BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: SB 203 --------------------------------------------------------------- |AUTHOR: |Monning | |---------------+-----------------------------------------------| |VERSION: |April 6, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |April 22, 2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Reyes Diaz | --------------------------------------------------------------- SUBJECT : Sugar-sweetened beverages: safety warnings. SUMMARY : Establishes the Sugar-Sweetened Beverages Safety Warning Act, to be administered by the Department of Public Health, and requires a safety warning on all sealed sugar-sweetened beverage containers, as specified. Requires the warning label to be posted in a place that is easily visible at the point-of-purchase of an establishment where a beverage container is not filled by the consumer. Existing law: 1.Establishes the Department of Public Health (DPH) to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. 2.Establishes the Sherman Food, Drug, and Cosmetic Law (Sherman Act), which is administered by DPH, to regulate the contents, packaging, labeling, and advertising of food, drugs, and cosmetics in California. 3.Allows DPH, upon the request of a health officer, to authorize the local health department of a city, county, city and county, or local health district to enforce the provisions of the Sherman Act and its regulations that pertain to retail food establishments, as defined, if DPH determines that the local health department has sufficient personnel with adequate training to do so, and requires that the enforcement be limited to the area under the jurisdiction of the local health department. This bill: 1.Establishes the Sugar-Sweetened Beverages Safety Warning Act SB 203 (Monning) Page 2 of ? (SSBSWA) whereby a person, as defined, is prohibited from distributing, selling, or offering for sale in the state sugar-sweetened beverages (SSBs) in a sealed beverage container; in a multipack of sealed beverage containers; in concentrate form, as defined; on the premises where a vending machine or beverage dispensing machine, as defined, is located; and where SSBs are sold in unsealed beverage containers unless the container bears a safety warning, as specified, or the safety warning is posted on the premises, as specified, and otherwise meets all the requirements of this bill. 2.Defines "sugar-sweetened beverage" as any sweetened non-alcoholic beverage, carbonated or non-carbonated, sold for human consumption that has added caloric sweeteners and contains 75 calories or more per 12 fluid ounces. Specifies that SSBs do not include any beverage containing 100 percent natural fruit juice or natural vegetable juice with no added caloric sweeteners; any liquid product commonly referred to as a dietary aid; any product for consumption by infants and that is commonly referred to as infant formula; or any beverage whose principal ingredient by weight is animal milk or a milk substitute. Defines "animal milk" as natural liquid milk secreted by an animal and consumed by humans, including natural milk concentrate and dehydrated natural milk, whether or not reconstituted. Defines "milk substitute" as a plant-based beverage in which principal ingredients by weight are (1) water and (2) grains, nuts, legumes, or seeds, including, without limitation, almond, coconut, flax, hazelnut, oat, rice, and soy milks. 3.Defines "non-alcoholic beverage" as any beverage that contains less than one-half of one percent alcohol per volume. Defines "caloric sweetener" as any substance containing calories suitable for human consumption that humans perceive as sweet and includes, without limitation, sucrose, fructose, glucose, and other sugars and fruit juice concentrates. Defines "caloric" as a substance that adds calories to the diet of a person who consumes that substance. 4.Requires the safety warning to read "STATE OF CALIFORIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay" on the front of SSB sealed beverage containers, separate and apart from all other information, on a contrasting background, and entirely in bold SB 203 (Monning) Page 3 of ? type; to be affixed to an SSB beverage container in a manner that it cannot be removed without thorough application of water or other solvents if the warning is not printed directly on a sealed container; to be printed on at least two sides of an SSB multipack and on each individual sealed container inside the multipack; and to be printed on the front of the packaging of a concentrate, as defined. 5.Requires every person who owns, leases, or otherwise legally controls the premises where a vending machine or beverage dispensing machine is located, or where SSBs are sold in an unsealed container, to place, or cause to be placed, a safety warning a) on the exterior of any vending machine that includes SSBs, b) on the exterior of any self-serve beverage dispensing machine, and, c) at the point-of-purchase where any consumer purchases an SSB in an unsealed beverage container, when the container is filled by an employee of a food establishment rather than by the consumer. 6.Allows DPH to assess a civil penalty of not less than $50 but no greater than $500 for any violation of the SSBSWA or any regulation by DPH. Specifies that a person is not to be found in violation of the SSBSWA more than once during any one inspection visit. 7.Creates in the State Treasury the Sugar-Sweetened Beverages Safety Warning Fund consisting of moneys collected for the violation of the SSBSWA, which is to be appropriated by the Legislature for allocation to DPH for the purpose of enforcing the SSBSWA. 8.Requires DPH to adopt regulations to implement the SSBSWA. Allows the department to adopt regulations to develop new language for the safety warning, after appropriate investigation and consultation with the State Health Officer. 