“Instead of eating a bag of crisps or Cheetos, I’ll go to the fruit section of the supermarket,” says Liliana Cano, a 43-year-old shopper at a supermarket in Bogotá. “But sometimes I still have a soft drink, as a little treat.”
Colombia became one of the first countries in the world to tax ultra-processed foods earlier this year. The ambitious new health measures, aimed at reducing the burden of non-communicable diseases such as cancer and diabetes, also include warnings carried on foods high in sugar, salt and other additives.
Like many low- and middle-income countries, Colombia is seeing an increase in the burden of non-communicable diseases, which account for an estimated 76% of all deaths in the country. On average, Colombians consume 12g of salt a day, the most of any country in Latin America. Nearly a third of adults have high blood pressure.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
The additional tax of 10%, which is planned to increase to 20% by 2025, is levied on unhealthy snacks and soft drinks, as well as some staples, such as processed meats.
A month after introduction of the measures, shoppers in Bogotá are beginning to feel the impact.
“Everyone knows that a high amount of sugar or sodium is bad for health, so it’s a good idea to increase the tax on those products. But eating healthily is expensive,” says Cano.
“The tax affects us in a tremendously unfair way,” says Hectór Cruz, a 45-year-old shopper at the discount supermarket D1. “I agree that they should tax products like soft drinks and beers, but not staples.
“Of course, you would like to consume a healthy product with good proteins and minerals, but the unemployment rate is high and the economy is weakening,” he adds. “So people who maybe haven’t had breakfast or haven’t eaten anything by midday will just buy a bag of crisps for 3,000 pesos [60p].”
Arne Dulsrud, a sociologist at Oslo Metropolitan University, says: “I don’t think that the tax itself will increase the nutrient consumption of Colombia’s poorest.” Dulsrud, with a team of researchers from Norway and the Pontifical Javierian University in Bogotá, has conducted a large scale study on food insecurity in Colombia’s conflict-affected south-west Cauca province.
“We found that even people in rural areas who have access to kitchen gardens or crop cultivation do not eat their crops but sell them on the market,” Dulsrud says. “They use this income to pay for school expenses for their children and to buy cheap food with lesser nutritional value, which is often highly processed.”
Even food packages distributed to Colombia’s poorest families as part of a government programme are full of processed food, Dulsrud says. “Tax can be one element of increasing consumption of healthy foods, but I think health reform would have to focus on the most vulnerable to be effective,” he says. “Introducing healthy meals to schools can be one way, land reform is another.”
Land ownership in Colombia is one of the most unequal in the world. More than 80% of the country’s productive land is owned by 1% of farming businesses, according to the Columbia Human Rights Law Review. “If the government is looking for sustainable long-term policies for food security, they should do something about land access,” says Dulsrud.
Cruz agrees that warnings on packaging are largely a good thing, but he is not convinced it will change the way he eats. “This is actually the product I could find with the least warning labels,” Cruz says, holding up a packet of crisps from his shopping basket. “Practically all these products are giving us cancer and we know it, but what can we do with our budget?”
“The price of healthy alternatives is an issue,” says Guillermo Paraje, an economist at the Adolfo Ibáñez University in Chile, a leading researcher on health taxes in Latin America. However, he disagrees that Colombia’s new tax is regressive or puts poor people at a disadvantage.
“You have to consider the whole package, not only the financial impact of the tax, but also the impact of illnesses caused by unhealthy food,” Paraje says. “In Latin America, as in most parts of the world, the poorest are most negatively affected by illnesses. They have poor access to the health system and many are employed informally and don’t have protections such as sick pay.”
But not all Colombians are troubled by the price of healthy choices.
“I think you should pay a bit more to eat healthy,” says Carlos Martínez, 54, a shopper at the high-end supermarket Carulla, known for its quality fresh produce. “In fact, look, I just bought healthy crackers, fruits and vegetables. The health warnings are working.”
