Myth-busting the new sugar tax – Health-e News

There has been a lot of controversy surrounding the sugar tax which was officially implemented on April 1st. The tax, equivalent to a levy of about 11 percent on a can of coke, is aimed at tackling South Africa’s obesity epidemic and the diseases associated with it. Health-e News busted five common myths.

Why tax sugary drinks because:

  1. Jobs will be lost hurting the South African economy

Industry has repeatedly published different estimates for how many jobs will be lost across the sugary beverage food chain. In May last year Beverage Association of South Africa (BevSA) said that they anticipate job losses in the region of 24 000. They had also previously claimed that up to 72 000 people could lose their jobs across the value chain. But Treasury published a report in June estimating job losses could be as low as 1475. But public health advocates argue that small short-term losses are dwarfed by the substantial cost to the economy of treating lifestyle diseases. Last month Health Minister Aaron Motsoaledi pointed out that “[y]ou cannot dream of growing your economy without good health”.

  1. The health of South Africans is not affected by sugar

South Africans have increasingly been higher-than-average consumers of sugar and sweetened beverages. A study published as far back as 2007 in the Journal of Public Health Nutrition found that South African toddlers in urban areas drank more sugary drinks than milk. We also have rapidly increasing rates of obesity, being the fattest nation in sub-Saharan Africa, and the diseases linked to it. Diabetes now kills more women than any other disease. Drinking just one sugary drink a day increases the risk of being overweight by 27 percent for adults and 52 percent for children, according to a 2009 study published in the same journal. Moreover, a 2012 study published in Circulation found that drinking one to two fizzy drinks a day can increase one’s risk of developing diabetes by more than 25 percent.

  1. The tax won’t reduce consumption

A number of other countries and areas within countries have instituted sugar taxes amid claims that the intervention won’t have any public health effect as people will continue to drink the same amount of fizzy drinks. Mexico introduced a 10 percent tax on sugary drinks in 2014 and saw a 7.6 percent decrease in sales of sugary drinks and an upturn in sales of bottled water within two years, according to 2017 study led by researchers from the University of North Carolina. It also found that consumption reduced the most in poor communities, which is significant because lifestyle diseases can be financially catastrophic to poor families with less access to healthcare.

  1. Eating sugar is the same as drinking sugar

Many have criticised the tax because it doesn’t address the sugar people consume in food products which also contributes to the rise in obesity, but liquid sugar has been found to be more dangerous than the solid version. Drinking calories in the form of sugar instead of eating it can leave people feeling less full, found a 2010 study in the International Journal of Obesity. Eating a muffin or cake, for example, will leave a person more satiated than drinking a cool drink which could lead to the consumption of more calories to achieve a feeling of fullness. Researchers from Penn State University found that people who drank a sugary beverage with their meal consumed on average more than 100 calories more than those who did not, identifying sugary beverages as an independent risk-factor for obesity.

  1. Industry wants to help solve the obesity problem

Industry fiercely fought the implementation of the tax through a fear-inspiring job losses media campaign, including paying for a study to be conducted and by lobbying workers and government. But they have also publicly said they want to work with government to tackle obesity. When the Healthy Living Alliance protested outside of Coca-Cola’s headquarters in Johannesburg last year Maserame Mouyeme head of Public Affairs, Communication and Sustainability said that “we want to fight obesity” and “work with you in the process of finding a solution”. But industry bodies like BevSA continue to ignore the independent health risks sugary drinks pose to South African consumers while companies have consistently targeted poorer communities to increase their sales. Research from Priority Cost-Effective Lessons for Systems Strengthening South Africa, based at Wits University, noted that Coca-Cola, the country’s largest soft-drink franchise, has identified its future growth strategy targeting those falling under the living standards measure (LSM) of one to six “with a specific focus on LSM 1–3” – the poorest consumers. The beverage industry also spends more than R500 million a year on advertising sugary drinks, “including other promotions that appeal to kids”, according to 2017 data from market research company Nielsen AdEx. This marketing does not include education around the risks of sugar or how much these products contribute to the recommended daily intake of sugar. Just one 500ml bottle of a typical soft-drink in South Africa contains around 10 teaspoons of sugar, almost double the six teaspoons per day recommended by the World Health Organisation. – Health-e News

Health-e News – New SA Smoking Laws ‘in 2 weeks’

 

Originally published For Health-e News
Witten by Kerry Cullinan

 

Regulations to ban smoking in all public spaces, remove branding from cigarettes packs and control electronic cigarettes will be published within two weeks.

