The UN political declaration on noncommunicable diseases (NCDs) was unequivocal. “Increase taxation on tobacco, alcohol and sugar-sweetened beverages, bearing in mind the World Health Organisation (WHO) recommendations,” read the first draft of the document, which is intended as a global commitment to lower deaths from NCDs.
But that draft is long gone — and public health experts say that’s bad news for our health. The draft that will be adopted at the General Assembly high-level meeting in New York on September 25 is decidedly undecided.
An NCD is an illness you can’t catch from someone else. These diseases usually develop over time due to lifestyle choices such as eating, drinking, smoking and exercise. Environmental issues and family health history also play a role.
NCDs, including diabetes, heart disease, cancer and chronic airway ailments such as asthma, caused more than half of all deaths in South Africa in 2020. This was up from about 100,000 in 1997 to over 160,000 in 2018. Tobacco, alcohol and sugar are among the biggest causes of these diseases.
The latest revision of the NCD political declaration (likely the final version), which South Africa is expected to sign, went from including the words “will increase taxation” to a more palatable — at least for Big Alcohol and Big Tobacco, say public health experts — “consider introducing or increasing”. And in a big win for Big Food, the call for sugary drinks taxes is removed altogether. This is just one of many changes South African public health experts are worried about.
“There is an explicit conflict of interest between public health goals and the goals of corporations that generate profit from selling unhealthy commodities,” says Tamryn Frank, an obesity and NCD prevention researcher at the University of the Western Cape. “They should not be allowed a seat at the policy-making table.”
Research backs this up. These industries employ tactics — from funding science that favours them to using front groups or courts to challenge new regulations — to delay and weaken policies on NCDs.
The new wording moves away from key recommendations from the WHO, including proven ways to prevent NCDs, such as banning tobacco advertising; comprehensive regulation or banning of alcohol advertising; placing graphic health warnings on tobacco products that show the harm caused by these products, and raising taxes. While the WHO — the UN’s health agency — gives guidance, the declaration is negotiated by member countries, which means the final wording depends on political compromise and not necessarily the strongest health science evidence.
We break down key points in the UN draft that changed, what the WHO recommends, where South Africa is on the organisation’s gold standard of compliance and how we compare with other countries.
Bad Food: Warning labels and sugar taxes
Original draft: Called on countries to tackle unhealthy diets, excess weight and obesity by raising taxes on sugary drinks and putting clear warning labels on the front of packs of foods with unhealthy ingredients.
Current draft: Doesn’t mention sugary drinks taxes, and only encourages nutritional information on packaging — such as front of pack labels — rather than directly recommending it.
WHO recommendations: A minimum 20% tax — which it aims to push to 50% in 10 years — on sugary drinks so fewer people will drink them, and simple front of pack food labels to help customers understand nutritional information and easily spot unhealthy products.
Global: Many countries already use warning labels. The UK has a traffic-light system showing whether a product is high, medium or low in sugar, salt and fat. Chile uses a black and white stop-sign warning on foods high in these ingredients, and has taxed high-sugar drinks at 18% since 2014. In Africa, Ghana has gone further with a tax of 20%.
South Africa: A sugar tax was introduced in 2018 and many manufacturers reduced the amount of sugar in drinks to avoid being taxed. Drinks now have less sugar and fewer people buy those with excessive sugar, as the tax makes them more expensive. But after pressure from the sugar industry, the tax, which is based on how much sugar a drink has, works out to around 11% of the retail price of popular drinks — half of what the WHO says is needed.
The health department is also deciding on new food labelling regulations that, if passed, will bring large, simple warning signs to the front of foods high in sugar, salt, saturated fat (often from animal fat or oils) and those containing artificial sweetener.
Still, despite weaker wording in the UN declaration, Frank doesn’t expect it to slow down South Africa’s progress: “There is no reason, given our burden of obesity, for the government to delay implementing regulations, or to water them down.”
Where there’s smoke
Original draft: Strongly recommended taxes on tobacco, specifically asking countries to help lower its use through plain packaging and graphic warnings policies, and to restrict newer products like heated tobacco and e-cigarettes.
Current draft: Raising taxes are now only optional; warnings (no longer required to be graphic) are just “encouraged”; plain packaging is removed entirely, and e-cigarettes and heated tobacco products should be “regulate[d] as appropriate”.