9.Makes findings and declarations about obesity and type 2 diabetes rates and resulting health costs in the state, as well as the link among obesity, diabetes, and dental caries and SSB consumption. 10.Specifies that the provisions of the SSBSWA are severable and that any provision or its application that is held invalid cannot affect other provisions or applications that can be given effect without the invalid provision or application. SB 203 (Monning) Page 4 of ? FISCAL EFFECT : This bill has not been analyzed by a fiscal committee. COMMENTS : 1.Author's statement. According to the author, California is in the midst of an obesity and diabetes epidemic that is wreaking havoc on the public's health. SSBs are a major contributor to the problem. SB 203 would provide information to consumers to make informed choices by requiring warning labels-similar to those on tobacco and alcohol-that explain the proven health risks associated with drinking SSBs. The science is clear and conclusive. Overwhelming research has unequivocally shown that SSBs are major contributors to obesity, diabetes, and tooth decay, which cost California billions of dollars in health care and lost productivity annually. Nearly 40 percent of California children are currently overweight or obese. Liquid sugar has a unique role in driving today's skyrocketing cases of preventable diabetes. Individuals who drink one or two sugary drinks per day have a 26 percent higher risk for developing type 2 diabetes. If current trends are not reversed, it is predicted that one in three children-and nearly half of Latino and African-American children-born in the year 2000 will develop type 2 diabetes in their lifetime. SSBs are the biggest contributor of added calories in the American diet and are unique in not providing any nutritional value. 2.SSB consumption. According to the U.S. Department of Agriculture, in 2009, Americans consumed 13.8 billion gallons of SSBs, which equates to nearly 45 gallons per capita annually of SSBs with added caloric sweeteners. According to the UCLA Center for Health Policy Research, in California, 41 percent of children ages 2-11 and 62 percent of adolescents ages 12-17 drink at least one SSB every day. In addition, 24 percent of adults drink at least one SSB on average per day. Adults who drink SSBs occasionally (not every day) are 15 percent more likely to be overweight or obese, and adults who drink one or more SSBs per day are 27 percent more likely to be overweight or obese than adults who do not. According to a report produced by the Robert Wood Johnson Scholar's Program, SSBs were the single largest contributor to energy intake during the last decade, and SSB consumption has increased by almost 500 percent during the past 50 years. SB 203 (Monning) Page 5 of ? 3.Obesity and other chronic diseases. DPH issued a study, The Burden of Chronic Disease and Injury, in 2013 that highlights some of the leading causes of death, such as heart disease, cancer, stroke, and respiratory disease, all of which have a strong connection to obesity. Diabetes is another serious chronic disease stemming from obesity that adversely affects quality of life and results in serious medical costs. The last decade has witnessed a 32 percent rise in diabetes prevalence, affecting some 3.9 million people and costing upwards of $24 billion per year. According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese, and approximately 12.5 million children and adolescents ages 2 to 19 years are obese. Research indicates a tripling in the youth obesity rate over the past three decades. While this increase has stabilized between the years 2005 and 2010, in 2010, 38 percent of public school children were overweight and obese. Overweight youth face increased risks for many serious detrimental health conditions that do not commonly occur during childhood, including high cholesterol and type 2 diabetes. Additionally, more than 80 percent of obese adolescents remain obese as adults. 4.Consumer view of SSBs. In February 2014, the Field Research Corporation released a poll of 1,002 registered voters in California on behalf of The California Endowment. The poll found that, statewide, 74 percent of voters support a requirement that beverage companies post health warning labels on SSBs to alert consumers that their daily consumption contributes to diabetes, obesity, and tooth decay. The requirement also carries strong bipartisan support. The poll also found that nearly two in three voters continue to support taxing the sale of SSBs and to use the proceeds for school nutrition and physical activity programs for kids and distributing the revenues to schools, public health departments, and local community programs across the state based on each community's diabetes and obesity rates, so places with higher rates would get more. Further, the poll found that seven in 10 Californians support changing the rules governing the food assistance program so that recipients cannot use the food assistance benefit to buy SSBs. The Rudd Center for Food Policy & Obesity at the University of Connecticut released a study in which 982 parents with at least one child aged two to 17, from an ethnically diverse SB 203 (Monning) Page 6 of ? population sample, were asked about SSBs. The survey found that one-third or more of parents relied on packing claims, such as "low-calorie," "real/natural," and "vitamin C," to influence SSB purchasing decisions. Many parents believe that SSBs with such marketing claims, which may imply they provide essential nutrition, are a healthy option for their children, particularly flavored waters and fruit and sports drinks. 