Today, we are delighted to publish the report of our My Healthy Heroes pilot project. This project ran from February to March 2020 and aimed to test our approach to promoting healthy eating in children.

Through our My Healthy Heroes project, we aim to educate and empower children to make healthy choices by tapping into their creativity to highlight the importance of a healthy lifestyle.

Our pilot was important in helping us test our resources and characters (Healthy Heroes, Sugary Drinks Assassins and Junk Food Villains) with children and teachers to see if we could successfully engage children and educate them about healthy eating, and more importantly, facilitate a change in their behaviour.

Although our project ended slightly early because of the COVID-19 pandemic, it was very successful and demonstrated that with a little creativity, we can get children excited about healthy eating, to learn and retain important information about the harms of unhealthy eating, to reflect on their lifestyles,  to attempt to change behaviour and to rethink their food choices.

The main lessons learnt from this project were:

1. Children accept that they should be eating a healthy diet, but the depth of their knowledge of healthy eating, its benefits and the harms of unhealthy eating is low and therefore means this acceptance doesn’t translate into a change in behaviour or a motivation to eat a healthy diet.
2. The major factor that impacts children’s choice of what to eat, if they are given a choice, is taste, but children also recognise that some foods are more accessible and that the significant amount of marketing of unhealthy foods impacts their choices.
3. Students’ favourite foods vary. They selected both fast food and home-cooked meals as their favourite foods, and these were selected mostly based on taste. This means there is the opportunity to encourage more healthy eating if parents, schools and vendors explore creative ways to prepare healthy foods that children would deem to be tasty.
4. Children and parents overestimate how healthy children’s diets are; in reality, children are not eating a healthy balanced diet. Students are not eating the recommended 5-7 servings of fruits and vegetables, and students are eating more unhealthy foods than they realise.
5. Children need constant reminders and nudges to make healthy choices.
6. A comprehensive marketing strategy for healthy food is required to compete with the marketing of unhealthy foods.
7. Creative approaches are needed to engage children and educate them on healthy eating. Our project has shown characters that children can relate to and are considered ‘cool’ will be effective at reaching children and creating an intention to change their behaviour.
8. Parents need support regarding time, knowledge and ability with healthy food preparation, and schools can compensate by ensuring there is a healthy environment in schools—healthy breakfast, lunch and snacks available in and around schools.
9. Healthy eating should be a core part of the curriculum in school and go beyond conveying simple facts; the approach should be interactive to create a long-lasting change in attitudes and behaviours towards food.

You can download our full report below to find out more about this project. In the meantime, we will be using the learnings from this work to develop this project further.

We would like to thank the Taiwan ICDF for funding this work and providing invaluable advice and support throughout this project.

On Friday December 13th 2019, The Healthy Caribbean Coalition CSO Regional Action Team for Childhood Obesity Prevention released the 2019 Sweet Beverages in the Caribbean Infographic Series: How much sugar is in your beverage? This infographic series is an update of the 2016 HCC Sugar In The Caribbean Infographic Series which showed the sugar content of some sweet beverages available locally.

The consumption of sugar-sweetened beverages (SSBs) is one of the major contributors to the obesity epidemic among adults and children. In the Caribbean on average data shows that 1 in 3 children is overweight or obese. The sugar content of one serving of many popular carbonated beverages and juices far exceeds the entire daily healthy maximum sugar intake for adults and children as recommended by the WHO and the American Heart Association (AHA).

This infographic series is intended to be an educational, awareness-raising tool which provides a snapshot of the sugar content of some of the drinks available in eight Caribbean islands: Antigua and Barbuda, Bahamas, Barbados, Belize, Jamaica, Saint Kitts and Nevis, Saint Lucia and Trinidad and Tobago. HCC congratulates the members of the CSO Regional Action Team for the development of these advocacy tools. National supporters include the Ministry of Health and Wellness in Barbados, Barbados Moves, the Barbados National NCD Commission, Saint Kitts and Nevis Moves and Trinidad and Tobago Moves. The work of the HCC would not be possible without the support of Sagicor Life Inc.

You can download the infographics below and find out more about the HCC and their work on their website.

In April 2018, the UK Government introduced their sugar sweetened beverage (SSB) tax. Drinks containing 5-8g per 100 ml of sugar are now taxed at a rate of 18p per litre and drinks containing over 8g per 100 ml are taxed at a higher rate of 24p per litre. The tax is applied to all manufacturers and to date 457 companies are registered to pay this tax.

