Finance Minister Pravin Gordhan took South Africans by surprise when he announced the introduction of a tax on sugar-sweetened beverages (SSBs) in his budget speech.
SSBs includes still and carbonated soft drinks, fruit juices, sports drinks, energy drinks and vitamin waters, sweetened ice tea, lemonade, cordials and squashes.
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In South Africa, there has been a call for a sugar tax of 20%, following research by the University of Witwatersrand suggesting that a tax on SSBs may reduce obesity in 220 000 adults.
A poll on News24 indicated that 47% (11 992) readers who participated in the vote were in support of a sugar tax. 28% (7 012) readers were not in favour of it, while 25% (6 492) didn't care.
Health Minister Aaron Motsoaledi's spokesperson, Joe Maila, told Health24 that a sugar tax is one of the measures that can assist the department in its bid to help reduce the burden of non-communicable diseases on the country.
It is not just about sugar
"For the health department it is not just about sugar. We need to make sure that we continue with education about the dangers of sugar, salt, the issue of not exercising and the ever increasing rate of non-communicable diseases that we need to put a stop on."
Maila said the department of health will be working with Treasury to determine the the way forward on the tax.
Health sociologist, Aviva Tugendhaft, told Health24 the sugary drink tax is an impressive first step on behalf of government, which needs to be followed by complementary interventions that make healthier choices the easier for consumers.
"Treasury will need to decide on the tax rate and what qualifies to be taxed," said Tugendhaft, who is deputy director of research programme PRICELESS SA at the Wits School of Public Health.
The type of tax on SSBs
"The government may decide to institute a flat rate on all beverages, as has been done in Mexico, or consider taxing the caloric content of the drinks."
France and several states in the US have also introduced a sugar tax; however critics have pointed out that it has not successfully curbed sugar related illnesses.
Tugendhaft said examples from high income countries may not be as relevant to the South African context.
"Mexico is certainly a good example for us and currently it is too soon to determine the health impacts, but the consumption impact has been impressive."
She noted that Mexico implemented a 10% tax in 2014, which resulted in a 12% decrease in sugary drink sales and an increase in water consumption.
"Importantly, we also cannot simply compare obesity rates to before and after the tax but must rather compare these rates after the tax with where they would have climbed to without the tax and other interventions in place."
Tugendhaft added that for South Africa to reap the full health benefits this sugary drink tax must be accompanied by a broader set of interventions.
"These include things like easy to understand food labelling, work site and school based interventions and a strong education campaign, among others."
Sugar tax just the tip of the iceberg
Dr Sundeep Ruder, a healthcare practitioner, specialising as a endocrinologist, welcomed the announcement of a sugar tax but added that it is just the beginning for what lies ahead.
"It is only the tip of the iceberg. Hopefully this will start a national conversation and help people look at sugar sweetened beverages in the same light as alcohol and tobacco," he told Health24.
"It always amazes me how much of the things that are harmful to our health are legal and sold at such high volumes. They are entrenched in society as normal so you have a situation where abnormal becomes the norm and drastic measures are necessary to shake people out of this dream-like state which is so harmful to us."
The sugar tax will begin to do this, said Ruder, but it must be supported by an escalating effort of education, awareness campaigns and proper food labelling.
"The message must be that food is information we put into our bodies and for all this time we have been putting in the wrong information, and that is why we see the rise in non-communicable diseases in South Africa and the world."
He noted that we must think in terms of cause and effect.
"If we act now and change the diets of the population, especially children, than we change the landscape of the future and reap the effect of a healthy productive population from our current efforts."
Ruder pointed out that any revenue generated from a sugar tax could be fed into funding measures to curb the obesity epidemic.
''Government could use such funds for media campaigns, education, supporting medical structures, development of specialists in the field of obesity, infrastructure like parks and other areas of for physical activity."
Furthermore, Ruder suggested a legislative effort to force food companies to reduce sugar content gradually over a stipulated period, e.g. a 20% reduction per year.
"Studies have shown that people are more likely to change behaviours and stick with them if gradual change is implemented. Also the taste difference over time which is the major driving factor in the consumption of these foods would be minimal."