Empirical evidence suggests that the quality of human health has declined drastically in the twenty first century. Health risks such as cardiovascular disease, cancer, diabetes, osteoarthritis, and chronic kidney disease all increase when a person’s BMI exceeds 23. Research indicates that if left unchecked, the rise in obesity could lead to future declines in life expectancy. Overweight is defined as having body mass index (BMI) or weight-to-height ratio greater than or equal to 25 and lower than 30 while obese is defined as having a BMI equal to or greater than 30. Globally, more than two billion children and adults suffer from health problems related to being overweight or obese and an increasing percentage of people die from these health conditions.
The World Health Organisation predicts that in the next 20 years, obesity-driven diabetes across sub-Saharan Africa will double. Research has also shown that undernourished children have an increased risk of becoming obese. Over the years, numerous reasons have been debated as to why the South African obesity statistics look so dire. One of the most common reasons cited is the increasing Westernisation and urbanisation of the South African population over the past few decades. Researchers say this is resulting in people living less active lifestyles and consuming more fast food, which has extremely high salt, sugar and fat content. South Africa has an average 30% obesity rate among adults (10 million). Of the 70% of overweight South African women, 42% are considered obese.
New global guidelines were published by WHO in March 2015 recommending that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. They also recommended that a further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits. These guidelines are based on the evidence that keeping intake of free sugars to less than 10% of total energy intake reduces the risk of overweight, obesity and tooth decay. The guidelines do not refer to the sugars in fresh fruits and vegetables, and sugars naturally present in milk, because there is no reported evidence of adverse effects from consuming these sugars.
Governments across the globe are taking proactive measures in an attempt to alleviate the impact of unhealthy lifestyle choices. The Department of Health and National Treasury of South Africa have opted to impose a tax on SSBs as a disincentive for unhealthy choices by decreasing the affordability of these beverages. Similar taxes have been seen to influence consumer behaviour in countries like Denmark, Finland, France, Hungary, Ireland, Mexico and Norway. Other interventions the government says it is planning to include are nutrition labelling, marketing restrictions on unhealthy foods and beverages to children, fruit and vegetable subsidies, physical activity policies and social marketing campaigns, but there is no real framework for those strategies yet.
From a political perspective, having a tax earmarked to fund spending in a particular area makes it more palatable for consumers but only if they feel tax raised is being used to fund health care or education platforms about healthy eating. The problem is that governments do not like directing tax to specific purposes but prefer to add it to general revenue so the tax collected from those who indulge in SSBs will go towards the general fiscus. There is no guarantee that taxes will be ring-fenced for the promotion of interventions as part of the fight against non-communicable diseases or health-related education. The potential to improve health should be greater when sugar taxes could be combined with incentives for choosing healthier foods but this has not occurred within government regulation frameworks.
Other policies, such as banning advertising aimed towards children or education initiatives could be more effective in reducing excess sugar consumption. There has also been a call for industry to reformulate the products they produce to contain less sugar, thus decreasing the availability of products with higher sugar content.
Criticism has been raised around the socio-economic impact of a sugar tax. Instead of a tax forcing consumers to choose healthier options, an increase in the cost of sugar products due to a tax may lead consumers to choose cheaper, inferior goods or higher calorie alternatives. A SSBs is what is known as a ‘regressive tax’ because it disproportionately affects poor people. The poor already pay a higher proportion of their income on food and paying more for SSBs may mean they spend even less on nutritious foods. There is also a suggestion that the introduction of a sugar tax will lead to job losses due to a decline in sales volumes. Furthermore, a population may be unaware of the personal costs involved in sugar consumption. Alternatively, people may be aware sugar is bad, but struggle to reduce consumption because of its addictive qualities.
Unfortunately, the poorer segment of the population fill their bellies with cheap food and this often means oil-drenched starchy carbohydrates and highly processed sweetened products. Meanwhile in low-income communities, mothers go without meals to ensure that their children eat, then gorge when they have money. All this can lead to ‘hidden hunger’, when people eat regularly and even put on weight but lack necessary nutrients and vitamins, leading to long-term health damage. In one household you can see children who are undernourished, the man with normal weight and then the wife who may be heavily overweight.
There are also cultural issues that fuel obesity in South Africa. A recent study in 2013 by the Human Sciences Research Council found that 88% of South Africans regard a fat body as their ideal. So, nearly 90 percent of the 25,500 people interviewed deemed fat as the preferable body type. There is also still a stigma in some communities related to illness, for instance, there is a believed that thinness is a sign of HIV/AIDS or Tuberculosis infection.
The Noakes Foundation advocates for the implementation of more nutritional education programs around South Africa. SSBs may help but there is no way to ensure the benefits of the strategy without giving people more food healthy options or the education needed to make the right decision. Eat Better South Africa’s educational intervention program advocate for a more equal and equitable communities with a better distribution of the resources. It’s not about the budget or the prices, it’s about the capacity to make the right decision and the only way to do it is by knowing which are the right ones.
by Georgina Pujol-Busquets Guillén
(1) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. (2014). The Lancet. Volume 384. no. 9945. 766-781. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60460-8/abstract
(2) Birrel, I. Obesity: Africa’s new crisis. The Guardian. September 21, 2014. https://www.theguardian.com/society/2014/sep/21/obesity-africas-new-crisis
(2) Veerman, J.L., Sacks, G., Antonopoulos, N., Martin, J. The Impact of a Tax on Sugar-Sweetened Beverages on Health and Health Care Costs: A Modelling Study. Plos one. 2016.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151460#pone.0151460.ref004
(4) Sharma A, Hauck K, Hollingsworth B, Siciliani L. The effects of taxing sugar-sweetened beverages across different income groups. Health economics. 2014;23(9):1159–84. http://onlinelibrary.wiley.com/doi/10.1002/hec.3070/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage