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Committee on Budgetary Oversight díospóireacht -
Wednesday, 19 Apr 2023

Report of the Commission on Taxation and Welfare: Discussion (Resumed)

I welcome Mr. Chris Macey from the Irish Heart Foundation. I must vacate the Chair at 6.30 p.m. but I am sure I will be more than adequately replaced.

Before we begin, I wish to explain some limitations to parliamentary privilege and the practice of the Houses as regards references the witness may make to other persons in his evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege. However, a witness giving evidence remotely from a place outside the parliamentary precincts may not benefit from the same level of immunity from legal proceedings as a witness physically present. The witness is reminded of the long-standing parliamentary practice that he should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if his statements are potentially defamatory in relation to an identifiable person or entity, he will be directed to discontinue his remarks. It is imperative to comply with any such request.

Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her or it identifiable. I remind members of the constitutional requirement that members must be physically present within the confines of the place in which the Parliament has chosen to sit, namely, Leinster House, in order to participate in public meetings. I will not permit members to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting.

I now invite our witness to give an opening statement.

Mr. Chris Macey

The Irish Heart Foundation welcomes the opportunity to discuss chapter 15 of the report of the Commission on Taxation and Welfare. We also welcome the commission's strong backing for the use of taxation as a lever to improve public health in Ireland. In particular, we support its recommendation to help tackle Ireland's obesity crisis through additional fiscal measures to incentivise reformulation of unhealthy foods. This is the focus of our statement, although taxation continues to play a critical role in tobacco control and alcohol policy.

The outlook in Ireland in relation to childhood obesity is truly horrific. Before the pandemic, State-funded research estimated it will cause the premature death of one in every 20 of this generation of children. We had evidence of children as young as eight presenting with high blood pressure in large numbers and teenagers with a cardiovascular age into the 60s. Things are even worse now. Consumption of unhealthy food rose sharply during the pandemic, while physical activity levels plummeted. We do not yet know the full impact of the pandemic but in the UK there have been record increases in obesity levels among primary schoolchildren that experts believe have been mirrored here.

Obesity is a complex problem with a vast array of causes. Fiscal measures are not a solution in isolation but are an important part of a larger portfolio of policy measures, particularly when designed with public health in mind, such as the sugar sweetened drinks tax, or combined with complementary interventions, such as fruit and vegetable subsidies.

Balancing taxation with subsidies is vital against a backdrop of likely long-term cost-of-living pressures and what the commission describes as a health equity gradient, whereby obesity rates are much greater in disadvantaged communities. We also know that disparities in these rates are continuing to widen, particularly among older primary school children in Ireland.

Affordable healthy diets are out of the reach of many families, a fact borne out by Food Safety Authority of Ireland, FSAI, research showing that healthy calories from, say, fruit or lean meat cost up to ten times more than unhealthy calories from products such as processed meats. The positive impact of tax measures could be magnified and any regressive impacts minimised by using the receipts in targeted ways. For example, since the introduction of the sugar-sweetened drinks tax, the IHF has called for its proceeds to be used to provide all children with access to a healthy diet through a children's future fund.

The facts demonstrate that the extension of the sugar-sweetened drinks tax is likely to have a powerful impact in combating obesity. Our tax in Ireland was based on the UK's soft drinks industry levy, and given that our beverage markets are integrated, similar effects are highly likely. Within a year of the introduction of the levy in the UK, the total sugar sold in soft drinks decreased by 35.4%. More than 45,000 tonnes of sugar was removed from sale, and there was a reduction of 6,500 in calorie intake per annum per UK resident. Due to a massive shift in sales to low- and no-sugar drinks, the industry's long-term profitability was not harmed.

This represents significant impact but it would be dwarfed by the ultra-processed food tax recommended by the commission, given that such products account for almost half the contents of Irish shopping baskets, 46%, or a comprehensive sugar tax such as that now proposed in the UK. Such measures would have a massive potential to reduce the national waistline if designed correctly, with no long-term impact on industry profitability or costs to consumers.

We need be clear, though: what we need are mandatory interventions incentivising reformulation. Voluntary programmes have failed miserably. As the commission notes, they can also delay more substantive strategies and can be used by industry to divert policy away from mandatory measures. This is backed up by research, such as a study showing an increase in sugar in chocolate confectionery of 23% since 1992.

The commission's rationale for taxation on unhealthy food is clear. It is underpinned by statistics showing that, for example, sugar intake among three-year-old children in Ireland is 250% above recommended levels, fat intake among five- to 12-year-olds 40% higher and salt intake among four-to-six-year-olds two thirds higher than the daily guidelines.

