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

Nicole McCreedy; Maylene Shung-King; Amy Weimann; Lambed Tatah; Clarisse Mapa-Tassou; Trish Muzenda; Ishtar Govia; Vincent Were; Tolu Oni

doi:10.3390/ijerph191811828

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

Int J Environ Res Public Health. 2022 Sep 19;19(18):11828. doi: 10.3390/ijerph191811828.

Authors

Nicole McCreedy¹, Maylene Shung-King¹, Amy Weimann^{2

3}, Lambed Tatah^{4

5}, Clarisse Mapa-Tassou^{4

6}, Trish Muzenda^{2

5}, Ishtar Govia⁷, Vincent Were⁸, Tolu Oni^{2

5}

Affiliations

¹ Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa.
² Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa.
³ African Centre for Cities, University of Cape Town, Cape Town 7701, South Africa.
⁴ Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, Yaoundé P.O. Box 812, Cameroon.
⁵ Global Diet and Physical Activity Research Group, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK.
⁶ Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang P.O. Box 96, Cameroon.
⁷ Caribbean Institute for Health Research, The University of the West Indies, Kingston 7, Jamaica.
⁸ Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu 40100, Kenya.

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.

Keywords: NCDs; SSBs; South Africa; noncommunicable diseases; sugar; sugar-sweetened beverages.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Beverages
Child
Diet
Humans
Noncommunicable Diseases* / prevention & control
Policy
Policy Making
South Africa
Sugars
Taxes

Substances

Sugars

Grants and funding

This research was funded by the National Institute for Health Research (NIHR) (GHR: 16/137/34) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. The funding sources have had no involvement in the design and conduct of the research, or in the preparation of the article. Additionally, one of the co-authors (A.W.) was supported by the PEAK Urban programme, funded by UKRI’s Global Challenge Research Fund, Grant Ref: ES/P011055/1.