Reducing Sugar Intake in South Africa: Learnings from a Multilevel Policy Analysis on Diet and Noncommunicable Disease Prevention
Abstract
:1. Introduction
2. Conceptual Framework
3. Materials and Methods
4. Results
4.1. Who Is Involved in the Policy Transfer Process and Why Engage in Transfer?
4.1.1. International Organizations: The WHO/FAO and Codex
The FAO
The WHO
The Codex
4.1.2. National Government
4.1.3. The Private Sector
4.2. From Where Are Policy Directives Drawn?
4.2.1. Global Level Key Policy Ideas
Recognition at a Global Level That Unhealthy Diets and High Sugar Intake Are Related to NCD Burden
“Limiting high intakes of free sugars, which provide energy without specific nutrients and increase the risk of unhealthy weight gain, improves the nutritional quality of diets and decreases the risk of dental decay”.[31]
Recognition of the Added Vulnerabilities of Women and Children, Especially in An Urban Context
“…children should maintain a healthy weight and consume foods that are low in saturated fat, trans-fatty acids, free sugars, or salt in order to reduce future risk of noncommunicable diseases”.
“…children with the highest intakes of sugar-sweetened beverages had a greater likelihood of being overweight or obese than children with the lowest intakes”.
A Multi-Sectoral Approach and Mix of Policy Options Is Needed to Address the Underlying Structural Determinants of NCDs
A Set of Cost-Effective Interventions or “Best-Buys” Are Available for LMICs
“Best buys to reduce major risk factors for noncommunicable diseases include:Reducing salt and sugar content in packaged and prepared foods and drinks”.[50]
4.2.2. Expression of Global Ideas in South African Policies
South African Recommendation and Definition of “Added Sugars”
Sugary Drinks Contribute to Excess Weight and Obesity in Sub-Populations
National Policy Documents Endorse a Multi-Sectoral Approach and Apply Cost-Effective Approach
A Mix of Policy Options Applied in the South African Context
Gaps Identified in Policies Targeting Sugar Intake
“a foodstuff not regarded essential as part of a healthy diet and healthy lifestyle, as listed in Annexure 6 …shall not advertise or promote in any manner, in any school tuck shop or on any school or pre-school premises”.[60]
4.3. Degree of Policy Transfer
4.3.1. Copying
4.3.2. Emulation
5. Discussion
- Policy learning 1: Identify local health priorities and use the WHO ‘roadmap’ for multisectoral and cost-effective policy action
- Policy learning 2: Strengthen participation in global and regional decision-making structures
- Policy learning 3: Build leadership, national capacity and increase provision for technical assistance to overcome policy constraints
- Policy learning 4: Evidenced-based approaches can support advocacy efforts to help combat private sector interference
6. Relevance for Other LMICs and Further Research
7. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Policy Transfer Framework Questions | Evident from the Policy Analysis |
---|---|
Who is involved in the policy transfer process and why engage in transfer? | International organizations, national government and private sector (food and beverage industry) |
Where are policy directives drawn from? | Global recommendations from the WHO/Food and Agricultural Organization (FAO) and Codex Alimentarius (the ‘Codex’) |
What elements of policy are transferred? | Policy ideas organized by three themes: the problem frame, suggested approaches (multisectoral/cost-effective) for addressing the problem of unhealthy diets and high sugar intake and policy options |
What are the different degrees of transfer? | Mostly policy dictates are emulated nationally, and very occasionally some wording is copied |
What restricts or facilitates the policy transfer process? | Private sector interference, skills capacity and policy expertise within government can constrain policy transfer, while international organizations actions help facilitate it |
Source | Textual Quote |
---|---|
Global United Nations Economic and Social Council (ECOSOC). UNIATF on the Prevention and Control of NCDs E/2017/54 | “Private sector interference that blocks governments in their efforts to implement certain very cost-effective and affordable measures to attain target 3.4 of the Sustainable Development Goals (for example, increasing excise taxes and prices on tobacco products, alcoholic beverages and sugar-sweetened beverages)” [42]. |
