It’s not about the money

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A macro-image of sugar granules laid along the markings on a ruler. Photo: Lauri Andler (Phantom)/ creativecommons.org

By HEALTHY LIVING ALLIANCE

Negotiations between the government, business and labour balanced the government’s initiatives to stem the terrible tide of disease caused by excessive sugar consumption, versus job losses. An adapted form of the the long-discussed sugar tax will be implemented in April 2018. The Healthy Living Alliance, which has argued strongly for the tax, argues here for the benefits of the tax.

The tax on sugary drinks

The government is set to apply a tax of about 11% on certain sugary drinks [in April 2018]. No such tax will apply to artificially sweetened “light” drinks or plain bottled water, which will become a cheaper option for consumers.

The tax has been introduced not to increase revenue but to reduce national consumption of sugary drinks as part of a national obesity prevention campaign.

  • These drinks are a source of highly concentrated sugar and sugar is a major cause of obesity.
  • Obesity is a well-established risk factor for diabetes, heart disease, hypertension, strokes and certain cancers.
  • These non-communicable diseases are running rife in South Africa and are a major cause of disability and death.

South Africa is one of the world’s top 10 consumers of sugary drinks[i] and consumption has been growing at about 3% a year[ii]. Recent growth has been highest among low-income households, the All Media Products Survey shows.

 

Why should you care about this tax?

Diabetes has become the number one cause of death among South African women and the second most common cause of death in the total population, according to Stats SA. Diabetes is a complex disease and its causes are multiple. However, the increase in diabetes in our country is unquestionably linked to the increase in obesity, particularly among women.

  • South African women have the highest obesity rate in Sub-Saharan Africa
  • 63% South African women are overweight or obese, compared to 51% women globally.[iii]
  • 82% of South African women are overweight by the time they reach the age of 45 years
  • Women living in urban areas have a higher likelihood of becoming obese compared to those in rural communities

 

Obesity is a risk factor for several life-altering health conditions

Obesity is the underlying cause for the steeply increasing cases of hypertension, cerebrovascular diseases (which include strokes) and heart disease. The development and recurrence of endometrial cancer, cervical cancer, breast cancer and other types can be attributed, in part, to obesity. Other conditions that overweight and obese women are low back pain and knee osteoarthritis.

 

What difference will it make to reduce sugary drinks intake?

Reducing the population’s intake of sugary drinks won’t, on its own, solve the obesity and non-communicable disease epidemics. But global research shows that it will have a significant impact in reducing and preventing these diseases.  Addressing the high consumption of sugary drinks in South Africa is a key starting point to tackling obesity prevention.

The tax on sugary drinks is a powerful but simple way to discourage consumption of one of the strongest drivers of obesity, diabetes and other non-communicable diseases – and, of course, tooth decay.

  • Sugary drinks are a major cause of increased calorie intake, weight gain, diabetes, hypertension and other diseases.[iv]
  • These calories are “empty” – they have no nutritional benefit– and people don’t count the calories in drinks the way they count calories in food, which can lead to overconsumption and weight gain.[v]
  • The sugars in sugary drinks are concentrated (an average of nine teaspoons per 330ml can) and alter the body’s metabolism, affecting insulin, cholesterol and metabolites that cause high blood pressure and inflammation.[vi]
  • Large amounts of liquid sugar are especially harmful to the liver because they are so quickly absorbed.[vii]

There is solid evidence that our government is starting in the right place by targeting the consumption of sugary drinks. In addition, its chosen strategy – a tax on consumption – is easy to administer, applies equally across the country, and costs virtually nothing while generating revenue that could be used to promote healthier living.

 

Will the tax work or will people just suck up the higher price?

Targeted taxes have been successful in reducing behaviour that is damaging to health. For example, hefty tobacco taxes have reduced smoking in numerous countries – South Africa is a global success story for the impact of tobacco taxes which halved smokers by 4 million in one generation. Taxes were used successfully in Denmark to deter shoppers from buying products with saturated fats and in Hungary to reduce consumption of processed foods with high levels of specific ingredients, including sugar and salt. [viii]

While these strategies do not work with every individual, their impact across entire populations can be significant.

A few countries have implemented a tax on sugary drinks, as have some cities in the United States. Not all of have collected statistics on the impact, so the evidence on the effect of this type of tax is limited.

