Developing Policy on Sugar-sweetened Beverages for Children and Adolescents in China

AbstractBackground China has witnessed a rapid increase in the prevalence of diabetes and childhood obesity over the past decades with an alarming increase in free sugar consumption, especially through sugar-sweetened beverages (SSBs). However, there are no national policies on SSBs in China. Little is known about the acceptability, adaptability, and scalability of policies on SSB consumption in China. Therefore, this study aims to explore stakeholder perceptions on the introduction of SSB policies and implementation challenges in China, and draw policy implications from the information gained.

MethodsThis study design is adapted from a theoretical framework “Analyzing and addressing governance in sector operations”, with context analysis, qualitative interviews and stakeholder analysis. Semi-structured interviews were conducted with 37 stakeholders in Shanghai and Chongqing, China, including health commission officers, CDC officers, market regulation officers, academia, nutrition association, industries, and consumers (parents of children and adolescents).

Results Currently, there is a rising trend of SSB consumption among children and adolescents in China, and the interviewed stakeholders were aware of the change in behaviors. Different stakeholders shared different understandings of the rising SSB consumption trends and conflicting prospects on whether SSB policies should be introduced in China. Besides, they also expressed different views on the choice of SSB policies, effectiveness, acceptability, and scalability. Most policy makers and nutrition experts agreed that health education is the most important and appropriate strategy to control SSB consumption by Chinese children and adolescents, and market regulation officers believe stricter policies such as taxes and mandatory front-of-pack labelling would be effective. On the other hand, industry stakeholders would prefer step-by-step policies including policies with multiple stages and voluntary labelling, wishing to create a better transition period for the market to respond. Furthermore, the interviewed consumers also observed the increasing trend of SSB consumption from their children. Some parents were aware of the health risk of excess SSB intake and believed in the positive impact of public health policy guidance, others would prefer the freedom to make their own choice as consumers and enjoy the sweet tastes of SSBs. In addition, perceived facilitators to the introduction of SSB policies include standard establishment or reform, the multi-sector collaboration of health, marketing, education departments and the industries, and step-by-step adaptation of SSB policies. Besides, potential challenges include responsibility distribution between different departments, resistance from industries, and consumer opposition.

ConclusionThis study examined the perceptions of SSB policy introduction among different Chinese stakeholders, including policy makers, nutrition experts, the industry and consumers. Although the SSB intake among Chinese children and adolescents is growing, interviewed stakeholders showed inadequate knowledge and awareness of SSB policies. Valid policy action on a national scale would require national standard reforms, as well as improving awareness of policy makers and the nutrition literacy of Chinese consumers. Future studies could conduct formative research and collect implementation evidence to better facilitate the establishment of SSB policies in China.