OP-ED: Sugar tax’ a huge success in curbing sugar consumption and promoting public wellness

The evidence is undeniable: the Health Promotion Levy, enacted in 2018 to combat South Africa’s soaring rates of diet-related diseases, delivered on its promise. Multiple studies have demonstrated that the tax has successfully reduced both sugary drink consumption and overall sugar intake. 

READ MORE: Media Statement: No evidence that the Health Promotion Levy has led to job losses

In the first year alone, the volume of sugary drinks purchased plummeted by half, leading to a nearly one-third drop in sugar consumption. At the same time, South Africans turned to healthier options, replacing fizzy drinks with non-taxed options like water or diet beveragesThese findings have been validated by peer-reviewed journals and industry alike. 

Cost-effective

Around the world, governments and international organisations have recognised that taxing sugary drinks is a simple, cost-effective way to promote public health. From the UK to the US to Mexico, these taxes have reduced sugary drink consumption without hurting the economy. In five US cities that implemented sugary drink taxes, sales of these drinks dropped and the trend continued over time. 

This op-ed was first published in the Daily Maverick on the 1st of November 2024. To read the entire article please click here.

OPINION: Let’s be upfront on front-of-pack labelling

By Nzama Mbalati and Zukiswa Zimela

It is really difficult to read food labels. What is trans-fat? How is it different from saturated fat? Why is sodium in milligrams instead of grams? Is it good for me?

That is, of course, if you even see the label on the back of the package.

On April 21, 2023, the National Department of Health published R3337, putting forward a draft regulation to introduce front-of-pack labelling in South Africa.

The draft regulation aims to provide easy-to-understand information on the front of packaged food to help consumers make healthy purchasing decisions.

This type of labelling has been incorporated successfully into several other countries and has been shown to help consumers better understand what they are eating.

The draft regulations also propose introducing restrictions on how foods can be marketed when those foods are deemed unhealthy.

The restrictions specifically aim to restrict techniques used to entice children to purchase and eat unhealthy food – an important measure as children are more vulnerable to persuasive marketing practices.

The draft regulation seems to be a no-brainer: more people will understand what is in food, and children will be less likely to be manipulated into making unhealthy eating decisions.

Especially in light of the worrying revelation early last week by Statistics South Africa that non-communicable diseases – diseases often associated with poor diets – have increased by 58 percent in the last two decades.

However, there has been staunch opposition from the food industry, and several red-herring arguments have been advanced.

We provide the following clarification to help the public understand the new proposed draft regulations.

Food producers will have fair use of their trademarks

The food industry argues that the restriction in the regulations aimed to remove misleading product descriptors “arbitrarily” deprive producers of their intellectual property rights.

First, the Trade Mark Act, the law regulating the protection of trademarks in South Africa, already contains a list of criteria limiting the use of trademarks, including allowing other laws to restrict trademarks or prescribing that marks which are confusing or misleading do not attract legal protection.

Second, food producers register multiple variations of their trademarks and will not face significant trade implications should a variation fall foul of the law.

As an example, we searched the Companies and Intellectual Property online database for trademarks affiliated with a popular soda brand in South Africa and found 60 different trademark results.

The regulations are deemed successful internationally The World Health Organization has called for front-of-pack labelling as a key consumer nutrition literacy intervention to promote healthy diets.

While it is very difficult to show how a policy intervention like a front-of-pack label can improve overall dietary choices, preliminary evidence exists (from Chile and more broadly), and strong evidence shows that the information-imparting objective is effective.

Additionally, the importance of the attached marketing restrictions to protect children has been proven, as studies show a strong link between unhealthy food marketing and childhood obesity.

Consumers should know that food contains ‘artificial sweeteners’

Evidence suggests that providing a warning label on excess sugar can lead consumers to unknowingly substitute sugar-sweetened beverages with alternative sweetened beverages (beverages containing artificial sweeteners).

The safety of artificial sweeteners is still debated.

The warning label is intended to be a consumer information intervention and warning consumers, especially parents, allows consumers to make a decision on appropriate artificial sweetener intake given the risk of allergic reaction, impact on diet for patients with diabetes, potential impact on long term food preferences and emerging evidence on the risk of cancer.

