Health taxes on tobacco, alcohol, food and drinks in low- and middle-income countries: a scoping review of policy content, actors, process and context

Elliott, Lana M., Daglish, Sarah L., and Topp, Stephanie M. (2020) Health taxes on tobacco, alcohol, food and drinks in low- and middle-income countries: a scoping review of policy content, actors, process and context. International Journal of Health Policy and Management.

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Abstract

Background: Taxation of tobacco, food, alcohol and other beverages has gained renewed attention in responding to non-communicable diseases (NCDs). While largely built on evidence from high-income countries (HICs), the projected economic and health benefits of these measures have increased calls for their use in price-sensitive low- and middle-income countries (LMICs). However, uptake has been sporadic and there remains little research on why and how LMICs utilise fiscal measures in response to NCDs. Methods: This scoping review analyses factors influencing the design and implementation of health-related fiscal measures in LMICs. Utilising Arksey and O'Malley's scoping review methodology and Walt and Gilson’s policy triangle, we considered the contextual, procedural, content and stakeholder-related factors that influenced measures. Results: We identified 75 papers focussing on health-related fiscal measures, with 47 (63%) focused on tobacco, 5 on alcohol, 6 on soft drink and 4 studies on food-related fiscal regulation. Thirteen papers analysed multiple measures and most papers (n = 66, 88%) were less than a decade old. Key factors enabling the design and implementation of measures included localised health and economic evidence, policy championing, inter-ministerial support, and global or regional momentum. Impeding factors encompassed negative framing and retaliation by industry, vested interests and governmental policy disjuncture. Aligning with theoretic insights from the policy triangle, findings consistently demonstrated that the interplay between factors – rather than the presence or absence of particular factors – has the most profound impact on policy implementation. Conclusion: Given the growing urgency to address NCDs in LMICs, this review highlights the need for recognition and rigorous exploration of political economy factors influencing the design and implementation of fiscal measures. Broader LMIC-specific empirical research is needed to overcome an implication noted in much of the literature: that mechanisms used to enact tobacco taxation are universally applicable to measures targeting foods, alcohol and other beverages.

Item ID: 65005
Item Type: Article (Research - C1)
ISSN: 2322-5939
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Copyright Information: © 2020 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Date Deposited: 10 Nov 2020 23:03
FoR Codes: 44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 40%
42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 30%
44 HUMAN SOCIETY > 4408 Political science > 440899 Political science not elsewhere classified @ 30%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 50%
94 LAW, POLITICS AND COMMUNITY SERVICES > 9402 Government and Politics > 940204 Public Services Policy Advice and Analysis @ 50%
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