HEALA: 2022 Division of Revenue Proposals

Submission to Standing Committee on Appropriations

1. Background

Introduced in 2018, the Health Promotion Levy (HPL) is a tax designed to precisely target the sugar content added to sugar sweetened beverages (SSBs) beyond acceptable thresholds. This lowers overall sugar consumption via SSBs through incentivising companies towards reformulating their products and affecting a reduction in demand and consumption of such goods by consumers. This levy is essential to enforce industry accountability for public health in the South African context; where excessive and increasing consumption of SSBs, driven by aggressive market behaviour, significantly contributes to our spiralling rates of obesity and diet-related non-communicable-diseases (NCDs) such as type 2 diabetes, cardiovascular diseases, certain cancers and tooth decay.

Despite its relatively short period of existence, and the watered-down rate at which it was introduced, its positive impact on sugar consumption is already evident. By arresting this trend, the longer-term effects will bring a massive saving of lives, as well as billions in healthcare costs and related economic burdens otherwise incurred.

While not the primary goal of the HPL, the additional positive impact is the raising of significant revenue for the state budget. For a struggling healthcare system that is increasingly financially constrained and overburdened, the availability of such funding is invaluable. However, the potential impact of these funds is currently limited by a lack of dedicated and effective oversight as to their use. Within the context of many competing socio-economic needs, policymakers are obligated to prioritise usage of the revenue raised in a manner that can most effectively advance rights to health and wellbeing of the most vulnerable people living in South Africa.

2. Assessment of Current HPL Collections & Usage

Currently, the HPL sets a levy-free threshold of four grams of sugar per 100ml in non-alcoholic SSBs produced or imported for domestic consumption (excluding certain items such as fruit juices and dairy products), levying a fixed rate per gram of sugar that exceeds this. National Treasury commendably raised this rate by 4.5% to 2.31 cents per gram in 2022 – while further consultations may see the welcomed inclusion of fruit juices and reduction of levy-free threshold. In practice, this amounts to a tax of 10% to 11% on the price of 1 litre of the average sugar-sweetened beverage.

From its inception to March 2021, the cumulative revenue raised from both domestically produced and imported SSBs amounts to R7.9 billion. This represents a collection of R3.2 bn, R2.5bn and R2.1bn across financial years 2018/19, 2019/20, and 2020/21 respectively. Declines in revenue collected are potentially expected as producer and consumer behaviour respond positively to the HPL. The impact of COVID-19 on the market also played a significant factor in the decrease over the previous two years. National Treasury estimates annual HPL collections to increase over the coming financial years due to market recovery and growth; increasing up to R2.8bn by 2024/25.

Here, we should note that the compromise with business to reduce the levy rate from the proposed 20% to 11% has meant not only massively restricting its positive impact on public health, but also forfeiting billions in potential revenue.

Nonetheless, even the current rate produces a substantial source of revenue; annually accounting for around 0.2% of the state’s total budget revenue. Yet the ongoing concern is the use thereof.

At present, neither the entirety nor simply a portion of this tax revenue is earmarked for any particular purpose, going instead to the National Revenue Fund for general government expenditure. Treasury’s explanation for this is that “the legislative earmarking of revenue is not supported as it will introduce rigidities in the budgeting process”.5 Rather it can be referred to as being ‘soft ring-fenced’. In this, the government has stated commitment for additional budgetary support for health promotion and chronic disease prevention programmes, as identified by the National Department of Health (NDoH). Presumably supported from this revenue, the 2021 Medium Term Expenditure Framework raised NDoH’s budget allocation for health promotion to around R50 million per annum. By 2021, actual expenditure under health promotion totalled a mere R34 million over 2019/20 and 2020/21.

It is deeply inadequate that from the Health Promotion Levy raising R7.9 billion over 3 years, the very justification for its existence receives such a miniscule budget allocation; which is then underspent at that. Meanwhile, the entire health budget faces cuts of over R50 billion in real terms over the next 3 years. This needs to be changed.

3. A More Comprehensive Approach to Health Promotion

Restructuring how the tax revenue from the HPL is allocated and spent, whether partially or entirely, is a necessary, beneficial and strategic consideration. The presence of unallocated funding in the National Revenue Fund may be seen as desirable for potential rainy days or administrative ease. Yet policymakers are obligated to weigh this choice against tangible alternatives to evaluate which route, or what compromise between them, best protects South Africans’ Constitutional rights while prioritising the most vulnerable.