5.Nutrition Facts label update. In February 2014, the FDA announced an update to the Nutrition Facts label on food packages to reflect new public health and scientific information, including evidence on nutrition, obesity, and chronic diseases. According to the FDA Web site, the update will reflect amounts of food people are actually eating and drinking now as opposed to 20 years ago when the Nutrition Facts label was first introduced. The FDA further states that serving sizes must be based on amounts of food and drink that people customarily consume, not on what people should be eating. People are generally eating more today than 20 years ago. The FDA set current reference values in 1994, based primarily on Nationwide Food Consumption Surveys conducted in 1977-78 and 1987-88, according to the FDA's Web site. The FDA states that the pending changes reflect new dietary recommendations, consensus reports, and national survey data and also reflect input obtained through four advance notices of proposed rulemaking and numerous citizens' petitions. According to the FDA, Americans on average eat 16 percent of their total calories from added sugars, the major sources being soda, energy and sports drinks, grain-based desserts, sugar-sweetened fruit drinks, dairy-based desserts, and candy. The proposed requirement to declare "added sugars" in addition to the total sugar requirement on the Nutrition Facts label was decided after taking into account new data and information, including U.S. consensus reports and recommendations, a citizen's petition, and public comments, according to the FDA. In an April 2015 email from Nutrition Programs staff in the Office of Nutrition, Labeling, and Dietary Supplements, FDA Center for Food Safety and Applied Nutrition, the FDA states that it is working on drafting a final rule for the Nutrition Facts label regulation. Final rules become effective 60 days after the final rule's publication in the Federal Register with a compliance date two years after the effective date, SB 203 (Monning) Page 7 of ? according to the FDA. 6.Providing understandable caloric information to consumers. A study published in December 2014 in the American Journal of Public Health, "Reducing [SSB] Consumption by Providing Caloric Information: How Black Adolescents Alter their Purchases and Whether the Effects Persist," concluded that one promising environmental program to reduce consumption of SSBs is to provide consumers with easily interpretable caloric information. In an area with six corner stores close to middle and high schools in Maryland, consumers were presented with information about caloric intake on signs posted on the stores' beverages cases that included the time necessary to burn off those calories in the form of a physical activity, such as running or walking. When provided with easily understandable caloric information, consumers purchased smaller servings of SSBs, switched from an SSB to a beverage with no calories, or opted not to purchase a beverage at all. The study found that providing the easily understandable caloric information had a persistent effect on reducing SSB purchases for approximately six weeks after the signs with the caloric information were removed. 7.Related legislation. AB 1357 (Bloom), establishes the Children and Family Health Promotion Program within DPH and consists of a competitive grant process in which grants are awarded to counties, cities, nonprofit organizations, community-based organizations, and licensed clinics that seek to invest in childhood obesity and diabetes prevention activities and oral health programs. This bill makes legislative findings and declarations relating to the consumption of SSBs, childhood obesity, and dental disease. AB 1357 is set for hearing in the Assembly Health Committee on April 21, 2015. SCR 34 (Monning), proclaims the month of September 2015, and each year thereafter, as Childhood Obesity Awareness Month, and expresses the Legislature's support of various programs that work to reduce obesity among children, including those that increase access to affordable healthful foods and beverages and provide less access to high-calorie foods and SSBs. SCR 34 has been ordered to third reading in the Senate. 8.Prior legislation. SB 1000 (Monning), of 2014, was identical to this bill. SB 1000 failed passage in the Assembly Health Committee. SB 203 (Monning) Page 8 of ? SB 622 (Monning), of 2013, would have enacted the Sweetened Beverage Tax Law, which imposed a one-cent per fluid ounce tax on any beverage that adds caloric sweeteners, such as sodas, energy drinks, sweet teas, and sports drinks. SB 622 would have required funds generated by the Sweetened Beverage Tax to be directed to the newly created Children's Health Promotion Fund and allocated to statewide childhood obesity prevention activities and programs. SB 622 was held under submission in the Senate Appropriations Committee. AB 1746 (Williams), of 2012, would have, commencing July 1, 2013, restricted the sale of electrolyte replacement beverages in middle schools and high schools to specified times before and after school. AB 1746 was held under submission in the Assembly Appropriations Committee. AB 669 (Monning), of 2011, was SB 622's predecessor. AB 669 was held in the Assembly Revenue and Taxation Committee. AB 2100 (Coto), of 2010, would have imposed a one cent tax per teaspoon of added sweetener in a bottled sweetened beverage or in a sweetened concentrate. AB 2100 was held in the Assembly Revenue and Taxation Committee. SB 1210 (Florez), of 2010, was a measure similar to SB 622. SB 1210 was placed on the former Senate Revenue and Taxation Committee's suspense file. 9.Support. Supporters of the bill argue that consumption of SSBs has been linked to the development of obesity, diabetes, and tooth decay, as well as other health-related issues. They state that the prevalence of overweight children has more than quadrupled and that research indicates taste preference and lifelong habits are formed in early childhood. Supporters further argue that health-relates illnesses linked to SSB consumption are having a disastrous effect on public health and health care costs, citing that the average cost for a hospitalization of a patient with diabetes is about $2,200 more than for patients without diabetes. 