The label will not make it more difficult to import or export food

All countries have variations in food safety and labelling standards and require different procedures to meet local laws. There is a definite trend towards introducing front-of-pack labelling, and food producers seek regulatory harmonisation, endorsing FOPL policies to best achieve this goal.

The food industry will unfairly lose profits

Some food producers argue that they will lose profit because consumers will not buy foods with the warning labels – that is the point!

People will always eat – having people eat healthier foods should encourage food producers to make better alternatives available to the public. Corporate profits can never be more important than public health.

* Nzama Mbalati is the programmes manager at the Healthy Living Alliance (Heala).

* Zukiswa Zimela is the communications manager at Heala.

This oped was first published on IOL on the 9th of November 2023

Open letter: Conflict of Interest at the Third Biennial Conference of the African Research University Alliance

Open letter to: Member Universities and Centres of Excellence within ARUA

23 November 2021

RE: CONFLICT OF INTEREST AT THE THIRD BIENNIAL CONFERENCE OF THE AFRICAN RESEARCH UNIVERSITY ALLIANCE (ARUA), GLOBAL PUBLIC HEALTH CHALLENGES: FACING THEM IN AFRICA (17 – 19 NOVEMBER 2021)

We are a group of concerned public health practitioners and academics working in the fields of child health, nutrition, non-communicable diseases (NCD’s) and health promotion.

We are pleased that the Third Biennial Conference of the African Research University Alliance (ARUA) on Global Public Health Challenges: Facing them in Africa to be held from the 17th to the 19th of November will include topics relating to food governance, systems, and access to nutritious food as well as discussions on the role of NCDs in global health.

We understand access to nutritious food to be a key driver of global public health.i We also note the role of diet-related non-communicable diseases in exacerbating the Covid-19 pandemic worldwide, and in Africa. ii Finally, the role of the private sector in influencing food environments in Africa cannot be overstated, iii with corporate political activity and progressive health policies relating to the diets frequently at odds.iv

We note that Professor Lindiwe Sibanda (UP) as one of the main conference speakers will be providing opening remarks. We also note from the biography connected to this conference that Professor Sibanda is a serving member of the Nestlé International Board of Directors. We are concerned that URUA does not recognize this as a conflict of interest.

Nestlé is an international company with a product portfolio that includes infant feeding products, soft drinks, coffee and tea products. Nestlé is a behemoth in the food and beverage industry, reporting CHF 7.3 billion profit for the first half of 2021 (ZAR 122.9 billion/ NGN 3293.4 billion/ 4530 CFA billion). Nestlé controls the world’s most valuable food and drinks portfolio.v Per its own admission, more than 60% of Nestlé’s food and beverage portfolio are deemed unhealthy products.vi Nestlé has also been accused of engaging in harmful corporate practices including the use of child slave labour, vii illegally promoting- breastmilk substitutes, viii unfair labour practices, ix and massive water usage sourced from water-scarce areas.x We only list allegations levelled against Nestlé in 2021. We do not purport to take a position on these allegations, but we are concerned by the gravity and scope of these allegations.

Specifically, in South Africa, we have documented repeated violations by Nestle of the R991xi xii regulations related to infant formula marketing and recently academics and civil society voiced opposition to a recent Nestle sponsored event for mothers which was subsequently cancelled.xiii

We note the Carnegie Corporation which is funding this conference is committed to avoiding conflicts of interest as per its 2009 Code of Ethics.xiv We believe the member universities of ARUA share in this commitment. Public Health England defines conflict of interest as an inability to contribute impartially to a programme of work, research, governance or oversight functions.xv The WHO described a conflict of interest as a set of circumstances where there is a potential for a secondary interest to unduly influence or be reasonably perceived to unduly influence the independence or objectivity of the primary interest. xvi The World Public Health Nutrition Association classifies possible conflicts of interest as any engagement with commercial producers of unhealthy foods, and specific industry involved in infant feeding products, ultra-processed foods and sugar-sweetened beverages (all part of Nestlé’s product portfolio).

As academics and professionals, we may think we are immune to conflicts of interest, yet a Cochrane review found that industry funding leads researchers to favour corporations either consciously or unconsciously. xvii While a conflict of interest does not necessarily equate to collusion or corruption it is often “difficult to distinguish subtle, unconscious bias from deliberately concealed impropriety”. xviii It is also important to recognise that perceived conflicts of interest may be as damaging as actual conflicts as they may “tarnish the reputation of scientists, organisations or corporations”. As such governments, universities and international organisations such as the WHO, have put measures in place to prevent and mitigate conflicts of interest.