The 17th World Conference on Tobacco or Health (WCTOH), Cape Town, South Africa,
JoseŽ Luis Castro, WCTOH co-chair; Dr Aaron Motsoaledi, Minister of Health, South Africa.
Photo©The Union/Steve Forrest/Workers’ Photos

This is according to Health Director General Precious Matsoso, who was speaking on the sidelines of the World Conference on Tobacco or Health, which opened for the first time in Africa yesterday.

“I had hoped they would be published this week to coincide with the conference, but they are still being discussed by the Cabinet sub-committee,” said Matsoso.

Two years ago, Health Minister Dr Aaron Motsoaledi indicated that government wanted to introduce the new regulations but admitted yesterday that South Africa had “lagged behind” in its fight against tobacco control.

“In 2005, we compromised and allowed smoking in 25 percent of public spaces but we are going to take that space away to protect everyone,” said Motsoaledi, addressing the opening the conference.

“We are also committed to plain packaging,” he added. “We are looking at regulating all nicotine delivery systems including electronic systems because we need to control those.”

Fighting back

“All the signs are there that the tobacco industry is staging a fight-back after a slew of tobacco control legislation in the past two decades,” said Motsoaledi. “They are targeting young people in Africa. In the US, they are targeting African American people, the homeless and mentally ill. They are targeting young, working class and the most vulnerable people. We need activism against this onslaught.”

The tobacco industry and the food industry used job creation to defend themselves against government regulation “but are we creating these jobs for corpses?” asked the minister.

Meanwhile, World Health Organisation (WHO) Director General Dr Tedros Adhanom Ghebreyesus warned that Africa was “ground zero” for tobacco companies, who had identified it as a major growth market.

But, said Tedros, six out of 10 people in the world were now protected by some of the measures developed by the WHO against smoking, and that eight African countries had introduced picture warnings of he effects of smoking on cigarette packs.

No co-operation

Tedros appealed to all governments not to co-operate with the tobacco industry, including the recently formed Foundation for a Smoke-free World, financed by Marlboro manufacturer Philip Morris, and headed by former WHO official Derek Yach.

Billionaire philanthropist and former New York mayor Michael Bloomberg warned that “one billion people will die this century from smoking despite our efforts”.

“The tobacco industry is doing everything to circumvent our efforts to control tobacco to sell a product that is deadly and kills the people who use it,” said Bloomberg, who has donated over $1-billion to tobacco control.

However, Bloomberg said there had been remarkable gains: “In the US, you cannot go into a restaurant and smoke. In Shanghai, the government owns the tobacco companies but it no longer allows smoking in public.”

NHI Gets Cash, But Detail Vague

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Witten by:
Kerry Cullinan

BUDGET: R4,2-billion has been allocated the National Health Insurance (NHI) scheme to be spent over the three years – but exactly how the NHI will work remains vague

Photo – Masutane Modjadji, Health-e News.T

The National Health Insurance aims to make a package of essential healthcare free to all citizens and legal residents of South Africa through compulsory employee contributions to a national NHI Fund – a noble cause with a hefty price tag.

But the health department’s attempt to introduce the scheme has floundered over the past five years, – partly dogged by huge management weaknesses in the public health sector.

According to yesterday’s Budget Review, the NHI will get R4,2-billion made up of allocations of R700 million, R1.4 billion and R2.1 billion over the next three years. This money will come from “an amendment to the medical tax credit”.

Tax credits reduced

It will be used to contract general practitioners to work in the public sector, increase schools’ eye and ear testing, for “community mental health” and “expanding the Chronic Disease Medicine Distribution Programme to enable three million patients to collect chronic medicines at their collection point of choice instead of at a clinic”.

It is plain wrong to increase VAT to pay for public health as it means that the people who are using public health will be the ones who are paying for this.”

Medical tax credits are given to taxpayers who opt for private medical aid. By offering below-inflation increases in medical tax credits (ranging from 2,2 to 2,5%), government estimates that it will save R700-million this year – the sum total of this year’s NHI allocation.

