PROFESSOR KAREN HOFMAN
Twenty years ago, encountering obese children was rare – so was children with diabetes. Only ‘the old people’ got high blood pressure or diabetes (colloquially called ‘Sugar’), cancer was not that common – and we certainly were not a nation of fatties.
Today South Africans are the most obese people on the continent. Diabetes has doubled in 20 years, high blood pressure is very common and almost everyone knows someone with cancer. So common in fact that these diseases together are rivaling HIV.
So what happened? Did we all suddenly lose all self-discipline become a nation of gluttons and couch potatoes who cannot stop eating and never exercise?
No, we didn’t – although Big Food (and the drink companies) would have us to believe that getting fatter and fatter is all our own fault. The biggest thing that has changed over the past twenty years is our diets, and in particular the number of sugary drinks we consume.
Sugary drinks include fizzy and non-fizzy soft drinks, fruit drinks, energy and sports drinks, all sweetened milk and yoghurt drinks and fruit juices (yes, fruit juice).
Between 2001 and 2015, the sales of sugary drinks in South Africa grew by over 65%.
It is noteworthy that most of the spend by industry is not on the actual products being produced – but on relentless and aggressive marketing spend, to influence and shape our consumption habits.
Big Food (and the beverage companies) are deliberately targeting the lower living standards measurement (LSM) market, particularly in developing countries such as ours.
In other words, they are deliberately focusing their attentions on hooking the poor, to get them to consume more and more fizzy, sugary drinks with absolutely no nutritional value.
This should be of great concern to everyone, but in particular to lawmakers in this country who are responsible for ensuring that our health budget is spent efficiently and optimally.
At the same time that our sugary drink consumption has exploded, so have our waistlines. Between 1998 and 2012, obesity grew from 30% to almost 40% in women, and from 7.5% to 10.6% in men.
Obesity-related diseases such as diabetes are putting an immense strain on the public health system, a system that is already struggling to deal with the huge burden of HIV and tuberculosis.
There is overwhelming scientific evidence that sugary drinks are one of the most significant contributors to health problems such as diabetes, obesity, heart diseases, liver and kidney diseases, certain cancers and tooth decay –all of which are entirely preventable.
Sugary drinks are also linked with under-nutrition. Often babies are given sugary drinks to wean them off breast milk, but these drinks have no nutritional value so these babies become under-nourished and some are even stunted. Stunted babies have a much greater risk of becoming obese and diabetic.
To put matters into perspective, we should consider that a loaf of bread and a two-litre fizzy drink is one of the commonest lunches in the country, despite the fact that although sugary drinks have so much sugar, they don’t make us feel full – so we do not eat less and our total energy intake increases.
There are so many sugary drinks being sold that the volume is equal to every one of us drinking more than a cup (260ml) of sugary drinks per day. This doesn’t count the extra sugar we might add to our tea or coffee, nor does it include the many teaspoons of “hidden” sugar in a lot of processed food, much of it marketed as “low fat”.
Most people are unaware that a standard 330ml can of fizzy drink contains about 10 teaspoons of sugar; important if one considers that the World Health Organization (WHO) recommends that people have no more than 12 teaspoons of sugar a day.
What we eat and drink has much more influence on our weight than a lack of exercise. Yet between 2010 and 2015 the beverage giant Coca Cola spent $120-million on research aimed at undermining the link between sugary drinks and poor health.
The same company helped to set up organizations such as the Global Energy Balance Network (GEBN) that shifted the blame for obesity away from diet – to a lack of exercise.
Not all calories are the same though. Sugar in a liquid form is particularly bad as it exhausts the supply of insulin much faster than when the sugar is consumed as a solid.
This allowed the development of diabetes at much younger age. Many women over 50 consider their diabetes to be “normal”.
