4th Dec 2018
As part of Singapore’s War on Diabetes, the Ministry of Health (MOH) and the Health Promotion Board (HPB) will conduct a public consultation to seek views from the public and key stakeholders on the possible measures to reduce Singaporeans’ sugar intake from pre-packaged sugar-sweetened beverages (SSBs). The public consultation will be held from 4 December 2018 to 25 January 2019.
Diabetes: A Serious Health Concern
2. Diabetes is a serious health concern in Singapore. We have the highest prevalence of diabetes among developed nations, and almost one in nine persons has diabetes. The number of Singapore residents with diabetes is projected to reach one million by 2050, if nothing is done to curb the rising trend. Diabetes is currently the second leading cause of ill health in Singapore. Poor management of the disease could lead to serious complications such as heart attack, stroke, kidney failure, blindness, and lower extremity amputation.
3. MOH declared a War on Diabetes in 2016 to mobilise a whole-of-society effort to tackle the disease. A multipronged strategy has been implemented under the War on Diabetes: prevention through healthy living; regular screening and follow up for early detection and intervention; and better disease management, anchored on public education, community outreach and industry partnership. The War on Diabetes has seen encouraging signs of progress, but more needs to be done to create a supportive environment for Singaporeans to lead healthier lifestyles, and to live free from diabetes.
High Sugar Intake among Singaporeans
4. High sugar intake is linked to increased risk of obesity and diabetes. A 2018 local review which included studies on Asian populations found that every additional 250ml serving of SSBs daily increases individuals’ risk of diabetes by as much as 26 per cent. The World Health Organization (WHO) has called on countries to take action to reduce individuals’ intake of sugar to as low as possible, stating that “nutritionally, people do not need any sugar in their diet”.
5. However, Singaporeans are consuming on average twelve teaspoons (or 60g) of sugar daily. More than half of Singaporeans’ daily sugar intake comes from SSBs, of which pre-packaged SSBs contribute 64 per cent of this intake. More pre-packaged SSBs are consumed per person per day in Singapore than in many other Asian jurisdictions.
6. In the Singapore market, although the average sugar level of all pre-packaged SSBs has fallen from five to three teaspoons over the past 10 years, the average sugar level for those with medium- and higher-sugar level has remained high at five teaspoons (see Annex). These medium- and higher-sugar products make up over half of the total sales of pre-packaged SSBs in Singapore
Possible Measures for Consultation
7. More needs to be done to further reduce Singaporeans’ sugar intake to help us accelerate our efforts to fight the War on Diabetes. As a start, MOH and HPB will consult on possible measures to reduce Singaporeans’ sugar intake from pre-packaged SSBs.
8. Globally and regionally, a growing number of countries have adopted a combination of measures to reduce sugar intake from SSBs and maximise their public health impact. These measures include front-of-pack nutrition labelling, advertising regulations, reducing availability of sugary foods and drinks in schools and public institutions, as well as excise duties on SSBs.
9. MOH has carefully reviewed the measures and practices adopted by other countries, and studied their impact in these countries. We are seeking views on four possible measures, which are not mutually exclusive, towards pre-packaged SSBs. These measures aim to accelerate industry reformulation to reduce sugar levels in pre-packaged SSBs, and empower Singaporeans to make informed and healthier choices.
(I) Mandatory Front-of-Pack Nutrition Label
10. To help consumers make healthier choices, one possible measure is to introduce a mandatory front-of-pack (FOP) nutrition label on pre-packaged SSBs. This will empower consumers to readily identify the range of less healthy SSBs ‒ those high in sugar and other nutrients such as saturated fats ‒ and complement the existing Healthier Choice Symbol programme, which is voluntary and marks out only the healthier drinks.
11. Evidence has shown that FOP nutrition-summary labels, as compared to a full listing of nutrition information, are more effective in helping consumers easily identify products with higher sugar content and/or poorer nutrition quality, as these do not require sophisticated nutrient knowledge. Overseas experience has also shown that adoption of such labels is slow and biased towards healthier products when implemented on a voluntary basis.
(II) Advertising Regulations
12. Studies have found that exposure to advertisements of less healthy food and drinks influences choice and induces consumption, especially among children. The WHO also concluded that there is “unequivocal evidence that the marketing of unhealthy foods and SSBs promotes childhood obesity”. Studies also show that restricting advertisements can reduce consumption of the product of concern. Many jurisdictions have enacted laws restricting advertisements of less healthy food and drinks.
13. Currently Singapore has voluntary guidelines to limit the advertising of less healthy food and drinks to children which cover only limited TV time-belts and media channels. There are no guidelines to address the needs of the general population. A possible measure is to regulate advertisements of less healthy SSBs in the mass media, including on online channels, to reduce their influence on consumer preferences. The possible options are:
- Make the current restrictions mandatory and expand them to include more TV time-belts and media channels that children are exposed to; or
- Ban advertising across all time-belts and mass media channels.
(III) Excise Duty on Manufacturers and Importers
14. Globally, there has been increased momentum to combat obesity and diabetes through fiscal measures. Currently, about 45 jurisdictions have imposed excise duties on SSBs including Brunei, Thailand, Mexico, the United Kingdom, and cities in the United States of America such as Berkeley, California. Experiences in these jurisdictions show that excise duties are effective in spurring industry reformulation to reduce sugar content in drinks.
15. A possible measure is to introduce an excise duty on manufacturers and importers of pre-packaged SSBs, to encourage the industry to reformulate and reduce the sugar content in their products. The objective of imposing duties on SSBs, if introduced, is not for revenue generation, but to shape the behaviour of manufacturers and consumers. Duties on SSBs aim to encourage manufacturers to reformulate their products and to encourage consumers to choose healthier drinks that are lower in sugar content or drink plain water. Switching to these healthier options can help consumers reduce their sugar intake, and in turn, lower their risk of obesity and diabetes further.
(IV) Ban on Higher-Sugar Pre-Packaged SSBs
16. In Singapore, SSBs with more than three teaspoons of sugar per 250ml serving are not allowed to be sold in schools and on government premises. While this restricts access to higher-sugar SSBs in schools, the students and general population can still obtain such SSBs from other avenues. In 2017, seven major SSB manufacturers have also pledged to limit the sugar content in their pre-packaged SSBs sold in Singapore to no more than six teaspoons per 250ml serving. Another possible measure is to introduce a nationwide ban on the sale of higher-sugar pre-packaged SSBs to further discourage consumption of such SSBs.
Details on Public Consultation
17. MOH and HPB would like to invite the public to contribute their views and feedback on the four possible measures to further reduce Singaporeans’ sugar intake from pre-packaged SSBs, as well as suggestions on other possible measures. The public consultation paper with details of the four possible measures can be found on REACH at http://www.reach.gov.sg/sugarydrinks.
18. Views and feedback can be submitted via the REACH website from 6:00pm, 4 December 2018 to 6:00pm, 25 January 2019. All responses received by the closing date will be carefully considered. As part of the public consultation exercise, MOH and HPB will organise dialogues with the public and industry in the coming months. Details of the public dialogues will be provided closer to date.
MINISTRY OF HEALTH
4 DECEMBER 2018
ANNEX
AVERAGE SUGAR LEVEL OF SSBS IN SINGAPORE
The average sugar level of medium and higher-sugar SSBs has remained high. These SSBs make up half of all pre-packaged SSBs sold in Singapore.