However, Mexico – which once had the highest consumption of sugary drinks worldwide – introduced a 10% tax on sugary drinks in 2014 and has conducted two studies on the effect.[ix] These showed that:

  • The tax was associated with a clear reduction in demand for sugary drinks. At the end of the first year, consumption was down by 5.5% and public health experts estimated that, if this drop was sustained, 200 000 new cases of diabetes would be averted.
  • The decrease in consumption of sugary drinks has grown over time. In the second year, the total decrease in consumption was 9.7% and the projected health benefits had grown proportionally.
  • Sales figures showed that some consumers have switched to healthier options, including bottled water.
  • The reduction in consumption of sugary drinks has been greatest among low-income groups who are most sensitive to price increases.

The World Health Organisation reviewed international use of tax policy to encourage healthy behaviour and concluded that a sizable tax of 20% or more was more likely than a modest tax to provide the incentive needed to alter behaviour.

The South African government initially proposed levying a 20% tax on sugary drinks but this was reduced to11% in the 2017 Budget Speech to Parliament. Taxes on alcohol and tobacco are revised upwards each year and the government may find it needs to adjust the sugary drinks tax in future.

 

If the tax is a good start, what else do we need to do?

The Healthy Living Alliance encourages South African to think of access to healthy food and clean water as a right. We should strive to enjoy this right and we should defend it when others undermine it.

The government has a role to play in enabling us to make choices. For example, government policies can:

  • Ensure the sale of non-nutritional food is excluded from public schools and healthy food is made available.
  • Prescribe clear labelling of processed foods so we know what we are buying.

Information about healthy eating is widely available and we are able to recognise that poor dietary habits have made us an overweight nation.  As individuals and families, we need to ask hard questions about the eating habits that are putting our health at risk. We must make conscious choices about how we respond to the plentiful and very attractive high-calorie, low nutrition products that surround us.

We encourage South African women to wield their influence as consumers and members of communities to create an environment where nutritious food is affordable and easily available – and where health comes before commercial interests.

  •  The Healthy Living Alliance (HEALA) is an alliance of organisations and thousands of interested South Africans with this mission in mind. Its current member organisations are: Health-e News Services, Health Promotion and Development Foundation, Khulisa Social Solutions, Rural Health Advocacy Project, Section 27, South African Dental Association (SADA), South African Paediatric Association (SAPA), Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA), Amandla.mobi and Treatment Action Campaign (TAC).

For more information, please visit www.heala.org.

REFERENCES

[i] Singh GM, Micha R, Khatibzadeh S, et al. Global, regional and national consumption of sugar-sweetened beverages, fruit juices and milk: a systematic assessment of beverage intake in 187 countries. PLoS ONE 2015; 10(8): e0124845.

[ii] Popkin BM, Hawkes C. Sweetening the global diet, particularly beverages: patterns, trends and policy responses. The Lancet Diabetes and Endocrinology 2016; 4(2): 174-186.

[iii] Shisana O, Labadarios D, Rehle T, et al. South African national health and nutrition examination survey (SANHANES-1). Cape Town: HSRC: 2014.

[iv] DeliaValle DM, Roe LS, Rolls BJ. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? Appetite 2005; 44(2): 187-93. Malik, Popkin BM, Bray GA et all. Sugar-sweetened beverages, obesity, type 2 diabetes mellitis, and cardiovascular risk, Circulation 2010; 121 (11): 1356-64.

[v] Mourao DM, Bressan J, Campbell WW, et al. Effects of food form on appetite and energy intake in lean and obese youn

g adults. International Journal of Obesity (London) 2007; 31(11): 1688-95. DiMeglio DP, Mattes RD. Liquid versus solid carbohydrates: effects on food intake and body weight. In J Obes Relat Metab Disord 2000; 24(6): 794-800.

[vi][vi] Malik VS, Hu FB. Fructose and cardiometabolic health: what the evidence from sugar-sweetened beverages tells us. Journal of the American College of Cardiology 2015; 66(14): 1615-24. Malik VS, Popkin BM, Gray GA et al. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010; 33(11): 2477-83. Te Morenga LA, Howatson AJ, Jones RM, et al. Dietary sugars and cardiometabolic risk: systematic review and meta-analysis of randomised controlled trials of the effects on blood pressure and lipids. The American Journal of Clinical Nutrition 2014; 100(1): 65-79.

[vii] Johnson RJ, Segal MS, Sautin Y, et al. Potential role of sugar in the epidemic of hypertension, obesity, and the metabolic syndrome, diabetes, kidney disease and cardiovascular disease. American Journal of Clinical Nutrition 2007; 86(4): 899-906. Stanhope KL. Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. Annual Review of Medicine 2012; 63: 329-43.

[viii] World Health Organisation. Fiscal policies for diet and prevention of non-communicable diseases. Geneva: WHO: 2015.

[ix] Studies conducted jointly by the Mexican National Institute for Public Health and the Gillings School of Global Public Health, University of North Carolina, Chapel Hill in the United States.

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