WHO, Montevideo Roadmap 2018–2030 on NCDs as a Sustainable Development Priority, WHA71.2 Annex, 2018 | ”One obstacle at country level is the lack of capacity to effectively address public health goals when they are in conflict with private sector interests, in order to effectively leverage the roles and contributions of the diverse range of stakeholders in combatting NCDs” [48]. |
Africa Region WHO Regional Office for Africa. Status of Implementation of the Four Time-bound Commitments of NCDs | “Tackling NCD risk factors in the region is hampered by the interference of the tobacco, alcohol and food industries” [47]. |
Global WHO Global Strategy on Diet, Physical Activity, and Health (2004) Policy Recommendations and Examples for Member States | National South African and Western Cape Corresponding policies Addressing Unhealthy Diets and High Sugar Intake |
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National strategies, policies and action plans need broad support | |
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Governments should provide accurate and balanced information | |
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National food and agricultural policies should be consistent with the protection and promotion of public health | |
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School policies and programs should support the adoption of healthy diets and physical activity |
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Source | Textual Quote |
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Global 2004 WHO Global Strategy | “The term ‘free sugars’ refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices” [35]. |
National South African FBDG-2013 | “Definition of ‘added sugars’ means any sugar added to foods during processing, and includes but is not limited to: mono and disaccharides (sugars), honey, molasses, sucrose with added molasses, coloured sugar, fruit juice concentrate, deflavoured and/or deionised fruit juice and concentrates thereof, fruit nectar, fruit and vegetable pulp, dried fruit paste, high-fructose corn syrup (HFCS), malt or any other syrup of various origins, whey powder, milk solids or any derivative thereof” [53]. |
Source | Textual quote |
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Global Codex guidelines for use of nutrition and health claims, CAC/GL 23-1997 | “Non-addition of sugars Claims regarding the non-addition of sugars to a food may be made, provided the following conditions are met: Claims (a) No sugars of any type have been added to the food (examples: sucrose, glucose, honey, molasses, corn syrup, etc.); (b) The food contains no ingredients that contain sugars as an ingredient (Examples: jams, jellies, sweetened chocolate, sweetened fruit pieces, etc.)” |
National South African regulations relating to the labelling and advertising of foods, 2014 (No. R. 429) | “Non-addition claims for sugar(s) (iii) Claims regarding the non-addition of sugars to a food may be made, provided the following conditions are met: (aa) the food contains no ingredients that contain sugars as part of an ingredient, such as, but not limited to, jams, jellies, sweetened chocolate, sweetened fruit pieces” |
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McCreedy, N.; Shung-King, M.; Weimann, A.; Tatah, L.; Mapa-Tassou, C.; Muzenda, T.; Govia, I.; Were, V.; Oni, T. Reducing Sugar Intake in South Africa: Learnings from a Multilevel Policy Analysis on Diet and Noncommunicable Disease Prevention. Int. J. Environ. Res. Public Health 2022, 19, 11828. https://doi.org/10.3390/ijerph191811828
McCreedy N, Shung-King M, Weimann A, Tatah L, Mapa-Tassou C, Muzenda T, Govia I, Were V, Oni T. Reducing Sugar Intake in South Africa: Learnings from a Multilevel Policy Analysis on Diet and Noncommunicable Disease Prevention. International Journal of Environmental Research and Public Health. 2022; 19(18):11828. https://doi.org/10.3390/ijerph191811828
Chicago/Turabian StyleMcCreedy, Nicole, Maylene Shung-King, Amy Weimann, Lambed Tatah, Clarisse Mapa-Tassou, Trish Muzenda, Ishtar Govia, Vincent Were, and Tolu Oni. 2022. "Reducing Sugar Intake in South Africa: Learnings from a Multilevel Policy Analysis on Diet and Noncommunicable Disease Prevention" International Journal of Environmental Research and Public Health 19, no. 18: 11828. https://doi.org/10.3390/ijerph191811828