Nutrition related non-communicable diseases and sugar sweetened beverage policies: a landscape analysis in Zambia

ABSTRACT

Background: Taxation on unhealthy products is recommended as a cost-effective intervention to address the global burden of non-communicable diseases. Taxation of sugar-sweetened beverages dis-incentivize consumption of unhealthy products. Implementation of such policies is difficult in Sub-Saharan African countries, which are targets for global corporate expansion by the sugar-sweetened beverages industry.

Objective: To identify opportunities to strengthen policies relating to sugar-sweetened beverage taxation in Zambia, through: (1) understanding the policy landscape and political context in which policies for nutrition-related non-communicable diseases are being developed, particularly sugar-sweetened beverage taxation, and exploring the potential use of revenue arising from sugar-sweetened beverage taxation to support improved nutrition.

Methods: We conducted a retrospective qualitative policy analysis with a review of nutrition-related non-communicable diseases policies and key informant interviews (n = 10) with policy actors. Data were coded and analyzed data using pre-constructed matrices based on the Kingdon’s Policy Agenda Framework.

Results: Government responses to nutrition-related non-communicable diseases were developed in an incoherent policy environment. The health sector’s commitment to regulate sugar-sweetened beverages conflicted with the manufacturing sector’s priorities for economic growth. Increased regulation of sugar-sweetened beverages was a priority for the health sector. Economic interests sought to grow the manufacturing sector, including the food and beverage industries. Consequently, incoherent policy objectives might have contributed to the adoption of a weakened excise tax. The general public were poorly informed about nutrition-related non-communicable diseases.

Conclusions: The tension between the Government’s economic and public health priorities is a barrier for strengthening fiscal measures to address nutrition-related non-communicable diseases. However, this did not prevent the introduction of a differential sugar tax on sugar-sweetened beverages. Opportunities exist to strengthen the existing taxation of sugar-sweetened beverages in Zambia. These include a more inclusive consultation process for policy formulation and comprehensive monitoring of risk factors.

KEYWORDS:

• Fiscal policies
• non-communicable diseases
• policy incoherence
• NCD prevention policies
• policy analysis
• sugar reduction policy

Responsible Editor

Jennifer Stewart Williams

Responsible Editor

Jennifer Stewart Williams

Acknowledgments

We thank all participants who participated in the key informant interviews for this study.

Disclosure statement

The authors report no conflicts of interest.

Author contributions

KH and AE conceptualized the study. MMM, SAK, KH, AE AMT designed the study protocol, MMM collected and analyzed data, and drafted manuscript; SAK, AE, KH, AMT reviewed manuscript; AMT, SAK, AE and KH approved the manuscript for submission.

Ethics and consent

This study adhered to all the standards of ethical conduct of research with human subjects. All participants voluntarily agreed to participate and provided an informed consent. Confidentiality was maintained and no risk incidence to participants was recorded. The study was approved by the ERES Converge IRB (IRB No.00005948, EWA No. 00011697), approval number 2018-Nov-021.

Paper context

Zambia’s government has adopted a tax on sugar-sweetened beverages in response to increased consumption of unhealthy foods and a growing burden of non-communicable diseases. Though there was strong political will from the Ministry of Health, conflicting government priorities on trade and economic growth negatively affected the introduction of an evidence-based and effective tax on sugar-sweetened beverages. Improving policy coherence across government sectors is needed to effectively address the epidemic of nutrition-related non-communicable diseases.

Additional information

Funding

This research was supported by the International Development Research Center grant [#108648-001]. KH, SAK, AE are supported by South African Medical Research Council/Centre for Health Economics and Decision Science – PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg South Africa [D1305910-03]. The funding sources had no role in the conduct of the research and the views expressed herein are not necessarily the views of the funding source.