We know that the Department of Finance has been interested in examining this area for some time. It is unable to move, however, until the Department of Health concludes its evaluation of the sugar-sweetened drinks tax on the Irish soft drinks market.

We are now less than two weeks away from the fifth anniversary of the introduction of the sugar-sweetened drinks tax here. The UK levy was introduced three weeks earlier than ours, but the evidence of impact there was first published by Public Health England more than three and a half years ago, and further research has been published since. It is not acceptable that a report so crucial, we believe, to the nation's health has been delayed so long. In the past day or so, a reply to a parliamentary question indicated that the Department intends to have the evaluation finalised in the second half of this year. If I may ask members for one thing this evening, it is to keep the Department to its word, not only to have the evaluation finalised but to have it published in 2023. We are abjectly losing the war on obesity, particularly in respect of our children, and the consequences for their future health are dire. It is just not acceptable that we are failing to make proper and timely use of one of the most powerful policy weapons at our disposal.

I thank Mr. Macey for that thought-provoking contribution. The first contribution will be from a Fianna Fáil member. Deputy Lahart is gone. Deputy Aindrias Moynihan is online. If he is available and wishes to contribute, he might indicate.

I am okay for a while. I will try to get down to the committee room in person to ask questions in a moment.

The next scheduled contribution, then, would be from a Fine Gael member but I do not think any is present. The next scheduled contribution, then, will be from a Sinn Féin member. Which member would like to contribute?

I thank Mr. Macey for his very interesting contribution. I acknowledge that Deputy Lahart had to go. He left his apologies because he was very keen to be here. He has actually given me his questions as well, so Mr. Macey will face two sets of questions. I am new to the committee so I am not sure how long we get for this. Deputy Lahart was making an interesting point about the amount of that has been gathered already by the sugar tax that has been in place. It raised €32 million in 2022. The fact that the revenue from it rose by €1.6 million last year shows that it is not working, so what we need, obviously, is behavioural change rather than a revenue-generating exercise. On that, where does this money, including the €32 million raised in 2022, go? Mr. Macey might just answer me that.

Mr. Chris Macey

The money is not ring-fenced for health purposes; it just goes into the general pot. What I will say about the money, however, is that there are two bands of the tax, one from 5 g to 8 g and one above 8 g.

Now Deputy Lahart is back.

Mr. Chris Macey

The higher band relates to things such as energy drinks that have much bigger amounts of sugar in them. We know that three companies control 80% of that market, and two of them have not reduced the sugar in their products. The result is that the receipts are going up. Those companies have not been incentivised to reformulate down the sugar in their products, so the tax revenue there is going up. What we want and, as the Deputy said, what will be successful, as is happening in the lower band, is that the receipts actually go down. This is not about raising money; this is about public health, particularly public health among children who drink a lot of sugary drinks. We would say, therefore, that for the higher band the tax rate should go up to further incentivise those companies to reduce the amount of sugar in their products. That will bring the receipts down and bring the public health benefits. Like in the UK, where 35% of the sugar in sugary drinks has just been taken out of the market by such a tax, we are pretty sure, because of the markets being so similar, that the effect is the same here.

Obviously, Mr. Macey will agree that we absolutely have to get the design of this tax right.

Mr. Chris Macey

Absolutely.

If we do not do that, we will have all kinds of externalities and unintended consequences. I would like him to elaborate on the class dynamic around this, that is, the people who are most impacted, what substitutes they have and so on.

Mr. Chris Macey

We do not think there should be taxation on its own. Taxation of unhealthy products should be mirrored with subsidies on healthy products and, as I said in my submission, targeted interventions. We want a children's future fund from these receipts that can be targeted to ensure that every child has access to a healthy diet. That is what we have proposed since the sugar-sweetened drinks tax came in.

There is an enormous volume of literature on this. One of the practical challenges is that it is unclear what set of foods should be taxed. There is no specific subset of foods that cause obesity, and the risk of taxing a small number of foods that cause obesity is that the consumer may switch to energy-dense items that are untaxed, so there is a complexity around all that as to what foods are used.

Mr. Chris Macey

Absolutely, and it has to be worked out. When the Broadcasting Authority of Ireland brought in restrictions on junk food marketing on broadcast media, there was a big debate around cheese and whether, because it is high in fat, it is a food that should be covered. We want to try to take that complexity out. We are not looking for the perfect tax here; we are looking for something that will be effective, especially in reducing levels of overweight and obesity. We want to try to target that top tier of the food pyramid, which contains confectionary, salty snacks, the high-sugar breakfast cereals aimed at children, sugary drinks - which is already being done - and fast food. They are called the big five driving high rates of overconsumption of fat, sugar and salt among children, which is what we want to target. There are ways of doing it. I totally accept it is complex, but it can be done.

