PICTURE: CINDY WAXA
SWEET SAVIOUR: Health Minister Dr Aaron Motsoaledi explains the health reasons behind the sugar tax.
Khathu Mamaila (KM):
Your critics accuse you of advocating for a “nanny state.” They say instead of trying to control the intake of sugar by individuals, you ought to give people information and they would be empowered to take correct decisions for themselves. Don’t you feel you are over regulating to a point of undermining people’s choices?
Aaron Motsoaledi (AM):
No, we are not over-regulating at all. The explosion of NCDs (Non-Communicable Diseases) around the world, but particularly in low-income and low-to-middle income countries like ourselves is a reality. The World Health Organisation (WHO) and the United Nations (UN) have commissioned many studies about this and advocate regulating the four (4) risk factors leading to the NCDs.
If you agree that all we have to do is to give information and people would be empowered to take correct decisions for themselves, you may as well argue that we should close all the law enforcement agencies and the courts, and just give people information on how to behave and they will automatically make correct choices. That is not the real world we are living in. In the real world, people live by regulations! When we wanted to regulate salt, we asked industry to self-regulate. Industry itself insisted that the State must regulate because if we allow self-regulation, there is going to be a lot of cheating by individuals within the food industry.
KM: Companies that benefit from the huge consumption of sugar spend millions of rands to market their products to increase sugar intake. What is your department doing to counter this marketing onslaught?
AM: It is precisely why we have to regulate. We are going to regulate to protect society from this marketing onslaught by companies that benefit from huge consumption of sugar. They spend huge amounts of money on misleading people through adverts. We will put up adverts to promote health. We will send in health promoters like Community Healthcare Workers to teach people. We will include information on dangers of excessive sugar consumption as part of our School Health Programmes to teach the young early in their stages of development. We will also regulate through taxes and also through minimising or doing away with adverts that mislead our people.
KM: The proposed tax on sugar-sweetened beverages is anchored on the belief that tax is a mediator of consumer behaviour. Is there any scientific data to prove this theory?
AM: Yes, there is. A peer-reviewed evaluation of the Mexican Sugar tax, which is the first of its kind, provides clear evidence that SSBC (Sugar Sweetened Beverages) tax is working: sugar sweetened Beverage purchases are declining after the introduction of the tax. The purchases reduced by up to 12% by December 2014
Mexicans are drinking healthier options. Purchases of non-taxed beverages, mainly bottled water, increased on average by 4% in 2014, demonstrating a positive substitute effect.
KM: There is an argument that reducing the intake of sweetened beverages would have a negative impact on jobs. Given the rising rate of unemployment in the country, is it not a tough battle to make any argument that appears to undermine job retention and creation?
AM: This narrative about negative impact on jobs is industry’s strategy to hold the nation at ransom. It is tantamount to what I would call jobs for poison scam.
Industry is actually threatening the nation and scaring them from making what you claim are informed decisions. It is saying allow us to poison you with excess sugar, we will reward you with jobs – reject our excess sugar, we will withdraw jobs away from you.
May I remind you that this similar threat of job losses was employed by the tobacco industry 20 years ago when the world started regulating tobacco. This job losses never materialised.
Industry is disingenuous. They should truthfully confess that they are scared to lose massive profits. It is not jobs that will be lost by people, it is massive profits that would be lost by industry.
Who are jobs being created for? Corpses? If you poison people with excess sugar, they develop diabetes, high blood pressure, cancer, kidney disease, obesity. They are either too sick to work and take advantage of any job, or even worse they die. Dead people cannot take advantage of any job. So this argument about jobs is flawed. It is just a scarecrow. It is dishonesty by industry at its best.
Let me repeat, dead people cannot work – only a healthy population can be engaged in productive employment. Name one nation, just one, which was able to grow the economy and expand their GDP with a sick population? KM: What are the actual
benefits of a reduced sugar intake? And what are the dangers of consuming too much sugar? AM:
● The benefits of reduced sugar intake. (see sidebar)
● Reduction in incidences of Obesity.
● Reduction in incidences of high blood pressure, strokes, kidney diseases and heart failure.
● Reduction in incidences of cancer.
The dangers of consuming too much sugar will simply be the opposite of what I have stated above, i.e explosion of non-communicable diseases like diabetes, high blood pressure, cancer etc. as it is happening already. KM: As a minister of health, do you think an average person knows these benefits? If not,
what can be done in the short term to raise awareness?
AM: No, many people do not. Hence we will have to educate at schools, through the media but also heavily regulate to modify behaviour. KM: There is a view that diseases caused by lifestyle are a huge burden to the health care system. What is the extent of the burden on the health care system?
AM: The extent of the burden of lifestyle diseases to the health care system is huge, very huge. The number of people seeking medical care from life style diseases have increased exponentially – particularly among the poor. Worldwide obesity increased by more than 200% since 1980. It is estimated that obesity caused 3.4 million preventable deaths globally in 2010, mostly from cardiovascular causes. The World Health Organisation estimates that globally high Body Mass Index drove between 2% and 7% of global healthcare spending, with up to 20% of all healthcare spending attributable to obesity through related diseases such as diabetes and heart diseases. KM: The World Health Organisation’s (WHO) guidelines recommend that adults and children reduce their intake of free sugars to less than 10% of total energy intake. What is the average sugar consumption in South Africa?
AM: In fact WHO is now moving towards 5% of body intake. At the moment South Africa is already above the 10% recommended. KM: Rand for rand, it appears that healthier alternative drinks of less sugar are
more expensive than fizzy drinks with high sugar content. Given the levels of poverty in South Africa, can the campaign be successful in poor communities?
AM: Those actually are the dangers of these sugar sweetened beverages. It is the same with junk or fast foods. They are all attractive to the poor because they are very cheap. But the cheap price masks a lot of problems. The costs of the diseases caused by obesity are a heavier burden on lower income households.
It is the poor who suffer the most in running around trying to cure the diseases caused by these so-called cheap beverages. Hence in the long run they are actually more expensive to individuals and to households and regulation is needed to protect the poor
– regulation through tax to discourage them. They will be losing nothing because these so-called cheap beverages have zero nutritional value. KM: Are there any mechanisms to measure if the campaign to encourage people to consume less sugar is working?
AM: Not yet. It is only scientifically possible to measure the effects after 5 to 10 years. We will check the levels of obesity and the incidences of high blood pressure, diabetes and cancer.
KM: While it may sound complicated and cumbersome, should we not begin a discussion on the possibilities of ring-fencing the revenues generated from the sugar tax so that the money can be used to advance the campaign?
AM: It is not complicated and cumbersome at all. We are actually trying to engage Treasury to allow us to do exactly that. It will help to strengthen the campaign to lower incidences of Non-Communicable Diseases (NCDs). This in the long run will relieve the huge burden on the fiscus. KM: While this is a serious campaign with dire consequences, an average person may be wondering why you are expending so much energy on sugar. How can you eloquently drive the point that this is a life and death issue?
AM: We have to expend much energy fighting excessive sugar intake because truly, it is a life and death issue. I have already given you the statistics.
Two days ago, I hosted the Minister of Health of China for dinner. She complained about the high incidence of diabetes and high blood pressure in China. I asked her how do they get such high incidences of diabetes in China because everybody knows that Chinese food is very healthy. Her answer was that yes, Chinese food is healthy but the diabetes is due to high sugar intake. I said but Chinese food does not have high amounts of sugar. Her answer was simple – she said: “Minister, Coca-Cola has invaded China in a way it never happened in the past”.