> For the complete documentation index, see [llms.txt](https://research.ambitiousimpact.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://research.ambitiousimpact.com/reducing-diet-related-disease-through-taxes-on-sugary-drinks/reducing-diet-related-disease-through-taxes-on-sugary-drinks/4-expert-views.md). # 4 Expert views We reached out to four experts across academia and non-profits. Having received no responses, this section outlines the findings from conversations that [CEARCH had with three academic and five non-profit experts](https://docs.google.com/document/d/1cg3e9SfwbyRKwAddbDskIn4YO_bI7wnwB37KI3KjEOE/edit?usp=sharing) for its deep-dive report on type 2 diabetes. The findings from these conversations have influenced our decision-making across the reporting. This section summarizes the key findings from the consultations not mentioned elsewhere. ## 4.1 Insights from public health academics ### The global burden of diabetes **Experts believed that the global burden of diabetes is higher than the 2021 GBD estimates and is on an upward trajectory. Note that in our CEA we use 2023 GBD estimates, which we think are more accurate than the 2021 estimates. The earlier figures were adjusted for COVID-19 in a way that likely led to underestimation of the true disease burden.** * One expert noted that the International Diabetes Federation (IDF) estimates there are around 540 million diabetic patients globally, a figure projected to rise to 800 million by 2045. * Along with population growth and aging (the pancreas, which produces insulin through the beta cells, is exhausted with age), several experts characterized the problem in terms of the food environment—increasing portion size, increasing availability/affordability of processed food, and the food industry having the ability to manufacture food that is highly pleasurable and encourages overconsumption. * The GBD relies on fasting glucose measurements, which may underestimate disease burden compared to more sensitive tests such as the oral glucose tolerance test. An expert commented that if fasting blood glucose is used, a third of the people who would have been detected by oral glucose tolerance would not be detected. * Note that although we consider the 2023 GBD estimates more accurate than the 2021 estimates, they still rely on fasting glucose measures and may therefore still be an underestimate. ### Effective solutions for reducing disease burden of type 2 diabetes **Experts broadly agreed that prevention is more favorable than treatment, and that population-wide policy interventions such as SSB taxes are likely the most effective approach.** * While views varied on the magnitude of the effect, experts were generally positive about the efficacy of SSB taxes, citing the successful case of Mexico. * Multiple experts thought that taxation leads to reformulation. One expert noted that in the case of South Africa, manufacturers reduced the sugar content added to their beverages. Another expert claimed that it is “easy” for companies to reformulate since it is the same production chain. * Experts also expressed interest in related policy approaches, including taxes on unhealthy foods, mandatory reformulation, clearer food labeling, and restrictions on the marketing of unhealthy products, especially those targeting children. ### Likelihood of convincing governments to implement SSB taxes **Experts generally agreed that advocating for SSB taxes is challenging, and that industry influence is difficult to overcome. One expert noted, however, that once an SSB tax is implemented, the risk of repeal is relatively low.** Experts also discussed the main arguments raised for and against SSB taxation. * Arguments in favor: * Revenue generation is likely the most persuasive argument for convincing ministries in the government. * Arguments against: * Experts confirmed that concerns about [regressivity](/reducing-diet-related-disease-through-taxes-on-sugary-drinks/reducing-diet-related-disease-through-taxes-on-sugary-drinks/3-quality-of-evidence.md) are the most commonly raised objection. * In some LMICs, SSBs may be among the safest beverages due to limited access to safe drinking water. * In HICs, consumers may substitute other sugary products (e.g. sweetened coffee drinks or yoghurt), potentially diluting health impacts. ## 4.2 Insights from non-profit experts ### Neglectedness **It seems unlikely that governments would institute SSB taxes of their own accord, and not many funders seem to be interested in this space.** Out of the five non-profit experts, three public health advocates (working in Global, EU, and American contexts) were pessimistic about governments instituting SSB taxation without external pressure. The other two (from Nigeria and Mexico) were uncertain. Except for the Mexican non-profit expert, there was a consensus amongst the other four that funding is scarce within the diabetes/non-communicable disease (NCD) space. ### Chances of convincing governments to implement SSB taxes **There is a near-consensus that i) we should be fairly strongly pessimistic about our chances of influencing SSB taxation, but that ii) once passed, the SSB tax is very unlikely to be repealed.** Experts from the EU and the US stated industry pushback and a lack of public awareness of the harms of SSBs (as opposed to tobacco, which would be much more feasible to oppose) as barriers to progress. The expert from the Global non-profit also claimed that the food and beverage industry usually has stronger ties with governments compared to the alcohol or tobacco industry. 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