South Africa is in the midst of a public health crisis fueled in large part by an obesity epidemic. Obesity-related diseases like heart attack and stroke account for more than half of the deaths in the country, and diabetes alone takes more than 25,000 lives a year. Sugary drinks are a significant part of the problem.

Building public support

In 2016, many South Africans did not recognize the harmful link between sugary drinks and obesity-related disease. It was therefore critical for public health advocates to share the evidence they knew: To address the public health crisis, South Africa would need to lower consumption rates by passing a sugary drink tax. Raising awareness of the link between sugary drink consumption and obesity-related diseases, as well as of the effectiveness of the tax, would be critical to build public support for National Treasury’s continued action and ultimate passage by Parliament.

With support from the Obesity Prevention Program, advocates in South Africa presented the best scientific evidence on the health problems caused by sugary drinks, the role of the beverage industry in promoting them, and the impact of the proposed tax. They used this firm foundation to create materials (e.g., fact sheets) to educate the public, media and policymakers. They also conducted research to understand public opinion on the issues and develop the most compelling messages for the campaign.

In addition to building awareness and support for the tax, local partners knew that policymakers in Parliament and key government ministries had the power to pass and implement the tax. A multicomponent strategy helped mobilize people to speak out on the issue.

Advocates also developed a communications strategy consisting of ongoing media advocacy to take advantage of and create earned media opportunities, a digital advocacy campaign to engage and mobilize South Africans, and a dynamic paid media campaign using television, radio, print and digital channels. Regular partner communication ensured that advocacy efforts reflected the latest political developments on the tax, so proactive strategies could be developed and adjusted throughout the campaign. Monitoring and evaluation showed that media coverage of the issue increased. More importantly, both knowledge and awareness of the issue and public support for the tax increased.


Advocates won a hard-fought and major public health victory when Parliament passed the sugary drink tax and the president signed it into law in December 2017. Called the Health Promotion Levy, the tax went into effect in April 2018.

The advocacy campaign also resulted in other significant victories. Poised for their next public health fight, advocates are armed with an active and coordinated coalition that includes new partners. The public dialogue around healthy eating in South Africa has also set the stage for further policy success.

The Global Health Advocacy Incubator continues to work with South African partners on the next phase of this work, including implementing the new tax and pushing for a broader set of policies to address obesity and its related diseases.