THERE were 2.28-million cases of diabetes in SA in 2015 when more than 57,000 people died of the disease.
These numbers can be likened to those for people with HIV/AIDS in the late 1990s, when our government failed to take act to prevent and treat HIV and pharmaceutical companies put profits before lives.
Similarly for diabetes: in 2012, 41% of women and 11% of men in SA were obese. Of children aged 2-14 years, 16.5% of girls were overweight and 11.5% were obese while 7.1% of boys were overweight and 4.7% were obese.
Why are we, as a country, buckling under our own weight and the weight of noncommunicable diseases? Well, there are various reasons but there is strong evidence that the consumption of sugar is linked to obesity, diabetes and other noncommunicable diseases.
The World Health Organisation has found that a high intake of sugar (in particular free sugar, or sugar without other nutrition — as is found in sugar-sweetened beverages) is associated with obesity and noncommunicable diseases, including diabetes, stroke and hypertension. While lack of exercise is relevant, Mark Spires writes in the 2016 South African Health Review that "poor diet now generates more disease than physical inactivity, alcohol and smoking combined, which is largely due to an observed change in diet at the population level".
In SA, we eat a lot of sugar. South Africans on average consume 40g-60g of sugar a day. We also consume a lot of sugar-sweetened beverages (SSBs), on average one a day. The percentage of adults drinking sugary drinks in rural areas doubled from 2005 to 2010.
One SSB a day increases the likelihood of a child being overweight by 55% and of an adult being overweight by 27%. An overweight child is more likely to become an overweight adult. Overweight adolescents have a 70% chance of becoming overweight adults.
What do obesity, diabetes and other noncommunicable diseases do to our population, our economy and our health system? It’s not good news. There is a cost to individuals, to the economy and to public health. Illness from obesity and noncommunicable diseases takes its toll on those who are sick and their families. It decreases quality of life. It decreases productivity and increases absenteeism from work. It results in early death (36% of deaths from noncommunicable diseases occur before age 60). It affects GDP. It also increases health costs, both to individuals and the health system. One study pins the increase in health costs due to severe obesity at 23%.
Our health system is already under severe strain. We have a split health system in which the public system treats 84% of the population with half of the total spending on health. We have a quadruple burden of disease in the form of HIV, maternal and child mortality, noncommunicable disease and injury and trauma. The increased prevalence of noncommunicable diseases contributes to at least 33% of the burden of disease.
So what should the state do about it? Wait for business to make more voluntary pledges only to ignore them? Request a progressive decrease in the amount of added sugar without consequences for a failure to act? No. In a world where producers of SSBs are not driven by the health interests of consumers, the state has a constitutional duty to take action to protect those interests. Any reasonable government takes measures to regulate the market in the interests of people’s health.
While the constitution does not create or require the creation of any one economic system, it sets certain parameters within which the economic system must operate. One of the parameters is that the government must make policies and laws geared at the realisation of socioeconomic rights. Another is locating within the obligation to realise rights the power for the government to regulate markets.
The mandate to regulate the market and tax SSBs stems from the constitutional obligation to realise the right of access to healthcare services, to an environment (including a food environment) that is not harmful to health, and the right of children to basic nutrition. The state may seek to realise these rights through legislative and other measures, including measures to preserve the health budget by averting preventable expense.
It wouldn’t be the first time that we have regulated industry for public health reasons. Dramatic increases in the tobacco tax from 1994; the 2013 regulations limiting transfatty acids, which are a byproduct in the process of making liquid vegetable oils more solid; and 2016 regulations to limit the addition of salt in bread and processed foods all spring to mind.
And it works. A tax on sugary drinks in Mexico (albeit a lower tax than that proposed here) is decreasing consumption. The tobacco tax in SA resulted in a sale reduction of a third between 1993 and 2009 and a per capita consumption decrease of 50% in that period.
No one would claim that the SSB tax in its current form (in the National Treasury policy paper) is perfect. Treasury and the Department of Health have a further obligation, which could be made possible with the additional revenue collected from the SSB tax, to fund the other interventions needed for the tax to achieve its aims fully, including labelling and advertising regulations, public education campaigns and measures to make healthy food more affordable.
But this imperfection does not justify the predictable pushback that we have seen from industry and libertarian think-tanks. The claim that 60,000 jobs will be lost is not peer reviewed and is industry commissioned. Why are we taking it as fact rather than demanding that it be tested? The statement that the tax is a slippery slope leading to the taxation of all that is good and fun is absurd. The argument that revenue from "bad habits" exceed healthcare costs (in that consumers die sooner) is both cynical and baseless.
In assessing whether an SSB tax is something we want, let us consider the evidence before us and from where the evidence comes. Let us acknowledge that the state has an obligation to act in the interests of the population by decreasing the causes of ill-health where possible and using its health budget wisely. Let us arm ourselves with the myriad information available to allow us properly to debate this important issue and assist the Treasury and the Department of Health to push back against the vested interests of industry in the interests of our health system and ourselves.
• Stevenson is an attorney at public law centre Section27