Challenges and way forward for implementation of sugar taxation in the Middle East and North Africa (MENA)

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology Pub Date : 2024-04-08 DOI:10.1111/cdoe.12955

Hazem Abbas, Carol C. Guarnizo-Herreño, Maha El Tantawi, Georgios Tsakos, Marco A. Peres

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Abstract

Background

Over consumption of added sugar beyond the World Health Organization (WHO) recommended level of 10% of daily energy intake has well-established negative health consequences including oral diseases. However, the average consumption of added sugar in the Middle East and North Africa region (MENA—World Bank's regional classification) is 70% higher than the WHO recommended level. Imposing taxes on added sugar has been proposed by the WHO to decrease its consumption. Yet, only 21.6% of the total MENA population are covered by taxation policies targeting added sugar.

Challenges

Well-recognized challenges for the implementation of sugar taxation in MENA include the tactics used by the food and beverage industry to block these type of policies. However, there are also other unfamiliar hurdles specific to MENA. Historically, there have been incidents of protest and riots partially sparked by increased price of basic commodities, including sugar, in MENA countries. This may affect the readiness of policy makers in the region to impose added sugar taxes. In addition, there are also cultural, lifestyle and consumption behavioural barriers to implementing added sugar taxation. Ultra-processed foods and sugar-sweetened-beverages (SSBs) rich in added sugar are perceived by many in MENA as essential treats regardless of their health risks. Furthermore, some countries even provide subsidies for added sugar. Also, (oral) healthcare providers generally do not engage in policy advocacy mainly due to limited training on health policy.

Ways forward

Here, we discuss these challenges and suggest some ways forward such as (1) support from a health-oriented political leadership, (2) raising public awareness about the health risks of over consumption of sugar, (3) transparency during the policy-cycle development process, (4) providing a free and safe environment for a community dialogue around the proposed policy, (5) training of (oral) healthcare professionals on science communication and policy advocacy in local lay language/dialect, ideally evidence informed from local/regional studies, (6) selecting the appropriate political window of opportunity to introduce a sugar tax policy, and (7) clear and strict conflict of interest regulations to limit the influence of commercial players on health policy.

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中东和北非（MENA）实施糖税的挑战和前进之路

背景添加糖的摄入量超过世界卫生组织（WHO）建议的每日能量摄入量的 10%，会对健康造成负面影响，包括口腔疾病。然而，中东和北非地区（中东和北非--世界银行的地区分类）添加糖的平均消费量比世卫组织建议的水平高出 70%。世卫组织建议对添加糖征税，以减少其消费量。挑战在中东和北非地区实施糖税面临的公认挑战包括食品和饮料行业为阻挠此类政策而采取的策略。然而，中东和北非地区还存在其他特有的陌生障碍。历史上，中东和北非国家曾发生过抗议和骚乱事件，部分起因是包括糖在内的基本商品价格上涨。这可能会影响该地区决策者征收额外糖税的意愿。此外，在征收添加糖税方面还存在文化、生活方式和消费行为方面的障碍。在中东和北非地区，许多人将富含添加糖的超加工食品和含糖饮料（SSB）视为必不可少的美食，而不考虑其健康风险。此外，一些国家甚至为添加糖提供补贴。此外，（口腔）保健服务提供者一般不参与政策倡导，这主要是由于他们在卫生政策方面接受的培训有限。前进的道路在此，我们讨论了这些挑战，并提出了一些前进的道路，例如：（1）来自以健康为导向的政治领导层的支持；（2）提高公众对过度食用糖的健康风险的认识；（3）在政策周期制定过程中保持透明度；（4）提供一个自由、安全的环境，让社区围绕拟议的政策进行对话、(5) 对（口腔）医疗保健专业人员进行科学传播和政策宣传方面的培训，使用当地的非专业语言/方言，最好能从当地/区域研究中获得证据；(6) 选择适当的政治机会窗口，引入糖税政策；以及 (7) 制定明确严格的利益冲突法规，限制商业参与者对健康政策的影响。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.