There is a proposal in the UK at the moment to bring in a broad sugar tax as the next step. The commission is suggesting an ultra-processed food tax and that is likely to lead to much complexity and many difficulties with what is in and what is out. For example, baked beans are seen as an ultra-processed food, but they are also good for kids. They are high-sugar, but beans on toast is a good healthy meal for any of us. There is a lot of sugar in it, the beans are ultra-processed and there are issues around that, but we do not want to bring in things like that. We want to deal with something that will have an effect rather than get into too much difficulty around the complexities of it.

There obviously has to be a combination of subsidies with the taxes. We must also bear in mind, and Mr. Macey's mention of baked beans reminded me of this, the cost of food and the huge food price inflation at the moment. In the context of all that, how do we put a further tax on top of such prices?

Mr. Chris Macey

We are not talking about taxation that will penalise consumers. Its purpose is to incentivise reformulation so industry over time reduces the level of sugar, fat and salt in the products. That is what has happened with the sugar-sweetened drinks tax. We only have figures for the UK at the moment, but there has been a huge reduction in the sugar in products sold as a result. There is a significant impact of 6,500 calories per year per resident of the UK. If we brought in a broader sugar tax or ultra-processed food tax it would have a much bigger impact than that, because as I said, ultra-processed food is now 46% of the shopping basket of the Irish consumer and therefore a huge area. There are very high-sugar drinks like energy drinks that have up to 17 spoons of sugar in a 500 ml bottle.

What responsibility do manufacturers have around the amount of sugar they put into products?

Mr. Chris Macey

They do not have any other than if people want to buy something they can buy it and if people do not-----

Should they have? Is there any relevant international practice?

Mr. Chris Macey

The sugar-sweetened drinks tax has proved that the best way to do it is to bring in these incentivising taxes. Two years before the sugar-sweetened drinks tax came in, industry accepted it was coming in. It was a level playing field for everyone and they started reducing the sugar in the products. That is what it is about. It is not about revenue or penalising anyone or costing them more. If it works well and is designed properly, it will not even have any impact on business because the purpose is to change people's tastes over time. There can be 17 spoons of sugar in a bottle of energy drink. Humans were not made to consume that level of sugar.

I am just watching the clock. On the asymmetrical information that is there for the consumer and the combination of the subsidies for say, exercise or other activities, is there international research showing the combination of those with the tax is most effective?

Mr. Chris Macey

There is a lot of research around and many examples of taxes being imposed, though less on subsidies. South Africa and India are two examples where subsidies on healthy products like fruit and vegetables have worked very well. The research that is out there says it works and where the two are combined it is bound to magnify. If we are spending the proceeds of the tax on helping the children who need help most, then we will magnify the impact of the tax, which is significant anyway, according to the UK figures.

Mr. Macey is saying we will end up with better outcomes if we have a combination of those things.

Mr. Chris Macey

Yes. It is a healthier overall diet.

I thank Mr. Macey for coming. I am on the Joint Committee on Health as well. We will try to get him in there too as this is a broad debate and I was very taken with some of the questions Deputy Conway-Walsh asked. Mr. Macey can see that we take a different perspective given we are concerned with budgetary oversight. It is not that we are not interested in the health aspect of it, but there are hard questions to be asked around it.

Mr. Macey talked about reducing the sugar, but I suppose we are replacing the sugar. I do not see a less-sweetened content to any of the products he is talking about. Is the jury out on replacing sugar with whatever? I am interested in his comments on that.

There will also always be the arguments that this is the nanny state and people will say they can drink what they want and consume what they want. A conversation like this is useful, therefore, for demonstrating the virtuous circle, namely, saying to people that if they keep consuming this it has a greater societal cost aside from the personal cost and may end up increasing their personal health costs over time. It may result in increasing their health premiums or PRSI contributions because so many more people are consuming this that it is beginning to create an exponential burden on the health system. Those connections sometimes are not made.

I will home in on one or two questions. In essence, our Department of Health has not completed and published an evaluation of the impact of the sugar-sweetened drinks tax in the almost five years since its introduction whereas the UK has, despite only introducing the tax three weeks earlier. Will Mr. Macey tell us what the UK found, in brief?