The tax has been successful in two regards. Firstly, in the run-up to the introduction of the tax many manufacturers reformulated their drinks to reduce the amount of sugar they contain to avoid paying the tax. This included supermarket giant Tesco’s who, in 2016, reduced the sugar content of their soft drinks to below 5g per 100ml. Other brands who have reduced the sugar content of their products include Ribena, Fanta and Lucozade.  Some brands, such as Coca Cola have decided not to reformulate their products as they are concerned about losing their customers. This means that in the UK the price of a can of coke has increased by 8p and a large bottle of coke by 50p.

The second success of the sugar tax is the revenue that has been raised. In the first six months of the tax being introduced £154m was raised. The money raised from the sugar tax will be used to double the funding available to primary schools for PE and sports programmes to support healthier, more active, lifestyles in children. The funding will not only go towards expanding PE and sports programmes but to also expand breakfast clubs in primary schools ensuring that children have access to a healthy breakfast every week day.

Islands states throughout the Caribbean are considering introducing a SSB tax and it is hoped that the recent success of the UK and other countries like Mexico will provide Governments with the evidence of the impact of a SSB tax.

On 1st November 2018, the Ministry of Health in St Kitts held a public consultation on SSB taxation. During this consultation they provided information on their proposed approach to sugar sweetened beverage (SSB) taxation. Lake Health and Wellbeing supports the government’s plans to tax SSBs and has published a position statement outlining our views on this topic.

SSB Taxation

The taxation of SSBs has been utilised as a method of tackling obesity by creating a deterrent which leads to a reduction in the purchase and consumption of SSBs.

Taxation of SSBs has three important aims. The first it to incentivise manufacturers to reformulate or replace their products to create healthier options, the second is to deter the public from purchasing and consuming SSBs by making them unaffordable and the third is to raise funds from the tax revenue that can be used to support initiatives aimed at improving the health of the public.

Caribbean Children’s SSB Consumption

Children in the Caribbean drink large quantities of SSBs putting them at risk of becoming obese or overweight.  Caribbean children’s frequency of consuming SSBs was found to be amongst the highest out of 187 countries. Furthermore, teenagers (12 to 15-year olds) in Barbados, Jamaica, the Bahamas and Trinidad and Tobago reported drinking SSBs three times or more a day, and in St Kitts and Nevis it was found that children consumed at least one carbonated soft drink a day.

SSB Consumption and Obesity

This high consumption of SSBs has been linked to weight gain and obesity in adults and children, and obesity or being overweight increases a person’s risk of developing a number of non-communicable diseases such as type 2 diabetes, stroke, heart disease and cancer.

Obesity is a significant challenge in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin island state were overweight and 14% were  obese. More recently, in 2017, a UNICEF report published that 26% of children in  St Kitts and Nevis are obese. When looking at adults in St Kitts and Nevis, the  PAHO study reported that 34% of adults were overweight and 45% were obese.

Tackling Obesity

In order to address the high rate of obesity in St Kitts and Nevis, a number of strategies are required and reducing the public’s consumption of SSBs by introducing a tax is just one of many approaches.

Our Position Statement

To find out more about the St Kitts Ministry of Health’s approach to SSB taxation and our position on this approach. You can download our position statement below.

Document: Taxing SSBs in St Kitts: A Position Statement

Published by: Lake Health and Wellbeing

Date: 15th November 2018

Download here: SSB Taxation Position Statement

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References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012
3. Xuereb, G. (2017). Sugar Sweetened Beverages Taxes in the Caribbean – Progress and Challenges.
4. Yang, L. et al. (2017). Consumption of Carbonated Soft Drinks Among Young Adolescents Aged 12 to 15 Years in 53 Low- and Middle-Income Countries.  American journal of public health, 107(7), pp 1095-1100.

On 5^th December, South Africa’s parliament passed a bill to introduce a tax on drinks with a high sugar content.  This comes after 18 months of negotiations which included four consultations with the public.

The tax will come into effect on 1^st April 2018 and will impose a levy of 2.1 cents per gram of sugar on all sugar-sweetened drinks; the first 4g of sugar per 100ml will be exempt. What this means in practice is that the price of the average can of coke will increase by 11%.

The South African government expects to raise a significant amount of money from this new tax which will be invested into health promotion projects to tackle obesity and facilitate the prevention of non-communicable diseases like diabetes, cancer and heart disease.

With South African being one of the top 10 consumers of sugary drinks in the world, it is hoped that this tax will lead to a reduction in the consumption of these drinks which will play a part in improving the health of South Africans.

Tracey Malawana, the coordinator of the Healthy Living Alliance said:

“We applaud Members of Parliament for putting the health of millions of South Africans before the narrow interests of the beverage and sugar industries.

