A 'whole systems' approach to reduce sugar-sweetened beverage consumption: issues for global health promotion through a small island lens.

Reducing sugar-sweetened beverage (SSB) consumption is a prominent strategy to reduce sugar intake and non-communicable disease (NCD) risk worldwide. Recommended measures encompass policy, environmental modification, health literacy, reformulation and taxation. This commentary draws from an intervention to reduce SSB consumption in a remote, rural context with high intake and under-developed alternatives and health literacy. The island of St Helena introduced SSB taxation from 2014, yet impact appeared limited. In 2018, supply and demand measures for substitute products were developed, alongside a taxation increase. Preliminary data indicate a shift away from SSB towards non-sugar beverages (artificially sweetened beverages (ASB) and tap water). Issues for global health promotion include the specific manifestation of social and commercial determinants of health in remote and rural contexts, integrated multifaceted strategies to provide supporting conditions for policies such as SSB taxation to deliver impact, and the role of ASB to reduce SSB in high consumption contexts.