Mr. Chris Macey

It found the reformulation began literally as soon as the programme was announced, which was two years before it was introduced. By 2019, a year after its introduction, 35% of the sugar consumed from sugary drinks was taken out of the system. The impact of that in calories per year was 6,500 calories per year per resident of the UK. Many people do not consume sugary drinks, so when we take people consuming those drinks at high rates, the drop was bigger. As there was a shift to low-sugar and sugar-free drinks, research has found there was no long-term damage to industry, meaning no jobs were lost. In the main body of sugary drinks, the consumer has not ended up paying more because they have just shifted onto the low-sugar drinks that are not additionally taxed. Thus, it has been a win-win-win over there and now the UK is looking at extending it beyond sugary drinks to all high-sugar products. There was a proposal that was taken on board, but due to the cost-of-living crisis it has been long-fingered for another year.

Deputy Bernard J. Durkan took the Chair.

Why does Mr. Macey think the Department of Health has not engaged in the evaluation?

Mr. Chris Macey

I slightly changed my statement because in the past day there has been a reply to a parliamentary question stating the Department thinks it will have an evaluation finalised in the second half of 2023. We see Departments saying things like that a lot. We would tonight ask the committee to press them to make sure that it is not only finalised, but published in 2023. The Department of Finance is interested in looking at this from a public health perspective, for the same reasons as the commission. From a taxation point of view also, anything that broadens the tax base is something it is interested in. As far as I am aware, the Department of Finance is waiting for that evaluation to decide what the next steps will be.

What does he think is the cost of not dealing with it?

Mr. Chris Macey

The cost of not dealing with this specifically, is that we continue. I had some figures showing that three-year-olds are consuming 250% of the recommended daily intake. That is ten spoons of sugar instead of two and a half.

That is per day.

Mr. Chris Macey

That is per day. Yes. The impact of that over time is going to be horrendous on children. They are overconsuming fat, sugar and salt. A Safefood report prior to the pandemic found that 85,000 children living on the island would die prematurely due to overweight and obesity. That is an avoidable toll of misery and death.

Why did the Irish Heart Foundation choose the Committee of Budgetary Oversight to make a case?

Mr. Chris Macey

The committee was looking at the commission's report. In our view, the commission has made sensible recommendations and proposals around this. We want to support it. We want this issue to be aired fully. We want the public health aspects of it to come through. We have done this on tobacco and alcohol, which have high tax regimes. They were initially sin taxes, but are now health taxes to a large extent. We need that to come more into the ambit of food. The food and diet we have is not conducive to a healthy nation.

The other side of the coin to what Deputy Conway-Walsh was saying, which I agree with, is that often the most vulnerable cohorts of society get hit. As Mr. Macey knows, I had a heart event before Christmas. Even before then I would have been conscious of looking at the foodstuffs I was buying. I cannot get over how expensive cereals are, and how full of sugar even the most woke of them are, to use that overused term. I am thinking of granola, for example. I made granola myself and I saw that if you follow the recipes religiously, you can pile a lot of sugar into granola. You can substitute, which we do, but you can pile an awful lot of sugar in. That started me looking at the sugar content of really upmarket granola. They are sold as a pro-health diet brand, and that is right down to brands that I do not want to mention. I am not talking about the cocoa chocolate covered fruit induced cereals. One thing I have noticed is the move to chocolate in so many cereals. I really feel for parents. It is also the price of them compared to wholesome things like porridge, oatmeal and things like that. There are lots of different varieties. When you are a busy parent with a busy family, you are able to grab a box that requires nothing more than to pour milk on it. I am amazed at the amount of sugar they get away with, but I suppose that is more proper to a health committee. If we were writing up a summary of what we are doing here, what would Mr. Macey be suggesting?

Mr. Chris Macey

I would suggest that the recommendations made by the commission are taken on board. That includes its recommendation to expand the sugar-sweetened drink tax, but also what it has said about voluntary industry action not working. They are just failing. Mandatory measures are the measures that work. I would ask the committee to take that on board. It is evidence based. The commission has not said it lightly. They have looked at the evidence as we have. We have come to the same conclusion. Mandatory action is needed, but mandatory action that is tailored not to raise revenue but to tackle public health. It will use taxation as a public health weapon. That can be most effective. If it is done correctly, like the sugar-sweetened drink tax, it can reduce the amount of sugar in the system and not hit anyone in the pocket at the same time.

