Reducing Sugar Intake in South Africa: Learnings from a Multilevel Policy Analysis on Diet and Noncommunicable Disease Prevention

Abstract

High sugar intake contributes to diet-related excess weight and obesity and is a key determinant for noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs). The World Health Organization (WHO) gives specific advice on limiting sugar intake in adults and children. Yet, to what extent have policy ideas on sugar intake reduction originating at the global level found expression at lower levels of policymaking? A systematic policy document analysis identified policies issued at the African regional, South African national and Western Cape provincial levels between 2000 and 2020 using search terms related to sugar, sugar-sweetened beverages (SSBs), and NCDs. Forty-eight policy documents were included in the review, most were global and national policies and thus the focus of analysis. A policy transfer conceptual framework was applied. Global recommendations for effectively tackling unhealthy diets and NCDs advise implementing a mix of cost-effective policy options that employ a multisectoral approach. South African country-level policy action has followed the explicit global guidance, and ideas on reducing sugar intake have found expression in sectors outside of health, to a limited extent. As proposed in this paper, with the adoption of the SSB health tax and other policy measures, South Africa’s experience offers several learnings for other LMICs.

Oral health in emerging countries and suggestions for adjusted care strategies

“…22,127 Thus, these are the urgent areas for population-wide oral health policy activities. Since a sugar tax (Health Promotion Levy) was already introduced in 2018 to reduce excess sugar intake -against great resistance of the influential sugar industry -it would be unrealistic at the present time to propose expanding the tax on all added sugar sources as recommended by Boachie et al 127 Instead, advertising restrictions on sugary products, which are not included in the tax legislation, 128 could be introduced to reinforce the effect of the current sugar tax. Furthermore, to protect teeth against cariogenic attacks, fluoride exposure must be strengthened by controlled water fluoridation combined with the regular use of fluoridated toothpaste.…”

Development of Emotion Lexicons to Describe Sugar-Free Chocolate According to Consumers’ PROP Taster Status

“…Note: 1 Likert scale: 1 = dislike extremely, 2 = dislike very much, 3 = neither like nor dislike, 4 = like very much, 5 = like extremely. 2 Likert scale: 1 = definitely would not buy, 2 = probably would not buy, 3 = might or might not buy, 4 = probably would buy, 5 = definitely would buy.…”

“…Excessive consumption of dietary sugar is a considerable public health concern as it is often linked to health conditions, such as non-communicable diseases (NCDs) and obesity which is consequently associated with cancer, diabetes, and cardiovascular diseases [1][2][3][4][5]. Currently, more than 50% of South Africans are either overweight or obese [6].…”