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Activists: “Sugar tax is working and should be increased’

The Healthy Living Alliance (Heala) has repeated its call for the Treasury to enact its initial proposal of a 20% health promotion levy on all non-alcoholic sugary beverages other than fruit juices – up from its present rate of about 11% – to achieve the greatest health benefits.

Heala head Nzama Mbalati says Baker McKenzie Johannesburg’s Virusha Subban and Keketso Kgomosotho have “misinterpreted basic facts” about SA’s “sugar tax” when they “disingenuously” ask why “liquid sugar” is taxed instead of all sugar.

Writing in Business Day, Mbalati points out that free sugar includes added sugars and sugars naturally present in foods such as honey, syrups, fruit juice and fruit juice concentrates. Sugar-sweetened beverages, he says, are high in added sugar, and such “liquid sugar” is taxed because it is demonstrably more harmful to health than what we refer to as free sugar. Mbalati says health taxes are an innovative tool policymakers can use to support and enable healthy behaviours and generate revenue for the state.

“Globally, the beverage industry is responding to these taxes across different markets where health levies are being implemented, and part of that response has been to reformulate beverages to reduce the amount of sugar.” He adds SA cannot afford to rely on sugar consumption at the expense of our current and future health and productivity. “Health taxes work. Since the Portfolio Committee on Trade & Industry’s request for an economic impact evaluation, two local, peer-reviewed, published studies assessing the sugar tax’s impact have found that the levy works to reduce harmful sugar consumption.”

Wits University researchers found it led to a 60% reduction in sugary beverage consumption among people who consumed a lot of sugar in Soweto. In Langa outside Cape Town, University of the Western Cape scientists found that adults between 18 and 39 years old slashed their overall sugar intake by almost a third after the levy was introduced. “The sugar tax also generated an extra R5.4bn for the country in its two years,” Mbalati said, adding that the levy is working just as intended to incentivise people to change the way they consume sugar.

The levy was introduced in 2018 in an attempt to curb rising levels of obesity and chronic health conditions like diabetes linked to excessive sugar consumption. It imposes a tax of 2.21c for each gram of sugar in a beverage that contains more than 4g of sugar per 100ml, which works out to about 11%. It does not apply to natural fruit juices or sweetened dairy products.


Study details

Assessing sugar-sweetened beverage intakes, added sugar intakes and BMI before and after the implementation of a sugar-sweetened beverage tax in South Africa

Stephanie V Wrottesley, Nicholas Stacey, Gudani Mukoma, Karen J Hofman and Shane A Norris

Published online by Cambridge University Press on 14 December 2020


Objective: To provide insight into the context and public health implications of the South African sugar-sweetened beverage (SSB) tax (Health Promotion Levy; HPL) by describing SSB and added sugar intakes, as well as BMI, one year prior to, at the time of and one year after implementation of the HPL.

Design: Longitudinal dietary intake was assessed using a quantitative food frequency questionnaire (QFFQ) and BMI was measured via anthropometry.

Setting: Soweto, Johannesburg, South Africa.

Participants: Adolescents, young adults and middle-aged adults (n 617).

At baseline, median SSB intakes were 36 ml/d, 214 ml/d and 750 ml/d for those in low, medium and high consumption tertiles, respectively. SSB intake decreased by two times/week in medium consumers and seven times/week in high consumers between baseline and 12 months, equivalent to 107 ml/d and 536 ml/d reductions, respectively. These reduced levels were maintained in the following year (i.e. to 24 months). There was an overall decrease in the amount of energy consumed as added sugar in the low (−48 kJ/d), medium (−153 kJ/d) and high (−106 kJ/d) SSB consumption groups between baseline and 24 months; however, the percentage of total energy consumed as added sugar remained relatively consistent (between 10 and 11 %). There were small overall increases in BMI across low (0·6 kg/m2), medium (0·9 kg/m2) and high (1·0 kg/m2) SSB tertiles between baseline and 24 months.

These findings suggest reductions in SSB and added sugar consumption contemporaneous to the introduction of the HPL – particularly for those with higher baseline intakes.

Study details

Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study

Nicholas Stacey, Ijeoma Edoka, Prof Karen Hofman, Prof Elizabeth Swart,
Prof Barry Popkin, Shu Wen Ng

Published in The Lancet on 1 April 2021


In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation.

We used Kantar Europanel data on monthly household purchases between January 2014, and March 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status.

Mean sugar from taxable beverage purchases fell from 16·25 g/capita per day (95% CI 15·80–16·70) to 14·26 (13·85–14·67) from the pre-HPL announcement to post-announcement period, and then to 10·63 g/capita per day (10·22–11·04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518·99 mL/capita per day (506·90–531·08) to 492·16 (481·28–503·04) from pre-announcement to post announcement, and then to 443·39 mL/capita per day (430·10–456·56) after implementation.

Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283·45 mL/capita per day (273·34–293·56) pre-announcement to 312·94 (296·29–329·29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented.

The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases.



Cambridge article – Assessing sugar-sweetened beverage intakes, added sugar intakes and BMI before and after the implementation of a sugar-sweetened beverage tax in South Africa (Open access)


The Lancet article – Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study (Open access)


Business Day article -NZAMA MBALATI: Sugar tax is working as planned and should be increased (Open access)


See more from MedicalBrief archives:


Number of young, obese South Africans doubled in 6 years


Sugar Tax is just the beginning, says Motsoaledi


SA's sugar tax pits jobs against lifestyle diseases


International call for South Africa to double its ‘sugar tax’



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