November 15, 2016

by Paul Jablow

To pass a soda tax in Philadelphia, politics and public health quietly joined forces. It was an odd pairing: Politics frames life in black and white, with competing constituencies vying for power and influence in a world of limited resources and all-or-nothing choices. In contrast, public health embraces connections and nuances - recognizing how the elements of well-being are intertwined, influencing each other and our quality of life for better or worse.

The outcome of the unusual partnership was a new revenue stream to fund pre-K education, and provide health services in nine schools in poor neighborhoods – with the side-benefit of possibly improving overall health in the city that made cheesesteaks famous and obesity is becoming commonplace.

HOW IT HAPPENED

When he took office in January, Mayor James Kenney knew that passing a tax on sugary beverages in Philadelphia was regarded as a long shot. No major city had ever passed such a measure, and attempts had been thwarted more than 40 times around the country. His predecessor, Michael Nutter, had twice failed to get City Council to approve a sugary-drink tax, often referred to as a ‘soda tax.”

Even Kenney, then a councilman, had opposed it: “He didn’t feel the revenue was going to clearly define, accountable initiatives,” according to his spokeswoman Lauren Hitt.

A month after Kenney’s inauguration, Tom Farley became Philadelphia’s health commissioner. He was very familiar with the idea of a soda tax because he and his boss, New York Mayor Michael Bloomberg, had been stymied twice on such a tax and once on a more modest plan to ban jumbo containers for sugary drinks. Labeling their proposal an “obesity tax” didn’t help.

Farley arrived in town skeptical about the chances of achieving one of his long cherished goals. Mayor Kenney was ready to try again, but with a novel strategy: Most of the $91 million generated by the soda tax would go to pre-K education, and to designated community schools in poor neighborhoods, along with funding parks, recreation centers and libraries. Rather than an unjustifiable burden or a prod to force healthy behavior, the tax was framed as a necessity.

“We knew if we led with (health benefits) we’d be defeated,” says Kevin Feeley, spokesman for Philadelphians for a Fair Future, a coalition of some 80 civic, labor and faith organizations. Pre-campaign polling showed that “we had to tie it to programs that resonated with voters and with elected officials.”

In June, a “thrilled” Farley joined Kenney, other local officials and health advocates around the country in celebrating Council’s passage of a 1.5 cent-per-ounce tax on a variety of beverages. The tax, which the American Beverage Association (ABA) is challenging in court, includes not only sugary drinks such as sodas, sweetened teas and sports drinks, but also artificially sweetened beverages such as diet sodas.

The final vote was 13-4, with opposition coming from the three Republicans in Council and a Democrat, Maria Quinones Sanchez, whose district includes a Coca-Cola bottling plant and numerous bodegas.

“A soda tax was fairest because it was a tax no resident or small business had to pay,” Hitt says, “unlike wage or property taxes.”

Prior to the big-city win in Philadelphia, only one other similar soda tax measure had won approval – passed by referendum two years ago in smaller Berkeley, CA. A recent study there found that consumption of sugary drinks was down 20 percent in some neighborhoods, significant reductions that researcher Kristine Madsen at UC Berkeley says could, if maintained, reduce rates of obesity and Type 2 diabetes.

The two successes have encouraged public health advocates to hope that the tide is turning so that sugary drink taxes could become as widespread and accepted as cigarette taxes. On November 8, four additional communities successfully passed soda tax proposals: San Francisco, Oakland, and Albany in California, along with Boulder, Colorado. (NOTE: The online version of this story has been updated to reflect election results)

Farley believes that New York’s failed efforts contributed to Philadelphia’s win almost a decade later. “Over the years we succeeded in getting people to recognize that this is a health problem we ought to do something about,” he says. “When we started with this work ... people viewed foods, but not beverages, as fattening. Now everyone knows that sugary drinks increase their risk of obesity and diabetes, and people are shifting away from them.”

THE OPPOSITION

The basic pro-tax campaign strategy was to have coalition members lobby members of Council. “Spending a lot of money on a citywide campaign wouldn’t have accomplished very much,” says Feeley. “We needed nine votes on Council, that’s all.”

