South Africa’s NEDLAC Let Industry Dominate Sugar Tax Talks, Study Finds

The study, published in Globalization and Health, examined NEDLAC’s engagement with the Health Promotion Levy (HPL), an excise tax on sugary drinks that took effect on 1 April 2018 and was designed to reduce sugar intake given its link to non-communicable diseases such as obesity and type 2 diabetes.

They asked NEDLAC for minutes, agreements, reports, correspondence and any other materials relating to the levy between January 2016 and June 2024. The first batch of 120 documents arrived on 23 July 2024, but gaps were immediately apparent: roughly 25 documents were missing, mostly meeting minutes, along with annexures and agendas. After repeated follow-ups, a further 11 documents arrived by email in November 2024 and 29 more, available only in hardcopy, were collected from NEDLAC’s offices. No documents from 2022 were ever received, and NEDLAC indicated these were all the documents it held. After screening out duplicates and irrelevant material, the final dataset comprised 94 documents spanning 2017 to 2023.

The analysis focused on meeting records, reports and presentations, the categories with the most substantive bearing on NEDLAC’s discussions. Using the READ approach, a structured four-step method for organising and analysing documentary data, two researchers independently coded the material and a third resolved discrepancies. Coding categories captured arguments for or against the levy’s existence, its rate, inflation-linked increases, possible extension to other products such as fruit juices, and the identity and number of stakeholders present at each meeting.

The centrepiece of the evidence was the Sugary Sweetened Beverages Task Team, established in the first half of 2017 to conduct a detailed analysis of the tax proposal with a view to reaching consensus. Across the seven recorded task team meetings between 2017 and 2019, attendance patterns were strikingly lopsided. Business stakeholders averaged six representatives per meeting and at times outnumbered everyone else, with nine business representatives present on 8 June 2017. Government averaged five attendees, peaking at eight in September 2019. Labour averaged just one attendee per meeting, and NEDLAC itself maintained two representatives throughout. Community representatives, one of the four constituencies the NEDLAC Act requires the Council to include, attended none of the recorded meetings.

This absence carries legal weight. Section 3(1) of the National Economic, Development and Labour Council Act 35 of 1994 specifies that the Council must include members from four constituencies: organised business, organised labour, organisations representing community and development interests, and the state. The NEDLAC Constitution’s quorum rules likewise require at least one third of the members representing each constituency to be present. The authors also found that business representation sometimes exceeded the maximum of six representatives per constituency permitted by NEDLAC’s own Protocol for Tabling Matters. The researchers note the dataset’s limits: unknown additional documents may exist that were never released, and conclusions rest on the material NEDLAC provided.

The documentary record also raised transparency concerns. Four of the eleven reports drafted by or presented at NEDLAC in relation to the levy were produced by Wesbound (Pty) Ltd, a company about which very little public information exists, and which lacks even a website. The advocacy group Healthy Living Alliance had flagged this problem as early as 2021, noting that there was no publicly available information on how the report authors were appointed, the timeframe for the research, or their terms of reference. The authors of the new study found the process lacked transparency, particularly regarding the authorship of NEDLAC’s HPL Report and the evidence used to support its conclusions.

The content of the reports and presentations skewed against the tax. Of the eleven reports, only one, a 2017 analysis by National Treasury’s Economic Tax Analysis Chief Directorate, specifically advocated for the levy’s existence and supported aligning its rate with the World Health Organization’s recommendation that sugary drink taxes raise prices by around 20 percent. Four reports contained language explicitly opposing the tax, and only one, from the business constituency, considered a rate below 20 percent. Among the nine presentations, none advocated for the levy’s existence, none pushed for the 20 percent rate, and, notably, there were no presentations by health-related entities or civil society groups at all. Only the Treasury report explicitly argued that the tax rate should rise annually at least with consumer price inflation to remain effective, a position National Treasury itself holds but which NEDLAC’s own outputs failed to stress.

A recurring industry argument, that the levy caused job losses in the sugar sector, fared poorly against empirical scrutiny. The study cites recent research using a single-group interrupted time series analysis of Statistics South Africa’s Quarterly Labour Force Survey data, which found no significant association between the levy’s introduction and job losses, or job creation, in sugar-related industries. Yet job losses dominated NEDLAC’s discussions, and the labour constituency’s minimal attendance, averaging one person per meeting, led the authors to question how seriously the threatened job losses were regarded even within labour’s own ranks. The authors connect this pattern to wider literature on corporate political practices, in which industries frame regulation as economically harmful to dilute health measures, and note that a separate study of NEDLAC’s handling of the Draft Liquor Amendment Bill 2016 found similarly weak community representation.

The stakes extend beyond procedural fairness. In South Africa, type 2 diabetes, stroke and heart disease account for three of the top four causes of death, and evaluations of the levy indicate that lower socio-economic groups, who benefited most from the tax, also showed the largest reductions in sugary drink purchases after its implementation. The levy’s effective tax burden at implementation stood at roughly 10 to 11 percent, below the WHO-recommended 20 percent, and it has not been reviewed since introduction. The authors argue that NEDLAC’s handling of the levy shows how participatory governance structures can, in practice, enable industry influence and weaken public health objectives, a form of corporate capture of a forum designed to prevent exactly that.

The study closes with concrete reforms: clearer procedural guidelines to guarantee inclusive representation of all four constituencies, public access to meeting summaries and deliberation records rather than a single impact assessment report, institutionalised roles for civil society and public health experts in health-related task teams, and regular communication of forthcoming engagements so interested parties can participate. The authors frame the South African case as a lesson for other middle-income countries navigating similar multi-stakeholder bodies, from Brazil’s ANVISA to emerging sugar tax debates in Botswana, Namibia, Zambia, Kenya and Mauritius: participatory mechanisms safeguard public health only when transparency, conflict-of-interest management and genuine community representation are built into their design.

Subject of Research: A qualitative content analysis of NEDLAC's role in South Africa's Health Promotion Levy policy process

Article Title: Commercial interests in health policy dialogues: a qualitative content analysis of NEDLAC’s engagement with South Africa’s Health Promotion Levy

Article References: Naidoo, D., Nzimande, N., Goldstein, S., & Mahomedy, S. (2026). Commercial interests in health policy dialogues: a qualitative content analysis of NEDLAC’s engagement with South Africa’s Health Promotion Levy. Globalization and Health, 22(1), Article 67. https://doi.org/10.1186/s12992-026-01234-8

Image Credits: AI Generated

DOI: 10.1186/s12992-026-01234-8

Keywords: NEDLAC, Health Promotion Levy, sugar tax, South Africa, commercial determinants of health, corporate capture, public health policy, sugar-sweetened beverages, access to information, health governance, non-communicable diseases, policy transparency