Download About ADSA Sugar consumption and health Free sugars

Health Promotion Levy on
Sugary Beverages
Presentation to Standing Committee on Finance
6 June 2017
Jessica Byrne, RD (SA)
Chief Operating Officer of ADSA
About ADSA
• ADSA is a professional organisation for registered dietitians
• ADSA’s VISION: To represent and develop the dietetic profession
to contribute towards achieving optimal nutrition for all South
Africans.
• ADSA’s MISSION: As the registered professionals in the field of
dietetics and nutrition we support and promote the continued
growth of the profession of dietetics in South Africa.
• Promote the nutritional wellbeing of all South Africans through
evidence-based public health messages and providing input into
nutrition-related regulations
Sugar consumption and health
• Free sugars: “energy-providing sugars such as monosaccharides (e.g.
glucose, fructose, galactose) and disaccharides (e.g. lactose, maltose
and sucrose) that are added to foods and drinks during processing by
the food manufacturing companies, cook or consumer, as well as sugars
naturally present in honey, syrups, fruit juices and fruit juice
concentrates” (WHO)
• Intake of free/added sugars is increasing in SA
– Intake estimated to be 40-60 g/d, up to 100 g/d (20% of energy)
• Main sources of added sugar: white sugar, SSBs (squash & carbonated)
– Carbonated drinks consumed more than milk
(Nel 2002, Steyn 2008, Mackwoen 2008, Temple 2013, Maunder 2015)
Sugar intake recommendations
• WHO:
– Reduce the intake of free sugars to less than 10% of total energy
intake (50g of sugar, ±12 tsp per day)
– Further reduction to less than 5% of total energy intake (25 g of
sugar, ± 6 tsp per day)
• SA Food Based Dietary Guidelines: ‘use sugar and foods and drinks
high in sugar sparingly’
– Upper limit of no more than 10% of total energy intake from added
sugar
– Further recommend to limit added sugar intake to less than 6% of
total energy intake, especially in those at risk of the harmful effects of
sugar
(WHO 2015, Temple 2013)
Sugar consumption and health
• Sugar-sweetened beverages (SSBs): beverages containing added
sweeteners that provide energy (measured in kilojoules or ‘calories’)
such as sucrose, high-fructose corn syrup, or fruit-juice
concentrates, which include but are not limited to: 1) soft drinks; 2) fruit
juices and drinks; 3) sport and energy drinks; 4) vitamin water drinks; 5)
sweetened ice tea; 6) sweetened milk drinks; and 6) lemonade, among
others
• Sales of SSBs more than doubled in SA from 1998 to 2012 (Stats SA)
• Sugary drinks are a significant source of added sugar (330ml
carbonated beverage = ± 35g sugar)
Sugar consumption and health
• High intake of free sugars,
energy (kilojoule) intake
particularly as SSBs, increases
• Increases risk for overweight and obesity >> non-communicable
diseases (e.g. diabetes, hypertension, stroke, heart disease)
– 65% of women and 31% of men
– Almost 1 in 4 children (22.9%) 2-14 years
• Increased risk for dental caries
• Dilutes micronutrient intake (“empty calories”)
(WHO 2015; SACN 2015; SANHANES-1
2014; Malik 2010)
Why a tax on sugary drinks?
