The Health Promotion Levy in South Africa: a public health review

In South Africa (SA), rising obesity rates are increasingly linked to high intake of sugar-sweetened beverages (SSBs), posing a serious public health challenge. To address this, SA implemented the Health Promotion Levy (HPL) in 2018, Africa’s first sugar tax, aiming to raise the cost of SSBs and reduce their consumption. Evidence indicates that the HPL reduced consumer SSB purchases and encouraged SSB manufacturers to reformulate their SSBs. However, challenges remain, including consumer substitution with untaxed sugary products, limited awareness of the HPL, and industry resistance. This review examines the design, impact, and limitations of the HPL, highlighting the need for complementary strategies and ongoing monitoring of the HPL to ensure long-term public health impact.