title: Decreasing the Burden of Type 2 Diabetes in South Africa: The Impact of Taxing Sugar-Sweetened Beverages.
abstract: BACKGROUND
  Type 2 diabetes poses an increasing public health burden in South Africa (SA) with obesity as the main driver of the epidemic. Consumption of sugar sweetened beverages (SSBs) is linked to weight gain and reducing SSB consumption may significantly impact the prevalence of obesity and related diseases. We estimated the effect of a 20% SSB tax on the burden of diabetes in SA.
  
  
  RESULTS
  We constructed a life table-based model in Microsoft Excel (2010). Consumption data from the 2012 SA National Health and Nutrition Examination Survey, previously published own- and cross-price elasticities of SSBs and energy balance equations were used to estimate changes in daily energy intake and its projected impact on BMI arising from increased SSB prices. Diabetes relative risk and prevalent years lived with disability estimates from the Global Burden of Disease Study and modelled disease epidemiology estimates from a previous study were used to estimate the effect of the BMI changes on diabetes burden. Diabetes cost estimates were obtained from the South African Council for Medical Schemes. Over 20 years, a 20% SSB tax could reduce diabetes incident cases by 106 000 in women (95% uncertainty interval (UI) 70 000-142 000) and by 54 000 in men (95% UI: 33 000-80 000); and prevalence in all adults by 4.0% (95% UI: 2.7%-5.3%). Cumulatively over twenty years, approximately 21 000 (95% UI: 14 000-29 000) adult T2DM-related deaths, 374 000 DALYs attributed to T2DM (95% UI: 299 000-463 000) and over ZAR10 billion T2DM healthcare costs (95% UI: ZAR6.8-14.0 billion) equivalent to USD860 million (95% UI: USD570 million-USD1.2 billion) may be averted.
  
  
  CONCLUSIONS
  Fiscal policy on SSBs has the potential to mitigate the diabetes epidemic in South Africa and contribute to the National Department of Health goals stated in the National NCD strategic plan.
authors.affiliation: PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Mercy
authors.initials: M
authors.lastname: Manyema
authors.affiliation: School of Public Health, University of Queensland, Brisbane, QLD, Australia.
authors.forename: J Lennert
authors.initials: JL
authors.lastname: Veerman
authors.affiliation: PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Lumbwe
authors.initials: L
authors.lastname: Chola
authors.affiliation: PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Aviva
authors.initials: A
authors.lastname: Tugendhaft
authors.affiliation: Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Capetown, South Africa.
authors.forename: Demetre
authors.initials: D
authors.lastname: Labadarios
authors.affiliation: PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Hofman
mesh_terms: D000293:Adolescent; D000328:Adult; D001628:Beverages / Q000191:economics*; D001835:Body Weight; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology*; D019422:Dietary Sucrose / Q000191:economics*; D002149:Energy Intake; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D013660:Taxes / Q000191:economics*; D055815:Young Adult
chemical_list: D019422:Dietary Sucrose