But Professor Alex van den Heever from Wits University’s School of Governance, says this reduction in tax breaks is unlikely to save much money, as it is likely to drive some of those who are already battling to pay private medical aid back into the state sector.

“The medical tax credit is an entitlement to compensate people who are paying for medical cover themselves rather than depending on the public sector. As most medical schemes have higher-than-inflation annual increases, the reduction in the medical tax credit will mean that people will be out of pocket and some will drop out of cover,” said Van den Heever.

VAT increase ‘wrong’

To Van den Heever, “it makes no sense to take the subsidy away from people but offer no substitute for what is lost. What the R4,2-billion NHI allocation is for is unknown. It is likely to go to institutions and consultants that will not improve healthcare.”

Van den Heever also decried the increase in VAT as “the wrong thing to do as it taxes the poor more than the rich”. Instead, government could have introduced an extra tax bracket for the super-rich, gone after pension tax subsidies for very high end earners and increased corporate taxes, which are “the lowest in 20 years”, said Van den Heever.

“It is plain wrong to increase VAT to pay for public health as it means that the people who are using public health will be the ones who are paying for this,” he said.

The Rural Health Advocacy Project’s (RHAP) Russell Rensburg was also against the VAT increase, arguing that it would affect poor communities more and “deepen inequality of access”.

Rensburg also warned that money alone would not create a viable universal healthcare system: “Adding additional resources to an increasingly inefficient system does not increase efficiency.”

The “on-going freezing of critical health posts, under-investment in the maintenance of key infrastructure, including medical equipment”, and “the under-allocation of resources” to rural areas were undermining the health system, he said.

Last week, The Davis Tax Committee said that the uncertaintly around how the NHI would be funded was a cause for concern. Government itself has estimated that it will need R256-billion (2010 prices) a year for the scheme. The Davis committee said that, if the economy only grew by 2%, there would be a shortfall of R108-billion by 2025.

Sugary drinks tax on 1 April

“The proposed NHI, in its current format, is unlikely to be sustainable unless there is sustained economic growth,” said committee, which urged more realistic costing and a detailed framework for implementation.

The Department of Health says that an NHI Bill is passing through the last stages of a Cabinet review process on its way to Parliament, and this is likely to also set out the creation of an “NHI Fund” to pay for the scheme.

Meanwhile, the tax on sugary drinks – referred to as the Health Promotion Levy – will be introduced on 1 April, according to the Budget Review. Government expects that this tax – approximately 11% on a can of Coca Cola – will net it around R1,93-billion.

The aim of the levy is to reduce consumption of sugary drinks, a leading cause of obesity – which drives a number of health problems including diabetes, strokes and cancer.

But Wits School of Public Health Professor Karen Hofman said that the tax “has been significantly watered down and needs to be around 20% in order to have a serious impact on reducing obesity”.

“It also exempts fruit juices, which sends the wrong message as fruit juice is also very high in sugar content,” added Hofman, who heads Priority Cost Effective Lessons for System Strengthening South Africa (Priceless SA).

Kids Consume Up To 200% More Sugar Than Recommended

Written for Health-e News

 

 

Written By: Thabo Molelekwa

Liquid sugar is easily absorbed, and most of the sugar from sweetened beverages has no nutritional value beyond the sugar content.

The fact that sugary drinks are a major cause of obesity and diabetes came into focus at the recent Cardio Vascular Disease Imbizo in Sandton, Johannesburg.

Speaking at the Imbizo Lynn Moeng Mahlangu, the cluster manager of Health Promotion and Nutrition at the National Department of Health, said that the consumption of sugar-sweetened beverages or SSBs has strongly been linked with type 2 diabetes.

“In 2013 the Department of Health developed a strategy to tackle non-communicable diseases, and one of the keys was to reduce sugar intake by 10%,” she said.

Moeng Mahlangu said that South Africa is in the top three countries in Africa when it comes to people living with obesity.

She said one of the reasons for this is the high cost of healthy food.

“People choose healthy products because they are cheaper,” said Moeng Mahlangu.

“This is one of the debates we are having, involving other departments like agriculture,” she said.

“Our children are consuming 40-to-60 grams of sugar a day. This means their intake is between 100 and 200% more than they should,” she said.

Obesity in children

She said this was a dangerous situation as obese children generally tended to remain obese throughout life, and much of this was due to the consumption of sugary drinks.

