101
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Bonnet C, Réquillart V. The effects of taxation on the individual consumption of sugar-sweetened beverages. Econ Hum Biol 2023; 51:101277. [PMID: 37657287 DOI: 10.1016/j.ehb.2023.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/28/2023] [Accepted: 07/15/2023] [Indexed: 09/03/2023]
Abstract
To assess the impact of taxation on the consumption of sugar-sweetened beverages (SSBs) most economic studies using household data consider the average consumer. Individual consumption is, however, very heterogeneous. In this paper, we propose a three-step methodology to evaluate the impact of SSB taxation on individual consumption. First, we use a disaggregation method to recover individual consumption from observed household consumption. Second, we estimate the demand for different categories of households. Finally, we simulate the impact of a tax policy on individual consumption. We find a high level of heterogeneity in consumption. Adults, both men and women, consume a greater quantity of SSBs than children. More importantly, for any given age category, the average consumption of SSBs increases with body mass index (BMI). Among heavy consumers of SSBs, obese and overweight people are over-represented. In France, a €0.20/l tax on SSBs might decrease sugar intake by more than 2 kg per year on average and by more than 5 kg, roughly 3 teaspoons/day, for 5% of the adult population. Moreover, overweight and obese men and women, who correspond to 41% of the adult population, represent 56% of the last five percentiles of the distribution of the variation in sugar intake. This is a key result because the objective of taxation is to decrease the consumption of individuals who are more at risk, that is those who are overweight and obese. We also show that classical method of the assessment of tax policies based on per-capita consumption underestimate the effect of the tax for obese adults by 9%. Finally, we estimate that a €0.20/l tax on SSBs might avoid about 640 deaths (about 1.6% of the considered diseases) as a consequence of the decrease in SSB consumption.
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Affiliation(s)
- Céline Bonnet
- Toulouse School of Economics, Université Toulouse Capitole, INRAE, France.
| | - Vincent Réquillart
- Toulouse School of Economics, Université Toulouse Capitole, INRAE, France.
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102
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Maclean JC, