South Africa suffers from a considerable health burden including
communicable disease, violence a... more South Africa suffers from a considerable health burden including communicable disease, violence and injury as well as noncommunicable 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 nutritionrelated 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.
A growing body of evidence indicates that excessive sugar consumption is driving epidemics of obe... more A growing body of evidence indicates that excessive sugar consumption is driving epidemics of obesity and related noncommunicable diseases (NCDs) around the world. South Africa (SA), a major consumer of sugar, is also the third most obese country in Africa, and 40% of all deaths in the country result from NCDs. A number of fiscal, regulatory, and legislative levers could reduce sugar consumption in SA. This paper focuses on a sugar-sweetened beverage (SSB) tax. The purpose of the paper is to highlight the challenges that government might anticipate. Policies cannot be enacted in a vacuum and discussion is focused on the industrial, economic, and societal context. The affected industry actors have been part of the SA economy for over a century and remain influential. To deflect attention, the sugar industry can be expected either to advocate for self-regulation or to promote public–private partnerships. This paper cautions against both approaches as evidence suggests that they will be ineffective in curbing the negative health impacts caused by excessive sugar consumption. In summary, policy needs to be introduced with a political strategy sensitive to the various interests at stake. In particular, the sugar industry can be expected to be resistant to the introduction of any type of tax on SSBs.
Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the ... more Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.
Penile circumcision is often claimed to be simpler, safer, and more cost-effective when performed... more Penile circumcision is often claimed to be simpler, safer, and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible - absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments, and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on an individual who is too young (or otherwise unable) to provide meaningful consent to the procedure.
South Africa suffers from a considerable health burden including
communicable disease, violence a... more South Africa suffers from a considerable health burden including communicable disease, violence and injury as well as noncommunicable 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 nutritionrelated 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.
A growing body of evidence indicates that excessive sugar consumption is driving epidemics of obe... more A growing body of evidence indicates that excessive sugar consumption is driving epidemics of obesity and related noncommunicable diseases (NCDs) around the world. South Africa (SA), a major consumer of sugar, is also the third most obese country in Africa, and 40% of all deaths in the country result from NCDs. A number of fiscal, regulatory, and legislative levers could reduce sugar consumption in SA. This paper focuses on a sugar-sweetened beverage (SSB) tax. The purpose of the paper is to highlight the challenges that government might anticipate. Policies cannot be enacted in a vacuum and discussion is focused on the industrial, economic, and societal context. The affected industry actors have been part of the SA economy for over a century and remain influential. To deflect attention, the sugar industry can be expected either to advocate for self-regulation or to promote public–private partnerships. This paper cautions against both approaches as evidence suggests that they will be ineffective in curbing the negative health impacts caused by excessive sugar consumption. In summary, policy needs to be introduced with a political strategy sensitive to the various interests at stake. In particular, the sugar industry can be expected to be resistant to the introduction of any type of tax on SSBs.
Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the ... more Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.
Penile circumcision is often claimed to be simpler, safer, and more cost-effective when performed... more Penile circumcision is often claimed to be simpler, safer, and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible - absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments, and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on an individual who is too young (or otherwise unable) to provide meaningful consent to the procedure.
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Papers by Alex Myers
communicable disease, violence and injury as well as noncommunicable
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 nutritionrelated
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.
Academic Articles by Alex Myers
communicable disease, violence and injury as well as noncommunicable
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 nutritionrelated
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.