The first step in managing conflicts of interest is disclosure and transparency at the individual and institutional level in order to screen and identify individuals/institutions with conflicting interests. xix While this is indeed a necessary first step, it is not sufficient to eliminate the COI, and where serious conflicts of interest arise between an individual’s private interests and public duties, it may become necessary to prohibit that individual from taking on positions of influence, and/or participating in key decision-making processes. Alternatively, the individual or institution should be asked to divest and rid itself of any interest that may undermine its integrity and independent judgement.

We are therefore concerned that Professor Sibanda’s leadership role in the conference, including hosting a workshop in her role as Director of the ARUA Centre of Excellence in sustainable food systems, while simultaneously holding a remunerated xx board of directors position with Nestlé constitutes a conflict of interest which may further compromise food and nutrition security on the African continent

Please clarify how this conflict has been investigated and how the conflict of interest will be managed.

Yours Sincerely,

List of Signatories:

NameInstitutional affiliation
 

Dr Chantell Witten

South African Civil Society for Women’s Adolescent’s and Children’s Health –

SACSoWACH

Prof Tanya DohertyHealth Systems Research Unit, South African Medical Research Council
 

Prof Karen Hofman

SAMRC Centre for Health Economics and Decision Science, PRICELESS SA,

Wits School of Public Health

 

Prof Susan Goldstein

SAMRC Centre for Health Economics and Decision Science, PRICELESS SA,

Wits School of Public Health

Lori LakeChildren’s Institute, University of Cape Town.
Dr Sara Jewett NieuwoudtSchool of Public Health, University of the Witwatersrand
Prof Ameena GogaHIV Prevention Research Unit, South African Medical Research Council
Prof Maylene Shung-KingSchool of Public Health and Family Medicine, UCT
Dr Catherine MathewsHealth Systems Research Unit, South African Medical Research Council
Prof Rina SwartDietetics and Nutrition, University of the Western Cape
 

Prof Mark Tomlinson

Institute for Life Course Health Research, Dept Global Health, Stellenbosch

University

Catherine Pereira-KotzeSchool of Public Health, University of the Western Cape
Prof Chris ScottPaediatrics and Child Health, UCT
Dr Louis ReynoldsPaediatrics and Child Health, UCT; People’s Health Movement
 

Prof Arvin Bhana

Health Systems Research Unit, South African Medical Research Council,

Centre for Rural Health, College of Health Sciences, UKZN

Dr Gillian SchermbruckerPaediatrics and Child Health, UCT
 

Dr Zoe Duby

Health Systems Research Unit, South African Medical Research Council;

School of Public Health & Family Medicine, University of Cape Town

 

Dr Wiedaad Slemming

Division of Community Paediatrics, University of the Witwatersrand;

SACSoWACH

Ms. Pumla DlaminiSACSoWACH Co-Chair
Ms Emmanuelle DaviaudHealth System Research Unit, South African Medical Research Council
Raul Mercer MD MScWorking group on Commercial Determinants of Child Health / CAP 2030
Precious RobinsonSACSoWACH Chairperson
Dr Elizabeth GoddardPaediatrics and Child Health, UCT
Mary KinneySchool of Public Health, University of the Western Cape
Prof. Ingunn Marie Stadskleiv

Engebretsen

 

Centre for International Health, University of Bergen, Norway

Jane BadhamGlobal Nutrition Consultant
Simela PetridouLa Leche League South Africa
Tamryn FrankSchool of Public Health, University of the Western Cape, South Africa
Stefan PetersonKarolinska Institutet
Leslie LondonSchool of Public Health, University of the Cape Town
 

