Diabetes: A Bitter Pill We Have to Swallow

No one—rich or poor—likes taxes. They are an unwelcome visitor, yet one that arrives whether people welcome it or not. The celebrated American author Mark Twain (1835–1910) once quipped, “The difference between death and taxes is that death doesn't get worse every time Congress meets.” His fellow countryman Benjamin Franklin (1706–1790), one of America's Founding Fathers, had expressed the same idea much earlier: “In this world, nothing can be said to be certain except death and taxes.”

Like it or not, taxes are often unavoidable. Governments rely on them to finance public services and reduce budget deficits. In the case discussed here, however, it is not governments calling for higher taxes, but rather a group of public health and medical researchers.

A few days ago, The Conversation, the international academic and research platform, published a review of a scientific study examining the harmful effects of sugar-sweetened and carbonated beverages in Egypt. The study found a strong association between increased consumption of these drinks and rising rates of Type 2 diabetes, cardiovascular disease, and other chronic illnesses.

Over the past two decades, the prevalence of obesity among Egyptian adults has risen from 22 percent to 32 percent. Meanwhile, non-communicable diseases—many of them linked to unhealthy lifestyles and behavioral habits—now account for 84 percent of all deaths in the country. All of this is occurring in a nation already burdened by significant public health and economic challenges, making it even more difficult to confront this growing epidemic of chronic disease.

The study notes that Egypt currently imposes a 14 percent value-added tax (VAT) on beverages, along with a general tax on non-alcoholic drinks. What it does not impose, however, is a specific excise tax targeting sugar-sweetened beverages.

The researchers therefore posed a simple question: What would happen if Egypt introduced a 20 percent tax on sugary drinks, the minimum level recommended by the World Health Organization to produce a meaningful public health impact?

The immediate consequence would be a corresponding increase in retail prices. Higher prices would likely discourage consumers from purchasing sugary beverages or encourage them to consume smaller quantities. Reduced consumption would mean lower calorie intake, leading over time to weight loss and lower rates of obesity-related illnesses, including diabetes, cardiovascular disease, cancer, and dental decay.

According to the study's projections, introducing such a tax could prevent approximately 350,000 cases of obesity, 250,000 cases of Type 2 diabetes, 65,000 cardiovascular disease cases, 39,000 strokes, 2,700 new cancer cases, and nearly 31 million cases of tooth decay.

The resulting savings in healthcare expenditure could reach $1.8 billion—equivalent to roughly 8 percent of Egypt's annual health budget—while also increasing Egyptians' healthy life expectancy, a measure that combines longevity with quality of life.

Young people, who consume the largest quantities of sugary drinks, and women, among whom obesity rates are comparatively higher, would be the principal beneficiaries of such a policy.

South Africa has already implemented a similar tax, leading to reductions in purchases of sugary beverages by as much as 32 percent.

Naturally, introducing such a measure in Egypt would face significant obstacles. Foremost among them is the powerful lobbying influence of soft drink manufacturers, processed juice producers, and the sugar industry.

Yet when weighed against the health of millions of Egyptians, the alarming statistics, and the realities witnessed every day, confronting—and exposing—these vested interests becomes not merely desirable, but essential.

Originally published in Al-Masry Al-Youm.