According to Professor Karen Sliwa, director of the Hatter Institute for Cardiovascular Research in Africa and president-elect of the World Heart Federation, there is overwhelming data to confirm that a very high sugar intake has a negative impact on health.

“It is bad in many ways. It makes us obese, especially when we don’t move enough,” she said.

“You can develop diabetes, high blood pressure, you can develop heart disease or have a stroke,” said Sliwa, adding that these factors can lead to long periods of ill health or early death.

According to Sliwa, implementing a tax on sugar tax is one way of trying to combat this disease, as making SSBs more expensive would drive down consumption.

“By decreasing the amount of sugar in beverages we can address some of those issues,” she said, adding that a sugar tax alone was not enough to address the problem properly.

“Although the sugar beverage tax will hopefully show the same results experienced in other countries where it saw a decrease in obesity, the core issues around poverty still needed to be looked at,”said Sliwa.

She said it was important for government to take the lead and make South Africa one of the first countries in Africa to implement the tax.

Sliwa said that educating the people on healthy living was important.

“Some people don’t know that if you are short of breath it can mean that your heart is failing. People don’t know that there is no cure for diabetes and that you always have to take your medication,” she said.

Professor Liesl Zuhlke, President of the South African Heart Association said the health of children needed to be made a priority.

“If you are fat at 13 years, its possible that you will stay fat until you are old,” she said, explaining why children needed to be taught to make good choices for themselves.

Politicians aid industry in dirty war over sugar tax

Written by: Kerry Cullinan
For: Health-e News

For over 18 months, the sugar and beverage industries have had the help of politicians to wage war against a proposed tax on sugary drinks in a microcosm of all that is rotten in this country. But the fight is not yet over.

Yunus Carrim, chair of the Standing Committee on Finance and Lindelwa Dunjwa, chair of the Portfolio Committee on Health, get a petition from HEALAs Fatz Simjee and Tracey Malawana

In Colombia, activists proposing a tax on sugary drinks have been harassed and physically threatened. In Mexico, their mobile phones were infected with spyware developed by the Israeli government. But in South Africa – nothing.

The beverage and sugar industries didn’t need to bother with the small but vocal group of activists aligned to the Healthy Living Alliance (HEALA) who were in favour of the tax. Instead, they went directly to politicians, especially those with bendy backbones and open pockets.

But Yunus Carrim, chairperson of Parliament’s Standing Committee on Finance, didn’t bend. And last week, he stood up in Parliament and revealed that he had received threatening phone calls from people linked to industry, telling him to drop the tax (now called the Health Promotion Levy) contained in the Rates and Monetary Amounts and Amendment of Revenue Laws Bill.

“There were various interventions, including as late as last night, to get us to drop this Bill. And of course it comes from people to are connected to the industry,” said Carrim

WATCH: Extract of Carrim’s speech here

Shortly after Carrim’s speech, the National Assembly passed the Bill, which also contains the all the changes to income tax and excise duties announced in the February Budget and it was referred to the National Council of Provinces (NCOP).

NCOP’s ‘unusual move’

As it is a money bill, the NCOP can delay but not prevent the passing of the Rates Bill – and it has done just that. The ANC’s Charel de Beer, chairperson of the NCOP’s Select Committee on Finance, has quietly allowed the Beverage Association of SA (BevSA), which represents Coca Cola and most sugary drinks owners, and Tiger Brands to make presentations to his committee tomorrow (Tues 28th). The NCOP will then vote on the Bill during the last week of Parliament, and if it proposes any amendments, these will have to go back to the National Assembly next year.

HEALA members protesting outside Coca Cola in Johannesburg on World Diabetes Day.

 

 

 

 

 

 

 

 

 

 

 

 

 

“Allowing only the losing side of the contested Health Promotion Levy to make a submission to the NCOP Select Committee on Finance is a most unusual move,” said Gaile Fullard, Executive Director of the Parliamentary Monitoring Group.

“One could call it a hijacking of the legislative process for this Bill as there have never been hearings on tax bills in the NCOP. It will be interesting to watch this play out – to see if there is a sudden change of mind by a majority in the Committee. Any NCOP amendment would mean it has to go back to the National Assembly for approval.”

De Beer failed to respond to questions about whether he had been under pressure from ANC heavyweights to allow industry representatives into his committee or received any financial offers or rewards from the industry.