South Africa struggles with a double burden of malnutrition – especially seen in children. The reality is that 1 in 4 children (27%) are stunted (chronically malnourished) which is coupled with an increasing child and adolescent overweight and obesity – all increasing the growing burden of NCDs. The need to intervene early is vital. The first 1000 days from conception to two years old is a critical time to address immediate undernutrition and consequent overweight or obesity later in life. Although this time is vital for long term results, addressing the current issue of childhood hunger must be prioritized. Positive results of good nutrition during early childhood may be reversed by poor nutrition
during adolescence. The reality is that 30% of South African children live in households living below the food poverty line – where adequate nutrition needed for optimum growth and development is out of their reach.7 The NIDS-CRAM reports, found that during the pandemic child hunger had risen to 14% (1 in 7 people indicated a child in their household had gone hungry in the prior week) and that 400 000 children lived in households that experience perpetual hunger (hunger every day or almost every day) during each of the waves.

The need to invest in food and nutrition security initiatives in South Africa that can protect children from both under and over nutrition is pertinent to creating a thriving population that can reach their physical, mental and economic potential. This can be done through increasing funding of existing interventions such as the National School Nutrition Programme (NSNP) to expand the programme and provide more meals to school learners and expanding existing social protection measures.

These alternatives should be identified by their alignment with the holistic intent of the HPL, and furtherance of its goals. This entails not only support for the NDoH’s health promotion programme, but other high impact areas that can contribute to decreasing the burden of obesity and diet related NCDs. Effectively, by linking the majority expenditure of HPL collections from the goals of the HPL itself, we are creating a far more comprehensive policy that can more directly funnel resources from unhealthy economic and behavioural activities into opposingly healthier ones for much greater overall impact. This strengthens the HPL into a far more impactful policy with greater measurable benefits. An inevitable result of this is the deepening of public trust in and support for the HPL and policy-makers’ intentions behind it; an invaluable resource in the event of widening or raising the HPL.

4. Potential Strategies for Utilisation

Proactive dedication of the levy’s revenue offers many benefits, but how and where. Our key proposals are as follows:

Proposed Strategies:

  • Increasing support for NSNP
  • Supporting nutrition of children in the critical first 1000 days: Maternity Grant
  • Improving nutrition in households: Basic Income Support
4.1 Increasing Support for the National School Nutrition Programme (NSNP)

The National School Nutrition Programme (NSNP) is a lifesaving feeding scheme that benefits over 9 million learners aged four and above every day. The programme’s objectives include providing all learners one nutritious meal to enhance learning, strengthening nutrition education in schools to promote healthy lifestyles with the use of food production initiatives (school gardens). This programme allows learners to realise their constitutional rights to basic nutrition (Section 28(1)(c)) and basic education (Section 29(1)(a)) and aims to improve their ability to learn through reducing hunger, combating malnutrition and improving school attendance. The NSNP is an effective poverty alleviation intervention, reaching some of the most vulnerable children in South Africa by targeting schools in the socio-economic quintiles one, two and three or the “no fee-paying schools”).

The NSNP is guided by a conditional grant framework (CGF) with specific budget allocations according to the following, at least 96% of the budget should be spent on school feeding and purchasing cooking, education including deworming should be a minimum of 0.5%and administration a maximum of 3.5%.

Although the NSNP can improve punctuality, school attendance, mental concentration, and learners’ general well-being – it has fallen short in implementation. In 2017, the Legal Resources Centre compiled an analysis of the NSNP in the Eastern Cape. The daily nutritious meal should provide 30% of the recommended daily allowance (RDA) of energy; however, the report found that the meals served only provided 16% of the RDAs – equivalent to a snack rather than a meal. The Department of Education (DOE) evaluation of the implementation of the NSNP in 2016 found that only half of the schools received balanced meals including three food groups (starch, protein, and vegetables) and 42.4% of schools only served two food groups, often omitting vegetables.

Schools argue that they cannot meet the NSNP’s nutrition requirements without sufficient funding, while most Provincial DBEs have underspent on their budgets for the NSNP implementation. In order to be a more effective program and meet the nutritional needs of many vulnerable children, the NSNP should be expanded to also include breakfast. Evidence shows that breakfast has positive benefits for children’s academic performance and attention in school. Using the funds from the HPL to strengthen and expand this existing national intervention could be an effective way to address child hunger.

Providing nutritious meals to learners contributes to the children’s health in the long term. Effectively decreasing socio-economic impacts of poor childhood nutrition such as non communicable diseases. Thus, decreasing the burden on the state’s public health burden. Consequently, investing in childhood nutrition also provides financial benefit to the state in the long term.

