Why economist Bram Wouterse wants to break the power of the sugar industry

Bram Wouterse can imagine living in a world without cigarettes: “The optimal number of cigarettes per day seems to be zero. We can do without, and there is political consensus on that.” Our take on sugar is less conclusive. Most people, Wouterse himself among them, would not want to do without it, but for our overall health it would be better to consume less of it. This is precisely why sugar consumption is a rewarding topic for Wouterse. ‘One has to look for what is optimal, and there are various dials to turn.’

One such dial is the sugar tax. When sugar becomes more expensive, people consume less of it, as was found in the UK, where a sugar tax has been in place since 2018. Wouterse, as an econometrician and health economist, can build a model in which he calculates the lifetime effects of such a measure. “A single measure does not alter people’s behaviour drastically. But if everyone consumes a little less sugar due to price increases, it makes a difference to a population’s health.”

According to Wouterse, how much sugar people ought to consume to live healthy lives is not for economists to decide. They do know that people are not rational beings, make wrong choices and are not quite clear on what is good for them. The question for Wouterse is: then who does know? Don’t expect political statements or activism from him: he prefers to stick to empirical research.

Still, as an economist he was challenged to think about the more fundamental question of where the need for sugar comes from. Economists do in fact turn out to have a responsibility there, as he discovered on reading The World of Sugar: How the Sweet Stuff Transformed our Politics, Health, and Environment Over 2,000 Years by Ulbe Bosma. In this book, Bosma outlines how, among other things, the rise of the sugar beet boosted sugar consumption. All European countries that did not have access to colonies with sugarcane started protecting their own sugar beet by boosting sugar consumption, causing people to eat more sugar.

“While economists tend to think that people make free choices, the book shows that our partiality to sugar did not come about for no particular reason. This partiality was determined by industrial policy and trade interests”, Wouterse says. “The economic market in which we live and consume has an impact.” The book gave Wouterse the idea of building a new economic model. Where Ulbe Bosma describes the historical perspective, Wouterse aims to explore how certain market structures are related to health outcomes.

He can feed that model with data that is already available. In the UK, people lived on sugar rations for about eight years after World War II. “Children born after 1953, the year the ration was abolished, consumed more sugar than the generation before them, with consequent long-term health effects (more type 2 diabetes – eds.).”

The research in the UK was done with empirical data, with actual people. Wouterse is setting himself the task of modelling the future long-term effects of policies on health. He is aware that such a model is always weaker than empirical data, that a model involves assumptions and that effects are often fairly small. “Even if it’s limited, it’s better than going around in circles with competing policy philosophies.”

Wouterse’s main focus in recent years has been on the behaviour of individuals and how to change it. He knows this will provoke resistance. “People have other priorities. But if you put the onus on the industry and tell people that the industry’s power must be broken, this is an attractive narrative and perhaps a more effective one.”

Bram Wouterse is associate professor at the Erasmus School of Health Policy & Managment. His research focuses on the relationship between health and healthcare costs, the sustainability of healthcare spending, elderly care, prevention and socioeconomic inequalities in health and healthcare use. He is president of the Vereniging voor gezondheidseconomie and coordinates the ESHPM Academy.