A tax on sugary drinks in Egypt could reduce disease and save US$1.8 billion in healthcare costs: modelling study

Non-communicable diseases – heart disease, stroke, diabetes, cancer – are no longer just a rich-country problem. Across Africa, they are becoming the leading cause of death, driven in part by a simple and overlooked culprit: what people drink. Globally, 2.2 million new cases of type 2 diabetes and 1.2 million new cardiovascular disease cases were attributable to sugar-sweetened beverages in 2020 alone, with the highest burdens falling on sub-Saharan Africa. A recent time-series study across nine African countries found that rising sugary drink sales between 2010 and 2024 were closely associated with increasing rates of type 2 diabetes, particularly in countries undergoing rapid urbanisation. Yet most African governments have done little about it. As health economists working on these diseases, we wanted to quantify exactly what a targeted tax on sugary drinks could achieve, and whether the numbers were large enough to compel action. Our study focused on Egypt, one of the most populous countries in the region and one where the health and economic burden of non-communicable diseases is already severe. Egypt’s obesity rate among adults has risen from 22% to 32% over the past two decades. Non-communicable diseases account for 84% of all deaths in the country. About 60 cents of every healthcare dollar is paid directly out of pocket by patients and their families. Egypt currently applies a general 14% sales tax to all drinks and a general excise tax on non-alcoholic drinks. But it has no specific excise tax targeting sugary beverages. Excise taxes are sales taxes that apply to specific goods or services. We asked: what would happen if Egypt did tax sugary drinks? We used a proportional multi-state life table model – a tool that tracks disease through a population over time – to project the health and economic effects of a tax that raised sugary drink prices by 20%. This is the level the World Health Organization recommends as the minimum needed to have a meaningful public health impact. When prices rise by this amount, people buy fewer sugary drinks. Consuming fewer sugary drinks means taking in fewer calories. Fewer calories mean lower body weight at the population level. Lower weight means fewer cases of obesity-related diseases: diabetes, heart disease, stroke, cancer and tooth decay. The model follows these chains of cause and effect across the entire Egyptian population over their lifetimes. The results are significant, even under conservative assumptions. They show a marked drop in non-communicable diseases as well as significant savings to the country’s healthcare costs. Based on our modelling we recommend that governments in Egypt and across Africa increase taxes on sugary drinks. Read more: Why African countries need reliable local data on sugary drinks taxes Significant impact Our modelling shows that over 25 years, a 20% tax on sugary beverages in Egypt could prevent an estimated 350,000 cases of obesity, 250,000 cases of type 2 diabetes, 56,000 cases of heart disease, 39,000 strokes, 2,700 new cancer cases, and nearly 31 million instances of tooth decay. The healthcare cost savings over that same 25-year period are estimated at US$1.8 billion – roughly 8% of Egypt’s entire health budget in a single year. And because we excluded indirect costs such as lost wages and reduced productivity from illness, the broader economic benefit is likely higher. Across the lifetime of Egypt’s current population, the tax could generate 1.6 million additional health-adjusted life years, a measure combining both longevity and quality of life. To put that in perspective, Egypt’s landmark national campaign to screen and treat hepatitis C, one of the country’s most celebrated public health achievements, is projected to save roughly 883,000 such life years between 2018 and 2030. The impact of a sugary drinks tax is in the same order of magnitude and is much easier to put in place. The effects are not evenly distributed. Young Egyptians benefit most because they consume more sugary drinks and respond more strongly to price signals. Women gain slightly more than men – around 11% more in healthy life years – reflecting higher rates of obesity among Egyptian women and greater sensitivity to added sugars. This suggests the tax could meaningfully narrow some of the gender-based health disparities that are hard to address through conventional healthcare interventions alone. Read more: Kenya doesn’t have a stand-alone tax on sugary drinks: we set out to find out why Why these findings matter Egypt is not an outlier. It sits within a continent-wide pattern. Obesity rates in sub-Saharan Africa have risen from 9% to 23% for men and from 17% to 39% for women between 1990 and 2022. In South Africa, obesity rates are among the highest in the region, costing an estimated US$7.6 billion (around 2% of GDP) in 2019. That’s projected to rise to US$42 billion by 2060. South Africa is one country among others on the continent that has already acted. The country introduced a Health Promotion Levy on sugary beverages in 2018. Studies evaluating the levy found a 32% reduction in sugary drink purchases among lower-income households and a 27% reduction among higher-income households, with reductions in sugar content exceeding reductions in volume. The tax is working, and the gains are largest among the people who need them most. Across sub-Saharan Africa, frequent consumption of sugary drinks is consistently associated with an increased risk of non-communicable diseases. Obesity is prevalent among nearly half of the women studied in the region. These are not abstract statistics. They are the future patient load of health systems that are already strained. Limitations worth noting Our model has limitations. The price sensitivity estimates we used draw on international data rather than Egypt-specific surveys, and Egyptian consumers may respond differently to price changes than the literature suggests. The model also cannot capture the possibility that consumers switch to cheaper sugary drinks with similar sugar content rather than reducing their intake altogether. We also included only direct healthcare costs. Factoring in lost productivity and the broader economic burden of obesity would push the estimated benefits substantially higher. Read more: We mapped the landscape for taxes on sugary drinks in seven African countries What this means for policy This study does not argue that a sugary drinks tax is the only answer to Africa’s non-communicable disease crisis. It is one tool among many, and its design matters: the tax rate, which beverages are covered, and how revenue is used all affect the health and equity outcomes. Future research should explore how effects differ across income groups and between urban and rural areas – questions that are especially important in diverse African contexts. What the evidence does show is that governments across Africa and the Middle East that are grappling with rising obesity, strained health budgets, and growing non-communicable disease burdens have a cost-effective, evidence-backed tool available to them. The question is no longer whether a sugary drinks tax can work. It is whether the political will exists to use it. Mariam Hamza, King Tam, Kate Mandeville and Sameh El-Saharty contributed to the research on which this article is based. Lennert Veerman receives funding from the World Bank.Yohani Dalugoda receives funding from the World Bank Group.

A tax on sugary drinks in Egypt could reduce disease and save US$1.8 billion in healthcare costs: modelling study

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