The political economy of sugar-sweetened beverage taxation: an analysis from seven countries in sub-Saharan Africa

Abstract

Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes. Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally. Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action. Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Healthoriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugarsweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency. Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region.

Strengthening Sugar-Sweetened Beverage Taxation for Non-Communicable Disease Prevention: A Comparative Political Economy Analysis Case Study of Fiji and Tonga

“…Attempts to restrict and regulate this influence have been, to date, thwarted. Additionally, new evidence from studies across seven sub-Saharan African countries on SSB taxation cited tension between industry (considered a key contributor to the economy of all of the case study countries) and its influence versus strong regulatory interventions aimed at reducing consumption of the taxed products [ 11 ].…”

“…One of the key interventions identified to reduce sugar consumption has been SSB taxes, considered a WHO “best-buy” NCD policy intervention [ 9 , 10 ]. However, implementation of effective interventions to address sugar consumption has proved challenging globally, in the face of strong industry resistance and cross-sectoral policy tensions [ 11 , 12 , 13 , 14 ].…”

The impact of trade and investment agreements on the implementation non-communicable disease policies, 2014-2019: protocol for a statistical study

“…Again these are lagged by 1 year in our models to allow for a delayed effect . Table 1 lists the data sources and measurement of these variables, and the rationale for their inclusion according to studies examining determinants of US/EU TIA ratification and NCD policy implementation (11,22,47,33,34,(41)(42)(43)(44)(45)(46).…”

New developments with the Health Promotion Levy in South Africa

“…[2] Examples of other countries include Nigeria (NGN10/L), Botswana (BWP0.02/g of sugar), Rwanda (39% of cost, insurance and freight/ex-factory prices), Kenya (KES10/L) and Tanzania (TZS54/L). [3] Outside sub-Saharan Africa, Estonia, France, Sri Lanka, the UK, the United Arab Emirates, Vanuatu and Thailand have varying tax structures. [4] The HPL has had a significant impact on the consumption of SSBs in SA, [5][6][7] yet the nominal amount of the HPL has remained constant since 2018 (Table 1), with the likely result that the health effects of sugary drink consumption may take longer to manifest.…”