Successive resolutions of the governing party, the African National Congress (ANC) have promoted the need for the ANC and government to ‘embark on activities to promote healthy lifestyles through mobilization of individuals and communities to engage in physical activities, good dietary practices and reduction of harmful use of alcohol, tobacco and to control substance abuse.”
The 2012 National Policy Conference of the ANC for instance resolved “to accelerate regulations on diet and content of salt in foodstuffs,” amongst other things.
In a far-reaching and progressive move that should be lauded, Treasury has proposed a new tax on sugary beverages, at a tax level of 0.0229 Rand per gram of sugar – or 20%.
This 20% tax on sugary drinks could reduce obesity prevalence by 3.8% among men and 2.4% among women, according our economic modelling.
This means that a quarter of a million South Africans could be prevented from suffering from obesity-related sicknesses.
The proposed tax would also raise around R6.4 billion a year, and Treasury has promised that it will use much of this revenue to fund health initiatives.
A tax on sugary drinks will be to save many more lives among the poor, as was the case with the tobacco tax.
It is a reality that the most vulnerable in our society are more responsive to price increases and it is also they who generally suffer far more from obesity-related health problems than wealthier people, who can afford healthier food and better healthcare.
But a but a higher level of 0.0344 Rand per gram – 30% – would be even better to reversing the rising rates of obesity. It is a more realistic figure to reach the goals we have set ourselves in the National Development Plan (NDP) as well as the global Sustainable Development Goals. (SDG’s) adopted by the United Nations in December 2015.
Predictably there has been stiff opposition from Big Food and the beverage industry, which has been
employing scare tactics in an attempt to rattle government away from implementing the tax.
Their tactics are similar to those used by the tobacco industry, which in previous decades also paid scientists to underplay the dangers of smoking.
The Beverage Association of South Africa (BevSA), which represents Coca Cola and other sugary drink companies, has hired two companies to look at the economic impact of the sugary drinks tax.
The company is claiming that around 60 000 jobs will be lost as a result of the proposed tax.
It should be considered that currently the beverage industry only employs around 14 500 people.
Both Treasury and independent economists, including Dr Neva Makgetla, from the Trade and Industry Policy Strategies, an independent group), say that the job loss figure is hugely exaggerated.
When Mexico, and Berkeley, California in the USA, introduced taxes on sugary drinks, there were no job losses. In addition, the sales of healthier alternatives increased.
Globally, taxes have clearly worked. Mexico had the world’s highest intake of sugary drinks. After a year, sugary drink purchases amongst the poorest third of the Mexican population were reduced by around 15% and consumers started replacing sugary drinks with healthier beverages like water.
Clearly the sugary drinks tax is only the first step in our journey to manage the obesity crisis.
It needs to be followed by many other interventions, including a public education campaign about healthy diet, and supported by mandatory regulations to prohibit marketing to our children, as well as clear information on all products – so people know how much sugar they are drinking if they choose to do so.
What is clear is that we cannot afford to wait any more.
South Africa is becoming more obese by the day. In the 5 years since we did our research another quarter of a million people became obese.
This sugary beverage tax will save lives.
Critically, it will cut healthcare costs in both the public and private sector.
As we head towards National Health Insurance (NHI), the cost savings in healthcare will be key – and revenue from the tax can be used to fund healthy initiatives.
This is a historic decision that we should all support.
PROFESSOR KAREN HOFMAN IS THE DIRECTOR OF PRICELESS SA (PRIORITY COST EFFECTIVE LESSONS FOR SYSTEMS STRENGTHENING) BASED AT THE WITS SCHOOL OF PUBLIC HEALTH.
PRICELESS is research programme providing information on “Best Buys” for health in SA. Analyses show how scarce resources, can be used effectively, efficiently and equitably to achieve better health outcomes.
A medical graduate of the University of the Witwatersrand and trained as paediatrician, Karen served as Director of Policy and Planning at the US NIH, Fogarty International Center and was on faculty at Johns Hopkins. She has consulted for WHO /PAHO and is published widely in international journals.