• Cost-effective, reaches the entire population
• Strong evidence shows reduction in sugary drinks consumption,
also increase consumption of healthier options
• Lower income consumers reduce consumption and receive
greatest benefit
• Increase public awareness of the harms of sugary drinks and
incentivizes the beverage industry to reformulate their products
and market healthier beverages
• Generate significant new revenue that can be used to fund important
health programmes
• In SA, a 20% tax on sugary drinks is estimated to reduce obesity by
3.8% in men and 2.4% in women resulting in 220 000 fewer obese
adults
(WHO 2015; Powell 2013; Manyema 2014; Backholer 2016)
Sugary drinks tax: global experiences
• Mexico:
– 12% decrease in the purchase of SSBs, with a 17% decrease in the
purchase of SSBs seen in the poorest households
– SSBs being replaced by healthier options
• The UK, Brazil, Chile and many other countries are promoting sugary
drinks taxes of 20% or higher
• Taxes on unhealthy food products in Hungary and Denmark led to
reduced purchases, as did a tax on non-essential food in Mexico
• Based on systematic reviews, the WHO and other global experts
recommend that taxes should be 20% or greater in order to impact
• Tobacco taxes have played a major role in reducing smoking
(WHO 2015; Powell 2013; Briggs 2013; Colchero 2016)
Strengthen the tax
1. Tax all the sugar in SSBs and increase the tax rate
• Proposed ‘discount’ for the first 4g of sugar per 100ml exempts a
large portion of the sugar & reduces the health impact of the tax
• Initial proposed tax rate in 2016 was 20%, which is now reduced
to 11% tax rate
1 L carbonated drink
2016
2017
Sugar content (g)
106
106
0
40
Taxable sugar (g)
106
66
Tax rate (c/gram)
2.29
2.1
242.74
138.6
Tax-free threshold (g)
Tax due (c)
Strengthen the tax
1. Tax all the sugar in SSBs and increase the tax rate
• Tax needs to be introduced at a sufficiently high level to have a
meaningful impact on purchasing, consumption, and ultimately
obesity (Powell, 2013)
• Recommendation: remove the 4g discount and tax all the
sugar in SSBs at the higher tax rate.
Strengthen the tax
2. Increase the tax rate of concentrates
• Tax rate for concentrates (squashes or syrups) is half the rate for readyto-drink products
• Consumption of concentrates is increasing (from 16.5% in 2009
to 32.9% in 2016)
• Similar sugar content to carbonated beverages
• Tax must encourage public to consume beverages that are lower
in sugar – instead of switching to cheap sugary concentrates
• Recommendation: the tax rate for concentrates should be
increased to align with the rate for readyto-drink SSBs
Strengthen the tax
2. Increase the tax rate of concentrates
• Do powders that are sold and then reconstituted to form drinks
also fall under the scope of the tax?
• Contain a significant amount of added sugar:
– Hot chocolate powders (e.g. 14g serving =
11g sugar)
– Juice powders (e.g. 24g serving = 22g sugar)
• Recommendation: powdered and reconstituted drinks should
also be included in the scope of the tax and are added to the
definition of a SSB
Strengthen the tax
3. Clarity on dairy drinks
• 2017 Budget Speech: include intrinsic and added sugars, but milk exempt
• For a sweetened dairy product, is the taxable amount only on the added
sugar and not the intrinsic sugar in the dairy product (i.e. lactose)?
• Unsweetened dairy drinks are the best way to consume dairy drinks
• Sweetened dairy drinks can provide a source of beneficial nutrients,
healthier alternative to sweetened carbonated beverages
• Milk and calcium intake in SA is low
• Recommendation: the tax should only be calculated on the added
sugar content in dairy drinks, rather than the total sugar content
(WHO 2015; Vorster 2013)
Strengthen the tax
4. Correct classification of fruit juices
• 2017 Budget Speech: include both intrinsic and added sugars, 100% fruit
juice exempt
• Intrinsic sugars: “sugars incorporated within the cell structures of intact
fruit and vegetables, and sugars naturally present in milk” (WHO)
• Fruit juice ≠ intrinsic sugar: once the fruit has been juiced, it no longer
has intact cell structures
• Fruit juice = free sugar
100% fruit juice
176 kJ/100ml
Sweetened carbonated drink
171 kJ/100ml
• Recommendation: all fruit juices should be subject to the same tax as
other SSBs and should not be exempt
Strengthen the tax
5. Some revenue from the tax used for health promotion
• A tax on SSBs is only one piece of the puzzle to address obesity
• Price is a major determinant of purchasing behaviours, but other factors
