Bad diets are to blame for scores of deaths in Botswana each year. These fatalities can be avoided, and using fiscal measures like subsidies is one way to motivate people to make healthier decisions. Public policies to reduce consumption of added sugars through taxes on sugar-sweetened beverages (SSB) have been effective in some countries. Proactive countries such as the United States 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.
Botswana could subsidise healthy foods such as fruit and vegetables and this could help reduce obesity and prevent premature death and disability. 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. “It has been almost two years since the introduction of the sugar tax. Botswana should 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.
In his budget statement in 2021, the then-minister of finance and economic development, Dr. Thapelo Matsheka, declared that the government will impose a sugar tax on beverages with added sugar as one of the steps to re-establish budgetary 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 she says.
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.
In Botswana, the Covid-19 epidemic has led to decreases in household earnings as well as changes in the accessibility and cost of nutrient-dense foods. The Covid-19 pandemic has forced most Batswana to switch to purchasing the cheapest and less healthier foods, with the intention of maintaining quantity rather than quality. Increased nutritional deficiencies such anaemia, stunting, and wasting will result from this.
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 also be of immense benefit if those revenues could be used to supplement public health promotion programmes that encourage healthier lifestyles.
