Good health doesn’t need to be taxing

A child drinking a sugary drink

Barbados has doubled the excise tax on sugary drinks to 20% to tackle the growing burden of diseases including cancer on the Caribbean country. Maggie Wetzel explores what spurred Barbados into action, why fiscal measures are important and what other countries can learn.

The Prime Minister of Barbados, Mia Mottley, has always championed action on non-communicable diseases (NCDs), which are a major concern in the Small Island Development States (SIDSs) of the Caribbean, where half of the countries import in excess of 80% of what they consume and imported foods are predominantly ultra-processed high in sugars, fats and sodium (pdf).

In the Caribbean region, the prevalence of child overweight and obesity has increased substantially in the past 4 decades, from an average of less than 5% in 1980 to approximately 30% (pdf) in 2016. SIDSs comprise 12 of the 24 small islands with the highest prevalence of childhood obesity.

SSB tax in Barbados: getting it done

A girl drinks from a bottle of sodaTaxes on sugar-sweetened beverages (SSB) – recommended by the WHO and increasingly used by governments across the world – are an effective intervention to reduce sugar consumption.

Barbados introduced its SSB tax in 2015 – when just 10 countries worldwide had implemented such a policy. It targeted locally produced and imported sugary carbonated soft drinks, juice drinks, sports drinks, syrups and others. 100% natural fruit juice, coconut water, plain milk and evaporated milk, as well as powdered drinks and non-sugar sweeteners, were exempt.

An evaluation of the tax a year after implementation found a decrease in sales of SSBs and an increase in sales of bottled water. Of concern however, researchers also found that some consumers may have responded to the tax by purchasing cheaper sugary drinks, raising questions about the design of the tax.

Around the same time, the WHO published guidance recommending countries place taxes on SSBs of no less than 20%. In response to this and the ongoing national NCD crisis, the government of Barbados signalled plans to increase the tax – however the rate remained at 10% until now.

The COVID-19 pandemic catalysed a refocusing of CARICOM governments on the interlinked challenges of obesity, NCDs, and food and nutrition security, and the policy actions needed to urgently address these issues – including taxation of unhealthy foods and beverages.

Strong advocacy has been critical to reinvigorate Barbados’ push for tighter fiscal measures. National advocacy efforts to build community awareness and support for childhood obesity prevention policies were led by the Barbados Childhood Obesity Prevention Coalition, which was able to tap into the Prime Minister’s personal commitment to tackle NCDs.


It is anticipated that civil society advocates, academia and government partners, following the imposition of the tax, will increase their programmes and campaigns to inform and educate Barbadians about the public health benefits of the tax and of the reduction in sugar consumption, thus contributing to the desired outcome of the tax, which is the reduction of sugar intake. Sir Trevor Hassell, President Healthy Caribbean Coalition

Why fiscal measures matter

The Barbados tax increase is designed to be first and foremost a health tool to reduce sugary drink consumption as part of a broader effort to address NCDs, while at the same time generating revenue.

The WHO recommends that adults and children restrict consumption of free sugars to less than 10% of total daily energy intake (and preferably less than 5%). Sugar consumption in many countries exceeds this amount, with SSBs being a major contributor.

Other aims of SSB taxes are to generate revenue, ideally directed to health and/or NCD prevention; to raise public awareness about sugar consumption; and to reformulate products to reduce sugar content. SSB taxes to date have demonstrated that they increase price, decrease purchases, and reduce consumption, while also at times leading to product reformulation.

Globally, SSB consumption is increasing, prompting governments to implement fiscal policies in the hope of changing behaviour. Our NOURISHING database contains many examples: from Barbados, France, Mexico, Chile and the UK to mention a few, and includes evaluations on the effects. However, uptake of SSB taxes remains low; in the European region only 19% of countries have such a policy in place. Across the Caribbean Community (CARICOM) only 3 of the 20 countries tax SSBs.

Taxation is just the first step

Barbados is setting a good example for adopting a set of broader policies. The Prime Minister’s speech announcing the higher SSB tax rate acknowledged that taxes are just a part of creating healthy food environments. Barbados has been among a growing number of countries in the region pushing for the introduction of octagonal front of package nutrition warning labels. Currently, a comprehensive school nutrition policy which regulates the sale and marketing of unhealthy foods in schools is on its way to cabinet for approval.


Despite the high-level political support, it will not be an easy road ahead. There is significant opposition from some actors in the business sector who are supported by giants in the global ultra-processed food industry. Advocates and policymakers have their work cut out for them, but we have evidence on our side and Caribbean people, including people living with NCDs and the young, are mobilising and using their voices to demand healthy environments. We are optimistic that winds of change are blowing, and momentum is building across the region. COVID has shown us that we desperately need transformative change and moral leadership which puts people’s needs at the centre of policymaking. Barbados is walking the talk [pdf]; we are hoping this is just the beginning. Maisha Hutton, Executive Director Healthy Caribbean Coalition

SSB taxes and front-of-pack labelling are key elements of an integrated approach to tackling obesity and diet-related diseases. This means that a comprehensive package of policies is needed to enable healthy communities, including policies that influence the food environment, food system, built environments and behavioural change across the life course. Sets of complementary policies that contribute to healthier environments can be found in the 10 policy areas of the NOURISHING database.