4.2 Supporting nutrition in the critical first 1000 days (Maternity Support Grant)

Intervening in a child’s nutrition in the first 1000 days can have positive lifelong results. Stunting arises from chronic malnutrition in pregnancy and the early years of life and impairs the physical and cognitive development of young children. Stunting from macro and micronutrient deficiencies in pregnancy and the early years of life casts a long shadow on children’s health, education and employment prospects across their life course. Improving the wellbeing and nutritional status of pregnant women during this critical period when the growth of the developing foetus is wholly dependent on the nutritional status of the mother, would go a long way towards shifting the needle on stunting in South Africa. At present however, pregnancy poses significant health, social and economic challenges for women. Many women working in the informal sector (which is where the majority of poor women work) have to give up paid work during pregnancy, while incurring additional costs related to the increased volume and variety of food they need to consume to support pregnancy, travel costs for healthcare and costs of a new child. Local surveys find that as many as forty percent of pregnant women report going to bed hungry, 15% of babies are born with low birth weight and 40% of poor children do not access the child support grant in the first year of life. Extending the Child Support Grant into pregnancy, in the form of a Maternal Support Grant, would help ensure that poor and vulnerable pregnant women have access to much needed income support to enable attendance of antenatal check-ups, healthy nutrition and improved mental health. In addition, enabling uptake of income support during pregnancy would support seamless transition to the Child Support Grant once the baby is born and mitigate against the access barriers to the Child Support Grant many poor and vulnerable women face immediately after their baby is born.

The idea of a Maternal Support Grant is not a new one. Different types of pregnancy support are available in many other countries. Maternity and early childhood support is presently provided in over 30 countries. Such support has also been discussed for at least a decade in South Africa.

An investment case on the MSG estimates that extending the CSG into pregnancy will cost a maximum of R2, 227 million at current CSG levels. This constitutes only 1,2% of the total grant budget. Considering that economic models suggest that stunting places a penalty of 9% of GDP per capita on African and Asian, the return on investing in extending the CSG into pregnancy and reducing SA’s high stunting prevalence, would far outweigh the costs.

4.3 Improving nutrition in households: Basic Income Support

Globally, Social safety net programmes that provide sufficient levels of cash transfers over long periods can be effective in breaking the intergenerational cycle of poverty, improving the living standards of the poor, reducing food insecurity, and can improve undernutrition outcomes. These programs have the potential to reach millions of people that can spend the money given on nutritious food and have better access to health care including nutritional and health education. In turn, social support can help reduce the risk of childhood undernutrition, obesity, and non-communicable diseases (NCDs).

Poverty, inequality and unemployment are not mere challenges, they are the most profound crisis confronting democratic South Africa. These are all drivers for the double burden of malnutrition we see in children. Households struggle to afford nutritious food, leaving their children and members hungry. Social grants are vital in mitigating the effects of poverty for households and children.

The South African government needs to create a society of greater equality by strengthening the social protection system. One that will guarantee sufficient nutrition for all families and provide access to quality healthcare and education. Cash grants reduced hunger and malnutrition and improved food sufficiency. The evaluations of Basic Income Support a Case for South Africa showed that grant recipients were significantly more likely to have enough income for their daily food needs than those in the control group. The grants also led to more varied diets, with greater relative consumption of fruit and vegetables. The number of households that reported that their income was sufficient for their food needs increased from about 50% in the baseline to about 78% and a further 82%. Lastly, income grants were associated with an improvement in children’s weight-for-age, with the most considerable effect being among young girls.

During the pandemic – Although the R350 was not enough to make households and beneficiaries food secure, those who did not receive it, and those who received it late, experienced hunger and food insecurity more frequently (Black Sash Social protection in a time of COVID Lesson for Basic Income Support). The Department of Social Development has acknowledged that the COVID-19 SRD grant was primarily used to buy food.

The implementation of a Basic Income Support (BIS) in South Africa is feasible, affordable, would contribute to economic growth and job creation, and similar to social grants. The BIS would ensure many households in the country have improved food security, health and educational outcomes, resulting in long-term impact on poverty reduction.

The Black Sash and HEALA demand that the government implement a permanent Basic Income Support for those aged 18 to 59 years who have no or little income that meets the upper-bound poverty line (R1335 per month). Unemployed Caregivers who receive the CSG must also qualify. Although the extension of the COVID-19 Social Relief of Distress (SRD) grant is welcomed, it must be increased to at least the Food Poverty Line (R624) until social assistance for the unemployed is made permanent.

5. Way Forward

If we are to improve the health of all South Africans – we need to start with helping our children thrive into their best potential. As there are limited funds it is not a possibility to embrace new programmes however there are existing effective programmes that reach millions of hungry children everyday such as the NSNP and child support grant. In order to address the food and nutrition insecurity that our children experience we must prioritise; including breakfast in the NSNP more children will reach their daily nutritional needs, addressing the intergenerational transfer of malnutrition through the expansion of the child support grant into pregnancy & acknowledging that households that include vulnerable children and women need additional resources through basic income support.

6. Recommendations

By directly confronting excess sugar consumption, the Health Promotion Levy currently serves as one key preventative policy against rampant health conditions such as obesity, type 2 diabetes and other diet related NCDs. Its ability to create effective impact is already evident despite its constraints. Yet without strengthening the levy, along with introducing additional measures, South Africa is unlikely to resist its current trajectory towards increasingly catastrophic loss of life and crippling economic costs.