Wrong for politicians

Tracey Malawana, co-ordinator of HEALA, was furious about De Beer’s decision: “I have protested to the chairperson and told him that we will also be coming to his committee and we also demand the right to present,” said Malawana. “Sugary drinks are killing our people. The beverage industry has a lot of money to market their products and influence politicians. But diabetes, hypertension, heart attacks, strokes and cancer are all increasing because of poor diet, especially sugary drinks.”

De Beer is likely to have fallen victim to the same people who tried to get Carrim to drop the levy. Carrim confirmed to Health-e that the people who had been trying to get him to drop the tax were well-known, but he wouldn’t name them: “It’s unfortunate that senior politicians with business interests or linked with those with business interests in the industry constantly tried to stop the Bill going ahead,” said Carrim.

“It is just wrong for politicians to try to shape legislation to serve their own business interests or those of businesses they’re connected with. The ANC is very clear about this, but needs to act more decisively against those who transgress. And most of those who intervened were so predictable.”

Initially, it looked as if industry would follow the same game plan in South Africa as in other countries that have introduced the tax – sponsoring researchers, journalists and fake community organisations to oppose it.

Leaked Coke emails

Leaked emails show that Coca Cola views a sugar tax as one of the biggest threats to its business. Hamish Banks, Vice-President of Public Affairs and Communication for Coca Cola Eurasia and Africa, outlined Coke’s three-point “fight back” messaging strategy in an emailon 18 April 2016 as: “Taxes don’t work in solving obesity challenges; They have unforeseen economic and societal impact; The industry is already taking steps to mitigate the consumption of excessive amounts of sugar through packaging, reformulation, and active promotion of lower calorie variants.”

This was the script followed by industry and its allies in South Africa, with particular emphasis on job losses. In September last year, an economic research organisation, Oxford Economics, released an alarming report commissioned by BevSA which claimed up to 72,000 jobs would be lost if the tax was introduced.

At a consultative meeting called by Treasury in early November 2016, members of the Tshebedisano Support Network, an Alexandra-based organisation of small businesses, and the Free Market Foundation’s Leon Louw, turned up wearing the same anti-tax T-shirts. An emotional Silas Hermans from Tshebedisano threatened mass marches in KwaZulu-Natal, the heartland of sugar farming. The sugar and beverage sectors were there in full force, supported by McKinsey

In December, Fin24 exposed the fact that Coca Cola had paid the Institute of Race Relations to produce research questioning whether the tax would work.

Anti-tax blogs and articles started to appear, mostly in the business pages, and BevSA placed anti-tax advertisements in national newspapers. Meanwhile, Coca Cola spent around R170-million on marketing in 2016.

Extensive consultation

But in 2017, the industry’s appetite for public mobilization waned, as it turned its attention to lobbying key policy makers. From early 2017, Carrim and Lindelwa Dunjwa, chair of the Portfolio Committee on Health – both members of the Central Committee members of the SA Communist Party (SACP) – facilitated one of the most extensive consultations on a proposed tax that South Africa has ever seen. There were four parliamentary hearings plus an extensive negotiation process in the National Economic Development and Labour Council (Nedlac).

But a concerted attack on the tax was being organised from within the ANC itself, led by MPs Pinky Kekana and Peace Mabe, with the ANC Women’s League as the battering ram.”

“We were excruciatingly aware of the need to reduce job losses and the impact on emerging African cane-growers, and we sought to find balances between these interests and the health interests of the country,” explained Carrim. “We had extensive public hearings both before the Bill was brought to Parliament and after, and referred the matter to Nedlac to seek to reduce the differences among the contending stakeholders, and we allowed people to engage with the issues, as our Committee usually does, until shortly before voting in the Committee on it.”

Even Cosatu was relatively satisfied, with official Matthew Parks saying that “this is the first time that a tax has been negotiated at Nedlac”.

Attack on tax led by ANC MPs

But a concerted attack on the tax was being organised from within the ANC itself, led by MPs Pinky Kekana and Peace Mabe, with the ANC Women’s League as the battering ram. Kekana, a member of the ANCWL Working Committee, has never hidden her opposition to the tax. At the final finance committee meeting on the matter a few weeks back, she could barely contain her anger after the committee had voted that the Bill was ready to be sent to the National Assembly for the vote.

