What Happens in Berkeley... Goes National

Many change makers, who don't necessarily want to risk being the first, are ready, once they see success, to follow in its footsteps. That's how norms change works -- each effort leads to greater success in the next round.
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It's amazing how quickly a good idea can gain currency and public attitudes can shift when people -- and the media -- think and talk intelligently about it. Just look at the overwhelming support -- 75 percent! -- that voters in our neighboring city of Berkeley, California, gave to a penny-an-ounce soda tax in this month's election. Across the Bay, 55 percent of San Franciscans voted for an even bigger tax. (Unfortunately, it needed a two-thirds majority to pass.) This despite the $10.4 million -- or $40 per voter -- the soda industry spent against the two measures.

I know that what happened in Berkeley and San Francisco won't stay in Berkeley and San Francisco. It's clear that the Berkeley victory and the strong showing in San Francisco are inspiring advocates across the country and building the national momentum -- it's something we've seen with many movements to create policy change, whether it's tobacco, seatbelt laws or making infrastructure changes that enable people in wheelchairs to cross city streets.

Many change makers, who don't necessarily want to risk being the first, are ready, once they see success, to follow in its footsteps. That's how norms change works -- each effort leads to greater success in the next round.

Sometimes, even when initial efforts don't pass they pave the way for future success. When New York City lost a court battle to impose limits on the serving size of sugar-sweetened beverages, people saw that as a win for the soda industry. But the coverage advanced the conversation about how damaging sugar-sweetened beverages could be and inspired a dialogue about how best to create policy change to discourage soda consumption.

As the New York policy was being fought out in the courts, advocates put soda-tax measures on the ballot in two small California cities, Richmond and El Monte. The American Beverage Association spent almost $4 million against them and cynically navigated the racial dynamics of the cities by portraying the measures as regressive taxes that would boost the grocery bills of working-class people of color. Both measures were defeated handily -- but they amplified the conversation over sodas and health, which health advocates and voters in Berkeley and San Francisco eagerly continued.

Roger Salazar, spokesman for the soda industry-funded campaign against the Berkeley soda tax, initially predicted it would suffer the same fate as the Richmond proposal. "It was defeated fairly overwhelmingly," Salazar said. "I think we'll see something similar here (in Berkeley)." But as the measure's support held, Salazar attacked city council members for engaging in "an exercise of vanity" and ridiculed Berkeley as an "anomaly."

He's wrong again. The victory in Berkeley, accompanied by the majority vote in San Francisco, is a tipping point for change. I've seen it in every community policy initiative I've been involved in. Once norms change begins it's inexorable. Many times legislators are just waiting for someone else to be first, so I see Berkeley as a trendsetter. It was among the first cities to put curb cuts in sidewalks to accommodate people in wheelchairs and to restrict smoking in public places. But Berkeley isn't the only place to pioneer policy changes that support public health and safety. It was more conservative Tennessee that passed the nation's first carseat law, and within 15 years we had laws in every state. And it was all eighteen ethnically and economically diverse cities of Contra Costa, California, that passed the nation's first multi-city no-smoking law.

I see a lot of similarities between the efforts to enhance prevention in these other areas and the efforts to reduce and tax soda. When I began working with colleagues in the 1970s and 1980s to restrict public smoking, tobacco companies spent millions of dollars lobbying, advertising, and trying to discredit evidence about the harms of their product. We were attacked and criticized for infringing on people's freedoms; our efforts were dismissed as quixotic and futile. Big Tobacco shifted its arguments over time, and now we see Big Soda doing the same. In the late 1960s, the tobacco industry, according to internal memos, wanted to "set aside in the minds of millions the false conviction that cigarette smoking causes lung cancer and other diseases; a conviction based on fanatical assumptions, fallacious rumors, unsupported claims..."

We saw the same kinds of arguments form the auto industry in opposing air bags and other safety measures, the same kinds of arguments from the petroleum industry in opposing lead poisoning legislation.

By the mid-1980s, refuting the science was a lot tougher so the industry went after anti-tobacco advocates. "We must attack the anti-smoking groups and zealots more confidently," said one memo. "Perhaps we could commission a book on the 'anti-industry industry' and show that our attackers actually make money out of their activities."

As one city after another took steps to limit smoking and protect people's health, people's views around the acceptability of cigarettes and public smoking shifted dramatically. Norms changed. Big Tobacco, for all its money and political influence, was unable to stop the inexorable push for policy change demanded by people no longer willing to put their health at risk. Now, diabetes and other diet-related chronic diseases have become huge and expensive public health problems -- and the link to sugar-sweetened beverages has become crystal-clear. And again, public health advocates are starting to gain traction as they push for policy changes that discourage consumption. These first policy proposals, while not immediately successful, are starting to change public attitudes towards Big Soda and its unhealthy products. By the next election we will see many more ballot initiatives to reduce soda consumption and enhance prevention. In time, these local policy decisions will bubble up to the state and national level. The effort to discourage unhealthy food and beverages is just beginning.

New research is documenting the supersized role sugar-sweetened beverages plays in fueling the diabetes epidemic and providing evidence that soda taxes can reduce consumption. The strongest evidence may come from Mexico, which passed a peso-per-liter tax on soda at the beginning of 2014. The result? In the first six months of 2014, soda consumption declined 10 percent and sales of bottled waters jumped 13 percent, according to Mexico's National institute of Public Health. This is just what you want to see in a country where the average person consumes 43 gallons of soda a year and where 90,000 people died from diabetes in 2012, up from 47,000 in 2000.

"The consumption of sugary drinks is a direct causal factor of diabetes and death, making the battle to reduce sugary drink consumption throughout the Americas a critical public health issue," said Alejandro Calvillo of El Poder del Consumidor, the consumer rights group that pushed the Mexican soda tax.

In Mexico, legislators have pledged to use some of the soda-tax revenue to increase access to clean drinking water and build water fountains in schools. Calvillo and his fellow activists will be pushing hard to make sure they follow though. Berkeley's measure established a panel of experts that will recommend how the revenue there can be used to promote children's health.

The point is that soda taxes -- like taxes on alcohol or even marijuana -- can not only discourage consumption, they also can help create sustainable sources of investment for prevention and public health activities. At Prevention Institute, we call this "closing the loop" and laid out our ideas in a recent paper published by the Institute of Medicine.

I was thrilled to visit Mexico last year when the Mexican soda tax was being passed. And now I'm just as happy that Berkeley has become the first city in the U.S. to pass a tax on soda. As my colleague Lori Dorfman of Berkeley Media Studies Group put it, Richmond and El Monte "threw big pebbles in the soda tax water" in 2012 and just two years later "Berkeley and San Francisco have pushed boulders in." It's important -- it's about saving lives and supporting health.

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