The world is changing fast and to keep up you need local knowledge with global context.
Sugar is marketed worldwide as a health food. Research suggests it is anything but. It is often called ‘white poison’. In excess, the white stuff is shown to be unhealthy, to say the least. It causes obesity, say researchers, that in turn raises your risk of hypertension, heart disease, stroke, even cancer, musculoskeletal disorders and dementia, and shortens your lifespan. South Africa’s Department of Health is considering a ‘sugar tax’ to persuade people to eat less sugar, and to lose weight along the way. Here, Metropolitan Health executive Dr Ali Hamdulay, answers seven burning questions on the sweet topic. MS
Put plainly, excessive sugar consumption results in obesity – and from obesity stems a myriad of health risks. High blood pressure, diabetes, kidney disease, heart disease, and strokes are all directly linked to obesity. There is also some evidence to suggest a link between obesity and cancer, and also musculoskeletal diseases. Less recognised, but also a threat, are the mental illnesses that often accompany the onset of obesity, such as depression.These comorbidities are responsible for more than 2.5 million deaths per annum worldwide.
You can also expect a shorter life. At a BMI of 45, life expectancy in males can decrease by up to 20 years, and up to eight years in females.
To frame this in a local context, South Africa is the most obese country in Sub-Saharan Africa. Over 60% of South Africans are overweight. In fact, we are the third heaviest nation in the word (as revealed in the 2011 health survey conducted by pharmaceutical company GlaxoSmithKline).The main catalyst for this is the increasing urbanisation of our population, which has resulted in people exercising less and consuming food high in salt, fat and sugar.
This places an immense burden on the public and private health sectors. Companies lose billions each year as a result of increased absenteeism (while obesity is not the root of all of these health conditions, it is associated with many different ailments and thus is a huge contributing factor). In terms of the public sector, the rise in obesity has also seen an increase in related health conditions, placing more strain on state resources.
What does the proposed “sugar tax”entail?
Health experts and consumer bodies are calling for a sugar tax as a means of curbing South Africa’s increasing obesity levels. As a result, our Department of Health is considering a sugar tax. Mexico, St Helena and Japan have implemented similar sugar/fat taxes.
In essence, what it will mean is that products that contain high amounts of added sugar – such as soft drinks – will be subject to a “sin tax” of up to 20%. The University of the Witwatersrand has reported that a 20% tax on sugar-sweetened beverages could lead to over 220 000 fewer cases of adult obesity in the country.
It employs a “stick” over a “carrot” method – instead of consumers being incentivised or rewarded for cutting down on sugar, they are penalised. What is your view on this?
There is concern over South Africa becoming a “nanny state” – that acts as a “policeman”, and doesn’t trust people to make good decisions about their own lifestyles. This ideology of allowing people the freedom to do what they like is all very well, but if it is costing the state, the private sector and the public lots of money, then something needs to change. Whether a “stick”, “carrot”, or combination of the two approaches is employed, if it works, well then it should be engaged.
If you consider what obesity costs the state every year, it makes sense that products linked to obesity be subject to punitive taxes. British economist Arthur Pigou has argued that if a business profits by selling a product that results in high costs, the state should mitigate these by taxing the product. After all, if we tax essential services, it is only fair that we tax something that is costing us billons each year.
What are the negative economic and/or behavioural repercussions of introducing this tax?
There usually are economic repercussions on any new health legislation. If we use the proposed ban on alcohol advertising as an example, it is argued that many companies could lose profits which would lead to an increase in retrenchment. This may be true, but it needs to be offset against what alcohol is costing us, both in terms of money, health and quality of life.
The sugar tax would most likely save us money, through decreasing the direct and indirect costs associated with managing obesity, and its comorbid conditions. There may be downsides to a sugar tax, but I believe the positives outweigh the negatives.
What is the private and public sector’s roles in changing consumer behaviour?
Both have important roles to play. The government’s role is to not only act as a “warden” of sorts; it is also tasked with driving advocacy and awareness of the health risks associated with excessive sugar consumption. Thus empowering the public through education is a key responsibility.
Private sector is well-equipped, and has developed and delivered well-researched, structured programmes that increase awareness, incentivise/reward healthy behaviour (member advocacy), and broadly assist in the prevention and management of lifestyle diseases.
Given the increase in awareness around how behaviour influences the onset of lifestyle diseases, how do we use this increased knowledge to change consumer behaviour?
Technology is a tool that can play a role in increasing awareness, and encourage healthier behaviours. If we consider social media, it can play a massive role in reaching people and driving advocacy. Just as it can lead us to consume products that may harm our health in the long run, it can also be used to motivate and encourage healthy habits.
Company and public wellness days are a great opportunity to identify potential health concerns before they become a massive issue. The most critical part of managing any condition or disease is to first identify that there is a problem. Once the awareness is there, preventative measures can be put in place.
We also see a rise in a new wave of technology that captures “big data” – a pool of members’ genetic, behavioural, and historical health claims data – and then analyses this data to formulate patterns that predict potential danger areas and prescribe how to best manage them.
Any programmes/case studies you feel have been successful in this regard?
I think the anti-tobacco campaign was a great success and example of government, private sector and advertisers working in synergy to result in a significant decrease in smoking. I always use the movies as an example. If you watch a movie produced in the 80’s, all of the characters smoked. Nowadays you rarely see actors smoking in movies, unless it is pivotal to their character (that is, the gun-wielding, chain-smoking villain).
This type of collaboration – that combines legislation that acts as a deterrent, incentives for healthy behaviour,and drives awareness and consumer advocacy – can generate amazing results.
* Dr Ali Hamdulay is GM of Metropolitan Health Risk Management Health Provider and Policy Unit
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