I welcome the witness. I want to put this in context, as it flows from the Commission on Taxation and Welfare report. For me, that report made grim reading. We have obesity levels, which from an economic point of view and for taxation purposes, means the equivalent per capita annual tax needed to cover increased fiscal pressure due to overweight is second only to the United States of America. That is a shocking statistic. When we see some of the other statistics related to obesity, and the cost of obesity, it is really alarming. In this context, we are talking about the success of the sugar-sweetened drinks tax. It is a tax I supported. I believe it can lead to behavioural change. As has been mentioned that behavioural change happened in the industry itself, mainly where they changed the structure or component for much of the drinks. The question is raised about whether it is as simple or as likely to happen with foods with high levels of sugar. That is my question for the Irish Heart Foundation. How confident is it that it would see a change in industry, as opposed to a penalty on consumers in terms of the drinks? I know we are waiting for the Irish report, which is ridiculous five years on. Across the water, they produced it within a year and a half. We expected the same change to happen here in Ireland as it did in Britain. Does the Irish Heart Foundation expect the same to happen if a tax were to be introduced for food products?

Mr. Chris Macey

I work in a health charity. I am not involved deeply and directly in this area. I will say that the UK Government has looked at it. Henry Dimbleby compiled a report. They were confident that taxation of sugar similar to the level of the sugar-sweetened drinks tax, a 10% to 25% increase depending on various factors, would work. It would incentivise the industry to reformulate. That is the key. If it does not incentive the industry to reformulate, it becomes a revenue raiser. The Deputy is right. We have to make sure it is something that is going to work. The view across the water is that it will certainly have the same impact as the sugar-sweetened tax. When talking about products, prices and industry profits, the other great thing about this type of mandatory action is that it creates a level playing field.

If there is a voluntary approach, only the good guys, if you like, are going to go down that road and others will stay in to maximise profit. This form of mandatory incentivised taxation will work because it is all about the bottom line for companies, at the end of the day, and about the competition. Once the tax was announced, industry went straight in. Businesses did not argue about it coming in but immediately started to reformulate and ensure they were ahead of the curve as much as possible. The result was that in the first year of the tax, their sales increased. They shifted to lower and no-tax products and their sales increased by 10%. While there has been some drift on that since then, the research clearly shows there is not going to be any long-term negative impact on any of them. I do not see why it would be any different for other foodstuffs compared with sugary drinks.

I take Mr. Macey's point but my concern is that in the case of sugary drinks, there is probably a small number of large market players. I am not sure whether the wider food industry is the same but some of the businesses relate to ultra-processed foods such as cakes, breads, processed meats and snacks including cookies. There is a large number of manufacturers, so I wonder whether it will have the same effect.

Another concern I have with regard to designing this, which my party colleague Deputy Conway-Walsh mentioned, relates to how we can ensure it is targeted properly. Obesity levels, as bad as they are throughout the State, have a greater impact in deprived areas. I am not sure whether it was in the Irish Heart Foundation's briefing notes or the commission’s findings, which are stark, that it is stated that a healthy calories approach costs ten times more than an unhealthy one. The issue is that ultra-processed foods are a lot cheaper than healthier foods and, therefore, in areas of higher deprivation low-income families use them as part of their staple diet. The danger is that if we do not get industry to move, we will just impose a greater burden on them given the alternatives are still probably going to be more expensive than ultra-processed foods. Does Mr. Macey have any concern in that regard?

Mr. Chris Macey

Yes, that point was made in my statement. Food Safety Authority research about 12 years ago showed the difference between an unhealthy and a healthy calorie. It is a huge concern. Today's children who are going to die prematurely are overwhelmingly in those disadvantaged areas. The disparities in primary school children are growing, not getting narrower, so we have to make this work. Three times more people from disadvantaged areas die than do people from advantaged areas and for heart disease, the differences are similar.

We have to take this on and the tax is a weapon to do it. We have to design it well and ensure it will work, in the same way as the sugar food and drink tax. That was modelled beforehand and the modelling has borne out. It is actually more successful than the modelling suggested it would be. The purpose of the tax is to reduce high fat, sugar and salt intake, especially among children in the most disadvantaged communities, and this is going to do that. The Department of Finance will not talk about hypothecation, although it makes use of it in other areas such as in agriculture and tourism, with the plastic bag levy and so on. If we were to spend the money from the tax we collected on addressing those issues, we could make sure there would be no additional burden on the people who can afford it least. We would be putting the proceeds of the tax back into schemes and programmes for people who need a healthier diet and do not have access to one at the moment.

Yes. It is always difficult to take with one hand and give with another, and in the context of the price of food, that is a major issue. It may be that we are able to argue that we have improved sports facilities in a community or done X, Y or Z. It is challenging-----

Mr. Chris Macey

I apologise for interrupting but this is about diet, not about sports facilities or similar measures that will benefit only a few. It is about improving the diets of all children.

