education campaigns would be essential to change attitudes toward sugar consumption.

  • Enforcement and implementation: it would be a second challenge to ensure proper implementation and enforcement of the tax. A sugar tax would involve heavy monitoring of the food and beverage industry to implement enforcement, along with transparent use of revenue generated from the tax.

Time for action

A sugar tax in India can be a powerful policy tool to curb the increasing incidence of diabetes and other lifestyle disorders. Scientific research across the world points out that sugar taxes tend to reduce the intake of sugar, improve public health results, and generate revenue for public health initiatives. However, caution is required regarding the potential challenges, such as its impact on low-income groups and cultural attitudes toward sugar, for such a measure to be successful. With the right framework in place, a sugar tax would be instrumental in curbing India's epidemic rise of diabetes since it would help the nation's overall wellness.