The history of the South African sugar industry illuminates deeply rooted obstacles for sugar reduction anti-obesity interventions

South Africa suffers from a considerable health burden including communicable disease, violence and injury as well as non-communicable diseases. Its formal health system is significantly challenged. Reducing morbidity and mortality for all South Africans requires an approach that transcends health services, where public policy addresses the broader social determinants of health by designing and implementing interventions that improve people's health more effectively than individual interventions within the health sector. Legislative, regulatory and fiscal policies could substantially and cost-effectively reduce the burden of nutrition-related non-communicable diseases. South Africa has successfully reduced the salt content of foods and there is evidence demonstrating that a 20 per cent tax on sugary beverages will reduce obesity. Facilitators and barriers for such interventions have been covered in a separate article. Some challenges are particularly difficult to overcome. This article focuses on the deep historical roots of the South African sugar industry and its influence on dietary sugar consumption at the population level. The sugar industry is a prime example of a colonial activity shaping the economy, polity, penetration of sugar content into food products, and diets over an extended historical period. In the modern, and specifically the post-apartheid, period the sugar industry has proved resilient. The priority for black empowerment in policy matters since the end of apartheid, and recent economic policy, have facilitated the promotion of products regardless of their known economic, social and health harms. These pressures have led contradictorily to the retention of a large privileged sector in the South African sugar industry, while simultaneously enriching a few select black entrepreneurs on the one hand, and impoverishing the greater number of small and informal producers on the other. Similar developments have characterised the South African experience with other harmful product industries - notably alcohol and tobacco. It is argued that understanding the historical roots and dynamics of the SA sugar industry illuminates the setting of a research agenda on policy processes involving the role of corporates producing harmful products.