Following a high-profile campaign on the adverse effects of too much sugar in our diet, in his March 2016 budget George Osborne announced a new levy on some sugar-sweetened drinks.
After much debate and following lobbying by us, alongside other organisations
, the levy came into force in the UK on 6 April 2018.
In terms of public health government policy, two years from announcement to implementation is a remarkably short period, and the government is to be applauded for not only doing the right thing, but doing it quickly.
Northern Ireland: a shocking number of tooth extractions
Of course there have been cries of “nanny state”
and “loss of individual choice” from some commentators.
Public health initiatives have been met with the “nannying” argument ever since Edwin Chadwick outraged 1830s sensitivities by proposing a sewage network, but I ask anyone who has any doubts to attend a GA tooth-extraction list - of which there will be at least one a week near you - to see the distress and horror of removing (often multiple) teeth in a child who can be as young as two-years-old.
In Northern Ireland, more than 5,100 children were admitted to hospital for tooth extractions last year.
That is more than for any other surgical procedure.
Despite the efforts of many dedicated dental professionals, Northern Ireland still has a stubbornly high-level of dental decay.
By the age of 15, just under a fifth (19 per cent) of children in Northern Ireland can be considered as having good oral health overall, and we are at the bottom of the league table when it comes to child oral health outcomes in the UK, with 72 per cent of 15-year olds having tooth decay compared to 44 per cent in England and 63 per cent in Wales.
Dental decay is a largely preventable disease, it is a national scandal that it continues to these levels in our children in the 21st century, and is simply not acceptable.
Oral health inequalities: sugar consumption and teeth
There have been laments of the sugar levy being a “tax on the poor”, but it is that same deprived population which will suffer the most from disease caused by too much sugar in the diet, including dental decay.
Children from lower income families are much more likely to have poorer diets and consume more sugary drinks.
In Northern Ireland, almost a quarter (24 per cent) of children on free school meals drink sugary drinks four or more times a day, compared to just one in 10 (10 per cent) of children who are not eligible for free school meals.
The 2013 Northern Ireland Child Dental Health Survey
quoted 23 per cent of parents of 12-year olds needing to take time off work in the last 12 months because of their child’s oral health, a statistic which will have a disproportionate burden in families on lower incomes.
In addition, it is those very same children from the more deprived backgrounds who in later life are more likely to suffer from the effects of chronic disease caused by excess sugar in the diet such as obesity and diabetes.
We know the sweet habits in children are having a devastating effect on their teeth. The Royal College of Surgeons in England have quoted that 90% of extractions on deciduous teeth could be prevented by eating less sugar.
Now there is a vision worth fighting for.
Sugar levy: will it work?
But will the sugar levy have an effect? In terms of reducing sugar in some drinks it already has, with many manufacturers reformulating their products in advance of its introduction. However, there are some notable exceptions.
Following their somewhat disastrous attempt some years ago to alter their “secret recipe”, perhaps not surprisingly, Coca-Cola has decided not to reduce the sugar in their regular drinks, but they plan to promote their low and zero sugar alternatives and offset the effect of the levy by increasing the price and reducing the size of their products.
It will be interesting to see what might be the long-term effects of that decision.
Fruit juices and milk-based drinks are not included in the sugar levy, and neither are other high-sugar products. The sugar levy as it stands is only a start, and even if it is extended to all high-sugar products, it is unlikely to work on its own.
Oral health strategy is needed for real prevention
Oral health education and prevention of dental decay must be embedded into all aspects of healthcare, with effective leadership to develop an up-to -date and evidence-based oral health strategy for Northern Ireland.
We must as a profession continue to lobby for other public health measures such as removing high-sugar products from checkouts and “snaking checkout aisles” (or if you prefer “chicane checkout aisles”) in supermarkets.
Dentists and their teams must have access to enough funding, so they can give the time they need to ensure patients are following good oral health routines.
Scotland has shown the way with Childsmile, which sits alongside a wider public information campaign addressing childhood obesity and diet. Let us learn from their experience and develop a similar scheme for Northern Ireland.
As dental teams, we see dental decay in children long before the same patients develop sugar-related chronic disease such as type 11 diabetes.
If you solve dental health issues, you will also make significant inroads into tackling chronic disease and obesity.
Tackling the poor state of children’s teeth in Northern Ireland
BDA Northern Ireland has been proactive on your behalf, engaging with stakeholders, politicians and the media, repeating our messages and calling for the government to take action to tackle the poor state of children’s oral health in Northern Ireland.
This work will continue as a key priority. Together we can make the vision become a reality, that GA extraction of teeth in a child is a rare and unavoidable event.
The introduction of the sugar levy is a battle won, but the war is not over.
Roz McMullan, Chair
BDA Northern Ireland Council
BDA Northern Ireland
BDA Northern Ireland
supports, represents and promotes, the interests of all dentists working in Northern Ireland. Working with elected committee members, we negotiate on behalf of the profession on terms and conditions, pay and contracts. Join us