Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study

Background In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. Methods We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. Findings Mean sugar from taxable beverage purchases fell from 16.25 g/capita per day (95% CI 15.80-16.70) to 14.26 (13.85-14.67) from the pre-HPL announcement to post-announcement period, and then to 10.63 g/capita per day (10.22-11.04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518.99 mL/capita per day (506.90-531.08) to 492.16 (481.28-503.04) from pre-announcement to post announcement, and then to 443.39 mL/capita per day (430.10-456.56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283.45 mL/capita per day (273.34-293.56) pre-announcement to 312.94 (296.29-329.29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. Interpretation The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.