“It ain’t over until the fat lady sings “-
the South African sugar tax finale
Authors: SANCDA Vicki and David Pinkney-Atkinson
Written for NCDA and published on the SANCDA website
After 18 months of public wrangling the Health Promotions Levy (HPL), also known as the “sugar tax”, is inching closer to a finale. With stakeholder consultation drawing to a close, a final step is an Act that includes a tax on sugary drinks. The decision must be made by legislative structures to implement or withdraw the tax. It is a final critical drama. For now.
The outcome cannot be taken for granted within the current South African political climate. In other words, it is a “don’t count your chickens until they hatch” scenario. A cliffhanger to the last. The South African NCDs Alliance (SANCDA), its partners and allies, have participated in the public roller coaster ride. It supports the tax as a positive step towards health in a whole package of interventions. Note, it is one of many planned but unfinanced interventions needed to promote health and kerb non-communicable diseases (NCDs). Sugar is the new tobacco.
If you are like us, the nuances of what it takes to pass a tax law are mysterious and not within our everyday grasp of life. So, get to know music overture to the final act of how this happens. In South Africa, this is how a law is tabled and passed.
Using the “sugar” and “tax” together is an oxymoron. Simply confusing with one seen as good and the other as bad. Like the “teenage brain”. So, from childhood we learn the following:
- Tax is bad = “Nothing is certain but taxation and death.”
- Sugar is good = “Sugar and spice and all things nice.”
So, sugar is good? Fact check: too much sugar, especially in a cheap and easy to access form like “soft drinks” or “sodas” is linked to obesity, diabetes, cancer, tooth decay and heart disease. The illnesses resulting from sugary drinks are estimated to have cost the South African economy R23 billion in 9 years to treat and fight obesity only. A local study shows R10 billion will be saved over the next 20 years if we count type 2 diabetes alone.
Tax is bad. So, predictably questions in our country are likely one of the following versions:
- Why should I care, I don’t drink Coke and I am not fat?
- This is another clever money grabbing way for the government to hit my shrinking wallet.
- Don’t waste my money on a frivolous tax that will be wasted like so much of our money is already lost through wasteful expenditure and other nefarious means.
Let’s start by educating our people that this is an important issue that is bigger than simply saying “no” to sugary drinks. South Africans simply don’t know enough about the risks and dangers of too much sugar and its relationship to obesity and NCDs. This tax has just highlighted how much further must be done. It’s not simply about sugary drinks, these are the visible part of the problem
The cost of obesity and diabetes to South Africans is called the “burden of disease” and is often expresses as the number of people who get sick and die of certain diseases. It costs all of South Africa because our fragile health system must cope with most of the people and each of us have to pay for it in some way. It may be your mother or brother or child. Who cares for you when you have lost your leg to diabetes and can’t walk? Someone in your family needs to stop everything and care for you. This means that they and often you lose their income in caring for you.
Fact checks
- South Africa is the fattest nation in sub-Saharan Africa
- Diabetes the number 2 killer of people in South Africa after TB
- Cutting sugar levels will cut obesity and crippling illnesses.
Our collective lack of awareness as a nation and education is why the SANCDA calls for part of the money collected to be used for the prevention of obesity and related non-communicable diseases (NCDs). NCDs in the health budget is neglected and underfunded, even though these illnesses are the leading cause of death in South Africa.
“Government is committed to increasing investment towards health promotion targeting non- communicable diseases alongside the implementation of the sugary drinks tax, such as diabetes screening and nutrition education.”
Minister Pravin Gordhan, Budget speech 22 February2017
The SANCDA celebrates the proposed allocation of additional resources for health and NCDs prevention. We lament that organisations like CANSA, Diabetes South Africa and the Heart and Stroke Foundation with active programmes are not considered for funding. Let’s not forget over 10 cancers are linked to, and many children lose teeth because of sugar excess.
The HPL is a better, if not as catchy, name that puts the focus where it belongs on health promotion and primary prevention of obesity and NCDs. The sugary drinks tax timeline in the box below shows where we have come from and where we are going in the “final” act for now.
As expected the food and beverage industry does not want this tax and has aggressively campaigned against it. The ultimate weapon, in a country with all-time high unemployment rates and in a technical recession, is to claim that massive job losses will result. Job loss claims range from 72,000 jobs to 5,000. The initial estimate from Treasury was less than 11% of those claimed.
The ball is firmly in the court of the food and beverage industry according to Treasury’s response published this week and presented to the Finance Standing Committee. If the beverage industry reformulates to meet the new requirements of 4g/100ml the job losses are estimated to be significantly less at 2,392 jobs across the sector.
The HPL isn’t only a tax digging into your pocket and costing you more. We, the South Africans, are acting now to change the health of our children’s future. We did it for HIV/AIDS now we need to do it for all of us once again. Take a lesson from the past. When taxes and levies were first placed on cigarettes it was met with the same view, but as money, educated people and the health risks became more abundant. You’d be hard pressed to find a single person upset about the cost of smoking and the measures taken to dissuade people from it. The HPL is here to stop an even greater cost to us in the next 10 years.
