The consumption of sugar-sweetened beverages (SSBs) have been increasing over the past years, globally [1]. However, there is overwhelming evidence linking SSBs to the rising prevalence in obesity and its comorbidities (such as diabetes, hypertension, stroke, cardiovascular diseases, dental caries, and many forms of cancer) [2,3,4]. The global prevalence of obesity nearly tripled since 1975 and is expected to increase further in the coming decades [5]. The highest prevalence rates have been recorded in in low- and middle-income countries (LMICs) [1, 5].

Non-communicable diseases (NCDs) account for over 70% of deaths globally, about 40% of which is attributable to dietary factors. In response to the rising incidence of obesity and a variety of diet-related NCDs, especially considering that SSBs are among the leading sources of free sugar intake in many countries, there has been growing interest in implementing SSB taxes to curb consumption [6, 7]. SSB taxes are regarded as a cost-effective measure which can be used to prevent or slow the growing burden of NCDs [8]. This is happening as the growing affordability of SSBs, especially in LMICs, threatens to worsen existing global health inequalities [7].

In South Africa, the prevalence of overweight and obesity is high and is among the highest in Sub-Saharan Africa. In 2016, 31% of adult males, 67% of adult females, and 13% of children under five years old were either overweight or obese [9, 10], posing a significant challenge to the healthcare system. This impacts heavily and negatively on income due to decreased productivity [11, 12]. The economic impact of obesity and its comorbidities on the South African economy is estimated at ZAR30 billion, in 2020 [13].

In response to rising prevalence in obesity and its comorbidities, in 2016 the South African government announced the introduction of an SSB tax based on sugar content, as recommended by the World Health Organisation (WHO). The announcement was followed by a white paper, evidence reviewing and making recommendations for a sugar-based tax to be levied at ZAR0.028 per gram of sugar, resulting in a tax burden of approximately 20% of the per-litre price of the most popular SSB [14]. After extensive consultation with the sugar industry, beverage manufacturers, civic society groups, and public health advocates, there were substantial concessions made to both the sugar and beverage industries. The tax was formally implemented on 1 April 2018 referred to as the Health Promotion Levy (HPL). The levy is limited to non-alcoholic sugary drinks, excluding fruit juice. It is levied at a rate of ZAR0.0221 per gram of sugar above a threshold of 4 g of sugar per 100 ml. Thus, the effective tax burden was reduced to about 10% from the 20% initially proposed.

Despite the concessions made, policymakers continue to face substantial opposition to the levy. The primary argument, which has also been raised against tobacco and alcoholic beverages taxes, is that the tax has led (and will continue to lead to) job losses, particularly in the industries involved in the production, distribution, and sale of these products [15, 16]. This argument by the industry led the government to suspend till 2025 its intention to increase the levy rate, reduce the threshold to below 4 g per 100 ml, and expand the tax to fruit juice. However, evidence from independent research globally show no significant changes in employment associated with SSB taxes e.g., in Mexico [17], Peru [18], San Fransisco [19], and Illinois and California [20]. Considering the persistent argument by the sugar and beverage industry (amid high unemployment rate), and limited evidence on the employment impact of the SSB tax, this study seeks to investigate the association between the HPL and employment in sugar-related industries in South Africa. This knowledge is important especially for policymakers as they consider reviewing the HPL. Given that South Africa’s economic and market conditions are largely similar to those of Mexico and Peru, we expect the HPL to have weak or no association with employment.