South Africa Sours on Sugary Drinks

Members of the Healthy Living Alliance showing their support for the sugary drinks tax outside parliament before a parliamentary hearing.
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Members of the Healthy Living Alliance showing their support for the sugary drinks tax outside parliament before a parliamentary hearing. Image Courtesy of Heala

“Are you drinking yourself sick?” South Africans were asked. The answer: A resounding yes.

On Sunday, April 1, South Africa will become the first country in Africa to implement an excise tax on sugary drinks in an attempt to stem the country’s growing obesity and diabetes epidemics. The tax, termed the Health Promotion Levy, was passed in December 2017 after 18 months of negotiations that included 4 parliamentary hearings and extensive debate.

South Africans are among the top 10 consumers of soft drinks in the world. Not surprisingly, more than two-thirds of South African women (69%) and almost half of men (49%) are now overweight or obese, and public health clinics battle to cope with 10,000 new diabetes cases every month.

Approximately 43% of deaths in South Africa are caused by non-communicable diseases (NCDs) associated with overweight and obesity, such as heart disease, diabetes, and some cancers. The Healthy Living Alliance (HEALA), together with media partner Health-e News and and supported by Bloomberg Philanthropies, campaigned for the tax. PRICELESS SA, a research group at Wits University’s School of Public Health, provided evidence to support taxing sugary drinks.

HEALA’s multi-pronged campaign aimed to educate mass media and the public, and rally local and international experts to provide scientific testimony in support of the tax at the public consultations.

A few months into the advertising campaign—which sported the tagline “Are you drinking yourself sick?”—more than three-quarters of South African adults agreed that the government should implement measures to discourage the consumption of sugary drinks and junk foods.

The beverage industry put up a big fight against the tax, arguing that it would lead to massive job losses. This was merely a scare tactic. Evidence from Mexico and Berkeley, California, which have had sugary drinks taxes in place for a few years, have shown no negative impact on employment. While the industry’s extensive lobbying of politicians managed to delay the tax, parliament ultimately voted in favor of scientific evidence and the health of South Africans.

“It is extremely encouraging that Members of Parliament from across the political spectrum appreciate the seriousness of the non-communicable disease epidemic we are confronting,” said HEALA Co-ordinator Tracey Malawana. “We need laws and policies that assist people to live and eat more healthily in a world where rampant commercialism has produced a toxic environment.”

A growing body of evidence from around the world (including studies in Health Affairs and PLOS Medicine) shows that taxing sugary drinks is one of the most effective measures to encourage people to cut down on their consumption of these drinks.

"This tax will save lives, increase life expectancy, avoid impoverishment and avert huge costs to the economy,” said PRICELESS director and health economist Professor Karen Hofman.

The tax has been structured to encourage manufacturers to reduce the sugar content in their drinks because drinks with more sugar are taxed more. Specifically, a drink with 4 grams of sugar per 100ml or less is not taxed at all, but drinks exceeding that amount of sugar will be taxed at a rate of 2.1 South African cents per gram. This means that the price of a can of Coke will increase by about 11%.

Researchers at Wits University and University of Western Cape plan to undertake a robust evaluation of the tax, looking at changes in sales, reformulation, and beverage intake over time. Meanwhile, HEALA and its partners, with continued support from Bloomberg Philanthropies, will continue to campaign to strengthen the tax to 20%, and to remove sugary drinks and junk food from schools.

And the next time someone asks, “Are you drinking yourself sick?” South Africans can say: Not anymore.

Kerry Cullinan is an award-winning journalist and managing editor of Health-e News, where she has worked on a number of high-profile health stories. Health-e News is a key stakeholder in the campaign for South Africa’s tax on sugary drinks.


Ed. Note: Michael R. Bloomberg is a benefactor of the Johns Hopkins Bloomberg School of Public Health, which publishes Global Health NOW.

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