Noncommunicable diseases – like heart disease, stroke, cancer, diabetes and chronic lung disease – are a significant and increasing cause of death and disability around the world, including in low- and middle-income countries. As such, many governments are considering or have already put in place a range of policies to help prevent some of the risk factors that are known to contribute to these diseases. To increase physical activity and improve air quality, for example, some cities have created car free days. Others have tried to increase the price of harmful products by increasing taxes on tobacco, alcohol and sugar.
Indeed, more and more governments are looking for advice on how best to design, implement and administer health taxes. But it is unlikely that these types of policies are one-size-fits-all: how they are framed and developed within their national political, economic and social context determines their success. Locally generated evidence and policy analysis – with a deep understanding of the contextual politics, processes and powers – can inform the creation of more tailored policies.
The Alliance, with support from the Government of Norway and in collaboration with WHO Departments and the Inter-Agency Working Group on Health Taxes, established a research programme to provide health policy analysis for health taxes in eight low- and middle-income countries in 2021 – with research teams in Bangladesh, Ethiopia, Ghana, Indonesia, Nepal, Pakistan, Peru, and Viet Nam. The programme developed case studies that examine how political economy factors influence and frame the design, adoption and implementation of health taxes.
By working on this project, the Alliance realized that a wider understanding of how political and economic factors influence and frame the design, adoption and implementation of health taxes across countries is needed. The Alliance has now expanded this work to include new research teams in a second cohort from Colombia, Egypt, India, Lebanon, Mongolia, Nigeria, Uganda, and Zambia.
Explore the map below to find out more about the areas of focus of each of the studies.
Map of country case studies have been selected
(Mouse over the bubbles to find out more about each study.)
Table of the first cohort of country case studies
| Country | Grantee institution | Project objective |
| Pakistan | Onto Global | To conduct a deep contextual analysis of the issues surrounding health taxes, particularly political issues and those linked to the policy-making process. Particular challenges in Pakistan include constitutional issues, political influence and lobbying and adequacy of oversight. |
| Ghana | Kwame Nkrumah University of Science and Technology (KNUST) | To provide new evidence on the political economy challenges and opportunities associated with new health tax proposals in Ghana, and to explore how these can be overcome and harnessed to improve population health. Specifically, to assess the current state of readiness among key stakeholders for the use of consumption taxes and to understand policy-makers' perceptions of and the public's response to these taxes. |
| Viet Nam | Thuongmai University | To explain what determines health taxes and to understand the role of different stakeholders and their influences. The project also aims to identify current views and perceptions of stakeholders and to explore engaging other stakeholders in a coordinated way towards more support for health taxes. The project also plans to focus on both the supply and demand side of taxes and show their real-world impacts in Viet Nam. |
| Ethiopia | University of Gondar | Recent tax reforms in Ethiopia have raised the prices of tobacco and alcohol for consumers. The policy-making processes to pass associated legislation was complex. This study aims to examine the period of agenda setting and legislative passage of health taxes in Ethiopia, elaborate on similarities and differences with other cases with LMICs, discuss policy implications and recommendation for future research on health policy analysis in LMICs. |
| Bangladesh | International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) | To understand the political economy factors (politics, ideas, evidence, institutional structures) that influence the design and implementation of existing health taxes, influential actors in the space and to describe the evolution of the health tax policy space over time. |
| Indonesia | University of Indonesia (UI) | To generate knowledge for health policy analysis and draw policy attention to health taxes in Indonesia and to support and build national capacity for health policy analysis concerning health taxes. This is in the context of dominant industries involved in producing these products, a lack of government support (especially concerning sugar-sweetened beverages) and complex hierarchical legislative systems. |
| Nepal | Health Economics Association (HEA) | To document and update information on the responsiveness of consumption of harmful products to health taxes, to conduct a political economy analysis on the design and implementation of health taxes – specifically the interactions between ideas, interests and institutions – and to initiate advocacy on the use of these taxes to curb the rising incidence of noncommunicable diseases in Nepal. |
| Peru | Independent | To analyze the political economy factors that shaped the development and implementation of health taxes in Peru, in particular the role of different stakeholders in that process and their framing strategies to shape the policy discussion. |
Table of the second cohort of country case studies
| Country | Grantee institution | Project objective |
| Colombia | Fundación Anáas | To promote and advance the use of health policy analysis for the effective implementation of health taxes, with a focus on generating knowledge, building national capacity, and providing cross-national insights to inform advocacy, policy-making, and research efforts. |
| Egypt and Lebanon | American University of Beirut | To develop and apply a Political Economy Analysis framework in the Egyptian and Lebanese contexts, compiling a comprehensive report, to ultimately advocate for and drive health taxation reforms in both countries. |
| India | The Center for Disease Dynamics, Economics & Policy, Inc | To analyse the impact of political economy on health taxes (e.g., tobacco, alcohol, sugar, fossil fuels, meat, salt) and associated subsidies, generating policy recommendations for enhancing fiscal health policies in India and other LMICs. |
| India | Sambodhi Research and Communications Pvt. Ltd | To analyse how the political context, policy, processes, and actor roles influence fiscal measures related to fossil fuels in India, aiming to provide insights that can advance strategic thinking about health taxes and their impact on public health in the country. |
| Mongolia | Mongolian National University of Medical Sciences | To examine the policy landscape and stakeholder roles concerning health taxes on tobacco and alcohol, while also identifying barriers that have hindered the development and successful implementation of such policies in Mongolia |
| Nigeria | Development Governance International Consult Ltd | To generate evidence on health policy reforms for advancing health taxes towards prevention and control of non-communicable diseases (NCDs) in Nigeria, and the influence of political economy on health tax adoption, design and implementation. |
| Uganda | Makerere University | To investigate the political economy factors underpinning the slow progression in the implementation of health taxes in Uganda. |
| Zambia | WHO Framework Convention on Tobacco Control (WHO FCTC) Knowledge Hub on Tobacco Taxation, University of Cape Town | To undertake an in-depth analysis of the factors that facilitate or constrain the development of optimal health tax reforms. . |
NOTE: This article was originally published on 23 September 2021. It has been republished on 15 September 2023 to reflect the addition of a second round of grantees