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Valizadeh P, Ng SW. Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income. Am J Prev Med 2024; 67:3-14. [PMID: 38573260 DOI: 10.1016/j.amepre.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. METHODS The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected. RESULTS A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities. CONCLUSIONS Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.
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Affiliation(s)
- Pourya Valizadeh
- Department of Agricultural Economics, Texas A&M University, College Station, Texas
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Ifeanyichi M, Dim C, Bognini M, Kebede M, Singh D, Onwujekwe O, Hargest R, Friebel R. Can sugar taxes be used for financing surgical systems in Nigeria? A mixed-methods political economy analysis. Health Policy Plan 2024; 39:509-518. [PMID: 38668636 PMCID: PMC11095260 DOI: 10.1093/heapol/czae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 01/11/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
This study determined the feasibility of investing revenues raised through Nigeria's sugar-sweetened beverage (SSB) tax of 10 Naira/l to support the implementation of the National, Surgical, Obstetrics, Anaesthesia and Nursing Plan, which aims to strengthen access to surgical care in the country. We conducted a mixed-methods political economy analysis. This included a modelling exercise to predict the revenues from Nigeria's SSB tax based on its current tax rate over a period of 5 years, and for several scenarios such as a 20% ad valorem tax recommended by the World Health Organization. We performed a gap analysis to explore the differences between fiscal space provided by the tax and the implementation cost of the surgical plan. We conducted qualitative interviews with key stakeholders and performed thematic analyses to identify opportunities and barriers for financing surgery through tax revenues. At its current rate, the SSB tax policy has the potential to generate 35 914 111 USD in year 1, and 189 992 739 USD over 5 years. Compared with the 5-year adjusted surgical plan cost of 20 billion USD, the tax accounts for ∼1% of the investment required. There is a substantial scope for further increases in the tax rate in Nigeria, yielding potential revenues of up to 107 663 315 USD, annually. Despite an existing momentum to improve surgical care, there is no impetus to earmark sugar tax revenues for surgery. Primary healthcare and the prevention and treatment of non-communicable diseases present as the most favoured investment areas. Consensus within the medical community on importance of primary healthcare, along the recent government transition in Nigeria, offers a policy window for promoting a higher SSB tax rate and an adoption of other sin taxes to generate earmarked funds for the healthcare system. Evidence-based advocacy is necessary to promote the benefits from investing into surgery.
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Affiliation(s)
- Martilord Ifeanyichi
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria Enugu Campus (UNEC), Enugu, Nigeria
| | - Cyril Dim
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Maeve Bognini
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
| | - Meskerem Kebede
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
| | - Darshita Singh
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria Enugu Campus (UNEC), Enugu, Nigeria
| | - Rachel Hargest
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
- School of Medicine, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
- Royal College of Surgeons of England, London, United Kingdom
| | - Rocco Friebel
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London WC2A 2AE, United Kingdom
- Center for Global Development Europe, London SW1P 3SE, United Kingdom
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kindom
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Frank T, Ng SW, Lowery CM, Thow AM, Swart EC. Dietary intake of low-income adults in South Africa: ultra-processed food consumption a cause for concern. Public Health Nutr 2024; 27:e41. [PMID: 38204376 PMCID: PMC10882538 DOI: 10.1017/s1368980023002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines. DESIGN Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017-2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. SETTING Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. PARTICIPANTS In total, 2521 participants (18-50 years) were included in the study. RESULTS Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. CONCLUSIONS Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.
