“IInstead of eating a bag of chips or Cheetos, I go to the fruit section of the supermarket,” said Liliana Cano, a 43-year-old shopper at a supermarket in Bogotá. “But sometimes I still drink a soft drink, as a little treat.”
Earlier this year, Colombia became one of the first countries in the world to tax ultra-processed foods. The ambitious new health measures, aimed at reducing the burden of non-communicable diseases such as cancer and diabetes, also include warnings on foods high in sugar, salt and other additives.
Like it many low- and middle-income countriesColombia 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 12 grams of salt per day, the largest share of all countries in Latin America. Nearly a third of adults have high blood pressure.
Quick guide A common condition
Show
The human toll of non-communicable diseases (NCDs) is enormous and rising. These diseases end the lives of about 41 million of the 56 million people who die each year – and three-quarters of them are in the developing world.
NCDs are simply that; Unlike a virus, for example, you cannot contract them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioral factors. The main types are cancer, chronic respiratory diseases, diabetes and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and all are increasing and spreading inexorably around the world as aging populations and lifestyles, pressured by economic growth and urbanization, make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now have a hold on the poor. Disease, disability, and death are perfectly designed to create and increase inequality—and if you're poor, you're less likely to receive an accurate diagnosis or treatment.
Investment in tackling these common and chronic conditions, which kill 71% of us, is incredibly low, while the costs to families, economies and communities are staggeringly high.
In low-income countries, NCDs – typically slow and debilitating diseases – see a fraction of the money needed being invested or donated. Attention remains focused on the threats of communicable diseases, but cancer death rates have long surpassed the death tolls from malaria, tuberculosis and HIV/AIDS combined.
'A Common Condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, solutions, causes and consequences, and telling the stories of people living with these diseases.
Tracy McVeigh, editor
The additional 10% tax, which is expected to rise to 20% by 2025, will be levied on unhealthy snacks and soft drinks, as well as on certain basic products such as meat products.
A month after the measures were introduced, shoppers in Bogotá are starting to feel the impact.
“Everyone knows that high levels of sugar or sodium are bad for your health, so it's a good idea to increase taxes on those products. But eating healthy is expensive,” says Cano.
“The tax hits us in a hugely unfair way,” said Hectór Cruz, a 45-year-old customer at discount supermarket D1. “I agree that they should tax products like soft drinks and beer, but not basic products.
“Of course you want to consume a healthy product with good proteins and minerals, but unemployment is high and the economy is weakening,” he adds. “So people who maybe haven't had breakfast yet or haven't eaten anything by noon, just buy a bag of chips for 3,000 pesos (60 cents).”
Arne Dulsrud, a sociologist at Oslo Metropolitan University, says: “I don't think the tax itself will increase the nutrient consumption of Colombia's poorest.” Dulsrud has collaborated with a team of researchers from Norway and the Pontifical Javierian University in Bogotá a large-scale study on food insecurity in Colombia's conflict-affected southwest province of Cauca.
“We found that even people in rural areas who have access to vegetable gardens or growing crops do not eat their crops, but sell them in the market,” says Dulsrud. “They use this income to pay their children's school fees and to buy cheap food with lower nutritional value, which is often highly processed.”
Even food parcels distributed as part of a government program to Colombia's poorest families are full of processed food, Dulsrud says. “Taxes can be part of increasing healthy food consumption, but I think health care reforms need to focus only on the most vulnerable to be effective,” he says. “Introducing healthy meals in 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 agricultural holdingsThis is evident from the Columbia Human Rights Law Review. “If the government is looking for sustainable long-term policies for food security, they must address access to land,” says Dulsrud.
Cruz agrees that package warnings are largely a good thing, but he's not convinced it will change the way he eats. “This is actually the product I could find with the fewest warning labels,” says Cruz, holding up a packet of chips from his shopping cart. “Almost all of these products are giving us cancer and we know that, but what can we do with our budget?”
“The price of healthy alternatives is a problem,” said Guillermo Paraje, an economist at 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 disadvantages poor people.
“You have to consider the whole package, not just the financial impact of the tax, but also the impact of diseases caused by unhealthy food,” says Paraje. “In Latin America, as in most parts of the world, the poorest are most negatively affected by disease. They have poor access to the healthcare system and many work informally and do not have protection such as sick pay.”
But not all Colombians are bothered by the price of healthy choices.
“I think you have to pay a little more to eat healthy,” said Carlos Martínez, 54, a customer at the luxury supermarket Carulla, known for its high-quality fresh produce. “Look, I just bought healthy crackers, fruits and vegetables. The health warnings are working.”