Public policies to reduce consumption of added sugars through taxes on sugar-sweetened beverages (SSB) have been effective in scores of countries across the world. Sadly, efforts to subsidise healthy food have received less attention despite the important role subsidies play in promoting healthier eating habits. Proactive countries such as the United State of America (USA) have already started investing part of the revenue raised by the sugar tax to increase access to healthy food. In neighbouring South Africa, Discovery Health which is probably the biggest private health insurer adopted a policy which provides a 10 percent rebate for purchases of healthy foods.
The statistics are quite stark. Eating too little fruit results in fourteen times more health loss globally than sugary beverages alone, while the absence of vegetables in a diet contributes to almost eight times more health loss around the world than sugary beverages.
A commentator who spoke to this publication indicated that the lack of money is the most serious barrier to accessing healthy food in Botswana. “As Botswana approaches the second year since the introduction of the sugar tax, she should also consider the critical role of healthy food subsidies,” says Ronald Dintle, adding that research has shown that a ten percent decrease in the price of healthy food as a result of subsidies led to a twelve percent increase in the consumption of that food.
However, Dintle says it is difficult for Botswana to implement such a policy because such subsidies require the government to spend money instead of taking it in.
On February 1st, 2021, then minister of Finance and Economic Development, Dr Thapelo Matsheka announced in his budget speech that the government will introduce a Sugar Tax on sweetened beverages as part of measures to restore fiscal stability. “Government will introduce a levy on sweetened beverages related to their sugar content,” said the former finance minister at the time.
Studies have shown that excessive intake of added sugars considerably contributes to obesity and non-communicable disease (NCD). Public health officials informally refer to these as empty calories because they add a lot of calories which provide very little or no nutritional benefits. Sugar-sweetened beverages are non-alcoholic caloric sweetened beverages such as soda, juice, and energy and sports drinks. They are believed to be the main culprits of added sugars in Botswana diets and are responsible for several diseases such as tooth decay, weight problems, obesity, type 2 diabetes and cardiovascular problems which mainly affect the heart and blood vessels.
To put it in context, a 330ml can of Coke contains nine teaspoons of sugar. A Dietician who spoke to this publication indicated that Batswana should be mindful of the fact that it is difficult to offset sugary beverage consumption with physical activity. “As an example, in order to offset consumption of a 330ml can of soft drink a person requires almost 18 minutes of running. The time increases if the person consumes more soft drinks per day,” says Gaone Matswe.
She adds that while there are no studies which have been done in Botswana to ascertain the extent to which the sugar tax has been successful on our health, research from other countries shows that it is an effective intervention to reduce sugar consumption, thus preventing obesity and diabetes.
However she says government should go the extra mile and place a subsidy on healthy foods such as fruits and vegetables. “Such a move would tip the pricing structure in favour of choosing healthier options. Furthermore, this move can also provide an incentive to processed food manufacturers to improve the nutritional profile of their products,” she says. Among other things, she says research has shown that a subsidy on fruits and vegetables provided additional health benefits in terms of DALYs when done in conjunction with other taxes such as the sugar tax. DALYs stands for disability-adjusted life years and one DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality and the years lived with a disability due to prevalent cases of the disease or health condition in a population.
An analysis conducted by the Food and Agriculture Organisation (FAO) highlighted that 64.5 percent of Batswana above the international poverty line of $1.90 purchasing power parity (PPP) per person per day cannot afford a healthy or nutritious diet. The analysis by FAO settles the fact that the problem of poor nutrition in Botswana is essentially on account of the unaffordability of good diets, and not on account of lack of information on nutrition.
Matswe says the pandemic has resulted in declines in household incomes and changes in the availability and affordability of nutritious foods. “Reduced incomes necessitated by the Covid-19 pandemic have pushed most Batswana to shift to buying the cheapest calories to eat—the aim being to maintain quantity and not quality. This will lead to an increase in nutritional deficiencies such as anaemia, stunting and wasting,” says Matswe.
Research conducted by the World Health Organisation (WHO) shows that current food systems encourage quantity over quality, and put more emphasis on cereal crops while at the same time reducing access to diverse, healthy foods. While the Sugar Tax is very much likely to raise revenues for the Botswana government, it would be of immense benefit if those revenues could be used to supplement public health promotion programmes that encourage healthier lifestyles.