I completely agree. The point I was making was that there is a significant gap between the levels of obesity in affluent areas compared with non-affluent ones and I would imagine it comes down to the issue of the price point of the basket. Does the Irish Heart Foundation have a view on why we are losing this battle? Mr. Macey made clear in his opening statement that we are losing the battle. We have seen all the healthy promotion and the strategies that exist. There has been a campaign on RTÉ encouraging people to get out and walk and we saw during the pandemic that more and more people were doing that, yet we are where we are, which is not a good place. Graphs in the report of the Commission on Taxation and Welfare showing the prevalence of sweet and savoury snack consumption throughout western Europe indicate that Ireland is the highest among all those surveyed. Our figures are about four times those for Italy, Hungary, Portugal, Lithuania, Poland and Slovakia. A range of countries have about one quarter of the intake of sweet and savoury snack consumption of Ireland. I admit that as I say this, I am thinking these are all the kinds of foods and drinks I consume and I probably need to go home and talk to my children about this. Nevertheless, why are we such an outlier? I acknowledge Britain's figures are close to ours but in a lot of cases, we are way above the European average in terms of our habits and our consumption of sweet and savoury snacks and ultra-processed foods.

As we increase taxation on the foods we do not want people to eat, such as ultra-processed foods, is there scope for an incentive? Mr. Macey talked about subsidising fruit and so on. How can we correct that balance? There would have to be a very high tax if we did not get the industry to change. Getting the industry to look at how it manufactures these foods would be the ultimate benefit, but if we do not get that across the board, we would have to try to bring healthier food within the price range of these families. Obviously, there would be a massive benefit for those individuals and families but also for our healthcare system and the economy, given this comes at a cost.

I fully agree with Mr. Macey regarding hypothecation. While that does not happen in Irish tax law, there is a strong argument that any tax that comes from this should be used to support families who may feel under pressure.

Finally, is there any international experience of all this? Has it happened in other areas, and if so, has it been successful?

Mr. Chris Macey

As far as we are concerned, there are four main drivers of childhood obesity according to the evidence. It is the increasing ubiquity of food, in that you can get it anywhere and at any time. The snack food industry was non-existent in the 1970s, when obesity was non-existent. Now it is a €390 billion global market. There is also the relative cheapness that we have talked about. From my reading of the evidence, the difference between us, the UK, the US and those other countries the Deputy was talking about is junk food marketing and the absolute bombardment of children, particularly online, with junk food marketing. The latter is something that we are not dealing with. We are still governed by a voluntary code. While we do not have the figures for Ireland, junk food marketing targeting children amounting to €15.1 billion in ads is hitting children in the online ecosystem in the UK every year. Again, what young people look at there and here is very similar. We did a survey recently in which 57% of children said they are influenced by junk food marketing ads online as the main influencer of what they eat, and 35% of them said that when they see junk food marketing online, they go and get some junk food. That is a huge area. In addition, sedentary lifestyles have been exacerbated by the pandemic. As far as we can work out at this stage, we have not got back to pre-pandemic levels of physical activity among kids.

As to whether there are examples of healthy food subsidies working, there are examples in South Africa and India. There is a lot of modelling around this and, certainly, what the research coming back is saying is that this is a sensible and serious approach. There is a lot more evidence on the impact of taxation rather than the impact of subsidies, because subsidies have not been tried as much. We have been accused of not being serious players by suggesting this over the years.

What are they doing in South Africa and India?

Mr. Chris Macey

There are subsidies on healthy products. There was a pulses subsidy in India whereby people were getting staple diet foods much cheaper and there were corresponding taxes that were helping to fund that. A lot of the evidence that is out there seems to be do with modelling. Again, if something has not been tried and has not been done, we have to either take the leap of faith or do some sort of modelling on it. That is what we did with the sugar sweets and drinks tax and, as I said, it has been a big success. Does that answer the questions?

Yes. I thank Mr. Macey for his presentation.

I sincerely thank Mr. Macey for what was a sobering and alarming presentation. It is my honest opinion that this whole issue is not being taken as the most awfully serious issue that it is, which is how it should be taken by the Government. For example, if those deaths that are going to potentially occur in the future of our beautiful young children were going to happen on our roads, there would be an outcry, and if we thought we could introduce some measure, as we have done to protect people and to try to reduce the number of deaths on our roads, I am sure the Government would be acting a lot quicker than it actually is.