The introduction of the draft taxation bill in February is watered-down version with the taxation reduced by almost half. The graphic shows the details.
In our democratic society, the bill must be passed with the taxation of sugary drinks at any level to change the health of the nation.
As the discussion is set continue as we reach the final act. The SANCDA, together with its global and local partners, will keep monitoring the progress and keep you informed. These insights make what is being worked towards an evidence based path to follow having been tailored to fit the uniquely South African way forward. Together they are all working towards this goal finally becoming a reality.
We are committed to sharing experiences and lessons learnt in this crucial final act as we wait for the “fat lady to sing”.
|
SOUTH AFRICA’S SUGARY DRINKS TAXATION TIMELINE |
| 1993 -2002 |
Taxation of “soft drinks and mineral water” by volume not related to sugar content. Repealed following lobby by the food & beverage industry. |
| 2013 |
National Department of Health NCDs policy published including SSB tax is part of the effective measures to combat obesity and non-communicable diseases (NCDs). |
| 2014 |
Food labelling and marketing to children regulation published (R429) and remains to be finalised. |
| 2015 |
Publication of SA National Health Promotion policy & SA obesity control and prevention policy |
| 2016 |
| February |
SSB tax announced in budget speech for implementation in 2017 |
| July |
Treasury releases SSB tax policy paper recommending a 20% tax. |
| August |
· Closing date for comments
· SANCDA submits comment. |
| November |
Treasury stakeholder workshop on the SSB
SANCDA makes a presentation |
| 2017 |
| January 31 & February 14 |
Standing Committee on Finance – legislative activities to allow for implementation of tax
SANCDA make a submission |
| February |
· Budget speech announcing a reduced SSB tax in a draft tax bill
· Tax rate reduce to half and amount of sugar to be taxed reduced.
· Now called a “Health Promotion Levy” (HPL)
· Unspecified part of money collected to be allocated for obesity prevention and diabetes care |
| May 28 & June 6 |
Standing Committee on Finance – more public hearings on HPL in the draft bill.
SANCDA makes presentation |
| 4 June |
National Economic Development and Labour Council (NEDLAC) meetings on SSB tax |
| 22 June |
Standing Committee on Finance meetings and publication of draft summary of findings |
| August |
Standing Committee on Finance decision referred to Council of the Provinces |
| 2020 |
ê obesity by 10% national target to be achieved |
The Council for Medical Aids Schemes has stated in their latest circular that submissions to the recent Undesired Business Practice. A proforma document has been circulated that is not aligned with the method of submission required.
This proforma document has been circulated through pharmacies and brokers to the public. The CMS states that this is not the correct procedure for applications. This is taken seriously by the council as it undermines what the Medical Aid Schemes Act seeks to achieve. The incorrect procedure will invalidate submissions and thus counter the aims of the Undesired Business Practices document. This was noted and publicised in Government Gazette 435 of 2017
The persons wishing to submit applications only need indicate whether co-payments are levied when they use service providers for medication not listed by the medical aid scheme, sign their name and provide personal details.
There are provisions for members of the council to reduce their costs when funding the Prescribed Minimum Benefits (PMBs). Furthermore, there are allowances for instances where the listed service providers are too far from the person’s place of work or home.
Pharmaceutical companies say that delayed drug registrations by the Medicines Control Council may have played a role in stock outs.
A deadly national cancer drug shortage is approaching its third month and patients may have to go without until October – if they can make it.
In February, Nic Basson was diagnosed with glioblastoma multiforme, a fast-growing malignant brain tumour. The tumour is located in his brain’s language centre and affects his ability to communicate.
He was prescribed the steroid betanoid to help control inflammation associated with the tumour. But in April, his local pharmacy told his wife, Debra, that it could no longer fill his prescription, sending Debra on a frantic country-wide search for the drug – to no avail.
She explains: “Within 24 hours without betanoid my husband had lost his ability to speak.”
She continues, softly: “He also has memory loss, so even when he can find words, he forgets what he was going to say. He is essentially trapped in his own mind.”
Betanoid is not just used to treat brain tumours, the medicine is also prescribed to patients battling leukemia, lymphoma and kidney diseases, warns Michael Herbst, health specialist at the Cancer Association of South Africa. Herbst says he is appalled at the shortage.
For cancer patients, skipping a day of betanoid can be life-threatening.
Betanoid works by suppressing the body’s release of stress hormone cortisol. To be effective, the treatment must be taken at exactly the same time every day to ensure that patients have enough of the drug in their blood at all times. Patients who stop taking betanoid have to be weaned off the drug slowly in order to allow their adrenal glands, where cortisol is produced, to slowly return to their normal function.
Herbst warns: “Patients cannot just stop taking betanoid. They could go into a state of shock – and nothing will be able to get them out of it.”
According to US non-profit the Mayo Clinic, withdrawal symptoms from steroids like betanoid also include severe fatigue, body ache and weakness.
Aspen Pharmacare is the sole manufacturer of betanoid for South Africa and says it cannot resume producing the drug until drug regulator the Medicines Control Council (MCC) approves a new manufacturing facility, according to spokesperson Shauneen Beukes.
