Non Communicable Diseases (NCDs) are increasingly becoming the leading cause of deaths in Botswana. Recently, the minister of Health and Wellness, Dr Edwin Dikoloti said NCDs are now estimated to cause 46% of all deaths in Botswana. The global epidemic of NCDs, which has become a substantial threat to human health and development in Botswana, has also caught the attention of some public health officials who are saying it is time for Botswana to throw weight behind the fight against NCDs.
On February 1st, the 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. The minister highlighted that the levy will be introduced on sweetened beverages related to their sugar content at a rate of two Thebe per gramme of sugar above a content of 4g of sugar per 100 millilitres. Although the minister made it clear that the sugar tax is a measure being taken by the government to restore fiscal stability, some public health officials say this move could also help deter excessive sugar consumption and assist in the prevention and control of NCDs.
According to the Global Food Research Program, only two countries in Africa had introduced sugary drink taxes as of 2019. One major concern is that consumption of sugary beverages has been snowballing globally, rising by 5.6% for men and 9.2% for women between 1990 and 2015. A similar trend has been observed in low-income and middle-income countries, where at least 3 in every 5 adolescents now consume sugary beverages daily compared with 2 in every 5 adolescents in high-income countries.
An analyst who spoke to this publication indicated that Sugar Tax is basically a win-win decision for governments as it increases government revenues while also addressing the country’s health burden. “The problem with this Sugar Tax is that it is only directed at beverages only and not other sweetened products. This means the tax will not do much to reverse the trend of NCDs in Botswana,” says Gaone Matswe. Matswe also says based on studies done in other countries, a Sugar Tax may have strong equity effects by improving health more among women, who are more likely to have higher obesity-related problems due to higher body mass index (BMI).
Adults over 20 years of age are considered obese when their body mass index (BMI) is greater than or equal to 30. BMI equals body weight in kilograms divided by height in metres squared. Past research shows that the prevalence of obesity among females in Botswana is way much higher as compared to the males. The female obesity prevalence as a share of female ages 18+ is currently at 31.1 whilst male obesity prevalence as a share of male population ages 18+ is 10.2.
The Botswana Multi-Sectoral Strategy for the Prevention and Control of Non-Communicable Diseases 2018-2023 says “a population based Non-Communicable Diseases and their risk factors survey (STEPS) conducted in Botswana in 2014 revealed adult prevalence of 29% for hypertension, 5% for diabetes, 30% for obesity, 18% for tobacco use, and 95% for unhealthy diet.” While prominent causes for heart disease, diabetes and cancer can be prevented, public health experts say Botswana needs preventive actions and efficient strategies to address risk factors such as tobacco, alcohol, obesity, blood pressure diet and physical inactivity.
In a report titled “Saving lives, spending less: a strategic response to NCDs,” prepared by the World Health Organisation (WHO), for every $1 invested in scaling up actions to address non-communicable diseases (NCDs) in middle income countries such as Botswana, there will be a return to society of at least $7 in increased employment, productivity and longer life. The WHO guidelines also state in clear cut terms that added sugars should constitute no more than 10% of an individual’s total calorie intake and preferably less than 5%.
Public health officials also say 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 Matswe.
However physical inactivity is also one of the problems causing the increasing number of NCDs in Botswana. There is consensus among global health researchers that a person qualifies for a healthy lifestyle only when they do not smoke or excessively drink, engage in exercise for at least 2 hours 30 minutes a week, and have a body fat percentage under 20 percent for males and 30 percent for females.
Overall a Sugar Tax increases public awareness of the harms of such drinks and incentivise the food industry to reformulate products and market healthier beverages. The 2030 Agenda for Sustainable Development adopted at the United Nations Summit on Sustainable Development in September 2015, recognises NCDs as a major challenge for sustainable development. Excessive sugar consumption is a major cause of obesity and its related diseases, increasing the risks of Type 2 diabetes, hypertension, liver and kidney damage, heart disease, and some cancers.
Countries such as Mexico which have introduced sugary drink tax have witnessed a drastic drop in the purchase of sugary drinks. After implementing the tax, Mexico also experienced an increase in water purchases. Just like Mexico, there is hope that Botswana will experience similar results which would result in consumption of healthier beverages.
As Botswana transitions from infectious to non-communicable diseases, there is hope that legislative and regulatory actions such as Sugar Tax will add to successful NCD prevention and control by helping to modify the obesogenic environment. While the Sugar Tax is very much likely to raise revenues for the government, it would be of immense benefit if those revenues could be used to supplement public health promotion programmes that encourage healthier lifestyles. Furthermore, while the Sugar Tax will not reverse the burden of NCDs alone, they generate revenue, can encourage reformulation of high-sugar products in the food system, and deter sugar sweetened beverages consumption.