Kekana has a history of using her position to facilitate favours. While she was Transport MEC in Limpopo, her friend Julius Malema (at the time ANCYL President) scored tenders worth millions of rands from the transport department. Public Protector Thuli Madonsela found that Kekana had “acted improperly” after she had arranged for a traffic officer to arrest one of Malema’s rivals but she was never investigated for facilitating Malema’s tenders.

Meanwhile, Mabe, an apologist for both Jacob Zuma and Dudu Miyeni, was ordered out of the National Assembly last year after it was found that she had been sworn in as a councillor in Mogale City in Gauteng without resigning as an MP.

On May 30 – the night before a parliamentary hearing on the tax – the ANCWL jumped into play, issuing a statement calling for the tax to be withdrawn.

Coke’s BEE offer

“Government must look at other mechanisms such as instructing sweetened beverage companies to reformulate their products and reduce the sugar content,” said ANCWL General secretary Meokgo Matuba. “The fight against obesity and non-communicable diseases must be intensified but not at the expense of job loss and economic marginalisation of black people who are in sugarcane growing sector and milling industry”.

A few weeks later – and two days before the start of the ANC’s national policy conference on 30 June – Coca-Cola Beverages SA (CCBSA) announced that it was committed to increasing its black economic empowerment (BEE) stake to 30 percent by 2021 and would engage with local partners who might be interested in a multimillion rand stake.

At the ANC policy conference, Kekana was instrumental in persuading the Economic Transformation Commission to recommend that the tax be scrapped on the basis that it would cost jobs and undermine transformation. Health Minister Aaron Motsoaledi and MP Thandi Tobias had to intervene from the floor during the plenary to reinstate the party’s support of the tax as part of government’s plan to cut obesity by 10 percent by 2020.

Tobias, a former deputy minister during Thabo Mbeki’s presidency, has diabetes herself and was a vocal supporter of the tax in the finance committee. At one meeting, she chastised MPs who did not support the tax, reminding them that they were not the ones that had to queue for hours at government clinics to get their chronic medication.

Skyrocketing obesity

Milton Buthelezi with his family.

Derek Hanekom, who joined the finance committee after being removed as Tourism Minister, has also been a vocal supporter of the tax, and at one stage remarked: “You don’t try not to reduce car accidents just because tow truck drivers are going to lose their jobs”. ANC MPs in the Portfolio Committee on Health have also generally strongly supported the tax.

But South Africa is at the start of a massive epidemic of non-communicable diseases and – as at the start of the HIV epidemic – many policy makers cannot yet seem the health crisis we are in, despite the fact that diabetes has become the biggest killer of South African women.

However, Treasury’s Deputy Director General Ismail Momoniat and senior economist Mpho Legote were persuaded of the importance of the tax some years back, when presented with solid evidence from PRICELESS, a health economics think-tank based at Wits University, that this is the most cost-effective intervention to curb obesity.

Obesity-related diseases have skyrocketed over the past few years, with medical aids reporting a 68 percent increase in diabetes just in eight years, and public health clinics reported seeing 10,000 new diabetes cases every month in 2016.

Tax is inevitable

Submissions to parliament from health academics were unanimous about the ruinous effects of a diet high in sugar on the health of South Africans. This even prompted the DA’s Wilmot James, then shadow health minister and firmly pro-industry, to declare that the academics had “colluded” – clearly misunderstanding the evidence-based nature of science.

Even industry – bar one lonely sugar industry representative – admitted that diets high in sugar were unhealthy and that obesity was a serious problem.

Despite the NCOP’s clumsy delaying tactics, it is inevitable that the tax on sugary drinks will eventually be passed by Parliament. But there is yet another hurdle: President Zuma has to sign the Bill into law and his susceptibility to business “persuasion” is well documented.

However, government is also desperately short of cash so Zuma might see the revenue as yet another cash cow to be milked. If the Health Promotion Levy does get implemented on 1 April 2018 as Treasury plans, civil society will need to monitor whether the proceeds actually do get spent on health promotion. – Health-e News.

* BevSA failed to repond to any questions about its lobbying tactics, including whether it had paid MPs to support the tax. Kekana and Mabe also failed to respond to queries about whether they had received any financial support or offers for their lobbying efforts.