A few decades ago city workers anticipated a cheap, relatively healthy lunch of a bunny chow – a dollop of stew or curry in a half loaf, along with a pint of milk. Today, a lunchtime visit to the corner shop or local supermarket reveals the extent of our dietary rot. For too many, lunch often means half a loaf of bread and a bottle of cool drink.
In our cities, cool drinks have almost become ubiquitous, the daytime drink of choice. Sales are driven by inescapable, hard-edged advertising, reinforced by aspiration, sugar rush and high doses of caffeine as worker fuel. Yet the reality is these are drinks from hell with no upside, either for productivity or health.
Despite pervasive industry spin, sugar, especially at such excessive levels, can never form part of a healthy diet. Sugar is basically empty calories, providing energy with no other nutritional benefit, all at considerable metabolic cost. Extensive research has shown how sugar is linked, through its close relationship to obesity and metabolic disruption, to increasingly common diseases such as diabetes, cardiac and circulatory problems, along with numerous other so-called dietary-linked lifestyle diseases.
The World Health Organisation (WHO), informed by numerous medical and scientific experts, has been convinced that excess sugar consumption essentially constitutes a dietary poison. It wants to recommend a halving of sugar consumption. Predictably, industry is counter-attacking. As far back as 2003, the WHO linked sugar consumption in South Africa to increased risk of chronic disease.
Since then sugar consumption has increased markedly. Sugar industry figures illustrate consumption rising by almost 15 percent over the past 13 years to over 37kg for every citizen. The incidence of diabetes has accelerated even faster, up by 3.8 percent in 2010 alone. Notably, deaths ascribed to diabetes have risen most in the black community, from 5 754 cases in 1999 to 12 513 in 2010.
But this unfolding epidemic has a far more sinister side. Individuals with diabetes are more likely to succumb to tuberculosis, our leading cause of death. They are more susceptible to hypertension and circulatory diseases. Diabetes complicates treatment of HIV and Aids. Even otherwise routine infectious diseases like influenza are more risky in diabetics for several reasons. Therefore, as an apparently distinct disease, diabetes has major impacts on other leading causes of death.
While sugar may not have been proved to be the sole cause of diabetes, it is nevertheless strongly associated with both causation and the worsening of outcomes. Some population sectors are highly predisposed to diabetes, particularly people of Indian origin in South Africa, where it is the single leading cause of death. More worryingly, at least half – and up to 85 percent – of local diabetics are undiagnosed. When they are, it is often too late.
This epidemic does not affect only South Africans. It is predicted to become a leading cause of mortality in sub-Saharan Africa by 2020. Drinking a single 330ml soft drink daily is estimated to raise the risk of diabetes by 22 percent. Two litres of cold drink contains at least a cup of sugar, sometimes more. In 2011, South Africans each consumed almost 50 litres of cool drink.
These excessive levels of sugar consumption affect everyone, from building site labourers to mothers inadvertently preparing their children for obesity and diabetes. Moreover, the market predicts accelerated growth in sales, with an anticipated near doubling of diabetes cases over the next 15 years as high sugar intake is compounded by other poor dietary and lifestyle choices, such as a lack of exercise and excessive intake of fats and salt.
The financial burden of the cost of medication alone for diabetes patients in South Africa is staggering, at around R7 000 per individual, or a cumulative cost of over R14 billion a year to our health system, further treatment aside.
So what can we do about this assault on our health?
Mexico recently proposed a tax of 1 peso (82c) a litre on sodas, as they are called there. With Mexican obesity rates reported at 70 percent of adults and a third of children, action is clearly needed. The initiative was attacked by manufacturers and the sugar industry. They questioned former New York mayor Michael Bloomberg’s attempt to promote the tax, which was recently rejected in his home city, accusing him of hypocrisy.
Other places around the world have mooted or instituted cool drink or sugar taxes to deal with the impacts of sugar consumption. Thirty-three states in the US have soda taxes, as does France, with a 3.5 percent tax introduced in 2012.
Norway has a broader sugar tax, as does Denmark, although the latter proposes to abandon it. Indian research shows a 20 percent cold drink tax could prevent almost half a million cases of diabetes and make a dent in obesity rates.
The concept of these taxes is neither new nor unfamiliar. The economist Pigou suggested that if business profited by selling a product that created high external costs – for instance, the health costs of tobacco and liquor – the state should mitigate these by taxing the product. In South Africa these are traditionally referred to as sin taxes. There is no reason that sugar, along with other unhealthy foods laden with fats and salt, should not be taxed to offset health costs while reducing consumption.
Of course the problem can arise, as with tobacco, that the state becomes as addicted to the tax revenue as consumers are to sugar or tobacco. This is not a glib comment. Studies show the addictive nature of sugar. Food technologists constantly strive to make food as enticingly palatable as possible through subtle combinations of fats, salt and sugar.
Given the combined health effects of these ingredients, stricter regulation, combined with taxation, would seem to be the most sensible way to protect ourselves against ourselves from this premeditated assault by the food industry. It is economically unsustainable to continue to subsidise junk food by absorbing the direct costs to our health system in order to treat the symptoms while failing to tackle their causes.
Glenn Ashton is a writer and researcher working in civil society. Some of his work can be viewed at www.ekogaia.org.