Talking about sugar in South Africa: A grounded policy reflection in the context of NCDs and HIV

Introduction: On 1 April 2018 the South African Sugary Beverages Levy (RSA levy) came into effect, with the goal of lowering the consumption of sugar-sweetened beverages (SSBs) across the population. The aim of this study was to explore grassroots understandings and perceptions of food choices, food access, and national policy within the context of a country with a double burden of non-communicable diseases (NCDs) and HIV, using individual and community experience as a metric for critical reflection. Methods: Focus group discussions were used to examine RSA’s levy as an example of people’s experience of a national policy aimed at improving health. I explored the lived context, food environments, and knowledge of and impact from the RSA levy among young adults (18-35)in an urban township outside of Cape Town (Ulutsha Town). Using a critical theory approach, I focused on two elements of the taxation policy mechanism: price influence over purchasing and consumption, and public awareness of the impact of sugary beverages on health. This policy reflection used a semi-iterative process of thematic development based on descriptive coding of the focus group discussion transcripts to identify key themes. Results: The primary themes from the focus group discussions were used to critically reflect on the RSA levy day-to-day. These themes are unemployment, anxiety, the cost of food and sugary drinks, and the role of the government in shaping and giving health. This reflection of the RSA levy sits in contrast to many of the other assessments and evaluations conducted prior to and following the RSA levy implementation. Wider, socio-economic barriers and structures within Ulutsha Town are currently preventing the RSA levy from having its intended impact within this community. Conclusions: As a policy designed to shape health, the RSA levy sits on top of entrenched structural barriers already in place for the young people of Ulutsha Town. Furthermore, young people in Ulutsha Town are navigating the shifting intersect between “old” HIV and “new” NCDs within their community. A combination of analytic approaches is necessary to evaluating policy and developing better and healthier public policies in the future.