WHO recommendations: Taxes, plain packaging and graphic warnings are part of the WHO’s six ways to stop people from smoking, which include offering help to smokers who want to quit, keeping track of tobacco use, and protecting people from smoke. It says taxes should make up at least 75% of the retail price of a pack of cigarettes, which should also carry plain packaging and graphic warnings that cover at least 50% of the front. Newer products such as heated tobacco and e-cigarettes should also be covered under tobacco control laws.
Global: Canada uses graphic warnings, with images including rotten teeth and red eyes with texts that cover 50% of the front and back of packs. Packs in Australia carry plain packaging that makes health warnings stand out better. Taxes in Mauritius and Indonesia make up more than 75% of the retail price of a pack of cigarettes.
South Africa: The same report found that taxes on cigarettes (based on the most popular brand) make up only about 60% of the retail price. Even though evidence shows smoking rates drop when tax is raised regularly, South Africa’s tobacco tax hasn’t increased in a long time, says Lekan Ayo-Yusuf, a public health expert at the University of Pretoria and member of the WHO’s tobacco regulation study group. Taxes on e-cigarettes and heated tobacco are also far lower than cigarettes.
South Africa’s cigarettes are also branded and have a text warning that covers only 25% of the front pack. This will change if the Tobacco Products & Electronic Delivery Systems Bill is passed. The bill would require all tobacco products (including e-cigarettes and heated tobacco) to carry plain packaging and graphic warnings that cover at least 65% of the front of pack.
Parliament’s portfolio committee completed hearings on the bill last month and has sent concerns raised by the public to the health department, before it decides on whether to proceed or not.
Ayo-Yusuf is concerned that watered-down language could delay and dilute local policies: “[It] weakens political will, and risks slowing South Africa’s progress on graphic warnings, smoke-free laws and other lifesaving measures.”
Watering down alcohol
Original draft: Asked countries to lower harmful alcohol use by banning or putting stricter rules on alcohol advertising, limiting when and where it can be sold, raising taxes and enforcing drunk-driving laws.
Current draft: The revised draft recommends countries consider raising taxes. As for the other steps, it says countries should speed up rolling out the Global Alcohol Action Plan 2022-2030, including “considering marketing and availability measures”. Experts say this is another way of weakening the language, making it difficult to implement.
WHO recommendations: Stricter rules on advertising, restrictions on when and where people can get alcohol, and taxes to encourage people to drink less. The organisation also recommends offering treatment for harmful alcohol use, lowering blood alcohol limits for driving and introducing a policy that sets a legal minimum price for alcohol products.
Global: After Russia banned alcohol advertising, introduced a zero blood-alcohol driving limit, reduced the times during which alcohol can be sold, and other measures, they saw a drop in alcohol use over a 13-year period. Scotland passed laws for a minimum price on alcohol units in a product in 2018, helping lower deaths caused by drinking alcohol over two years.
South Africa: South Africa taxes alcohol products by litre of pure alcohol (ethanol), which encourages producers to reformulate their products with less alcohol content, says Estelle Dauchy, principal research officer at the Research Unit on the Economics of Excisable Products. However, beer, the country’s most popular drink, is sold at some of the lowest prices in Africa, according to a July report by public health organisation Vital Strategies.
Late last year, the National Treasury said it would consider a minimum unit price on alcohol. The Liquor Amendment Bill, drafted in 2016, also proposed changes such as raising the legal drinking age to 21 and banning the sale of alcohol in a 500m radius from schools and public institutions. Though a minimum unit price on alcohol doesn’t relate to taxation, it prevents alcohol beverage producers and sellers from “trading down” prices by absorbing a portion of tax increases through offering customers discounts.
But the process to introduce the Liquor Amendment Bill has stalled since public comments were completed in 2016. The reason? A 2025 case study that looked at meeting reports and minutes on the bill from 2016 to 2022 shows the alcohol industry has put pressure on the government, slowing the process.
Nearly 10 years later, the bill is still sitting with parliament, says Aadielah Maker Diedericks, secretary-general of the Southern African Alcohol Policy Alliance. She says the weakening of commitments at the global level has an impact on South African alcohol policy. “We are concerned about the watered-down language in the UN and the limited inclusion of alcohol as a whole.”
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
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