The Policy We Have, The Action We Need

South Africa's 2022–2027 NCD strategy promised a stronger focus on prevention. Five years on, the country continues to face a growing burden of diabetes and hypertension.

Recognition

Commitment

Reality

The 2022–2027 NCD NSP acknowledges social and commercial determinants as primary drivers of disease.

The plan commits to fiscal measures, food labelling, and multisectoral action to reduce NCD risk.

Three years in, implementation lags while diabetes and hypertension rates continue to climb.

What the NSP Says

South Africa's 2022–2027 National Strategic Plan for the Prevention and Control of Non-Communicable Diseases recognises that poverty, unhealthy diets and commercial determinants of health contribute to the country's growing NCD burden. It calls for a coordinated, whole-of-government response that addresses the social and commercial conditions shaping people's health. But translating that recognition into effective prevention policies has proved difficult. The Health Promotion Levy remains relatively low, while proposed mandatory front-of-pack warning labels and restrictions on the marketing of unhealthy foods to children have yet to become law.

Addressing the commercial determinants of health is not optional. It is the foundation of prevention.

Brightly coloured sugary drinks and snack packets on a township supermarket shelf under warm fluorescent lighting

What South Africa Has Done

Sugar Levy
Introduced in April 2018 at 2.1 cents per gram of sugar above 4g per 100ml. The rate was adjusted to 2.21 cents in 2019 but has not increased since.
NSP Launch
The 2022–2027 NCD plan was published with ambitious prevention targets.
Pilot Labels
Proposed front-of-pack warning labels remain unimplemented more than three years after draft Regulation R3337 was published in April 2023. The regulations are now being considered through Nedlac.

The Implementation Gap

Close to the end of the 2022–2027 plan period, progress on prevention remains minimal. The Health Promotion Levy has not been adjusted for inflation or evidence since 2018, making it less effective each year.

Front-of-pack warning labels, proven to reduce purchases of unhealthy foods by up to 25% in Chile and Mexico, remain stalled in South Africa.

Meanwhile, the prevalence of type 2 diabetes continues to rise, particularly among Black South Africans and low-income communities.

Chapter01·Impact
Mexico's Sugar Tax Success
Chapter02·Prevention
Chile's Warning Labels
Chapter03·Evidence
The Results That Followed

Lessons from Mexico and Chile

Mexico introduced a tax of one peso per litre on sugar-sweetened beverages in 2014. Research found that purchases of taxed drinks fell by an average of 7.6% over the first two years, with the largest reductions among lower-income households. Subsequent modelling estimated that the combined taxes on sugary drinks and energy-dense foods could prevent approximately 189,000 diabetes cases and 20,000 cardiovascular deaths over the longer term. These are projected benefits, rather than observed reductions in disease incidence.

Chile introduced a comprehensive food labelling and advertising law in 2016, combining mandatory front-of-pack warning labels with restrictions on marketing unhealthy products to children and sales of certain products in schools. A study published in 2020 found that household purchases of high-in beverages fell by approximately 24% compared with projected purchases in the absence of the policy. The amount of sugar purchased from these drinks fell by approximately 25%. The findings demonstrate that comprehensive food regulation can influence purchasing behaviour, although changes in disease prevalence take longer to establish.

Side-by-side comparison showing a sugary drink can with Mexico's tax label and a snack package with Chile's black octagonal warning label

What the Models Show for South Africa

Researchers at PRICELESS SA modelled that increasing South Africa's Health Promotion Levy—currently 2.21 cents per gram of sugar above 4g per 100ml—to an effective 20% tax rate could prevent 619,000 cases of type 2 diabetes, avert 26,000 deaths, and save R23.9 billion in healthcare costs over 20 years.

Advocacy group, the Healthy Living Alliance (HEALA), highlights that mandatory front-of-pack warning labels under Draft Regulation R3337 would help consumers identify ultra-processed foods high in sugar, salt, and saturated fat, addressing a major driver of South Africa's R2.7 billion annual direct public healthcare spend on diagnosed diabetes.

The Rural Health Advocacy Project (RHAP), which convenes the Health Tax Alliance, emphasises that preventative fiscal and labelling policies are critical to reducing the chronic disease burden in rural districts, where healthcare access is most limited and treatment budgets are under severe strain.

Why the Delay?

Industry lobbying has been intense. Food, beverage, and sugar producers argue that higher taxes and warning labels will cost jobs and hurt the economy. Health economists have challenged these claims, showing net economic gains from lower healthcare spending and improved productivity.

Political will has wavered. While the Department of Health supports stronger measures, the National Treasury has been reluctant to increase the levy, and the Department of Trade, Industry and Competition has slow-walked front-of-pack labelling regulations, citing concerns about compliance costs and international trade obligations. Activists argue the delay translates into tens of thousands of preventable diabetes cases and billions in avoidable treatment costs.

Annual direct medical costs

According to Wits University researchers, treating diagnosed type 2 diabetes costs South Africa’s public health system roughly R2.7 billion per year in direct medical expenses — medication, hospital admissions, dialysis, amputations, eye care, and cardiovascular complications — rising to R21.8 billion when undiagnosed cases are included. That excludes productivity losses, early retirement, premature death, and uncounted costs borne by families. With cases projected to reach 7.2 million by 2030, the annual public-sector bill for all cases will exceed R35 billion.

The Economics of Prevention

Public health evidence consistently shows that every rand invested in prevention saves multiples in future treatment costs. According to PRICELESS SA, increasing the Health Promotion Levy to an effective 20% tax rate, along with with mandatory front-of-pack warning labels, will save the public health system an estimated R23.9 billion in avoided type 2 diabetes treatment costs over 20 years.

Beyond the fiscal savings, prevention reduces the human toll of the disease. Preventing 619,000 new cases of type 2 diabetes means being spared from lifelong medication, daily insulin, limb amputations, dialysis, blindness, or early death. It means families who will not lose breadwinners to preventable complications.

People seated in a public health clinic waiting room, natural light streaming through high windows

Questions, Answered

Won't a higher sugar tax hurt the poor?

Low-income households benefit most from prevention. They bear the highest disease burden and spend the largest share of income on treatment. Modelling shows the health gains far outweigh the small price increase.

Will warning labels really change behaviour?

Yes. Chile and Mexico saw 20–25% reductions in purchases of labelled products. People use the labels to make informed choices, and manufacturers reformulate to avoid the warnings.

What about jobs in the food and beverage industry?

Independent economic studies show that revenue shifts to healthier products, not out of the sector. Job losses are minimal, and healthcare savings create jobs elsewhere in the economy.

Isn't personal responsibility enough?

Individual choice is shaped by environment. When healthy options are scarce and expensive, and unhealthy products are aggressively marketed and cheap, structural change is essential.

How long before we see results?

Mexico saw measurable reductions in sugary drink purchases within two years. Health outcomes follow more slowly, but prevention is the only way to bend the curve on diabetes incidence.