(Un)sweetened deal? Young people’s views on the South African Health Promotion Levy and food in Khayelitsha, Cape Town

On 1 April 2018 the South African Health Promotion Levy on sugary beverages (HPL) came into effect with the goal of lowering the consumption of sugar sweetened beverages (SSBs) across the South African population. The Republic of South Africa, following the economic and nutrition transitions that occurred after the end of Apartheid, has one of the highest rates of obesity in sub-Saharan Africa. Within this context, this qualitative study examined the food choices and food access of young people living in one neighbourhood of Khayelitsha, Cape Town in 2019 during the period soon after the implementation of the HPL. Through seven focus group discussions, we spoke with 71 young people (18-34) about their lives in Khayelitsha, their understandings and perceptions of food choices, food access, health and the HPL. Using a critical theory approach, we assessed the role of on-going income inequalities and high rates of unemployment on the lives of young, low-income South Africans, as well as how this continued to impact their food access, choices, and awareness of health. At the time of this study, the HPL was not having the desired impact in shifting and lowering the consumption of SSBs amongst this population. We used this exploration of the individual experience of the HPL in Khayelitsha as a metric for a critical policy reflection over time; adding to the small number of qualitative studies on this topic, strengthening the evidence for the inclusion of social and historical context in assessing global health interventions in local settings.