“Thanks to Treasury and MPs, South Africa is on the right path to reverse the alarming numbers of diabetes cases and other NCDs associated with obesity. We now look to the President to sign this important law without delay. “

South Africa joins a growing number of countries who have introduced a tax on sugary drinks. These countries include Mexico, Barbados, France, Denmark, Hungary, Portgual, Saudi Arabia,  India, Thailand and others.

Sugar taxes are just one part of the global strategy to improve the public’s health through government policy. Health policy experts recommend that governments explore policies around three main areas: unhealthy foods, alcohol and cigarettes, and within these three areas to explore policies that restrict access, ban advertising (particularly to children) and increase taxes.

South Africa will have to wait a few years to determine the effect of introducing the sugar tax but initial evaluations from Mexico, who has had a sugary drinks tax for a couple of years, are very promising. An analysis of the sugar tax in Mexico found that sugary drinks consumption dropped by 5.5% one year after the sugary drinks tax was introduced, and in the second year sugary drinks consumption fell by 9.7%. Based on this,  the introduction of this tax  in South Africa brings the nation one step closer to tackling one of the key risk factors for non-communicable diseases and obesity.

Story update:  The Canadian government’s alcohol  and  cancer warning label experiment has been halted due to pressure from the alcohol industry who threatened legal action for defamation and trademark infringement.

Many drinkers are unaware that alcohol causes a number of cancers including breast and bowel cancer. In order to raise awareness of this the Yukon government, in collaboration with researchers, has introduced labels on alcoholic drinks warning that alcohol causes cancer. The labels also provide recommendations on safe alcohol consumption for men and women as well as advising that people should plan to have two or more non-drinking days a week.

This new initiative was a challenge to implement as Yukon is a small jurisdiction and couldn’t influence drinks manufacturers to change their labelling. Therefore the Yukon Liquor Corporation and Public Health Ontario researcher, Erin Hobin, affixed the labels to thousands of bottles themselves.

These labels are a world’s first. No other country warns drinkers, through labelling on drinks, that alcohol causes breast or bowel cancer; South Korea highlights the link between alcohol and liver cancer and the US only warns of the dangers of drunk driving and risks of drinking while pregnant.

Researcher Erin Hobbs explained the reasoning behind the labelling:

“Alcohol is such a big part of our culture in Canada. We’re inundated with alcohol marketing that shows us how much fun alcohol is. It’s part of most of our celebrations … (But) consumers have a right to know the health risks if they do choose to drink alcohol. If they do choose to drink, they can do so in a safer manner.”

Alcohol is not just linked to breast and bowel cancer, but has also been linked to cancers of the mouth, upper throat, food pipe, voice box and liver.  The number one cancer impacted by alcohol is breast cancer.

The International Agency for Research on Cancer  has classified alcohol as a type 1 carcinogen, which means there is the highest level of evidence to suggest that it does cause cancer.

It is hoped that governments will follow Yukon’s example as awareness of the link between alcohol and cancer is very low and people need to have this information so they can make an informed decision about their drinking habits, and hopefully protect their health.

Sadiq Khan, the Mayor of London, in a bid to tackle childhood obesity and its related health problems, has announced a ban on new fast-food outlets being located within 400m of existing or proposed primary and secondary schools.  The Mayor’s office has said that currently a quarter of fast-food outlets are within five minutes of schools.

In addition, the Mayor is proposing that when planning permission is granted to fast-food outlets, that they be required to sign up to the Healthier Catering Commitment for London. This is a scheme that recognises businesses in London that demonstrate a commitment to providing their customers with a healthier option by reducing saturated fat, salt and sugar in their dishes.

This ban is much-needed in London where there are 8,000 fast-food outlets throughout London with 2,000 of these being within five minutes of schools. This gives children quick and easy access to unhealthy foods, that are very cheap.  The Mayor’s office said that just one of these meals  contains 60% of our recommended daily calorie intake, half of our recommended salt and saturated fat intake and  no fruits and vegetables.

We know that many school children consume the unhealthy meals prepared by these outlets every day contributing to the childhood obesity crisis.

In London, a staggering 40% of children are overweight or obese when they finish primary school. This puts them at an increased risk of developing type 2 diabetes, heart disease and a number of other diseases.

The Mayor of London, Sadiq Khan said:

“Takeaway restaurants are a vibrant part of London life, but it’s important that they are not encouraging our children to make poor food choices.

“I am working hard to create a healthier London and this must start with the food that our children eat. As promised in my manifesto, I am using all of my powers through my new London Plan to prevent new takeaways from being built just down the road from schools as part of a package of measures to tackle the ticking time bomb of childhood obesity and help us all lead healthier lives.”

