“Despite overwhelming evidence, governments around the world are missing an efficient and cost-effective opportunity to improve health, raise revenue, invest in equity and save lives,” argue Dr Tedros Adhanom Ghebreyesus, and the Rt Hon. Helen Clark in a commentary piece in BMJ Global Health. That missed opportunity, they suggest, is implementing and expanding health taxes. According to a 2023 report by the World Health Organization (WHO), only 13% of the global population benefits from optimal levels of tobacco taxes, which are the most effective means of reducing tobacco consumption. So, why is there such a gap? “Understanding the national context – the politics, the process and power – is critical”, they conclude.
A new special collection of BMJ Global Health on health taxes aims to do just that. The Alliance for Health Policy and Systems Research (a WHO-hosted partnership), with support from the Government of Norway and in collaboration with WHO 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 examining how political economy factors influence and frame the design, adoption and implementation of health taxes. This work, along with other studies, is captured in this special collection.
It comprises analysis, commentary, original research, and practice articles offering both theoretical and methodological insights, along with empirical research findings. A scoping review on framing health taxes noted that evidence is rapidly increasing – especially from high-income countries and for sugar-sweetened beverage taxes – about how to best frame health taxes. Clear communication can help the public grasp the rationale behind these taxes and their intended benefits for public health and government revenue. Articles touch on how taxes are framed, and on countering narratives that undermine such taxes. For example, in Ethiopia, authors noted that a public health coalition worked to discredit the tobacco industry’s cost–benefit assessments by making an argument in favor of taxes as a way to reduce consumption of harmful products, improving health outcomes. In another example in Ghana, government stakeholders and civil society actors focused on prioritizing the importance of generating revenue for health programmes to expand health taxes.
This special collection is an important resource for policy-makers, researchers and advocates seeking to navigate the complex world of health tax policies. It shares lessons and experiences from a range of low- and middle-income countries on how best to support countries to accelerate, develop, expand and sustain health tax policies.