Impact case study database

Improving health through policy-mandated reductions in population sugar consumption

Overconsumption of sugar is a major contributor to poor health, implicated in childhood and adult obesity, type 2 diabetes, cardiovascular diseases, fatty liver disease, and dental caries. These conditions are responsible for widening inequalities in health and impose strain on health systems. For example, in the UK one in three children are overweight or obese by age 11, rising to two in three people in adulthood, at an annual cost to the NHS of GBP6 billion and cost to the wider economy of GBP27 billion (Public Health England statistics).

According to Diabetes UK, type 2 diabetes affects almost four million people in the UK and costs the NHS around GBP10 billion annually. Globally, around 450 million people have type 2 diabetes (International Diabetes Federation statistics), and around two billion people are overweight or obese (World Health Organization statistics), with numbers rising. Reducing consumption of sugar is therefore a key health goal nationally and internationally, and is identified as a priority by the UK government and by the World Health Organization (WHO).

Though the importance of sugar in contributing to health problems has been known for some time, it is through the recent studies of Cambridge University and other researchers that the specific – and major – role of sugary drinks has become more fully clear. Cambridge’s research has directly informed international guidance and national policy.

Influencing national and international dietary policy

The body of evidence produced by University of Cambridge researchers on the effects of sugar consumption on health and on how to reduce sugar intake from sugary drinks has been influential in major UK policy initiatives and dietary guidance, as well as in international dietary guidelines. Cambridge researchers have engaged closely with key decision-makers at policy and system level, for example through submissions to major parliamentary committees and inquiries, involvement (by invitation) in stakeholder consultations, and directly briefing and advising policy-makers, guidance bodies and advocacy groups.

Influence was further achieved through Professor White’s secondment as Specialist Adviser to the House of Lords Select Committee on Food, Poverty, Health and Environment and contributions to the 2018 annual report of the Chief Medical Officer of England and Wales, and through Dr Mytton’s Parliamentary Academic Fellowship at the House of Commons Health and Social Care Select Committee and contribution to the Chief Medical Officer’s report on childhood obesity [A]. Cambridge researchers have also forged productive collaborations with leading charities and other influencing bodies to secure impact.

Making the case for the sugar levy

WHO, International Diabetes Federation, multiple national guidelines: Cambridge evidence on sugary drinks and diabetes risk has been recognised globally in making the case for fiscal measures to reduce sugar consumption. It is cited in the WHO Global Report on Diabetes 2016, the International Diabetes Federation Diabetes Atlas report, and the World Bank report on disease control priorities [B]. The WHO report cited Cambridge research in noting “an association between high consumption of sugar-sweetened beverages and increased risk of type 2 diabetes” [B]. It recommended implementation of an effective tax on sugary drinks as one of several key measures to address childhood obesity. The Chief and the Director of the Division of Diabetes Translation, US Centers for Disease Control and Prevention, stated that the Cambridge-led systematic review of global research on sugary drinks [3] presents “a compelling case that beverages sweetened with sugar should be a major target for policies aimed at reducing the risk of diabetes” [C]. Cambridge research is now cited in dietary guidelines in the United States [C].

Public Health England: Cambridge research was extensively cited in the key policy documents leading to the introduction of the Soft Drinks Industry Levy in the UK. A key report from Public Health England, Sugar reduction: responding to the challenge (2014) [D], cited Cambridge’s work on sugary drinks and the potential of taxation-based interventions. The 2015 report by the government’s Scientific Advisory Committee on Nutrition, Carbohydrates and Health [D], citing the EPIC-InterAct study among others, identified sugary drinks as a specific risk factor for weight gain and type 2 diabetes. It recommended that sugary drink consumption should be minimised to improve health. In line with the modelling work undertaken at Cambridge [5], Public Health England’s subsequent sugar reduction strategy focused in particular on encouraging reformulation – reduction or removal of sugar from products by food and drinks companies – as the approach most likely to have an impact on health [D]. According to Public Health England’s chief nutritionist, the Cambridge team’s research was crucial in informing its strategies, with the Scientific Advisory Committee on Nutrition report providing “a platform for subsequent policy actions to improve diets, including through legislation and taxation” [D].