Mr. Macey wants us to do certain things. We should all take it upon ourselves, as a group and as individuals, to raise this matter at every level that we can. All Mr. Macey can do is highlight the problem that is there and will potentially be there in the years ahead, which he has done in an excellent fashion. I do not think anything is more important than the protection of our young people. As children, they are not able to protect themselves. It is our job and our place, first, as parents, aunts and uncles, and then as politicians and decision-makers, to try to protect them from the harm they might put themselves in by getting into the habit of wrong and bad diets, which are, in themselves, addictive.

We have taken every type of measure to stop people smoking, we have tried to stop people from over-indulging in alcohol and there is a continuous war on illegal drugs. It will have to be agreed by all of us that, having listened to the excellent presentation, we are not doing enough in the war, as I would call it, on sugary and fatty foods, addictive sweets, sweet drinks and all of those sorts of things that are bad for children. In life, any one of us can fall into a bad habit and we can become addicted to something, whatever it is. We all have to work together on this issue. I would label this evening’s presentation as one of the most important we have had since the committee was formed a number of years ago, and that is not to make little of any other witnesses who came before us. This issue is of paramount importance.

Mr. Chris Macey

I thank the Deputy for that. I agree with every word he said. This is the biggest health crisis facing the children of Ireland and I totally appreciate everything he said.

I thank Mr. Macey for being here. I go back to the question on targeted measures. Mr. Macey indicated that affordable healthy diets are out of reach for many families. Sadly, due to the cost of living and other factors, it is safe to include older families in that. I am Sinn Féin spokesperson for older people, but I would like to do more to encourage healthy eating among people of all ages. Can Mr. Macey elaborate on what targeted measures he would advocate that would help with access to improved diets and information for our elderly?

Mr. Chris Macey

When talking about targeting subsidies at disadvantaged areas, that would obviously include older people. I am also a director of patient support for the Irish Heart Foundation, so I meet a lot of older people who are affected by heart disease and stroke, as the vast majority of people are. Diet is very important for people who are living with those chronic diseases. We put a great deal of emphasis on helping people to adopt healthy diets, particularly after they have had a health event.

In terms of helping people to make the right choices, we are doing that already. We would not be looking at any age bar on subsidies. What we need to do is target people who do not have a healthy diet and to make sure they have access to this. People do not have access to affordable diets at the moment.

It is an affordability issue. We have outlined, as has Mr. Macey, the issue of low incomes and people having to rely on sugary and ultra-processed foods.

I apologise if this sounds very repetitive, but the last thing we want to do as elected representatives is create an extra burden for folks who are struggling to make ends meet. When Mr. Macey defines "ultra-processed", would this be a blanket term for foods that are frozen? How would he describe the term? How would a person distinguish between ultra-processed and overly sugary foods, when it comes down to it? Having listened to people, and particularly older people who have come into my office and who are on very low incomes, they are talking about food that perhaps we would class as containing too much sugar or too much salt, or maybe the microwaveable dinners or whatever, which they might stick in the microwave due to being on a low income. Will we be creating an indiscriminate blanketing of foods that may lead to increased hardship? What are Mr. Macey's thoughts on that?

Mr. Chris Macey

Defining what ultra-processed foods are is quite a complex area. There is a system of categorisation with four food groups that is generally used by dieticians. Before coming here I spoke to our dieticians. They are saying that these are foods that are typically high in sugar, fat, salt and refined starches. Such foods often use ingredients that would not be used in ordinary kitchens such as soya protein isolates or dextrose, colourings, emulsifiers, flavourings and other additives. We are talking about sugar-sweetened drinks, salty snacks, confectionery, pre-prepared frozen dishes, reconstituted meat products, canned and instant soups, chicken nuggets, ice creams, and so on. That is the area. As I said, we are not looking for complexity around this. We are looking to be effective rather than to be perfect. I believe we can be if we target that top tier of the food pyramid that is supposed to be 1% of the diet but is actually maybe 30% to 40% of the diet. Certainly, the marketing of the 1% is about 60% of the marketing that goes on. It is crazy. It is bound to lead to the situation we are in. We are not purist about what it is. We do not want things like cheese to be touched. We do not want any of that. We do not want any major controversy about something such as fruit juice, which has come up under sugar because fruit juice is high in sugar. In low amounts, drinking fruit juice is very good because there is so much other good stuff in it. We do not want to get into that. We want to get into the stuff that there is not much argument about such as confectionery, for example, and that type of thing. Again, we do not want to stop people eating chocolate but we just want to bring it back to the way it used to be when it was a treat. Treats are now sold as, "A Mars a day helps you work, rest and play", whereby you have worked hard and you deserve a snack, which is a high fat and high sugar snack. I do not mean to single it out. One could pick any one of hundreds of products. We will all see some of those advertisements today where they have changed a treat into a snack and this is part of the problem we are in.

