The Rising Toll of Sugar-Sweetened Beverages: A Case for Taxation to Combat Noncommunicable Diseases in Uganda

Background and Introduction

Noncommunicable diseases (NCDs) have become a global crisis, accounting for 41 million deaths annually—approximately 71% of all deaths worldwide. The four leading NCDs, which contribute to the majority of these fatalities, include cardiovascular diseases (17.9 million deaths), cancers (9 million), respiratory diseases (3.9 million), and diabetes (1.6 million). Alarmingly, 15 million of these deaths occur among individuals aged 30 to 69, with over 85% of these premature deaths occurring in low- and middle-income countries.

Uganda is no exception to this trend. According to the World Health Organization (WHO), NCDs caused 97,600 deaths in 2016, representing 33% of the country’s total annual mortality. Reports indicate a 22% risk of premature death among Ugandans aged 30 to 70. A significant contributor to NCDs globally is the consumption of sugar-sweetened beverages (SSBs). These beverages include any liquids sweetened with added sugars such as brown sugar, corn syrup, fructose, glucose, high-fructose corn syrup, honey, and sucrose. Common examples of SSBs are regular soda (non-diet), fruit drinks, sports drinks, energy drinks, sweetened waters, and sweetened coffee or tea beverages. A single 330ml carbonated SSB can contain nearly nine teaspoons of sugar.

Excessive sugar intake is a key driver of obesity, tooth decay, and diabetes. There is growing evidence that the consumption of free sugars—particularly through SSBs—increases overall calorie intake while displacing more nutritious foods, leading to unhealthy diets, weight gain, and heightened NCD risks. Sugary drinks often lack nutritional value and are metabolized rapidly by the liver, which converts excess sugar into fat or glycogen deposits. This process contributes to obesity, hypertension, liver and kidney damage, heart disease, and certain cancers. Unregulated SSB consumption thus undermines the right to health by fueling preventable NCDs.

The WHO estimates that 80% of premature NCD-related deaths could be prevented through healthier dietary habits. Notably, research suggests that well-designed taxes on SSBs—particularly those increasing retail prices by 20% or more—can significantly reduce consumption. Such measures would help curb NCD prevalence and advance the realization of the right to health.

Uganda’s Obligations on Fiscal Policies for Diet

The right to health is enshrined in Uganda’s legal framework and international commitments. The WHO Constitution (1946) defines health as “a state of complete physical and mental well-being,” a principle echoed in Article 25 of the Universal Declaration of Human Rights, which guarantees an adequate standard of living, including health. The International Covenant on Economic, Social, and Cultural Rights (Article 12) further obligates states to ensure “the highest attainable standard of physical and mental health.”

Regionally, Article 188 of the East African Community Treaty mandates partner states to harmonize health policies and regulations. As a signatory to these agreements, Uganda must promote safe food and healthy diets to combat NCDs linked to SSBs.

The WHO’s Global Action Plan on NCDs (2013–2020) advocates for fiscal measures, such as taxes and subsidies, to encourage healthier choices. Evidence supports that SSB taxes reduce consumption, while subsidies on fruits and vegetables (lowering prices by 10–30%) increase their intake. Uganda must urgently implement such policies to safeguard public health.

Current Laws on SSB Taxation in Uganda

The Excise Duty (Amendment) Act (2017) imposes a 13% tax or Shs 240 per liter on non-alcoholic beverages (excluding fruit/vegetable juices) and Shs 300 per liter on fruit/vegetable juices (unless made from at least 30% locally sourced pulp).

Gaps in the Legislation

The current tax applies broadly to all non-alcoholic beverages, including sugar-free products, rather than targeting SSBs specifically. Additionally, the 25% Common External Tariff rate on this category is disproportionately high for healthy products like mineral water. The tax is not structured to incentivize sugar reduction through reformulation, and excise data indicate rising SSB consumption. Moreover, revenue from the tax is not earmarked for health initiatives.

SSB Taxation in Other Jurisdictions

Zambia
NCDs accounted for nearly 25% of deaths in Zambia by 2016, with obesity rising by 75% among women (2001–2014). A 25% SSB tax generated US$5.46 million annually and reduced obesity by 0.49 percentage points, particularly among women.

South Africa
With obesity rates at 68% (women) and 31% (men), South Africa introduced a Health Promotion Levy (HPL) in 2018, taxing SSBs at 2.21 cents per gram of sugar exceeding 4g/100ml. Within a year, the tax raised R3.2 billion (US$214 million).

Mexico
A 2014 peso-per-liter SSB tax led to a 7.6% drop in purchases (11.7% among low-income households) and a 2.1% rise in water consumption. Revenue exceeded US$2.6 billion, partially funding school water fountains.

Recommendations

For Parliament:

• Amend the Excise Duty Act to tax SSBs based on sugar content rather than volume.
• Categorize non-alcoholic beverages and apply tiered taxes accordingly.
• Increase the tax exemption threshold for juices made from at least 50% locally sourced pulp.
• For the Ministry of Finance:
• Propose amendments to Parliament for sugar-content-based taxation.
• Allocate at least 40% of SSB tax revenue to health initiatives.

By implementing these measures, Uganda can reduce SSB consumption, mitigate NCD risks, and uphold its commitment to the right to health.