Sugar tax is not pie in the sky

The soon-to-be-implemented sugar tax is backed by heaps of research and is a step in the right direction, but needs to be supported by an array of public health interventions to make a serious dent in South Africa's non-communicable disease scourge.

This was part of the UCT School of Public Health and Family Medicine's submission to Parliament in late 2016, and was impressed on the Portfolio Committee for Finance by Associate Professor Tolullah Oni just before the national budget speech in February this year.

In his last budget speech, Finance Minister Pravin Gordhan announced that from 1 April 2017 there will be a tax imposed on sugar-sweetened beverages.

In her presentation to Parliament, Oni pointed to South Africa's skyrocketing obesity and diabetes figures to argue that this was no bad thing.

People from low-income households were particularly susceptible to gaining weight due to drinking sugary drinks. South African children between 9 and 10 years old drink an average of 254 Coca-Cola products per year; the global average is 89, observed Oni.

This is unacceptably high, she said.

Oni argued that preventing non-communicable diseases (NCDs) should be a priority and that it requires a multi-sectoral approach, as key determinants of a person's health lie outside the health sector. Citing a Global Burden of Disease Study, Oni showed that poor diet causes more disease than physical inactivity, alcohol and smoking combined.

People from low-income households were particularly at risk as research showed them to be the most susceptible to NCDs such as obesity and heart disease, largely due to the inequitable access to health-promoting environments such as the food, built and natural environments that can be harnessed to protect and promote health.

Fix the food environment

The inaccessbility of healthy food, economically and geographically, are a significant impediment to NCD prevention, with healthy foods being more expensive than less healthy foods, as the School of Public Health and Family Medicine's submission reported last year. The UCT submission was drafted by Professor Mohamed Jeebhay, Professor Leslie London, Dr Jo Hunter-Adams, Dr Olufunke Alaba and Oni.

Healthier delicacies might be available, but at between 10 and 60% more expensive in rural areas, according to one study, they're simply unattainable.

There's precedent for a tax

Using prices and taxes to combat public health emergencies like obesity is backed by a legion of global evidence, said Jeebhay et al, and it's not an unusual step either.

Mexico's done it to great effect. Their sugar tax seems to have driven down consumption of sugary drinks slightly, with a bigger decline among the poor, said the authors, citing a 2016 study by M Arantxa Colchero. With many more South Africans living on less than $1.90 a day, and with SA's much higher Gini co-efficient, which indicates great inequality, it's possible that a sugar tax's effect might be even more tangible here.

There is also evidence showing that raising the price of sugary drinks in Brazil was linked to reduced consumption among the poor, too. Six US studies showed that higher prices could lead to lower body mass indexes (BMIs) and less prevalent cases of obesity and being overweight.

Sugar tax: check. Now what?

Useful as it might be, the sugar tax is no panacea. For maximum potency, it needs to be supplemented by many more progressive measures, say the UCT authors.

Among these, which the state should take the lead on, were ensuring consistent access to clean drinking water, including water fountains and taps; subsidising healthy foods, including minimally processed foods; improving food sovereignty by investing in South African agriculture; and improving access to open green spaces to promote physical activity.

“South Africa has an extraordinary burden of non-communicable disease requiring co-ordinated inter-sectoral action,” they concluded.

Story Yusuf Omar. Photo Michael Hammond.