To do so, requires not only raising the levy and widening its scope, but finding ways to maximise the use of funds it raises to protect and enhance South Africans’ rights to health, nutritious food and a decent quality of life. To this end, we propose that:

  • Usage of HPL tax revenue as general revenue must be reprioritised via earmarking the entirety or majority thereof towards projects in line with the HPL’s vision.
  • Regulate and subsidise daily staple and healthy foods and reduce food prices.
  • Key projects to be considered for this should include:
    • Increasing support for NSNP
    • Supporting nutrition of children in the critical first 1000 days: Maternity Grant
    • Improving nutrition in households: Basic Income Support
7. About HEALA

HEALA is a coalition of civil society organisations that advocate for equitable access to affordable, nutritious food in South Africa by building a more just food system.

For further information contact:

HEALA: Nzama Mbalati
Email: Nzama@heala.org
Cell phone: 082 734 5414

Rural Health Advocacy Project: Nathan Taylor
Email: NTaylor@rhap.org
Cell phone: 082 406 1208

Grow Great: Dr Kopano Matlwa Mabaso
Email: kopano@growgreat.co.za
Cell phone: 071 861 5796

Black Sash: Hoodah Abrahams-Fayker
Email: hoodah@blacksash.org.za
Cell phone: 072 252 0333

Section27: Baone Twala
Email: twala@section27.org.za
Cell phone: 081 464 3033

South African Council of Churches: Reverend Parkson Mohlala
Email: lechipishaparksonm@gmail.com
Cell phone: 082 547 6434

SACSoWACH: Pumla Dlamini
Email: pdlamini@vitaminangels.org
Cell phone: 079 806 5406

TAC: Ngqabutho Mpofu
Email: ngqabutho.mpofu@tac.org.za
Cell phone: 061 807 6443

Equal Education: Nontsikelelo Dlulani
Email: ntsiki@equaleducation.org.za
Cell phone: 073 469 8750


Download the presentation

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Joint sign-on letter: Nestlé’s violation of SA Regulation R991 (on foodstuffs for infants and young children)

12.08.21

Dear National Department of Health

RE: Nestlé’s violation of SA Regulation R991 (on foodstuffs for infants and young children)

It has come to our attention that Nestlé has sponsored a (now cancelled) free event that was planned for the 14 August 2021 that violates South African law. The event was advertised together with You, Drum and TrueLove magazines and shared on the News 24 platform. The advert referred to in this letter (which at the time of writing was still displayed online) prominently features Nestlé, as well as three Nestlé products (Cerelac, Nestum and Nido3+). The planned event was a one-hour online ‘Free Stokvel Mom and Child Forum’, where various panellists (including health professionals and Nestlé brand ambassadors) would share information with attendees. The event targeted “all moms, grandmas, aunties and guardians of little ones”. The virtual advert refers to “fab freebies” and “winning some epic prizes”. The emotive language in the advert creates the impression that this event supports and protects the audience: “Drum and the Nestlé INFANT NUTRITION team have our back!” We explain below why this planned event undermines attempts to improve short and long-term health in South Africa (SA) and violates SA Regulation R991 (on foodstuffs for infants and young children). 

The nutritional status of children in South Africa has been a cause for concern for many years and is set to worsen due to the impacts of the COVID-19 pandemic. Chronic malnutrition, manifested as stunting (or low height-for-age) affects more than a quarter (27%) of children in South Africa as reported in the 2016 South African Demographic and Health Survey. Pre-COVID-19, 11% of children (2.1 million) lived in households that reported child hunger. In the context of COVID-19, child hunger has increased with 1 in 7 (i.e. 14%) households reporting a child went hungry in April 2021. While undernutrition is still a major problem in South Africa, rates of overweight and obesity in children are also increasing with 13% of children under five being overweight for their height. A recent report by the World Obesity Federation anticipates that SA is likely to have the 10th highest level of childhood obesity in the world by 2030. These rising rates of obesity are linked to increased ultra-processed food consumption.

The products advertised in this ‘Stokvel Mom and Child Forum’ are ‘baby cereals’ marketed for children from six months of age and a ‘fortified milk powder’ marketed for children over three years of age. All three products are ultra-processed, contain added sugars and are costly. In a country like South Africa, these products are unaffordable for most households. In 2018, 59% of children (close to 2 in 3) lived below the poverty line,  30% were without water on site, and 21% without adequate sanitation. If mothers or caregivers purchase these products, they may over-dilute them to make the product last longer. Additionally, there are challenges with keeping bottles clean in the absence of adequate water and sanitation, and the results are potentially life-threatening. These advertised products often interfere with optimal infant and young child feeding practices. The World Health Organization (WHO) and UNICEF, together with the National Department of Health (NDoH) recommend exclusive breastfeeding for the first six months of life and continued breastfeeding up until two years and beyond together with the addition of safe, affordable and nutritious complementary foods from six months. Unfortunately, in South Africa, breastfeeding under the age of six months remains low, at 32%, below the WHO target of 50%. South Africa also has high rates of the early introduction of complementary foods.  It is particularly pressing that South Africa promotes infant and young child practices that are healthy, affordable and sustainable both for children and the planet.

