Anne Marie Thow1, Safura Abdool Karim2, Mulenga M Mukanu3, Gemma Ahaibwe4, Milka Wanjohi5, Lebogang Gaogane6, Hans Justus Amukugo7, Charles Mulindabigwi Ruhara8, Twalib Ngoma9, Gershim Asiki5, Agnes Erzse2, Karen Hofman2. 1. Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia. 2. SAMRC/Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 3. Health Policy and Management Unit, University of Zambia School of Public Health, Lusaka, Zambia. 4. Economic Policy Research Centre (EPRC), Makerere University, Kampala, Uganda. 5. Health and Systems for Health Unit, Nairobi, Kenya. 6. Department of Health Promotion & Education, Boitekanelo College, Gaborone, Botswana. 7. Community Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia. 8. School of Economics, University of Rwanda, Butare, Rwanda. 9. Economic Social Research Foundation (ESFR), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Abstract
Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes.Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally. Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action. Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Health-oriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugar-sweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency.Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region.
Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes.Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally. Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action. Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Health-oriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugar-sweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency.Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region.
Entities:
Keywords:
Noncommunicable disease; policy; political economy; sugar-sweetened beverage; tax
Authors: Georgina Mulcahy; Tara Boelsen-Robinson; Ashleigh Chanel Hart; Maria Amalia Pesantes; Mohd Jamil Sameeha; Sirinya Phulkerd; Reem F Alsukait; Anne Marie Thow Journal: Health Policy Plan Date: 2022-05-12 Impact factor: 3.547