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A bill that levies a 2-cents-per-ounce fee on soda and other sugar-sweetened beverages including juice and tea is still pending at the Hawaii Legislature. It is disheartening that has not yet been scheduled for a hearing this session, but I continue to hope.

Why aren’t our lawmakers moved to act given the current state of Hawaii’s health, with Native Hawaiian and other Pacific islander populations particularly suffering disproportionately from diet-related chronic disease?

Lawmakers dropped the ball last year. Are they planning to do so again this year? As a community, we cannot let this happen. We must urge policymakers to take action.

If we are serious about making a change in our health and advocating for those most at risk, changes in policy are necessary. Educating the public on what is healthy to eat and drink takes us only to a certain point and is not enough to see a change in behavior.

As long as highly palatable items such as sugar-sweetened beverages are plentiful, offered at a cheap price and aggressively marketed to the most vulnerable, underserved populations will continue to suffer the consequences of consuming too much of it.

What we so desperately need are changes to our food environment to make such choices less desirable. One of the ways to do this is to adjust the price through a measure such as charging a fee on these beverages.

Chronic Diseases

The negative effect of excess sugar consumption on health is well known and provides an important basis for such a measure.

The most recent release of the Dietary Guidelines for Americans states that a healthy dietary pattern limits discretionary calories from added sugars and saturated fat to less than 15% of calories per day. The unhealthy reality is that many Americans exceed this limit.

Sugar-sweetened beverages are a significant source of added sugar in the American diet. The empty calories in these drinks show that they are a source of energy but don’t provide the nutrients the body needs, such as vitamins and minerals. Sugar in liquid form also does not provide a sense of satiety to keep caloric intake at a recommended level.

While consumption of sugar-sweetened beverages has declined in recent years, it remains high in children and adolescents. The pandemic has only made it worse, driving child obesity to alarming levels.

Research links a high intake of sugar to obesity, and high intake of sugar-sweetened beverages in particular to increased risk of Type 2 diabetes. In Hawaii, the prevalence of self-reported obesity in 2020 was about 25%. Low-income and minority groups are particularly at risk, with higher rates of obesity and associated chronic diseases in these groups.

The benefit of the fee to low-income communities is clear. Studies have shown that this additional cost really helps to disincentivize the purchase of sugary drinks. A study conducted in Mexico, for example, showed a decline in purchasing of taxed beverages, with households at the lowest socioeconomic level showing the largest decreases in purchases of taxed beverages.

As low-income communities in Hawaii generally have ample access to calorie-rich nutrient-poor food and drink but insufficient access to nutrient-rich items, increasing the cost of sugar-sweetened beverages, far from punishing them as some like to argue, would help them nutritionally.

The high rates of obesity in low-income communities result in part from the easy access to cheap, high-calorie items, and the fee is one way to discourage the purchase of such options. In addition, while some may consider this strategy constitutes the government dictating what people should eat and drink, it’s important to consider the way in which companies producing these beverages have already dictated the diet of vulnerable, low income communities through clever marketing.

Attractive celebrities are often featured in ads for these products, sending the message that consumption of sugar-sweetened beverages is associated with success and beauty. Low-income people are lured into spending scarce dollars on items that deliver little value and a lot of harm. Allowing this to continue without any kind of intervention is what truly punishes these communities.

We cannot afford to let this opportunity slip by us again.

We as a community need to counter the pernicious health impacts of companies that continue to sell these products and take advantage of those most at risk. Taking a step toward reigning in their activities is crucial as we address the epidemic of chronic disease that in the end affects all of us. The past three years have driven home that lesson of shared suffering very painfully.

The added benefit of enacting SB 2211 is that some of the revenue from the fee gets invested in health and nutrition programs designed to prevent chronic disease through the “Healthy Ohana Fund.” There is a great need to shift toward prevention of chronic disease rather than treatment after it develops.

Our current model places a burden on the health care system due to the lifestyle-related illnesses it promotes. Some business owners will push back as they see a possible drop in revenue from sugar-sweetened beverages. We cannot let our lawmakers yield to the pressure of these voices.

There is a dire need in the U.S. to make changes in diet to improve the health of the nation. Focusing on diet and physical activity by funding initiatives in this area is a step in the right direction.

All of us who care about the health of our keiki and their chances to thrive look forward to learning soon that a hearing has been scheduled for SB 2211. We cannot afford to let this opportunity slip by us again to do what is right for our children in terms of their diet.