Aspen did not say when production will resume, but Cape Town’s Groote Schuur Hospital’s spokesperson Alaric Jacobs said they were told to expect stock by the end of October.
National department of health spokesperson Popo Maja has confirmed a nationwide shortage but says the department has imported alternatives to betanoid — dexamethasone and prednisone — to prevent interruptions to cancer care. These drugs are not registered for use in South Africa and must be procured with special MCC permission.
Director of pharmaceutical company Haempharm Caroline Rich says her company will apply to the MCC to register dexamethasone for use in South Africa as a possible alternative to betanoid early next year. She says applications to register the drug have been unsuccessful: “We need to get this drug registered as a matter of urgency.”
Although the country has rushed to import alternatives to betanoid amid stock outages, they may not work for everyone.
Both Rich and oncology pharmacist Carien van der Merwe say that switching patients from betanoid to prednisone is tricky. Van der Merwe, owner of The Oncology Pharmacy, says patients like Nic are often prescribed high doses of prednisone, which is not as potent as betanoid. Patients often suffer from increased side effects as a result.
Nic is now using prednisone but Debra says the medication has left him with side effects such as heart palpitations.
South Africa’s national betanoid shortage comes about one year after Bhekisisa reported a national stock out of common childhood cancer treatments. At the time, doctors complained that the MCC had also been slow to respond to individual requests for special access to generic dexamethasone after the registered provider of the brand name drug, Merck & Company, discontinued production.
Wednesday, June 21st saw South African Medical Device Industry Association (SAMED) public launch of the Medical Device Code of Ethical Marketing and Business Practice “The Code”. This is the first major step in the right direction for the oversight between the medical devices industry, consumers, and healthcare professionals.
SAMED acts as the curator of the code of ethics for its member organisations. The code of ethics is a living document working for the industry and members self-regulating with the oversight of SAMED. The document aims to work toward best practices in ethical business and marketing practices.
The document breaks down to stop and inhibit member companies from offering incentives to healthcare providers and customers. While also putting a stop to bad business practice with sole profit driven motive rather than the best interests of the patients as the primary goal. Covering areas of focus that have been seen to become an area of contention or seen as unethical business practices now and in the future.
This first step is a move to creating buy-in from industry as well as every member working towards a global industry standard. Without this first step buy-in and jumping straight to legislation brings in the problem of loophole exploitation. The code of ethics has been welcomed by the National Department of Health as a step forward and proactive move toward eventual legislation in the years to come. As stated before this is a living document and will change as clashes or problems arise.
This document does have repercussions for members that breach the code of ethics while offering anonymity for whistleblowers as an important part to prevent backlash towards those coming forward. The process will see an independent investigator brought in to gather evidence and the validity of the claims. Furthermore, there will be an independent board of inquiry towards the findings of the investigation. Depending on the severity of the infraction there is an action that will be taken with hefty fines imposed upon the guilty party with no room for appeals within the process, this will have to be taken up in legal courts.
The SANCDA welcomes this move as well as the code of ethics as a movement in the right direction by SAMED and its members.
To download the full code of ethics please use the link below.
If you, or someone you know, have overcome a medical condition with the help of medical technology, and are now giving back to make a positive impact in the world, apply for the Medtronic Foundation’s 2017 Bakken Invitation Award and join a global philanthropic movement of patients who “Live On. Give On. Dream On.” Applications are open through July 24, 2017.
[video]
About the Award
The Bakken Invitation Award, funded by Medtronic Foundation, promotes access to healthcare by recognizing and connecting people who, with the help of medical technology, have overcome health challenges and are now making a difference in communities around the world. The program is named after Medtronic co-founder, Earl Bakken, who openly acknowledges that medical technology has given him 10+ years of “extra life”— time he has put to good use, with heavy community involvement.
Each year, the Medtronic Foundation selects a new group of Honorees and invites them to:
- Convene in Hawaii (USA), where Earl Bakken resides, for an all-expenses-paid experience where Honorees acquire skills to inspire and empower others to manage their own health condition; mobilize other patients to give on in service to others; and learn how to use their voices and scale up their volunteer efforts to make a broader impact.
- Select a charity of their choice to receive a grant from the Medtronic Foundation.
Since 2013, the Medtronic Foundation has recognized 47 Bakken Invitation Award Honorees and disbursed $940,000 USD to nonprofit organizations through the program to further their work. View profiles of past honorees to see how their work impacts the lives of others.
What can you do?
- Invite patient volunteers to apply: Forward this email to your network of people who volunteer and serve others.
- Connect with us on Facebook and visit our website.
- Tag us and include the hashtag in your posts #BakkenInvitation #LiveOnGiveOn.
How to Apply
All applicants 14 years of age or older with eligible medical technology are welcome to apply, regardless of device manufacturer. For a complete list of application requirements, and information on how to apply, visit liveongiveon.org to apply before July 24, 2017.
Your support helps to lift the voices and the charitable initiatives of patients around the world.