Furthermore, the marketing strategies used in the advert for this event contain emotive, persuasive language that could mislead the undiscerning public. The use of the word ‘stokvel’ in the name of the ‘Mom and Child Forum’ is problematic as a ‘stokvel’ refers to a community-based savings scheme that has traditionally been used in South Africa for essential items. A stokvel would not traditionally be used to purchase or access the types of products being advertised in these events. In South Africa, stokvels form part of many vulnerable people’s social protection net, allowing households to build resilience, particularly at a time when COVID has intensified poverty and hunger. However, the event organisers are instead using this event as an opportunity to promote their products, that are not essential for health or wellbeing, and can be viewed as harmful to health due to their ultra-processed ingredients. Furthermore, the organisers of this event, sponsored by Nestlé, have used emotive words in the advert, such as – “get ready to be empowered“; “you’ll learn valuable information“; “It’s all about learning together and building a community of like-minded caregivers who want to grow with their little ones” to persuade mothers that these products are necessary. The use of a health professional (a nurse with a PhD) on the panel is another marketing strategy used in this advert, intended to convince mothers or caregivers that these products are endorsed by health professionals. Not only are Nestlé promoting their ultra-processed products as suitable for feeding young children, but they are also in violation of South Africa’s R991 Regulations relating to foodstuffs for infants and young children.

Given the importance of exclusive breastfeeding and efforts by formula producers and related companies to undermine exclusive breastfeeding, the South African government implemented Regulation R991 to limit the promotion and marketing of an array of products including infant formula, complementary foods and powdered milks presented as suitable for infants and young children under the age of three years old.

Regulation 2(14) of R991 provides that “no incentives, enticements or invitations of any nature, which might encourage consumers to make contact with the manufacturer or distributor of a designated product which might result in the sale or promotion of a designated product for infants or young children shall be used on the label or in the marketing of a designated product(s) for infants and young children”. Not only are Nestlé incentivising consumers to make contact with Nestlé through this free event, but they are also providing those who attend the opportunity to win R500 Shoprite vouchers and for those who attend to receive information about the use of their products in childhood and infant feeding. This is a clear violation of the R991 regulations.

Regulation 7(5) of R991 states “No manufacturer, distributor, retailer, importer or person on behalf of the aforementioned shall produce, distribute and present education information relating to infant and young child nutrition“. In violation of this regulation, the webinar invite indicates that Nestlé (a manufacturer of infant formula) will be involved in providing infant and young child feeding advice. The invite states: “Feeding your littles one can be challenging, but it doesn’t need to be. We’ve got you covered! Join the FREE Stokvel Mom and Child Forum event on 14 August 2021 – brought to you by NESTLÉ   CERELAC, NESTLÉ NESTUM and NESTLÉ NIDO +3 – to learn everything you need to know about feeding your little one.

Though the event is billed as educational, three of the speakers are described as Nestlé brand ambassadors representing or well-trained in infant (referring to a child younger than 12 months of age) nutrition. Regulation 7(5) of R991 prohibits the provision of education information related to infant and young child nutrition by a manufacturer. The event is billed as being about nutrition for infants and young children and nowhere does it specify that they will be speaking about nutrition of children over the age of 3 years.

Furthermore, the products being advertised are known to be subject to this prohibition and despite this, Nestlé intends to promote these products as an integral part of childhood nutrition. This is evidenced by the notices at the bottom of the advertisement which illustrate further violations of R991:

“1.1.   Important Notice for all in-scope products from 0-36 months (IF, FUF, GUM, all complementary foods)

IMPORTANT NOTICE. A well-balanced diet, both during pregnancy and after delivery, helps sustain an adequate supply of breastmilk. Exclusive breastfeeding is recommended during the first 6 months of life followed by the introduction of adequate nutritious complementary foods, along with sustained breastfeeding up to two years of age and beyond. As babies grow at different rates, seek advice with your health professionals on the appropriate time when your baby should start receiving complementary foods.

1.2 Important notice for IFSMPs

IMPORTANT NOTICE. A well-balanced diet, both during pregnancy and after delivery, helps sustain an adequate supply of breastmilk. Exclusive breastfeeding is recommended during the first 6 months of life followed by the introduction of adequate nutritious complementary foods, along with sustained breastfeeding up to two years of age and beyond. As babies grow at different rates, seek advice with your health professionals on the appropriate time when your baby should start receiving complementary foods.