10.Opposition. Opponents argue that this bill exposes manufacturers and retailers of SSBs to significant liability and litigation just because a consumer chose to consume an SSB. They also claim that this bill would have a negative SB 203 (Monning) Page 9 of ? impact on jobs in the state and say that education, rather than regulation, should be the goal in providing consumers with information about SSBs. The California/Nevada Beverage Association cites a recent RAND Corp. study on the fast-food ban in South Los Angeles that concluded there is no simple resolution to a complex public health challenge like obesity and diabetes. SUPPORT AND OPPOSITION : Support: California Black Health Network (cosponsor) California Center for Public Health Advocacy (cosponsor) Health Officers Association of California (cosponsor) Latino Health Access (cosponsor) Action Network Alameda County Board of Supervisors AltaMed Health Services Corporation American Cancer Society Cancer Action Network American Diabetes Association American Federation of State, County and Municipal Employees, AFL-CIO American Heart Association/American Stroke Association Asian Law Alliance Asian and Pacific Islander American Health Forum Asian and Pacific Islander Obesity Prevention Alliance Berkeley Media Studies Group Blue Shield of California California Academy of Family Physicians California Academy of Physician Assistants California Association for Health, Physical Education, Recreation and Dance California Chapter of the American Association of Clinical Endocrinologists California Chapter of the American College of Cardiology California Children's Hospital Association California Chiropractic Association California Dental Association California Dental Hygienists' Association California Dietetic Association California Food Policy Advocates California Immigrant Policy Center California Medical Association California Naturopathic Doctors Association California Nurses Association/National Nurses United SB 203 (Monning) Page 10 of ? California Pan-Ethnic Health Network California Park & Recreation Society California Pharmacists Association California Physical Therapy Association California Primary Care Association California Project LEAN (Leaders Encouraging Activity and Nutrition) California Public Health Association - North California Rural Legal Assistance Foundation California School-Based Health Alliance California School Nurses Organization California State Alliance of YMCAs California WIC Association Center for Collaborative Solutions Center for Communications, Health & the Environment Center for Ecoliteracy Center for Science in the Public Interest Central California Alliance for Health ChangeLab Solutions Charles R. Drew University of Medicine and Science Children Now Children's Hospital Oakland City of Richmond City of South El Monte Community Bridges Contra Costa County Councilmember Laurie Capitelli, City of Berkeley Cultiva La Salud Day One Diabetes Coalition of California Dignity Health First 5 Association of California First 5 Monterey County 47 Games, Inc. Having Our Say Coalition Health Access California Health Improvement Partnership of Santa Cruz County Healthy & Active Before 5 Hunger Action Los Angeles Junior League of Monterey County Khmer Girls in Action Latino Coalition for a Healthy California Latino Health Access Lucille Packard Children's Hospital Stanford Maternal and Child Health Access SB 203 (Monning) Page 11 of ? Napa County Board of Supervisors National Coalition for 100 Black Women Sacramento Network of Ethnic Physician Organizations Pacoima Beautiful Physicians for Social Responsibility Prevention Institute Public Health Institute Roots of Change San Diego Hunger Coalition San Francisco Medical Society San Francisco Unified School District Santa Clara County Board of Supervisors Santa Monica Family YMCA SEIU California Shape Up San Francisco Coalition South Asian Network Southern California Public Health Association Strategic Alliance for Healthy Food and Activity Environments Sunnyvale School District Board of Education UCLA Housing & Hospitality Services Department Venice Family Clinic Vice Mayor Linda Maio, City of Berkeley YMCA of Burbank California YMCA of the Central Coast YMCA of the Channel Islands YMCA of Greater Long Beach YMCA of Greater Whittier YMCA of Metropolitan Los Angeles YWCA of Watsonville Zion Hill Baptist Church One individual Oppose: CalAsian Chamber of Commerce California Automatic Vendors Council California Chamber of Commerce California Grocers Association California Hotel and Lodging Association California Hispanic Chambers of Commerce California Independent Oil Marketers Association California League of Food Processors California Manufacturers and Technology Association California/Nevada Beverage Association California Retailers Association SB 203 (Monning) Page 12 of ? California Restaurant Association California Service Station and Auto Repair Association California Teamsters Public Affairs Council California Travel Association Can Manufacturers Association Civil Justice Association of California Grocery Manufacturers Association International Franchise Association Juice Products Association Los Angeles Area Chamber of Commerce Los Angeles County Business Federation National Automatic Merchandising Association National Federation of Independent Business SPI: The Plastic Industry Trade Association Valley Industry and Commerce Association 7-Eleven -- END --