NATASHA STURGESS

Mr Gan Kim Yong
Ministry of Health
16 College Road
College of Medicine Building Singapore 169854

6th March 2022

Dear Minister,

I hope this letter comes to you well. I am writing to you in light of the recent parliamentary budget debate on the 28th February 2022, to which Sembawang Minister of Parliament (MP) Poh Li San proposed the regulation and reduction of bubble tea out of concern for rates of obesity and diabetes in our community (MCI 2022). In response, I intend to advocate for further investment into sugar alternatives and sustained intervention to ensure healthy consumer choices in our nation.

In a few months, I am graduating from my bachelor’s degree in Anthropology at University College London. I remember when I first decided to pursue the degree, having taken it as a teenager in School of the Arts believing that it can be used for good, especially within the medical sphere. In my gap year, whilst I began to volunteer with Joo Chiat GRC in Meet-the-People sessions and the elections, I  began to understand how decisions are made and adapted to the community at a grassroots level. I began to seriously consider the real life impact anthropology has the capacity to make when informing actions within our world.

As I pursue my dissertation research centred around Singaporean malay food practices and conceptualisations of health, I am increasingly affirmed about the possibilities of anthropology’s impact in policy research. I understand the suggestions that brought significant uproar from ‘netizens’ on social platforms such as Instagram, claiming suggestions like these are not useful nor relevant in the scheme of the wider community.

MP Poh presents a pressing concern – as well loved as the drink is, bubble tea is extremely high in sugar and remains largely unregulated in consumption, especially in comparison to packaged SSBs (Sugar Sweetened Beverages). In an article by Jalelah Abu Baker, it was reported from an experiment commissioned by CNA that brown sugar boba contains a whopping 92g of pure sugar, three times the amount of a coca cola can, excluding pearls and toppings (2019). Bubble milk tea contains on average even more, at 100% sweetness containing 102.5g of sugar, and with 500g as a portion size this means the sugar accounts for 1⁄5 of the entire drink (ibid). This is particularly worrying when considering that as of now, rates of obesity have hit an all-time high (Lim 2021) and almost half a million Singaporeans suffer from diabetes as of 2019 (Abu Baker).

That said, whilst I do also believe that her musings were very valid, I believe that  centring approaches more around sustained interventions would be more beneficial to in the long run, which can be done by making the healthier choice easier and more sustainable to make. Dr. Eric Finkelstein has looked at interventions within Singapore before, and suggests in his research that making the healthy choice accessible, while also making the unhealthy choice harder, was particularly useful in ensuring changes in behaviour (Philomin, 2016).

Such outcomes can be seen in programs such as the Healthier Choice Symbol (HCS) and Healthier Dining Programme (HDP). These initiatives increased the availability of healthy options, and incentivize healthier purchases both on the part of both consumers and suppliers (Chia, 2020). The approach combined both investment into healthier choices and implementation of financial policies to increase the price of SSBs, providing incentives for the purchasing beverages lower in sugar whilst at the same time increasing awareness of health risks that SSBs pose. With the combination of these approaches, making the ‘healthier choice’ became increasingly marketable and preferable to the consumers. (Krieger et al. 2021:440)

Such elements of choice in the face of have been explored in Mexico, where a sugar-sweetened beverage is implemented resulting in a decrease in purchase of taxed beverages, and a 4% increase in purchase of untaxed beverages. However this alone did not cause that much of an effect – as the effect was not as clear in 2015 it had been in 2014 what was first implemented (Colchero et al. 2017).  From this study, it was found that while taxing sugary products were at first useful, households in the long run adjusted their purchases to still purchase these products, meaning they in the long run purchased less of the food choices the governing body was trying to incentivise. Looking at this outcome with Dressler (2001) we see agency is multidimensional and is associated with affiliations that consequently define behaviour as opposed to singular factors. This means that, to bring sustained change in behaviour, one would have to culturally offer alternative options that are feasible, preferable and convenient, and devoid of this the likelihood of structural changes making a long-term impact is not high.

Applying that back to our understanding of sugar consumption, while I stress the importance of regulation, I believe that an agency-centred approach through instilling awareness and choice could be extremely valuable and sustainable in regulating consumption whilst not making citizens feel overly restricted. This I believe can be done by instilling a nutritional value transparency requirement onto companies selling bubble tea, or indeed most unpackaged processed food or drinks so individuals may be able to make an informed choice in their purchases instead of simply restricting outlets available.

Global health specialists Lesley Weaver and Emily Mendenhall (2014) also affirm this notion : they suggest that letting go of restrictive changes and focusing on promoting health and overall function is a better alternative towards ensuring the sustainability of public health programs than trying (often unsuccessfully) to restrict public action.

Such an approach could also open up the possibility of working with companies to develop sugar alternatives, which opens up markets and could even increase accessibility to say accommodate diabetics without posing significant risk, and is even ideal for economic growth and innovation. It is in such a manner, in combination to initiatives already being driven, that we can move forward as an aware population whilst still enjoying the same foods in moderation.

Holista CollTech, for example, has put into production a patented formula mixing the tapioca starch in boba with other ingredients such as guar gum, ladies fingers, fenugreek and lentils to create pearls that are both tasty and more nutritious, without such a high sugar content (Arulnathan,2021). Rajen Manicka, the CEO, elaborates upon how the pearls they have in production, while still of a similar texture, do not digest so quickly and do not cause such a sugar spike to consumers. The involvement of low sugar and low GI create alternatives to the rush, proving that they are in fact other ways of maintaining health without restriction, an investment in such programmes in the long term has the possibility of creating sustainable change, and not at the expense of choice and enjoyment.