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Affiliation(s)
- Tamryn Frank
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, Cape Town7535, South Africa
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa
- DSI/NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
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Kruger P, Goldstein S, Hofman K. The passage and implementation of a Health Promotion Levy in South Africa as a case study of fair financing procedures. Health Policy Plan 2023; 38:i49-i58. [PMID: 37963079 PMCID: PMC10645051 DOI: 10.1093/heapol/czad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 11/16/2023] Open
Abstract
Procedural fairness is an accepted requirement for health decision-making. Fair procedures promote the acceptability and quality of health decisions while simultaneously advancing broader goals of participatory democracy. We conducted a case study of the Sugary Beverage Tax in South Africa known as the Health Promotion Levy (HPL), which was legislated in 2018. The case study examines the process around the adoption of the HPL from the perspective of procedural fairness with the view of identifying local gaps and lessons transferable to other local decision-making processes and other jurisdictions. We conducted a desk review of publically available data relating to the passage and implementation of the HPL, including a review of the policy documents, public submissions during the public participation process, response documents from policymakers, review of national legislative committee minutes, legal instruments and academic literature capturing public awareness, stakeholder views and media content. The data collection is novel in terms of the large scope of data considered, as well as the variety of sources. An analytical framework consisting of key criteria for procedural fairness, informed by a scoping review of the literature, guided the analysis of the decision-making process in South Africa. The process of the adoption and passage of the HPL met the majority of the procedural fairness criteria. However, a shortcoming, which impacted several criteria, was the failure to actively source the participation of community representatives and the larger public. Non-governmental organizations did not adequately fulfil this representative role. Industry interests were also disproportionately considered. The case study highlights the overall importance of viewing general members of the public as interested parties in health policies and the dangers of over-involving policy opponents under a mistaken understanding that this constitutes meaningful public engagement in decision-making procedures.
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Affiliation(s)
- Petronell Kruger
- The SAMRC/Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Office 233, 2nd floor, Wits Education Campus, 27 St Andrews Road, Parktown, Johannesburg 2197, South Africa
| | - Susan Goldstein
- The SAMRC/Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Office 233, 2nd floor, Wits Education Campus, 27 St Andrews Road, Parktown, Johannesburg 2197, South Africa
| | - Karen Hofman
- The SAMRC/Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Office 233, 2nd floor, Wits Education Campus, 27 St Andrews Road, Parktown, Johannesburg 2197, South Africa
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Kanozire B, Pretorius D. Obese patients' dissatisfaction with weight, body image and clinicians' interaction at a district hospital; Gauteng. Afr J Prim Health Care Fam Med 2023; 15:e1-e9. [PMID: 37526554 PMCID: PMC10476451 DOI: 10.4102/phcfm.v15i1.3872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/05/2023] [Accepted: 05/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Obesity in South Africa has created a public health crisis that warrants a multilevel intervention. However, patients' perceptions and clinicians' challenges hinder the management of obesity in primary care. AIM The study aimed to assess obese patients' dissatisfaction with weight and body image and their perspectives on interaction with clinicians regarding obesity management in a primary care setting. SETTING Outpatient department of Dr Yusuf Dadoo District Hospital. METHODS Cross-sectional study of 213 adult obese patients. A semi-structured questionnaire, a body image assessment tool and patients' medical records were used for data collection. RESULTS The study found that, contrary to popular belief, obese patients were dissatisfied with their weight (78.9%) and body image (95.3%). Many felt comfortable while discussing weight reduction with clinicians, although 37.1% reported never engaging with a doctor and 62.9% never interacted with a nurse on the subject. Only 6% reported receiving adequate information on weight reduction measures and 19.7% were followed-up. Clinicians' advice was mainly associated with patients' high body mass index and waist circumference. Doctors were less likely to recommend weight reduction to employed obese women, while nurses were more likely to engage Zulu-speaking patients. Patients were more likely to be followed up if they were young and excessively obese. CONCLUSION The study found that most obese patients were dissatisfied with their weight and body image and perceived their interaction with clinicians regarding obesity management as inadequate.Contribution: The study provides an angle of view of challenges in obesity management from patients' perspectives.