I agree with Mr. Macey completely. I see it at first hand. I have been dealing with people who would have been very obese and were perhaps dealing with gastric bypasses or gastric sleeves and so on. Since Covid, and I believe we are all a little guilty, people may have gone back to their old ways. Perhaps it is for another committee but we must discuss the fact that people who may have had the surgery are being left and have not been dealt with since Covid. Maybe we need to be re-educating them. In some cases, many of them are going back to their old ways and one will see that the weight is creeping on after surgery. Maybe we need to target people like that who have had surgeries. I do not know how we would deal with that but perhaps it is something we need to look at also.

Does Mr. Macey have any comment to make on the impact of the current taxation of alcohol and tobacco and how it should evolve going forward?

Mr. Chris Macey

These taxes started as sin taxes and revenue raisers and have become very much public health taxes. There is an element of alcohol, in small doses such as a glass of red wine, where there is evidence it can actually be good for a person's cardiovascular health. This would be a small amount of red wine occasionally and that type of thing. This is a little more complex than tobacco which is just bad for you. For a long time we have advocated for the €20 pack of cigarettes. Certainly taxation has been the biggest weapon in reducing smoking rates in Ireland, and particularly in stopping the take-up of smoking among young people. Unfortunately, that is now starting to change and for the first time in a generation the youth smoking rate is increasing. It is not proven yet but there appears to be a link to that and the rise of e-cigarettes and the rise of nicotine addiction through that. We are proposing that there is some taxation on e-cigarettes that is not high enough to stop people who are genuinely using them to try to quit smoking, but will be high enough to stop children using them. There has been a huge explosion in child and youth use of e-cigarettes. These measures are really important. The taxation of cigarettes and tobacco takes in some €1 billion a year for the State. It spends around 1% of that in helping people to quit but 70% to 80% of people who smoke want to quit and they are not getting enough help to do that. The last figure I saw on this was €30 million per year being spent on the whole panoply of tobacco control measures or smoking cessation measures but it is not enough. These are people who are addicted to one of the most addictive substances on the planet. They need more help.

As legislators, what would Mr. Macey want us to do?

Mr. Chris Macey

The €12 million being spent per year on helping people to quit should be quadrupled to €50 million and we should take a much more serious approach to it. The evidence is really clear that when people get help it increases the chances that they are going to quit. However, the first thing that gets cut when there is any pressure on the HSE is the quit services. This has happened constantly over the years. Those services are very patchy around the country. In some places they would be good and in other places they will not be. Regardless of where a person lives, if it is going to help then he or she should have it, and particularly when they are paying that amount of money in additional tax on top of all the other taxes they pay to the State.

I thank Mr. Macey. That was my point around the obesity clinics as well. The backup service, the follow-up service and the wraparound service is very patchy at the moment. In order to progress that system we need to be working hard on that as well. I thank Mr. Macey for his time.

Would anybody else like to come in? No. I thank Mr. Macey for coming before the committee and for giving us his excellent advice.

We must make it attractive for children to pursue a policy of healthy foods. It is easy to go the other way but we need to make it attractive for them to see what they can achieve by eating carefully and by combining food groups carefully.

The question of the more expensive healthy foods and how that affects the habits of people must eventually be dealt with. Some years ago I gave up salt, sugar and smoking all in the one day. It was not a great idea I can tell you as it was a bit of a challenge. I lost four stone in weight in about eight weeks. It was rapid. I know that one is not supposed to do that but it worked. It certainly brought down the weight. It has gone up a bit but it has not gone back up to the same extent.

It is noticeable what youngsters do nowadays.

They go for the sweet option, for want of a better description. There is no doubt that it is damaging to them and will be damaging to us all. If we can, we should do something by way of illustrating to them the benefits of healthy eating and the economic benefits as well in the long run. I can remember a good few years ago the campaign by the late Dr. Noël Browne on tuberculosis. Back in the 1950s they went around to all the schools and showed a film. It was very seldom that a film was shown in school at that time. Every schoolchild in the country had a viewing of a film which was targeting them in terms of the kind of lifestyle to follow in order to achieve the targets required.

I again thank Mr. Macey for coming before the committee. The meeting is now adjourned until Wednesday, 26 April 2023. I thank all, including members, for attending.

The select committee adjourned at 7.11 p.m. until 5.30 p.m. on Wednesday, 26 April 2023.
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