Wider influence: Cambridge researchers also worked closely with major influencing charities to provide evidence for policy change, helping them both to influence the political climate and make evidence-based calls for the introduction of specific policies. These include the Obesity Health Alliance, a coalition of 45 leading health charities and medical royal colleges, who confirm that “Cambridge University’s research has been key” to their evidence-based advocacy [E]. Diabetes UK has described how Cambridge’s research on sugary drink consumption “fed into our discussions with other stakeholders including Public Health England. […] These discussions culminated in the introduction of the Soft Drinks Industry Levy, which has been so far successful in making companies reduce the amount of sugar in their drinks” [E]. Diabetes UK’s dietary guidance is now informed directly by Cambridge evidence [E]; they write that they are “indebted to [Cambridge researchers] for improving our understanding of the role of sugar-sweetened beverages […] in increasing the risk of type 2 diabetes.” [E].

Fuelling sustained government action on sugary drinks

Cambridge researchers have contributed to parliamentary deliberation around sugary drinks policy through briefing papers, through Parliamentary Office of Science and Technology (POST) POSTNotes on the health impacts of sugar, and through interviews with POST that have informed parliamentary debate [F]. For example, Cambridge’s modelling work comparing the likely impacts of various approaches to sugar reduction [5] was cited in the House of Commons Briefing Paper on the Soft Drinks Industry Levy [F].

Written and oral evidence submitted by Cambridge was cited extensively in the reports of the House of Commons Health and Social Care Committee that paved the way for the Soft Drinks Industry Levy. The 2015 report on the impact of diet and physical activity on health featured written and oral evidence from the Cambridge team throughout, while the 2018 report – which focused on childhood obesity – cited submissions from the group, and was supported by Dr Mytton in interpreting the evidence presented [G]. More broadly, Cambridge researchers provided evidence to wide-ranging forums that “helped inform opinions and influence key policy makers in government, which supported the introduction of the soft drinks industry levy (SDIL) announced in 2016” [D]. The then Chief Medical Officer, Professor Dame Sally Davies, confirms that the Cambridge team is “at the forefront of generating evidence that has supported policymaking for childhood obesity, including strategies to reduce sugar consumption” [H].

The work of Cambridge researchers has also been crucial in maintaining momentum and political support for the levy [E,H]. Members of the Obesity Health Alliance, for example, have maintained a close relationship with the Cambridge team, and “used emerging findings from [Cambridge research] to advocate for changes to the structure of the policy to increase the impact” [E]. In 2019, an interdisciplinary workshop organised by Cambridge [I] fed into the Prevention Green Paper of the government’s Department of Health and Social Care [J]. The workshop findings were used, together with findings from the evaluation of the Soft Drinks Industry Levy [6], in a private briefing in May 2020 for the Prime Minister’s Health Adviser, to inform the new obesity strategy. Published on 27 July 2020, the strategy reaffirmed the success of the levy and committed to its continuation [J].

Achievement of significant real-world reductions in sugar consumption

In a context where 35 million adults and over three million children in the UK are obese or overweight (Obesity Statistics 2019, House of Commons Library), the benefits of the Soft Drinks Industry Levy on sugary drinks are far-reaching [6]. It has helped to secure an 11% reduction in sugar content [K]. Consumers have also shifted towards buying products that are not subject to the levy, meaning they are more likely to buy drinks with sugar levels below 5g per 100ml [K].

Modelling of the potential health benefits of these reductions suggests that, at a population level, the levy will appreciably increase life expectancy and improve quality of life for today’s children and adolescents (the group that will benefit most). For example, modelling studies have suggested that the levy will achieve about a 1% reduction in obesity prevalence in adults and children, translating into long-term better health for tens of thousands of people in the UK alone, avoiding many cases of heart attack, stroke and other life-altering consequences of obesity [5]. The levy is important in addressing inequalities in outcomes most benefitting the least privileged; children will have the greatest relative health benefit in terms of obesity and dental health [5,E].