Dr Annibale Cois

Division of Health Systems and Public Health, Department of Global Health,

Stellenbosch University

Prof Amy SlogrovePaediatrics and Child Health, Stellenbosch University
Dr Rahmat BagusGeneral Practitioner, IBCLC, La Leche League Leader South Africa
Dr Gabriel UrgoitiRX Radio SA
Dr Elmarie MalekPaediatrics and Child Health University of Stellenbosch
Joan TrubyLa Leche League South Africa
Prof Desiree LewisWomen’s and Gender Studies Department, University of the Western Cape
Vicky ReynellLa Leche League South Africa
Prof Mignon McCulloch 
Dr Wanga Zembe 
Maryse ArendtBFHI coordinator Luxembourg
Nzama MbalatiHealthy Living Alliance (HEALA)
Elisabeth Sterken, MSc Dt.Director INFACT Canada/IBFAN North America
Tony Waterston, MD FRCPCHInternational Society for Social Pediatrics and Child Health
Dr Christine MagendiePCP
Dr Dr Seth Christopher Yaw AppiahKwame Nkrumah University of Science and Technology, Kumasi, Ghana
Jeffrey GoldhagenInternational Society for Social Pediatrics and Child Health
Dr Lucy ReynoldsInternational Society for Social Paediatrics and Child Health
Suné GreeffEastern Cape Department of Health
Jenny WrightMilk Matters
Lebogang RamafokoTekano Atlantic Fellows for Health Equity
Scott DrimieDepartment of Global Health, Stellenbosch University
Delena StrydomIBCLC – Panorama Breastfeeding Clinic
Koketso Moetiamandla.mobi
 

Judy Kirkwood

IBCLC and Midwife, Developer of the The Best Start Feeding Initiative. Shark

Latch – breastfeeding technique (patent and TM)

Nicolette HenneyDietitian
Tobie MullerIBCLC, La Leche League Leader South Africa
Hettie GroveSACLC
Julia GaneLa Leche League Leader South Africa, Physiotherapist
Prof Neil McKerrowPaediatrics & Child Health, KZN
Carol BrowneIndependent nutrition consultant
Anna ShevelGood Food Network
Aadielah Maker DiedericksSouthern African Alcohol Policy Alliance
Prof Uta LehmannDirector, School of Public Health, University of the Western Cape
Prof Nicola ChristofidesSchool of Public Health, University of the Witwatersrand
Dr Tanya RuderDivision of Community Paediatrics, University of the Witwatersrand
Dr Anri MandersonThe Hoedspruit Hub, Limpopo
Alison BakerSouth African Certified Lactation Consultant
Dr Nandi SiegfriedChief Specialist Scientist, SA Medical Research Council
Tanya ThomasLLL Leader South Africa
Leana Habeck IBCLCThe Breastfeeding Clinic
Brenda PierceIBCLC
Dr Nanette JollyMedical Doctor, IBCLC, La Leche League Leader South Africa
Ana FrawleyLactation Consultant
Barbara ChambersIBCLC, CFT
Lynn ShierIBCLC, LACSA, Midwife
Pauleen NelsonIBCLC, LACSA, Midwife
Dr Nadine HarkerSpecialist Scientist, SAMRC
Mervyn AbrahamsNational Department of Health, SA
Alan RosenbergSouth African Organic Sector Organization
Dr Christiane HorwoodCentre for Rural Health, UKZN
Lynette SmitSACLC, IBCLC, CFT
Liezel EngelbrechtDietitian
Melissa ZwartSACLC
Kari OosthuizenSLT & LLL representative
Nicole MeyerLa Leche League Leader South Africa
Lenore SpiesPublic Health Nutrition Consultant
Maya BhardwajUniversity of Pretoria
Zani SmithDietitian & SACLC
Dr Michelle De JongUniversity of the Western Cape
Ulla WalmisleyUniversity of the Western Cape
Claire MoffattSACLC
Dorle VerrinderRD IBCLC
Lindie PittDoula
Katinka FourieIBCLC
Carey HauptRD SACLC MSc(Med)
Dr Khaleed SayedMBChB, Dip of Obs
Dr Natasha RamjeeMO in Paediatrics, Mowbray Maternity Hospital
Ceferino CenizoEarth And Man Foundation
Claire BracherM.Sc nursing RN. RM. IBCLC
Luyanda MajijaCommunication Manager, Vital Strategies
 

