Ekram, Rakan Abdulaziz M; (2021) Combating obesity in Saudi Arabia through taxation on sugar-sweetened beverages: political and public views and determinants in Mecca city. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

A 2013 national survey in Saudi Arabia estimated an obesity prevalence of 28.7% among citizens aged 15 years or older. As part of social and financial reforms, the government implemented taxation on sugar-sweetened beverages (SSBs) with the aim of tackling obesity and diversifying the government's economic resources. The goal of this thesis is to explore whether this recently imposed tax addresses the drivers of SSB consumption and could, therefore, help reduce the prevalence of obesity. The primary objective of this thesis is to explore the contextual factors shaping the political priority for the taxation of SSBs over other nutrition-related policies. The secondary objectives are to explore the drivers of SSB consumption and the attitudes of the participants towards the taxation and its acceptability. To address the primary objective, 14 semi-structured interviews were conducted with elite actors who influenced the food policies in Saudi Arabia. Relevant documents were reviewed and analysed separately and subsequently triangulated with the other findings. To address the second objective, 30 semi-structured interviews and four discussion groups were conducted with men from Mecca. In addition, a non-participant observation of industry marketing strategies was utilised. Each finding was analysed separately and triangulated with the other findings. The main findings of this thesis are as follows: 1- SSB taxation was influenced and facilitated by the recent transition in the government, the need for financial resources following the price drop in oil and the recommendations from the World Health Organisation. 2- Three main domain factors influenced SSB consumption among Meccan men: individual (enjoyable attributes related to consumption, a lack of knowledge about the risk factors associated with consumption and the perception that SSBs are affordable), social (social norms, hospitality and family requests), and environmental (the high level of availability and accessibility and the increased industry marketing activities). The participants appreciated the need for the tax but thought it was too high, regressive, unfair and likely ineffective in reducing the consumption of SSBs. By attempting to reduce the purchasing power through taxation, the Saudi government did not consider several factors that influence SSB consumption. To reduce the consumption of SSBs, more comprehensive policies and strategies that address the drivers identified in this work are needed.

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