This scheme is very promising and if successful should ensure that we improve young Londoner’s health. There is also a need to ensure that existing fast-food outlets are targeted so that the 8,000 outlets in London play their role in improving the health of Londoners.

The government of St Lucia has announced that they will be starting a campaign aimed at banning the sale of soft drinks in schools across the island.

This is part of a global public health effort to reduce the amount of sugar consumed by children. This worldwide effort has seen many countries explore various options to reduce sugar consumption such as taxing sugar sweetened drinks, clear front-of-package labelling, restrictions on unhealthy foods in schools and hospitals, tighter regulation of marketing of unhealthy foods to children, reformulation of foods by companies to make them healthier and increasing the availability of healthy foods.

Reducing sugar consumption, particularly in children, is extremely important as most people are consuming too much sugar which is linked to weight gain and obesity which increases risk of diabetes, cancer and a number of other non-communicable diseases.

This move by St Lucia follows that of Barbados and Jamaica who have both banned the sale of soft drinks in schools.  The Ministry of Health and Wellness in St Lucia has met with principals of schools to discuss the best way forward in implementing the soft drinks ban. They stressed that their intention is not to affect the success of local drinks manufacturers, but to build a healthier nation. They want to encourage children to drink more water and turn away from soft drinks and juices.

Chief Nutritionist, Lisa Hunt Mitchell said:

“Sweetened beverages are bad for the health in general, but soft drinks have added ingredients such as caffeine, phosphoric acid, and colourings that are far worse. These ingredients have very negative effects on the health.”

You can find out more about St Lucia’s Ministry of Health and Wellness here

Public Health England this week revealed that results from a recent survey suggest that children are consuming half of their daily recommended sugar intake before the morning school bell rings.

Their research shows that children consume more than 11g of sugar (almost 3 cubes) at breakfast alone. The government recommends that 4 to 6 year olds consume no more than 5 cubes a day and 7 to 10 year olds consume no more than 6 cubes a day. The main sources of these high levels of  sugar are cereals, drinks and spreads.

The research was conducted in November 2016 and involved 200 parents of children aged 4 to 10 years old completing an online survey about their child’s breakfast. The survey also revealed that, as well as children’s consuming too much sugar, 84% of parents whose children were consuming more that 11g of sugar at breakfast thought that they were giving their child a healthy breakfast. This means there needs to be some clarity around the content of breakfast foods to ensure parents are making informed choices about the food they buy.

To address this issue Public Health England’s Change4Life programme have launched the ‘Be Food Smart’ campaign which is encouraging parents to be more aware of the sugar, saturated fat and salt content of the food they buy. It also aims to educate parents of the harm caused by eating unhealthy food.

To support this campaign, Change4Life have developed an app that allows parents to scan the barcodes of products and get a breakdown of their sugar, saturated fat and salt content.  It also provides hints and tips on how to cut down on unhealthy foods and the app also has fun features like food detective activities and missions for the whole family.

The app free and is available on the iTune Store or Google Play.

For more information visit Change4Life’s website.

Yesterday, the UK government published its policy document, ‘Overview of Legislation in Draft’,  which outlines the changes to tax law which the government plans to introduce in its 2017 finance bill, in secondary legislation and in future finance bills.

This draft legislation includes information on the soft drinks industry levy (sugar tax) which will come info effect from April 2018.

With regards to the sugar tax the Overview of Legislation in Draft says:

“As announced at Budget 2016, and following consultation on the design and implementation of the levy over the summer, the government will legislate in Finance Bill 2017 for the Soft Drinks Industry Levy. This is a levy on importers and producers of beverages that contain added sugar to help tackle childhood obesity. The 2 thresholds, at 5g and 8g of sugar per 100ml have been designed so that, by taking reasonable steps to reduce sugar content, UK producers and importers of soft drinks can pay less or escape the charge altogether. The levy will take effect from April 2018.

There will be an exemption for the smallest operators and a credit against levy liability, subject to evidence, for liable drinks that are exported.”

The government expects the sugar tax to raise £520M in its first year and these funds will be used to double the funding available to primary schools for PE and sports programme. The government has estimated that the sugar levy will raise £320 million a year for primary schools to support healthier more active lifestyles in children. The funding will not only go towards expanding PE and sports programmes but to also expand breakfast clubs in primary schools ensuring that children have access to a healthy breakfast every week day.

The government has also published a full policy document on the sugar tax which gives further information on the objectives of the tax, who it will affect and how it will be monitored.

The Lake Foundation is glad to see that the government is making progress on implementing the sugar tax and hope that it will go some way to tackling obesity in the UK.