Skip to main content Accessibility help

Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation

  • Edna N Bosire (a1), Nicholas Stacey (a2), Gudani Mukoma (a1), Aviva Tugendhaft (a2), Karen Hofman (a2) and Shane A Norris (a1)...



A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa’s use of a tax to reduce SSB consumption.


We conducted six focus group discussions using a semi-structured guide.


The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa’s SSB tax was implemented.


Adults aged 18 years or above living in Soweto (n 57).


Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government’s stated motivation in introducing the tax for health rather than revenue reasons.


While an SSB tax is a policy tool that could be used with other strategies to reduce people’s high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.


Corresponding author

*Corresponding author: Email


Hide All
1. Popkin, BM & Hawkes, C (2016) The sweetening of the global diet, particularly beverages: patterns, trends and policy responses for diabetes prevention. Lancet Diabetes Endocrinol 4, 174186.
2. Finucane, MM, Stevens, GA, Cowan, MJ et al. (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377, 557567.
3. Bleich, SN & Vercammen, KA (2018) The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC Obes 5, 6.
4. Skinner, J, Byun, R, Blinkhorn, A et al. (2015) Sugary drink consumption and dental caries in New South Wales teenagers. Aust Dent J 60, 169175.
5. Shisana, O, Labadarios, D, Rehle, T et al. (2014) The South African National Health and Nutrition Examination Survey, 2012: SANHANES-1: The Health and Nutritional Status of The Nation. Pretoria: Human Sciences Research Council and Medical Research Council.
6. Sartorius, B, Veerman, LJ, Manyema, M et al. (2015) Determinants of obesity and associated population attributability, South Africa: empirical evidence from a national panel survey, 2008–2012. PLoS one 10, e0130218.
7. Cois, A & Day, C (2015) Obesity trends and risk factors in the South African adult population. BMC Obes 2, 42.
8. Igumbor, EU, Sanders, D, Puoane, TR et al. (2012) ‘Big food,’ the consumer food environment, health, and the policy response in South Africa. PLoS Med 9, e1001.
9. Vorster, HH, Kruger, A, Wentzel-Viljoen, E et al. (2014) Added sugar intake in South Africa: findings from the Adult Prospective Urban and Rural Epidemiology cohort study. Am J Clin Nutr 99, 14791486.
10. Theron, M, Amissah, A, Kleynhans, IC et al. (2007) Inadequate dietary intake is not the cause of stunting amongst young children living in an informal settlement in Gauteng and rural Limpopo Province in South Africa: the NutriGro study. Public Health Nutr 10, 379389.
11. Hu, FB (2013) Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev 14, 606619.
12. World Health Organization (2015) Fiscal Policies for Diet and Prevention of Noncommunicable Diseases: Technical Meeting Report, 5–6 May 2015, Geneva, Switzerland. Geneva: WHO; available at
13. Malik, VS, Popkin, BM, Bray, GA et al. (2010) Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121, 13561364.
14. Mozaffarian, D, Hao, T, Rimm, EB et al. (2011) Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 364, 23922404.
15. Malik, VS & Hu, FB (2011) Sugar-sweetened beverages and health: where does the evidence stand? Am J Clin Nutr 94, 11611162.
16. Schulze, MB, Manson, JE, Ludwig, DS et al. (2004) Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 292, 927934.
17. Vartanian, LR, Schwartz, MB & Brownell, KD (2007) Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 97, 667675.
18. Cawley, J & Meyerhoefer, C (2012) The medical care costs of obesity: an instrumental variables approach. J Health Econ 31, 219230.
19. Sturm, R, An, R, Maroba, J et al. (2013) The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme. S Afr Med J 103, 840844.
20. Tugendhaft, A & Hofman, KJ (2014) Empowering healthy food and beverage choices in the workplace. Occup Health S Afr 5, 20.
21. Cabrera Escobar, MA, Veerman, JL, Tollman, SM et al. (2013) Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health 13, 1072.
22. Andreyeva, T, Chaloupka, FJ & Brownell, KD (2011) Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue. Prev Med 52, 413416.
23. Colchero, MA, Popkin, BM & Rivera, JA et al. (2016) Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ 352, h6704.
24. Batis, C, Rivera, JA, Popkin, BM et al. (2016) First-year evaluation of Mexico’ s tax on non-essential energy-dense foods: an observational study. PLoS Med 13, e1002057.
25. Manyema, M, Veerman, LJ, Chola, L et al. (2014) The potential impact of a 20% tax on sugar-sweetened beverages on obesity in South African adults: a mathematical model. PLoS One 9, e105287.
26. Steyn, NP & Temple, NJ (2012) Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health 12, 502.
27. Eyles, H, Ni Mhurchu, C, Nghiem, N et al. (2012) Food pricing strategies, population diets, and non-communicable disease: a systematic review of simulation studies. PLoS Med 9, e1001353.
