The SAMRC/Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Office 233, 2nd floor, Wits Education Campus, 27 St Andrews Road, Parktown, Johannesburg 2197, South Africa.
Health Policy Plan. 2023 Nov 14;38(Supplement_1):i49-i58. doi: 10.1093/heapol/czad068.
Procedural fairness is an accepted requirement for health decision-making. Fair procedures promote the acceptability and quality of health decisions while simultaneously advancing broader goals of participatory democracy. We conducted a case study of the Sugary Beverage Tax in South Africa known as the Health Promotion Levy (HPL), which was legislated in 2018. The case study examines the process around the adoption of the HPL from the perspective of procedural fairness with the view of identifying local gaps and lessons transferable to other local decision-making processes and other jurisdictions. We conducted a desk review of publically available data relating to the passage and implementation of the HPL, including a review of the policy documents, public submissions during the public participation process, response documents from policymakers, review of national legislative committee minutes, legal instruments and academic literature capturing public awareness, stakeholder views and media content. The data collection is novel in terms of the large scope of data considered, as well as the variety of sources. An analytical framework consisting of key criteria for procedural fairness, informed by a scoping review of the literature, guided the analysis of the decision-making process in South Africa. The process of the adoption and passage of the HPL met the majority of the procedural fairness criteria. However, a shortcoming, which impacted several criteria, was the failure to actively source the participation of community representatives and the larger public. Non-governmental organizations did not adequately fulfil this representative role. Industry interests were also disproportionately considered. The case study highlights the overall importance of viewing general members of the public as interested parties in health policies and the dangers of over-involving policy opponents under a mistaken understanding that this constitutes meaningful public engagement in decision-making procedures.
程序公平是健康决策的公认要求。公平的程序促进了卫生决策的可接受性和质量，同时推进了参与式民主的更广泛目标。我们对南非含糖饮料税（HPL）进行了案例研究，该税也被称为健康促进税（HPL），于 2018 年立法。该案例研究从程序公平的角度考察了 HPL 的采用过程，目的是确定当地的差距和可转移到其他地方决策过程和其他司法管辖区的经验教训。我们对与 HPL 的通过和实施相关的公开数据进行了桌面审查，包括对政策文件的审查、公众参与过程中的公众意见、政策制定者的回复文件、国家立法委员会会议记录的审查、法律文书和学术文献的审查，这些文献都捕捉到了公众意识、利益相关者的观点和媒体内容。就所考虑数据的范围广泛以及来源多样性而言，数据收集具有创新性。一个由程序公平关键标准组成的分析框架，通过对文献的范围审查，指导了对南非决策过程的分析。HPL 的通过和实施过程符合程序公平的大多数标准。然而，一个缺点是未能积极争取社区代表和更广泛公众的参与，这影响了几个标准。非政府组织没有充分履行这一代表作用。行业利益也被不成比例地考虑。该案例研究强调了将一般公众视为健康政策利益相关者的重要性，以及在错误理解的情况下过度涉及政策反对者的危险，这种错误理解认为这构成了决策程序中有意义的公众参与。
