Health Promotion Levy FAQs

• What is the Health Promotion Levy (HPL)?

  The Health Promotion Levy (HPL) is a sugar-sweetened beverage (SSB) tax of approximately 11%, based on sugar content. It was implemented in South Africa in April 2018 as part of the South African Department of Health’s Strategic Plan for Prevention and Control of Obesity, that aims to reduce obesity by 10% by 2025. The HPL currently imposes a tax of 2.21 cents ZAR for each gram of sugar in a beverage over 4g per 100 mL.

• Why is HEALA advocating for an increase of the HPL to 20%?

  SSB taxes are an effective public health strategy to reduce the burden of health conditions linked to the overconsumption of sugar. Evidence has found that the 11% tax has shown positive impacts, however increasing it to the World Health Organisation (WHO) recommended 20% would have an even larger impact on the health of South Africans by reducing the burden of obesity (A modeling study from 2014 found that a 20% SSB tax in South Africa would lower obesity prevalence by an estimated 3.8% in men and 2.4% in women, resulting in approximately 220,000 fewer South Africans living with obesity) and diet-related diseases and provide increased revenue and healthcare cost savings.

• Why should we have policies such as the HPL in place that prevent obesity and non-communicable diseases?

  South Africa has an obesity crisis, where 1 in 3 men and a shocking 7 in 10 women are overweight or obese. This problem is not only seen in adults, unfortunately 13% of South African children are overweight or obese which puts them at a lifelong risk for non-communicable diseases (NCDs). Drinking SSBs regardless of any other behaviours can lead to weight gain. SSBs are high in sugar and excessive sugar consumption is a major cause of obesity that places a person at risk for common NCDs such as diabetes, hypertension and heart disease. More and more people are being diagnosed with these NCDs at a younger age which affects their quality of life and places a huge financial burden on their households and the health system.

  In South Africa NCDs are a main cause of death, with diabetes and hypertension among the top 10 leading causes of natural death in the country. It is estimated that by 2030, 4.5 million South Africans will have type 2 diabetes. Obesity is also one of the top five risk factors for premature death and disability. In 2020 the total cost of overweight and obesity was estimated to be R33,194 million (15.38% of government health expenditure) and the burden of type 2 diabetes is projected to cost the South African public healthcare system over ZAR35.1 billion by 2030.

  The COVID-19 pandemic highlighted the vulnerability of people living with NCDs or obesity, where obesity increased the risk of COVID-19 by 46%, for COVID-19 hospitalization by 113%, of ICU stay by 74%, and of dying from COVID-19 by 48%.

• Why are sugars found in sugar sweetened beverages particularity bad?

  SSBs are what we call empty calories. This means that they are very high in energy because of the high amount of sugar in them, but they do not provide the body with any nutrients. Sugary drinks are a significant source of added sugar and drinking these do not benefit the body at all, but rather cause a lot of harm. This is because the liquid form of sugar found in these drinks is absorbed very quickly by the liver and can alter the body’s metabolism which leads to altered blood chemistry, metabolites and cholesterol. These chemicals increase the risk of type 2 diabetes, heart & liver disease, cancer and tooth decay.

• How much sugar is too much?

  The amount of sugar in different SSBs vary but a popular fizzy drink brand has about 7 teaspoons of sugar in a 330ml can and a well-advertised energy drink has about 9 teaspoons of sugar in a 440ml can. Fruit juices are also high in sugar and average with six-and-a-half teaspoons of sugar in a 250ml glass, which is in the range of some cold drinks. Even if labelled as 100% pure fruit juice, these drinks can have the same negative effects as a can of cool drink. SSBs are a significant source of added sugar and to put it in perspective the WHO recommends that no more than 10% (but ideally less than 5%) of your daily energy should come from added sugar, which is about 12 teaspoons of sugar. Drinking just one SSB a day can make you reach this, which is why they should be taxed to help decrease consumption.

• Do South Africans really drink that many sugary drinks to create a need for the HPL?

  Yes, over the past 50 years, consumers have increasingly purchased ultra- processed foods and beverages, a trend in both rural and urban areas. In South Africa, per capita consumption of SSBs increased from approximately 150 mL per day in 2004 to 250 mL in 2018. Prior to the passage of HPL, SSB sales in South Africa were growing by 3% per year, and South Africans, were amongst the top 10 consumers of soft drinks in the world.
  According to market research by Euromonitor International analysed by the South African Medical Research Council (SAMRC) Centre for Health Economics and Decision Science (PRICELESS SA) South Africans more than doubled the volume of sugary drinks they consumed from 2001 to 2015. The study found that the industry depended on reaching South Africa’s poorest to build these profits. By 2012, one of South Africa’s largest soft drink companies had identified LSM 1 through 6 — those households earning less than R7 000 a month — as its primary market opportunity, according to 2015 research published in the journal Public Health Nutrition. The company’s focus? Those earning less than R3 000 a month.

• What effect has the HPL had on decreasing the amount of sugary drinks that South African’s drink?

  Evidence is showing that the HPL may positively influence many in our communities to cut back on the number of sugary drinks they consume. According to a study published in the journal Public Health Nutrition, the health promotion levy led to a 60% reduction in sugary beverage consumption among those surveyed in Soweto. Another study in Langa outside of Cape Town, found adults between 18 and 39 years old reduced their overall sugar intake by over a third after the levy was introduced. Furthermore there have been greater reductions in middle-LSM households than in higher-LSM households.

• Are the claims that the HPL has resulted in job losses true?

  The industry has claimed that HPL would harm the economy and lead to job losses, but there is no evidence linking SSB taxes to job losses in the beverage industry.
  Evidence from the United States, Mexico and South Africa show that SSB taxes do not negatively impact employment. The South African government should not be intimidated by food and beverage industry claims that these policies will harm the economy.
  Role players in the sugar industry have reiterated their call for an in-depth socio- economic impact analysis of the sugar tax after the proposed call to double the HPL. The South African Cane Growers Association has called for an immediate decrease to the HPL stating that this will help in the recovery of the local sugar industry and safeguard the one-million jobs that depend on it however; PRICELESS SA conducted an analysis using data from the South Africa Quarterly Labour Force Survey from January 2008 to June 2019, and found that the HPL has not led to reductions in employment in the sectors most likely to be impacted by HPL (beverage manufacturing, food and beverage retail, and food service).

• What role does HEALA play in raising awareness around the HPL tax increase?

  HEALA has developed evidence-based mass media campaigns including social media, community engagements and citizen activism to raise the public’s awareness of the harms of excessive consumption of unhealthy foods and the most effective policy-related solutions to the problem. The campaign exposes the role the industry plays in making unhealthy foods widely accessible in communities and amplifies the voices of individuals, particularly those at risk of developing obesity and associated NCDs, to demand policies that will make the food system more conducive for healthier diets.

• What does HEALA hope to achieve from this campaign?

  The aim of the campaign is for the industry to be held accountable for the products it produces that contribute to South Africa’s high rates of obesity and NCDs.

  An increase on the HPL from its current 11% to 20% is needed in order to improve health outcomes and support increased revenue collection. This money should be used for social, economic and health programs to advance the lives of ordinary citizens.

• I want to be kept updated about HPL

  To keep updated about our HPL and other campaigns as well as our Food Justice work, please visit:
  Website: www.heala.org Facebook: @healaSouthAfrica
  Twitter: @heala_SA Instagram: @heala_sa