1.3 IMPORTANT NOTICE. NESTLE NIDO 3+ is not a breastfeeding substitute and is formulated to meet the changing nutrition needs of healthy children older than 3 years.”

Point 1.1 above clearly contains education information relating to infant and young child nutrition, which is prohibited by provision 7(5) of R991.

Point 1.3 above indicates ‘that NESTLE NIDO 3+ is not a breastfeeding substitute’. However, simply labelling a product as for children above 3 does not exclude it from the ambit of R991. Specifically, a designated product includes ‘liquid milks, powdered milks, modified powdered milks, or powdered drinks marketed or otherwise represented as suitable for infants or young children.’ Placing a disclaimer that the NIDO is not suitable for children under 3 does not then allow Nestle to market the milk powder at an event on infant nutrition or engage in marketing activities about infant or childhood nutrition. If Nestle engages in activities, such as the ‘mum and child’ stokvel event where Nido is presented as suitable for infant feeding, it can be considered a designated product under R991. It also worth noting that public health recommendations are that breastfeeding should continue up until two years and beyond. Therefore, if a product like NIDO 3+ is marketed to the mother of a 3-year-old who is breastfeeding, it could be a breastfeeding substitute.

This event was only cancelled due to pressure placed on Nestle. This is clear by their initial response to an interview by the Daily Maverick, where they indicated that they would be proceeding with the event. Only after publication of the article, and pressure placed by various public health activists, did they cancel the event, which was not a once off event. Although this has come to our attention now, there have been past events. There are a series of “mum and child” stokvel events targeting followers of You, Drum and TrueLove magazines that fall within the News24 stable that have occurred in April 2021 and May 2021. Whilst we appreciate the attempt by these magazines to support families around infant feeding, partnering with infant milk companies is not recommended. We urge You, Drum and TrueLove Magazines to take the necessary action to re-imagine any similar events in the future. Future events need to be free from the influence of infant milk companies, or the ultra-processed food and beverage industry. Academic and non-governmental experts not aligned to or influenced by the food and beverage industry are a good unbiased source of information on infant and young child feeding.

We thank you for the leadership you showed as the National Department of Health, placing pressure on Nestle, and the role it has played in this event being cancelled. We urge you to consider taking legal action against Nestle for violating Regulation R991, to prevent this from ever happening again.

#NotTodayNestle

Regards,

A collective group of concerned individuals and organisations

Catherine Pereira-Kotze

Dietitian, PhD Candidate, School of Public Health, University of the Western Cape

Safura Abdool Karim

Public Health Lawyer

SAMRC Centre for Health Economics and Decision Science/ PRICELESS, University of Witwatersrand School of Public Health

 

Tamryn Frank

Dietitian, Researcher, School of Public Health, University of the Western Cape

 

Chantell Witten

Lecturer, Division Health Sciences Education, Faculty of Health Sciences, University of the Free State

 

Lori Lake

Communication and Education Specialist, Children’s Institute, University of Cape Town

 

Lisanne du Plessis

Associate Professor, Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University

 

Rina Swart

Professor, Department of Dietetics and Nutrition, and DSI/NRF Centre of Excellence in Food Security, University of the Western Cape

Karen Hofman

Director, SAMRC Centre for Health Economics and Decision Science/ PRICELESS, University of Witwatersrand School of Public Health

 

HEALA

Healthy Living Alliance

 

Uta Lehmann

Director, School of Public Health, University of the Western Cape

RHAP

Rural Health Advocacy Project

Linda Richter

Distinguished Professor, University of the Witwatersrand

Lenore Spies

Chairperson Professional Board for Dietetics and Nutrition

Carlos Monteiro

Professor, Department of Nutrition, School of Public Health, University of Sao Paulo, Brazil

 

Luyanda Majija

Communication Manager South Africa, Vital Strategies

Shu Wen Ng

Associate Professor, Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina

Barry Popkin

Kenan Distinguished Professor, Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina

 

Haroon Saloojee

Professor, Division of Community Paediatrics, University of the Witwatersrand

Marita Hennessy

Postdoctoral Researcher, College of Medicine and Health, University College Cork, Ireland

 

Inês Rugani Ribeiro de Castro

Associate Professor, Department of Social Nutrition, Institute of Nutrition, State University of Rio de Janeiro, Brazil

Mélissa Mialon

Research Fellow – Trinity College Dublin, Ireland & University of Sao Paulo, Brazil

Kimiellle Silva

Researcher, State University of Rio de Janeiro, Brazil

Kate Sievert

PhD Candidate, School of Exercise and Nutrition Sciences, Deakin University

 

Cecília Tomori

Associate Professor, Director of Global Public Health and Community Health, Johns Hopkins School of Nursing

Healthy Food Systems AustraliaPhillip Baker

Research fellow, Institute for Physical Activity and Nutrition, Deakin University