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Affiliation(s)
- Buhendwa Kanozire
- Department of Family Medicine and Primary care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Boachie MK, Goldstein S, Kruger P, Ng SW, Hofman KJ, Thsehla E. Beverage industry's advertising expenditures and airtimes in South Africa from 2013 to 2019 target children and families. J Public Health Res 2023; 12:22799036231168207. [PMID: 37122639 PMCID: PMC10134126 DOI: 10.1177/22799036231168207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
With the growing burden of non-communicable diseases (NCDs), countries across the globe are finding ways to reduce the consumption of ultra-processed food and drinks including sugar-sweetened beverages (SSBs). South Africa implemented a health promotion levy (HPL) in April 2018 as one strategy to reduce sugar intake. Such efforts are frequently countered or mitigated by industry action in various ways, including through marketing and advertising strategies. To better understand trends in the extent of advertising, this paper analyses advertising expenditures and exposure of children to SSB advertisements in South Africa. Using Nielsen's monthly data on advertising expenditure before and after the introduction of the HPL, for the period January 2013 to April 2019, the results show that manufacturers spent ZAR 3683 million to advertise their products. Advertising expenditure on carbonated drinks accounted for over 60% (ZAR 2220 million) of the total expenditure on SSBs. The results also show that companies spend less in advertising powdered SSBs (an average of ZAR 0.05 million per month). Based on expenditure patterns, television (TV) was the preferred medium of advertisements, with companies prioritizing what is often considered children's and family viewing time. Urgent mandatory regulations are needed to prevent child-directed marketing.
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Affiliation(s)
- Micheal Kofi Boachie
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Petronell Kruger
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shu Wen Ng
- Department of Nutrition, Gillings
School of Global Public Health, University of North Carolina, Chapel Hill, NC,
USA
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ghodsi D, Haghighian-Roudsari A, Khoshfetrat M, Abdollah-PouriHosseini SF, Babapour M, Esfarjani F, Ajami M, Zargaraan A, Mohammadi-Nasrabadi F. Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households? Front Nutr 2023; 10:1035094. [PMID: 36814511 PMCID: PMC9939810 DOI: 10.3389/fnut.2023.1035094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
Objective This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households. Methods The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications. Results Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated. Conclusion The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.
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Affiliation(s)
- Delaram Ghodsi
- Department of Nutrition Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Haghighian-Roudsari
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MohammadReza Khoshfetrat
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Fatemeh Abdollah-PouriHosseini
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Babapour
- Department of Economics, Allameh Tabataba’i University, Tehran, Iran
| | - Fatemeh Esfarjani
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ajami
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azizollaah Zargaraan
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Azizollaah Zargaraan,
| | - Fatemeh Mohammadi-Nasrabadi
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Fatemeh Mohammadi-Nasrabadi,
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Smit S, Hagemeister DT, van Rooyen C. Clinical review of stroke care at National District Hospital, Bloemfontein. S Afr Fam Pract (2004) 2023; 65:e1-e7. [PMID: 36744481 PMCID: PMC9983283 DOI: 10.4102/safp.v65i1.5608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality affecting sub-Saharan Africa. Studies show that dedicated stroke units improve patient outcomes. National District Hospital (NDH) manages strokes, with the potential of becoming a dedicated stroke unit in Bloemfontein, South Africa. The study aimed to describe the clinical characteristics, management and outcomes of patients presenting with stroke at NDH. METHODS In this retrospective descriptive study, emergency department registers were used to identify patients presenting with symptoms of a stroke between 01 January 2019 and 31 March 2019. Relevant data were extracted from hospital files. RESULTS Of the 106 identified patients, 53 were included in the study. The median age was 61 years (range 28-89 years), with an almost equal split between genders. The most common risk factor was hypertension (81.3%). The median time from symptom onset to presentation at NDH was 9 h. No patient received thrombolysis. One patient received neurosurgical intervention. The most prescribed secondary preventative drugs were antihypertensive medication, statins, anticoagulation and antiretroviral therapy. Half (52.8%) of the patients received rehabilitation as in-patients. Final diagnoses were ischaemic strokes (26/53, 49.0%), transient ischaemic attacks (10/56, 22.7%) and haemorrhagic strokes (6/56, 13.6%). The 6-month post-infarct mortality rate was 37.5%. CONCLUSION Patient outcomes were comparable to similar South African studies. Time delays in stroke management remain a major obstacle. Identified action points include community education, improving emergency medical services and establishing a dedicated stroke unit.Contribution: This study underlines the importance of stroke and cardiovascular disease prevention and stresses the value of establishing dedicated stroke units.