28. Powell, LM, Chriqui, JF, Khan, T et al. (2013) Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev 14, 110128.
29. Chriqui, JF, Chaloupka, FJ, Powell, LM et al. (2013) A typology of beverage taxation: multiple approaches for obesity prevention and obesity prevention-related revenue generation. J Public Health Policy 34, 403423.
30. Powell, LM & Chaloupka, FJ (2009) Food prices and obesity: evidence and policy implications for taxes and subsidies. Milbank Q 87, 229257.
31. National Department of Health, Republic of South Africa (2013) Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013–2017. Pretoria: South African National Government.
32. National Treasury (2018) Budget Review 2018. Pretoria: National Treasury.
33. National Treasury (2016) Taxation of Sugar-Sweetened Beverages. Pretoria: National Treasury.
34. Financial Times (2017) How corruption became ‘state capture’ in South Africa. (accessed February 2019).
35. Statistics South Africa (2011) Statistical release (Revised), Census 2011. (accessed August 2018).
36. Boeije, HA (2002) Purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 36, 391409.
37. The Times (2017) Smaller soft drink sizes leave bitter taste of shrinkflation. (accessed February 2019).
38. Finkelstein, EA, Zhen, C, Nonnemaker, J et al. (2010) Impact of targeted beverage taxes on higher- and lower-income households. Arch Intern Med 170, 20282034.
39. Bleich, SN, Wang, YC, Wang, Y et al. (2009) Increasing consumption of sugar-sweetened beverages among US adults: 1988–1994 to 1999–2004. Am J Clin Nutr 89, 372381.
40. Farley, TA, Halper, HS, Carlin, AM et al. (2017) Mass media campaign to reduce consumption of sugar-sweetened beverages in a rural area of the United States. Am J Public Health 107, 989995.
41. Krukowski, CN, Conley, KM, Sterlin, M et al. (2016) A qualitative study of adolescent views of sugar-sweetened beverage taxes, Michigan. Prev Chronic Dis 13, E60.
42. Grimm, GC, Harnack, L & Story, M (2004) Factors associated with soft drink consumption in school-aged children. J Am Diet Assoc 104, 12441249.
43. Van Der Horst, K, Kremers, S, Ferreira, I et al. (2007) Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents. Health Educ Res 22, 295304.
44. Moodley, G, Christofides, N, Norris, SA et al. (2015) Obesogenic environments: access to and advertising of sugar-sweetened beverages in Soweto, South Africa, 2013. Prev Chronic Dis 12, E186.
45. de Villiers, A, Steyn, NP, Draper, CE et al. (2012) ‘Health Kick’: formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa. BMC Public Health 12, 794.
46. Poorer Not Thinner (2016) Pledge your support for the ANTI sugar tax PETITION. (accessed February 2019).
47. HEALA (Healthy Living Alliance) (2017) Obesity and NCDs. (accessed February 2019).
48. The Citizen (2017) WHO supports SA sugar tax. (accessed October 2018)
49. Walt van der, J (2014) On South African tax compliance, tax morality and taxpayers’ freedom to do tax planning. (accessed September 2018).
50. Thomas-Meyer, M, Mytton, O & Adams, J (2017) Public responses to proposals for a tax on sugar-sweetened beverages: a thematic analysis of online reader comments posted on major UK news websites. PLoS One 12, e0186750.
51. Somerville, C, Marteau, TM, Kinmonth, AL et al. (2015) Public attitudes towards pricing policies to change health-related behaviours: a UK focus group study. Eur J Public Health 25, 10581064.
52. Niederdeppe, J, Gollust, SE, Jarlenski, MP et al. (2013) News coverage of sugar-sweetened beverage taxes: pro- and antitax arguments in public discourse. Am J Public Health 103, e92e98.
53. Julia, C, Mejean, C, Vicari, F et al. (2015) Public perception and characteristics related to acceptance of the sugar-sweetened beverage taxation launched in France in 2012. Public Health Nutr 18, 26792688.
54. Basu, S, Vellakkal, S, Sutapa, A et al. (2014) Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic–epidemiologic modeling study. PLoS Med 11, e1001582.
55. Gonzalez-Zapata, LI, Ortiz-Moncada, R & Alvarez-Dardet, C (2007) Mapping public policy options responding to obesity: the case of Spain. Obes Rev 8, 99108.
56. Ritchie, J & Lewis, J (2003) Qualitative Research Practice. London: SAGE Publications Ltd.
57. Hennink, MM, Kaiser, BN & Marconi, VC (2017) Code saturation versus meaning saturation. Qual Health Res 27, 591608.
58. Battram, DS, Piché, L, Beynon, C et al. (2016) Sugar-sweetened beverages: children’s perceptions, factors of influence, and suggestions for reducing intake. J Nutr Educ Behav 48, 2734.
59. Bos, C, der Lans, IA, Van Rijnsoever, FJ et al. (2013) Understanding consumer acceptance of intervention strategies for healthy food choices: a qualitative study. BMC Public Health 13, 1073.


Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation

  • Edna N Bosire (a1), Nicholas Stacey (a2), Gudani Mukoma (a1), Aviva Tugendhaft (a2), Karen Hofman (a2) and Shane A Norris (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed