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.
Changing policy to save lives
When the South African finance minister signaled intentions in 2016 to introduce a tax on sugary drinks, public health advocates who had been pushing for a tax for several years saw a tremendous opportunity.
South Africans are among the top consumers of soft drinks in the world. With clear evidence that taxing sugary beverages drives down consumption and improves health, advocates seized the opportunity to take action to advance life-saving policy change while also recognizing that opposition would be fierce.
Developing the campaign plan
Through the Bloomberg Philanthropies’ Obesity Prevention Program, the Global Health Advocacy Incubator provides resources, along with strategic and technical assistance, to locally led policy advocacy campaigns. Working with other global partners, Vital Strategies and the University of North Carolina, our strategic, targeted support helps advocates wage impactful campaigns to change public health policy and create the change they envision.
In South Africa, this meant supporting local partners to develop a comprehensive campaign strategy to advocate for the tax. The strategy, based on proven advocacy approaches from years of experience across issues and countries, brought together research and policy analysis, advocacy, communications, coalition building and grassroots mobilization to achieve three core campaign objectives: raising awareness to mobilize public support, engaging and educating policymakers, and countering powerful opposition.
To be successful, the plan also had to be flexible enough to adapt to a rapidly changing political landscape.
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.
In a very short time frame, partners built a coalition of groups interested in taking action – the Healthy Living Alliance (HEALA). HEALA members spoke at public hearings, attended events and voiced their support for the tax with decision-makers.
During public consultations on the tax, public health experts, practitioners and advocates submitted comments on the need for and evidence supporting a strong tax proposal. At Treasury and parliamentary hearings, global and local tax experts and advocates presented evidence on the need to address the health problems caused by sugary drinks.
Social media engagement
At the grassroots level, partners mobilized an active online community of individuals via mobile phones that amplified calls for passage of the tax.
Social media efforts generated almost 80,000 followers, with 150,000 online actions and more than 12 million content views.
Advocates hand-delivered 2,000 petition signatures in support of the tax to committee members in Parliament.
Years of advocacy experience underscore the importance of anticipating and countering fierce opposition to policy change from vested interests. In South Africa, the sugary drink companies and their allies opposed the tax from the beginning and used their influence and resources to try to stop it. Publicly, they launched a campaign claiming the tax would not work and that it would cost South African jobs. Privately, decision-makers received threatening calls about not supporting the tax.
Advocates relied on scientific evidence from other countries to counter the industry’s arguments and demonstrate that sugary drink taxes reduce consumption without hurting jobs. They also called on policymakers to protect South Africa’s health versus protecting private interests. This drumbeat of actions helped frame the debate around the public health messages and to mitigate some of the industry influence.
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.