also affect purchasing decisions
• Need multiple additional interventions across multiple sectors
• Supportive interventions: education around healthy choices and
creating an enabling environment to make those choices easier
• Earmarking of revenue recommended
– Mexico: US$ 2.6 billion raised in 2 years – install
water fountains
– France: total of the contribution is allocated to NHI
Strengthen the tax
5. Some revenue from the tax used for health promotion
• Recommendation: revenue generated used
to support implementation of the DoH’s
Strategy for the Prevention and Control of
Obesity in South Africa
– Support inter-sectoral engagement;
– Enabling environment that supports the availability
and accessibility of healthy food choices;
– Increase physical activity;
– Support obesity prevention in early childhood;
– Educate and mobilise communities;
– Surveillance system, strengthen research
Summary
• ADSA acknowledges that many South Africans are at a
greater health risk due to the high consumption of free
sugars, particularly as SSBs
• ADSA supports the proposed taxation of SSBs
• It is ADSA’s view that the proposed tax needs to be
strengthened to be more effective in reducing consumption
of SSBs in order to have an impact on obesity and longterm health
References
•
•
•
•
•
•
•
•
Nel JH, Steyn NP. Report on South African food consumption studies undertaken amongst different population
groups (1983-2000): average intakes of foods most commonly consumed. Pretoria: Department of Health; 2002
[homepage on the Internet]. Available from: http://www.mrc.ac.za/chronic/foodstudies.htm
Steyn NP, Nel JH, Labadarios D. Will fortifcation of staple foods make a difference to the dietary intake of South
African children? S Afr J Clin Nutr. 2008;21(1):22-26.
MacKeown JM, Pedro TM, Norris SA. Energy, macro- and micronutrient intake among a true longitudinal group of
South African adolescents at two interceptions (2000 and 2003): The birth-to-twenty (Bt20) study. Public Health
Nutr. 2007;10(6):635-643
Temple, Steyn. Sugar and health: a food-based dietary guideline for South Africa. S Afr J Clin Nutr 2013;
26(3)(Supplement): S100-S104
Maunder EMW, Nel JH, Steyn NP, Kruger HS, Labadarios D (2015) Added Sugar, Macro- and Micronutrient Intakes
and Anthropometry of Children in a Developing World Context. PLoS ONE 10(11): e0142059.
doi:10.1371/journal.pone.0142059
World Health Organization. Guideline: Sugars intake for adults and children. Geneva: World Health Organization;
2015 (http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/
Scientific Advisory Committee on Nutrition. Carbohydrates and Health. 2015, London, TSO
(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and
_Health.pdf)
Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus,
and cardiovascular disease risk. Circulation 2010; 121(11): 1356-64.
References
•
•
•
•
•
•
•
Shisana O, et al & the SANHANES-1 Team (2014) South African National Health and Nutrition Examination Survey
(SANHANES-1): 2014. Cape Town: HSRC Press. (http://www.hsrc.ac.za/uploads/pageNews/72/SANHANESlaunch%20edition%20(online%20version).pdf)
World Health Organization. Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting
report, 5-6 May 2015, Geneva, Switzerland (http://www.who.int/dietphysicalactivity/publications/fiscal-policies-dietprevention/en/)
Powell, LM., Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and
beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight
outcomes. Obesity Reviews, 2013; 14:110-128
Briggs ADM, Mytton OT, Kehlbacher A, Tiffin R, Rayner M, Scarborough P. Overall and income specific effect on
prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk
assessment modelling study. BMJ, 2013; 347 (oct31 4): f6189 DOI: 10.1136/bmj.f6189
Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on
sugar sweetened beverages: observational study. BMJ, 2016 Jan 6;352:h6704
Manyema M, Veerman LJ, Chola L, Tugendhaft A, Sartorius B, Labadarios D, et al. (2014) The Potential Impact of
a 20% Tax on Sugar-Sweetened Beverages on Obesity in South African Adults: A Mathematical Model. PLoS ONE
9(8): e105287. doi:10.1371/journal.pone.0105287
Backholer, K., Sarink, D., Beauchamp, A., Keating, C., Loh, V., Ball, K., Martin, J. and Peeters, A. (2016) ‘The
impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the
evidence’, Public Health Nutrition, pp. 1–15. doi: 10.1017/S136898001600104X
Thank you
[email protected]
Website: www.adsa.org.za
Email: [email protected]
Facebook: ADSAorgza
Twitter: @ADSA_RD