 

Alexey Kotov

Director, Vital Strategies, USA

Alexandra Jones

Research Fellow (Food Policy and Law), The George Institute for Global Health, UNSW, Sydney, Australia

 

Makoma Bopape

Lecturer, Department of Human Nutrition and Dietetics, University of Limpopo, South Africa

Rob Moodie

Professor of Public Health and Deputy Head Melbourne School of Population and Global Health, Australia

Thandi Wessels

District Paediatrician and Lecturer, Department of Paediatrics and Child health, Tygerberg hospital, Stellenbosch University

 

Julika Falconer

CEO Zero2Five Trust, Durban, South Africa

Claudio Schuftan

Member of WPHNA and PHM

Kim Jonas

Specialists Scientist, Health Systems Research Unit, SAMRC

 

Zoe Duby

Specialist Scientist, South African Medical Research Council

Namukolo Covic

Senior Research Coordinator, International Food Policy Research Institute, Ethiopia, Member of the Nutrition Society of South Africa

 

Lynette Daniels

Senior Lecturer, Division of Human Nutrition, Department of Global Health, Faculty Medicine and Health Sciences, Stellenbosch University

 

Britta Boutry-Stadelmann

Consultant for IBFAN-GIFA, Geneva, Switzerland

Karessa Govender

Rural Health Advocacy Project

Jaco Murray

Head of Clinical Unit Department of Paediatrics, Paarl Hospital.

Catherine Mathews

Chief Specialist Scientist, South African Medical Research Council

Ruth Hall

Professor, SA Research Chair in Poverty, Land and Agrarian Studies, University of the Western Cape

 

Megan Marais

Registered Dietitian, Khayelitsha Eastern Substructure, MDHS, Cape Town

Nomajoni Ntombela

Chairperson.Technical Advisor IBFAN Africa

 

Wanga Zembe-Mkabile

Specialist Scientist, South African Medical Research Council

Prof Susan Goldstein

Public Health Medicine Specialist

Dr J Dippenaar

Specialist midwife and technical advisor Health Systems Trust

 

Dr Louis Reynolds

Paediatrician, People’s Health Movement.

 

 

 

Dr Jane Battersby

Senior Lecturer, Department of Environmental and Geographical Science, UCT

Prof Robert Pattinson

Emeritus Professor, UP Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies

Prof Ute Feucht

Director, Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria

 

Dr Christiane Horwood

Senior researcher, Centre for Rural Health, University of KwaZulu-Natal

Dr Valerie Vannevel

Researcher, Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria

 

Dr Tsakane Hlongwane

Researcher, Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria

Prof Jannie Hugo

Director, Research COPC Research Unit, University of Pretoria

 

Sylvia Kimmie

Program Associate IBFAN Africa

Dr Max Kroon

Paediatrician, Mowbray Maternity Hospital, University of Cape Town

Dr Ben van Stormbroek

Paediatrician, Victoria Hospital and University of Cape Town

 

Nazeeia Sayed

Post-doc Reserach fellow, Dieititian. University of the Western Cape.

Aiesha Mohamed

Dietitian Retreat CHC, Southern Western SS MDHS, DOH

Ass.Prof Diane Gray

Department of Paediatrics and Child Health, University of Cape Town

Michael Hendricks

Department of Paediatrics and Child Health, University of Cape Town

 

Fiona Duby

Director, Babymilk Action, UK

Jane Badham

Independent global nutrition consultant, Managing Director of JB Consultancy

Dr Adelaide Masu

Paediatrician, Senior lecture University of Cape town

 

Shihaam Cader

Chief and HOD Dietitian RCWMCH

Dr. Claire Procter

Paediatric Intensivist, Red Cross Children’s Hospital

Inger Hendry

Lecturer, Post Grad Child Nursing, University of Cape Town

Prof Brenda Morrow

Professor, Department of Paediatrics and Child Health, University of Cape Town

 

Maylene Shung King

Associate Professor, School of Public Health and Family Medicine, UCT

Aesha Arnold Isaacs

Dietitian, Lady Michaelis CDC, Southern western Substructure MDHS DOH-western cape

Jane Vos

Programme Coordinator, Children’s Nursing Development Unit, University of Cape Town

 

Assoc Prof Minette Coetzee

Director, Children’s Nursing Development Unit, University of Cape Town

Mary Kinney

Researcher, School of Public Health, University of the Western Cape

Scott Drimie

Extraordinary Professor, Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University

 

Emmanuelle Daviaud

Senior Specialist Scientist, South African Medical Research Council

Tanja Venter

Dietitian, Delft CHC, Northern Tygerberg Substructure MDHS DOH – Western Cape

 

Dr Phumza Nongena

Paediatrician, New Somerset Hospital, University of Cape Town

Tanya Doherty

Chief Specialist Scientist, SAMRC

Diane Cooper

Extraordinary Professor, School of Public Health, University of the Western Cape

 