Grab driver Tan Hong Ming  was interviewed by Jalelah Abu Baker in an article of hers encouraging better  awareness in consuming bubble tea products (2019). When enquired on his preferences towards sweet made-to-order drinks, he explained that he prefers to have drinks with a full sugar option as an aid for when he gets sleepy, and what consistently brings him back to consuming bubble tea drinks is the variety available in toppings and types. His consistent consumption of bubble tea is able to keep his blood sugar in a rush and his body continually craves more to maintain those levels of energy. I find this supports my suggestion of affordable accessible alternatives, they can be made to accommodate livelihoods such as Mr Tan who have already developed a dependency upon these drinks. Introducing alternatives would maintain individual responsibility and choice, yet allow them to enjoy their routines without placing their long term health at detriment, particularly important towards reinforcing agency within the community too, also contributing back to aspects of mental health.

I truly believe that through the introduction of better diet alternatives and educational support, individuals get on much better footing to tackle further mental health issues, especially those arising from stressors leading to and craving of unhealthy foods in the first place, to break the cycle of indulgence as a coping mechanism and reinforcement of safety and stability (Starr et al. 2021), another concern that was raised in MP Poh’s speech.

Food is much more than a simple calorie count or metric – what we eat and drink has as much to do with pleasure as it does physical health. As important as it is to reach ideal determinants of health on a countrywide scale, more must be kept into consideration towards a truly holistic representation of what being ‘healthy’ actually means.

As a young Singaporean, it is my primary aim to contribute in my own way to a healthy growing Singapore and I hope my perspective is able to deepen the conversations surrounding diet and public health, and that such considerations are kept in mind on implementation of further policy.

Kind Regards,

Natasha Sturgess

Works Cited

Lim, Vanessa. “Obesity Rate Rises to Highest Level since 2010; MOH Urges Public to Exercise and Adopt Healthier Diet.” Channel News Asia, November 18, 2021. https://www.channelnewsasia.com/singapore/obesity-rate-rises-highest-level-2010-moh-urges-p ublic-exercise-and-adopt-healthier-diet-2322321.

Arulnathan, John. “Is There Bubble Tea Even Diabetics Can Love? Low-Sugar, Low-Calorie Tweaks Are Being Made.” Channel News Asia . Accessed March 6, 2022. https://www.channelnewsasia.com/cnainsider/healthier-bubble-tea-even-diabetics-can-love-low -sugar-calorie-398741.

Baker, Jalelah Abu. “Sweeter than Soda? the Hidden Sugars in Bubble Tea.” Channel News Asia . Accessed March 6, 2022. https://www.channelnewsasia.com/singapore/bubble-tea-sugar-content-sweeter-than-coke-soda916016.

Chia , Shi Lu. “Obesity Trend and Programmes.” Ministry of Health. Ministry of Health, January 6, 2020. https://www.moh.gov.sg/news-highlights/details/obesity-trend-and-programmes.

Colchero, M. Arantxa, Juan Rivera-Dommarco, Barry M. Popkin, and Shu Wen Ng. “In Mexico, Evidence of Sustained Consumer Response Two Years after Implementing a Sugar-Sweetened Beverage Tax.” Health Affairs 36, no. 3 (2017): 564–71. https://doi.org/10.1377/hlthaff.2016.1231.

Dressler, William W. “Medical Anthropology: Toward a Third Moment in Social Science?” Medical Anthropology Quarterly 15, no. 4 (2001): 455–65. https://doi.org/10.1525/maq.2001.15.4.455.

Hardon, Anita, and Carolyn Smith-Morris. “Reconfiguring Metabolism: Critical Ethnographies of Obesity and Diabetes.” Medical Anthropology 38, no. 8 (2019): 777–80. https://doi.org/10.1080/01459740.2019.1681993.

Krieger, James, Sara N. Bleich, Stephanie Scarmo, and Shu Wen Ng. “Sugar-Sweetened Beverage Reduction Policies: Progress and Promise.” Annual Review of Public Health 42, no. 1 (2021): 439–61. https://doi.org/10.1146/annurev-publhealth-090419-103005. 5

Lobstein, Tim, Rachel Jackson-Leach, Marjory L Moodie, Kevin D Hall, Steven Gortmaker, Boyd A Swinburn, W Philip James, Youfa Wang, and Klim McPherson. “Child and Adolescent Obesity: Part of a Bigger Picture.” The Lancet 385, no. 9986 (2015): 2510–20. https://doi.org/10.1016/s0140-6736(14)61746-3.

Parliament Sitting 28 February 2022 (English Interpretation). YouTube . MCI , 2022. https://www.youtube.com/watch?v=V_KZ-qdc0_0&t=27292s&ab_channel=MCISingapore.

Starr, Rebecca Lurie, Christian Go, and Vincent Pak. “‘Keep Calm, Stay Safe, and Drink Bubble Tea’: Commodifying the Crisis of Covid-19 in Singapore Advertising.” Language in Society, 2021, 1–27. https://doi.org/10.1017/s0047404521000567. Today.  

“Sugar Tax among MPs’ Suggestions to Tackle Diabetes.” TODAY, 2016. https://www.todayonline.com/singapore/sugar-tax-among-mps-suggestions-tackle-diabetes. Weaver, Lesley Jo, and Emily Mendenhall. “Applying Syndemics and Chronicity: Interpretations from Studies of Poverty, Depression, and Diabetes.” Medical Anthropology 33, no. 2 (2014): 92–108. https://doi.org/10.1080/01459740.2013.8