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Affiliation(s)
- Selma Smit
- Department of Family Medicine, Faculty of Health Science, University of the Free State, Bloemfontein.
| | - Dirk T. Hagemeister
- Department of Family Medicine, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
| | - Cornel van Rooyen
- Department of Family Medicine, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
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Koen N, Ebrahim Z, Louisa Marais M, Nel D, Smit Y. Taxation of sugar-sweetened beverages in South Africa: Perspectives of consumers in Cape Town. J Public Health Res 2022; 11:22799036221129369. [PMID: 36310822 PMCID: PMC9597050 DOI: 10.1177/22799036221129369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Globally, fiscal measures are deemed effective in combating the obesity epidemic at population level. A health promotional levy (HPL) on sugar sweetened beverages (SSBs) was implemented in April 2018 in South Africa to reduce sugar consumption. DESIGN AND METHODS This cross-sectional, descriptive study investigated consumers' understanding and opinion of the HPL, and impact on consumption of SSBs. Data was collected outside 15 grocery stores, within four health sub-districts of the City of Cape Town. An interviewer-administered questionnaire was completed with literate, adult consumers (N = 696). RESULTS Participants (46.0%) were aware of the HPL but regarded it insufficient to change purchasing behaviour (55.4%). The lower income group (56.4%) was most affected by the increased price of SSBs. Those who agreed (46.8%) that the levy would help to reduce the prevalence of obesity was significantly more likely to notice a price increase in SSBs (54.5%) (p < 0.01) and had a higher education level (p < 0.01). Overall, self-reported consumption of SSBs decreased by 7.7% since the HPL was enacted. Participants who were aware of the detrimental effect of consuming large amounts of sugar, were more likely to change their behaviour (p < 0.01). CONCLUSIONS Participants were receptive for legislative measures to combat the prevalence of obesity but lacked clarity of the goal and implementation of the HPL. A multipronged approach is crucial to lower sugar intake sustainably and an environment which offers healthy alternatives to SSBs. A higher HPL combined with transparency of how revenue is utilised could enhance the impact of the sugar tax strategy.
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Affiliation(s)
- Nelene Koen
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa,Nelene Koen, Division of Human Nutrition,
Department of Global Health, Faculty of Medicine and Health Sciences,
Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.
| | - Zarina Ebrahim
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
| | - Maritha Louisa Marais
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
| | - Daan Nel
- Centre for Statistical Consultation,
Stellenbosch University, Stellenbosch, South Africa
| | - Yolande Smit
- Division of Human Nutrition, Department
of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
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Wiles NL. The battle against ultra-processed food consumption in a post-COVID-19 era. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2105492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nicola Laurelle Wiles
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Science, College of Agricultural, Engineering, and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Bercholz M, Ng SW, Stacey N, Swart EC. Decomposing consumer and producer effects on sugar from beverage purchases after a sugar-based tax on beverages in South Africa. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101136. [PMID: 35358759 PMCID: PMC9288974 DOI: 10.1016/j.ehb.2022.101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 02/05/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers' product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households' non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.
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Affiliation(s)
- Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates.
| | - Nicholas Stacey
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
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New developments with the Health Promotion Levy in South Africa. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Ross A, Swart EC, Frank T, Lowery CM, Ng SW. South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets. Public Health Nutr 2022; 25:1-26. [PMID: 35249582 PMCID: PMC9991735 DOI: 10.1017/s1368980022000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. DESIGN Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). SETTING Langa, Western Cape, South Africa. PARTICIPANTS Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). RESULTS Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. CONCLUSIONS We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.
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Affiliation(s)
- Alexandra Ross
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa
- DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tamryn Frank
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
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