Awareness, attitudes and response to the health promotion levy in Pietermaritzburg, KwaZulu-Natal

Abstract

The South African Minister of Finance implemented the sugar-sweetened beverage (SSB) tax, subsequently renamed the Health Promotion Levy (HPL), on 01 April 2018, as part of a multidisciplinary strategy to alleviate the obesity problem. The HPL is relatively new in South Africa and there is a lack of published studies on the awareness, attitudes and response to the HPL among South Africans. Therefore, this study aimed to fill this gap by determining the awareness, attitudes and response to the HPL among residents of Pietermaritzburg, KwaZulu-Natal. An observational, cross-sectional study was conducted at seven shopping centres in Pietermaritzburg, using a self-administered questionnaire, developed in English for this study. The questionnaire consisted mainly of binary questions and a five-point Likert scale, where participants could express how much they agreed or disagreed with particular statements. Participants were recruited (n=394) using a non-probability sampling method. A significant number of these participants (58.1%; n=229) were aware of the HPL (p<0.05), while 38.8% (n=153) were not aware. The participants were divided in their attitudes towards the HPL. Nearly equal amounts of participants agreed (n=141; 35.8%) and disagreed (n=146; 37.1%) with the HPL. About 30.5% (n=120) of participants self-reported that they would respond to the HPL by continuing to buy SSBs less often, while 22.6% (n=89) self-reported that they would continue to buy SSBs in the same quantity and with the same frequency that they did before the HPL was introduced. Half of the participants (50.8%; n=200) indicated that they would choose water as an alternative if SSBs were no longer affordable to them, followed by 100% fruit juice (49.2%; n=194) and milk and milk products (30.2%; n=119). The differences in attitudes towards the HPL shows that there is a need for awareness campaigns on the HPL. Future research should investigate the impact of the HPL on health, obesity rates and the economy