Soft-drink manufacturers are targeting Africa, but industry-led pledges to reduce the sale of sugary drinks subvert better government-led policy options.
Two years after Coca-Cola South Africa voluntarily pledged to fight high rates of childhood obesity by removing sugary drinks and their advertisements from primary schools in Gauteng province, 31 percent of school tuck-shops were still advertising it and 54 percent were still selling sugary soft drinks.
Self-regulation by drink manufacturers who commit to stop marketing their product to certain sectors of society has no public health benefit. Worse, these voluntary commitments are often prompted by government efforts to regulate unhealthy food and substituted for more effective government policy and legislation.
A plethora of evidence now shows that consuming sugary drinks, including soft drinks and fruit juices, can lead to obesity and put people at risk of developing cardiovascular disease, type-2 diabetes and, ultimately, lead to premature death.
Over the past few years, the amount of sugar and sugary drinks consumed in low- and middle-income countries, has rapidly increased. This increase is not an accident. Consumption of these unhealthy drinks is decreasing in Europe and other wealthy countries, but soft drink manufacturers identifying Africa as a growth market have begun a systematic expansion into the continent, influencing the physical, economic, policy and sociocultural surroundings that people live in, and steering their choices and diet towards unhealthy options.
The alarming increase in poor-diet-related diseases poses a particular problem for countries in which there are resource constraints and fragile healthcare systems already burdened with high rates of malaria, HIV and tuberculosis. As a result, people in these settings who develop diet-related diseases have significantly worse health outcomes than people elsewhere.
However, unlike many other health conditions, most diet-related non-communicable diseases are preventable with relatively cost-effective fiscal and policy interventions. Individuals buy more unhealthy foods when they are cheap, available and accessible and when marketing promotes these products as very desirable. Regulations intended to drive up prices and make these foods more expensive and restrict where they can be sold and advertised are proven to prevent disease. Introducing a tax on sugary drinks is a key public health strategy to reduce consumption of unhealthy food, with many countries showing these taxes reduce how much people purchase and drink.
Other effective and inexpensive measures include limiting or prohibiting certain harmful ingredients (such as sodium or trans-fats), restricting advertising of unhealthy foods to children and introducing simpler labels to explain the healthfulness of foods.
However state and local government efforts to tax beverages or remove them from schools face intense opposition, particularly from industry. Governments also face pressure from international bodies such as the United Nations, who have called for governments to collaborate with industry and endorsed the use of voluntary commitments — as opposed to mandatory regulation — in the fight against diet-related diseases.
Allowing industries to self-regulate may be appealing in low-income countries which may lack the money to enforce mandatory regulations and which can rely on these industries to promote economic growth. However, policing voluntary commitments and self-regulation is often left up to the producers themselves who can only be responsible for their own product.
When Coca-Cola South Africa pledged to remove in-school products, students were still able to purchase sugary drinks from rival suppliers and Coca-Cola’s in-school advertising was commonly the branded fridge — often the school’s only fridge — so the incentive to request its removal was low.
Strong evidence shows that South Africa’s 2018 mandatory tax on sugary drinks reduced sugar consumption with positive consequences for public health, and more than two thirds of the foods covered by sodium-limiting regulations are compliant with the law.
People consume far more unhealthy foods in an environment that is engineered by industry to encourage its consumption, so where governments choose to adopt interventions (rather than rely on voluntary self-regulation) they will likely see higher compliance, more effective implementation and better public health outcomes.
Safura Abdool Karim is a public health lawyer and researcher who focuses on using laws to improve health. Her work on the development and evaluation of non-communicable disease prevention interventions such as front of package labelling and sugary beverage taxes in Sub-Saharan Africa has supported policy change in a number of countries. She declares no conflict of interest.
Agnes Erzse is a senior researcher at the SAMRC/ Wits Centre for Health Economics and Decision Science – PRICELESS SA at the Wits School of Public Health, Johannesburg. Her research focuses on priority setting to improve maternal and child nutrition and engaging the public in the priority setting process. Her research is supported by the SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA (grant number 23108).
Karen Hofman is research professor and founding director of the SAMRC/ Wits Centre for Health Economics and Decision Science – PRICELESS SA at the Wits School of Public Health, Johannesburg. She leads policy research to evaluate interventions both inside the health system and in other sectors that provide the biggest return on investment for health. She initiated the research that culminated in the sugary beverage tax. She declares no conflict of interest.