Sugar tax, a small price to pay for saving lives - expert

Published May 8, 2017


As South Africa moves towards the introduction of a tax on sugar-sweetened beverages (SSBs), the debate continues on whether paying more for these drinks could assist in reducing South Africa’s growing epidemic of non-communicable diseases, particularly obesity and diabetes.

According to Karen Hofman (crt), Professor at the University of the Witwatersrand’s School of Public Health, taxing SSBs is a deterrent conveyed by the price increase.

This will in turn encourage the demand for healthier alternatives while also convincing the industry to reconsider the formulation of their products and marketing strategies.

Hofman is also the Director of PRICELESS SA, a programme that is aimed at enabling smart decisions about health investments in South Africa.

Currently, it is estimated that an average single 350ml can of a carbonated sugar-sweetened beverage contains 10 teaspoons of sugar and a glass of fruit juice is about the same. This is significantly more than the maximum limit of six teaspoons per day recommended by the World Health Organisation.

In South Africa, the annual consumption of sugar is growing.

A few years ago this was estimated to be 31 kilogram per person per year of which a third is consumed through sugary drinks. SSB consumption is growing in both rural and urban areas. Without a tax this will continue to skyrocket, according to Hofman.

The professor, who will be presenting research results on the potential impact of an SSB tax on reducing obesity and diabetes at the upcoming Africa Health Exhibition & Congress, is one of the authors of a paper published in 2014 in the journal PLOS ONE that investigated the potential impact of a 20 percent tax on SSBs on obesity in South African adults.

The mathematical model suggests that such a tax could reduce obesity in men by 3.8 percent and 2.4 percent in women, translating in preventing obesity in up to 220 000 people in South Africa, and reducing diabetes prevalence by 4 percent, slashing the cost of treating obesity-related diseases by millions of rand.

While a 20 percent tax on SSBs was initially proposed in the 2016 Budget, it was subsequently reduced to 11 percent in the 2017 budget following submissions to Parliament and consultations with stakeholders.

Hofman stressed that doing nothing to reduce sugar consumption will just add to the morbidity and mortality associated with South Africa’s growing burden of non-communicable diseases, particularly those related to obesity.

Figures released by the Department of Health last year showed that almost 70 percent of women and 40 percent of men in South Africa are overweight or obese with 43 percent of deaths in the country now associated with obesity-related diseases. These obesity-related diseases have now overtaken HIV in SA.

According to Hofman, their research has shown that consuming SSBs on a regular basis (1-2 cans per day) potentially increases the risk for developing type 2 diabetes by 25 percent whether a person is obese or not. If a person is already obese, the consumption of sugary drinks can up the risk to 50 percent.

But, why target only sugar-sweetened beverages and not sugar in general?

“Because the sugar in SSBs is liquid sugar, it is absorbed differently in the bloodstream than sugar taken in a solid form. As it absorbs very rapidly, it causes a rapid spike in blood glucose levels, increasing the demand for insulin from the pancreas. Over time this leads to pancreatic exhaustion, resulting in glucose intolerance and the subsequent development of type 2 diabetes,” Hofman explained.

However, she conceded that the tax should not be seen as the silver bullet that will stop the consumption of SSBs. “It is the first step in a multipronged strategy that is needed to reduce obesity and convince people, and the industry, of the harms it is causing to people’s health. Improving South Africa’s product labelling laws and regulating the marketing of these products to children are the next steps.”

Hofman will be speaking at the Public Health conference, which will form part of the 7th annual Africa Health Exhibition & Congress 2017 taking place from 7-9 June 2017 at the Gallagher Convention Centre in Johannesburg, South Africa.

More than 9,300 regional and international healthcare professionals and medical experts are expected to attend the event.

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