Health policy analysis on health taxes

Overview

Noncommunicable diseases (NCDs) like heart disease, cancer and diabetes are rising globally, are a significant and increasing cause of death and disability around the world, including in low- and middle-income countries. Governments are implementing policies to prevent risk factors, such as promoting physical activity through car-free days or taxing harmful products like tobacco, alcohol and sugar. These measures, however, need to be tailored to fit national contexts to be truly effective.

The Alliance, in collaboration with several WHO departments and supported by the Government of Norway, is leading a research programme to provide tailored health policy analysis on health taxes in low- and middle-income countries. Through this work, the Alliance aims to understand how political and economic factors shape their design, adoption and implementation.

Map of country case studies

(Mouse over the bubbles to find out more about each study.)

Key facts

Duration

Cohort 1
2021 – 2023

Cohort 2
2024 – 2026

Alliance area of work

Achieving universal health coverage through a primary health care approach

Countries

Cohort 1

Cohort 2

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. .