Anna Coutsoudis

Professor Emeritus, School of Clinical Medicine, University of KwaZulu-Natal,

Durban

Ann BehrNational Department of Health
Melissa Whitson 
Simone finkDoula, Yoga Teachers trainer, Bcom
Cristel CloeteBirth & Bereavement Doula
Jean RidlerIBCLC, RM, RN
Dr Surya EbrahimMowbray Maternity Hospital
Sandy BaymanWOMBS Doula
Irene BourquinWOMBS Doula Trainer, Registered Nurse/Midwife
Amanda NeitoLa Leche League Leader, South Africa, WOMBS Birth and Postpartum Doula
Lizl DunnWOMBS Doula, Breastfeeding Counselor
Pamela WilmentLa Leche League Leader, South Africa, WOMBS Doula
Dr Vanessa FarrEnvironmental Humanities South, University of Cape Town
Laura Sayce IBCLCIBCLC
Dr Sharon NyatsanzaNational Council Against Smoking
Sithabile ShobowaleWOMBS DOULA
Jane PittIBCLC – SOUTH AFRICA
Samantha CromptonRN, SACLC – The Baby Lady SA
Adriano CattaneoEpidemiologist (retired), Trieste, Italy
Bronwyn Balcomb, RD (SA), IBCLCRegistered Dietitian, South Africa
Anneleen De KeukelaerePeople’s Health Movement South Africa
David Pienaar 
Dr Max KroonPaediatrician, UCT
Ronel SorgenfreiRegistered Dietitian, South Africa
Vongani MkhabeleRegistered Nutritionist, South Africa
Michael HendricksPaediatrician, UCT
Vanessa BlackBiowatch South Africa
Marion Stevens 
Nikki SchaaySchool of Public Health, University of the Western Cape
Anton DelportSchool of Public Health, University of the Western Cape
Brittany KesselmanSociety, Work & Politics Institute (SWOP), WIts University
Prof Susan FawcusDepartment Obsterics and Gynaecology, University Cape Town
Manya van RyneveldSchool of Public Health, University of the Western Cape
Estelle WasserfallADSA, WOMBS doula
 

Prof Minette Coetzee

Children’s Nursing Development Unit, UCT Department of Paediatrics and

Child Health

Dr Hazel BradleySchool of Public Health, University of the Western Cape
 

Andrea Amos

Children’s Nursing Development Unit – Department of paeds and child

health, UCT

Prof Rachel WynbergDepartment of Environmental and Geographical Science, UCT
 

Angela Leonard

Children’s Nursing Development Unit, UCT Department of Paediatrics and

Child Health

Angelika PeczakHEALA
Prof Nick SpencerInternational Society for Social Pediatrics and Child Health (ISSOP)
 

Florian Kroll

DSI-NRF Centre of Excellence in Food Security; UWC Institute for Poverty,

Land and Agrarian Studies

Russell RensburgRural Health Advocacy (RHAP)
Zolile MlisanaRetired paediatrician
Emeritus Professor Marian JacobsUCT Department of Paediatrics and Child Health
Katinka Musavaya – IBCLCIBCLC – Maternal and Childhealth Zimbabwe
Prof Ashraf Hassen CoovadiaAcademic Head of Paeds Wits University
Dr Nomlindo MakubaloDCST Paediatrician Eastern Cape
Beatrix CallardAPN, RN, Windhoek Namibia
Thandi PuoaneEmeritus Professor
 

Prof Bruno Losch

Institute for Social Development, University of the Western Cape / DSI-NRF

Centre of Excellence in Food Security / Cirad, France

 

Prof Diane Cooper

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

Cape

 

Prof Stephen Devereux

Institute for Social Development, University of the Western Cape / DSI-NRF

Centre of Excellence in Food Security / IDS Sussex, UK

 

Dr Simon Lewin

South African Medical Research Council and Norwegian Institute of Public

Health

 

Lisanne du Plessis

Division of Human Nutrition, Department of Global Health, Faculty of

Medicine and Health Sciences, Stellenbosch University

Marcus SolomonNational Coordinator Children’s Resource Centre
Rifqah RoomaneyPhD intern, SAMRC

 

Richard Matzopoulos

 

Burden of Disease Research Unit, South African Medical Research Council

 

Maurice Smithers

 

Southern African Alcohol Policy Alliance in SA (SAAPA SA)

 

Dr Edward Nicol

 

Burden of Disease Research Unit, South African Medical Research Council

 

Carole Dobrich

 

RN, IBCLC, International Institute of Human Lactation Inc.