Julian May

Professor, Centre of Excellence in Food Security, University of the Western Cape

Sue-Ann Fortuin

Registered Dietititan, MPICF, Klipfontein Mitchells Plain Substructure, Cape Town

 

Maryse Arendt

Lactation consultant IBCLC, BFHI coordinator Luxembourg

Sara Nieuwoudt

Senior Lecturer, School of Public Health, University of the Witwatersrand

Olinda Mugabe

Member of IBFAN Mozambique and Reencontro Assotiation

Mark Richards

Paediatrician, Red Cross Children’s Hospital

Christiaan Scott

Paediatrician, Red Cross Children’s Hospital

 

Mphasha Pitso

Parttime lecturer and PHD Candidate at University of Limpopo, South Africa

Anton Delport

Social scientist, PhD candidate

Ditope Rabodiba

Head of Department, University of Limpopo, Department of Human Nutrition and Dietetics

 

 

 

Yousouf Jhugroo

Chairmain and Co-Founder of MAPBIN

Geeta Tekchandani

Operations Director MAPBIN

David Clark

Independent Consultant, Public Health and Human Rights Law

 

Leslie London

Chair of Public Health Medicine, University of Cape Town

Constance Ching

Technical Consultant (Code Implementation and Advocacy), Alive & Thrive

 

Hussein H.T.Tarimo

WABA Steering Council member

Naefa Kahn

Advocate and member of the Cape Bar

Leah Margulies, Esq.

Founder, Infact, IBFAN and Nestle Boycott – Senior Staff Attorney, CAMBA Legal Services

Kent Buse

Director, Healthier Societies Program, The George Institute

Yogan Pillay

Affiliate, Center for Innovation for Global Health

  

Tell Minister Mboweni a 20% sugary drinks tax is long overdue! Sign the petition to increase the sugary drinks tax and help save lives.

Sign the petition below:

Sugary Drinks Tax

The health promotion levy, commonly known as the sugary drinks tax, was introduced in April 2018, at a watered-down 11% instead of the proposed 20% recommended by the World Health Organisation to effectively reduce consumption of sugar-sweetened beverages and fight obesity and its associated non-communicable diseases such as Type 2 Diabetes, Hypertension and Stroke.

In South Africa, up to 70% of women and 39% of men are obese or overweight. 10 000 new cases of diabetes are reported each month. Non-communicable diseases currently account for more than 40% of deaths in the country. The excessive consumption of sugar-sweetened beverages has been linked to obesity, which leads to an increased risk of non-communicable diseases.

South Africa needs to implement the recommended threshold for tax on sugary beverages together with a combination of other interventions to change social norms. The recommended sugary drinks tax will not only help prevent non-communicable disease-related morbidity and mortality but will also increase revenue collection towards the health budget. HEALA will continue to advocate for the South African government to urgently increase the Health Promotion Levy to 20% as the required recommended threshold.

Send a message to the Minister of Health, Dr Zweli Mkhize, urging him to increase the sugary drinks tax to 20% at Awethu Amandla Mobi

Schools Campaign

HEALA’s research into over 60 Gauteng schools in 2018 found high consumption of overly processed unhealthy foods, very little regulation of tuck-shops and food vendors, a lot of beverage industry branding in and around schools, a general lack of knowledge about healthy food and healthy eating, as well as the socio-economic determinants of what informs people’s, more especially in this case, children’s eating habits.

The low nutritional value contained in the foods consumed by the average children has had a negative impact on their health. As a result, 13% of South African children are either overweight or obese. The beverage and food industry cannot be allowed to continue behaving unethically and irresponsible. The HEALA’s school campaign aims to advocate for government to urgently implement policies and regulations that protect the school environment from junk food and sugar-sweetened beverages.

Front of Pack Warning Labels

Pre-packaged foods and beverages have increasingly become readily available in virtually every community around the world, with South African shops inundated with these pre-packaged foods that are processed with high levels of added sugars, salt, and saturated fats. Research has found these nutrients are connected to increased obesity and chronic nutrition-related diseases.

The dominance of these unhealthy products in stores, incomprehensible food labels and aggressive advertising by the food industry undermine consumers’ ability to choose healthier food options.

It is on this premise that HEALA started the #whatsinmyfood campaign, the aim of which is to encourage South Africans to question the contents of the processed foods they eat and understand how high levels of sugar, salt and saturated fat negatively affect their health. The overarching message of this campaign is “you have the right to know what’s in your food”. The campaign also reveals the complexity of current food labels and how they disempower the consumer from making healthy food choices. HEALA will continue to campaign and advocate for progressive Front of Package Labelling related policies and regulations that have been proven to work.

Take the pledge to demand that government require the food and beverage industry to put warning labels on food at What’s In My Food