“One does away with drinks stall and some stop sales of sugary drinks in fight against diabetes” (Sweet Drinks Off The Menu At Primary Schools, Clara Chong and Raffaella Nathan Charles).
Against the background of a nationwide campaign to fight diabetes, moves by the Health Promotion Board (HPB) to encourage “schools to sell drinks with less sugar” (ST, Nov. 16) – so as to lower the consumption of carbonated drinks – are to be applauded.
Critics, however, are also justified to argue that these moves may be unnecessarily intrusive. Even if it is true that sugary beverages are unhealthy, and that students who are addicted to them from a younger age are more likely to develop more health complications in the future, they add, students should still be allowed to make their own choices. In fact, students who arrive at their own conclusions to stay away from these beverages – instead of being compelled to, or to be denied access altogether – could make more informed health or lifestyle decisions at a later age. Along this tangent, on a more practical and immediate note, changes within the school could push students to get their drinks and other sugary snacks from other sources such as neighbouring convenience stores or even their own homes.
HPB’s response to the critics and these potentially unintended consequences, therefore, should be to specify, to measure, and to compare the desired outcomes of its Healthy Meals in Schools Programme. At the moment, primary schools appear to have adopted three broad strategies: First, not having a drinks stall or vending machines in the canteen; second, encouraging vendors to sell drinks with less sugar or to remove carbonated drinks; and third, educating students on the effects of sugar consumption as well as the importance of leading a healthy lifestyle. When contrasting these different strategies – especially if it is assumed that not having a drinks stall or vending machines is the most effective – then the HPB and the schools should want to know if their students actually benefit from these arrangements.
A quasi-experiment, in other words, can be set up by the HPB. A simple design would involve three schools – ideally in the same neighbourhood, or within close proximity to each other – through which students, at the beginning of the year, are surveyed about their sugar consumption patterns, both in school and at home. Each of the three schools chosen for this experiment, respectively, would have in place each of the aforementioned strategies. And if the hypothesis about not giving students access to sugary drinks at all holds, when students are again surveyed at the end of the year about their sugar consumption patterns, then students from the first school should show the biggest reduction in consumption vis-à-vis their contemporaries from the other two schools. The other two strategies can be evaluated too.
Only with these results and data about outcomes in place, can the HPB definitively conclude the effectiveness of its moves.
Deeper dives into the mechanisms of these interventions, in this vein, can guide policy improvements and changes. If it is hypothetically found that students from schools without a drinks stall or vending machines do not consume fewer sugary beverages, then the HPB would be prompted to understand why: Is it because students are resourceful enough to buy their own? That the inability to consume sugary beverages in schools pushes them to do so outside of it, perhaps even more so, especially with peer influence and as they compare with their friends from the other schools? Or is the home and a student’s pattern of consumption even before they enter primary school more important predictors of later age consumption? Accumulating such knowledge, in the long run, will only benefit the HPB.
A version of this article was published in The Straits Times.