Anti-tax forces led by the American Beverage Association relied on lobbying by small grocers and the Teamsters Union, whose members deliver bottled and canned beverages, and on a publicity campaign that described the measure as a “grocery tax.”

The beverage association spent $10.6 million and the coalition, $2.5 million –actually a large war chest for a pro-tax campaign, with over half the cash coming from billionaire Bloomberg. Nationally, according to an analysis by the Center for Science in the Public Interest, the ABA, Coca-Cola Co. and PepsiCo have spent $67 million since 2009 trying to defeat initiatives in 19 states. Federal lobbying the tally.

Larry Ceisler, a spokesman for the beverage industry in the campaign, discounted the loss in Philadelphia as a sign of things to come. “What happened in Philadelphia was very particular to Philadelphia,” he says. “This was not an ideological decision but a transactional decision.

“The mayor was able to use the full force of his office to trade favors for votes.”

On September 14, the beverage association, some businesses and residents sought an injunction in Common Pleas Court stating that the tax, scheduled to go into effect Jan. 1, violates the Uniformity Clause of the Pennsylvania Constitution, which requires that similar products be taxed at the same rate. The city has allocated $1.6 million to retain two former city solicitors to lead the defense. Calling the sweetened-beverage tax “a political choice of necessity,” lawyers for the city have asked the state Supreme Court to dismiss the lawsuit.

ON THE HORIZON:

A Day in Court… and Change

In a news conference following passage of the soda tax, Kenney said, “This is the beginning of a process of changing the narrative of poverty in our city.” That’s a very “public-healthy” declaration from a politician.

Philadelphia has the highest rate of deep poverty among the nation’s 10 largest cities. According to the U.S. Census Bureau’s 2014 Annual Community Survey, 186,000 Philadelphians – including 60,000 children – live on $12,000 per year, about half of the federal poverty level of $24,000 for a family of four. Poverty, obesity, access to education and health services are intertwined variables –key social determinants of health and well-being. Poor people also consume more sugary drinks than the affluent,and are disproportionately affected by health problems associated with excess calories, including obesity, diabetes and heart disease.

The soda tax revenue will not only help prepare young children for school success, but also teach them and their families to live healthier lives and, in the selected community schools, improve access to health services.

The value of pre-K has been well established for decades. Starting with a cohort of at-risk students from 1962-1967, the HighScope Perry Preschool Study showed that pre-K returned $17 for every dollar invested for such benchmarks as income, high school graduation and incarceration.

The beverage-industry lawsuit notwithstanding, preparations are underway by Philadelphia to offer 2,000 pre-K slots to 3- and 4-year-olds in January and gradually build up to 6,500. The Mayor’s Office estimates that there are 15,000 kids in what would be considered “quality” day care and maybe another 17,000 with providers who don’t meet that standard. The goal is for all providers to meet state standards, which would include a health curriculum – or to replace them.

Cheryl Bettigole, who heads the city Health Department’s Division of Chronic Disease Prevention, says the nine community schools funded by the soda tax will get coordinators to work with parents, students and the public on health-related issues. The Health Department is partnering with the University of Pennsylvania and Johns Hopkins University on a three-year study of the tax’s impact on price and consumption.

Whatever the outcome of the beverage-industry lawsuit, awareness that less sugar is good for your health is taking hold – even in the industry itself.

The American Heart Association recently released its first-ever guidelines on sugar limits for children to less than six teaspoons of added sugars a day. And a September New York Times story revealed that historical documents showed the sugar industry paid scientists in the 1960s to downplay the link between sugar and heart disease, and to promote saturated fat as the culprit.

The beverage industry has already removed full-calorie soft drinks from U.S. schools, and is developing lower-sugar products. PepsiCo reports that 45 percent of its revenues come from lower-calorie to fully sugared sodas.

In Philadelphia, water stations in public schools will be installed district-wide by the end of the school year. Students can fill water in containers as well as sip from a fountain.

“As a society, access to very cheap sugary drinks shouldn’t be our focus,” says Amy Auchincloss, PhD, MS, associate professor in the Department of Epidemiology and Biostatistics at the Dornsife School of Public Health. “They’re not necessary for well-being and, in fact, can have harmful consequences.”