 

Jennifer Welch

 

IBCLC International Board Certified Lactation Consultant

 

Dale Hansson, RN, CFHN

 

BFHI Lead Assessor, Lactation Consultant

 

Janelle Maree

 

Director, Breastfeeding Advocacy Australia

 

Dr Magdalena Whoolery

 

MCH-IYCF Consultant and IBFAN Member

 

Prof Sharon Fonn

 

Wits School of Public Health

 

Ateca Kama

 

Chief Dietitian & Nutritionist, Ministry of Health and Medical Services, FIJI

 

Prof Alice Nte

 

Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

 

Milton Semenekane

 

South African Medical Research Council

 

Noloyiso Matiwane

 

North-West University

 

Hassan Mahomed

 

Division of Health Systems and Public Health, Dept of Global Health, Stellenbosch University

 

Jane Simmonds

 

South African Medical Research Council

 

Dikoloti Morewane

 

Botswana Breastfeeding Association

 

Jane Joubert

 

South African Medical Research Council

 

Dr Jane BattersbyUCT

 

Mr. Phillip Mokoena

 

Global Health Advocacy Incubator

 

Makoma Bopape

 

University of Limpopo

 

Maria van der Merwe

 

Independent public health and nutrition consultant

 

Bill Jeffery

 

Centre for Health Science and Law

 

Dr Anam Nyembezi

 

Senior Lecturer, School of Public Health, University of the Western Cape

 

Tara Callow

 

Pediatric Nurse Practitioner, MSN, CRNP USA

 

Prof Di Gray

 

UCT Department of Paediatrics and Child Health

 

Ravi Ram

 

Madhira Institute & PHM Kenya

 

Sarah Motha

 

Umphakatsi Peace Ecovillage

 

Ronel Beukes

 

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

 

Petronell Kruger

 

Public health lawyer and researcher at PRICELESS

 

Denis Joseph Bukenya

 

Human Rights Research Documentation Center (HURIC)

 

Jamiru Mugalu

 

People’s Health Movement Uganda

 

Dr Phumza Nongena

 

UCT Department of Paediatrics

 

Prof Yousuf Vawda

 

UKZN School of Law

 

Dr Natisha Dukhi

 

Human Sciences Research Council (HSRC)

 

Ms Bongekile P. Mabaso

 

Registered Nutritionist, PhD Candidate at UCT, School of Management Studies

 

Prof Salim S. Abdool Karim

 

Director: CAPRISA

 

Laurie Schowalter

 

HEALA

 

Patti Rundall

 

Baby Milk Action, IBFAN Global Council

 

Sam Waterhouse

 

Womxn and Democracy Initiative

 

Dr Gwen Norton

 

La Leche League Leader

 

Nadine Nannan

 

Specialist scientist, SAMRC

 

Duduzile Mkhize

 

 
Nomajoni Ntombela

 

IBFAN Africa
Dr Irena Zakarija-Grković

 

Croatian Association of Lactation Consultants; University of Split School of Medicine, Croatia

 

Nomajoni Ntombela

 

 
Nophiwe Job

 

Registered Nutritionist

 

Sasha Stephenson

 

Section27

 

Sally Raine

 

La Leche League Leader South Africa

 

Prof Julia Goedecke

 

Non-Communicable Diseases Research Unit, South African Medical Research Council
 Public Health Association of South Africa
 Rural Health Advocacy Project
 HEALA
Stuart GillespieNon-resident senior fellow, IFPRI
Rene WilliamsRetreat Feeding Initiative feeding community and serving to uplift those in need. Independent non Gov
Shireen Marks

 

Retreat Feeding Community Worker exposed daily to mothers and children dealing with affordability issues regarding feeding

 

Colleen BricklesRetreat Feeding Assistant working with kids feeding daily
Dr Anna HerforthIndependent researcher
Ralph HamannUniversity of Cape Town
Aviva TugendhaftSAMRC Centre for Health Economics and Decision Science, PRICELESS SA, Wits School of Public Health
Dr Thandi WesselsDistrict Paediatrician, Western Cape Dept Health, Department of Paediatrics and Child Health, Stellenbosch University
Prof Linda RichterDistinguished Professor, DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand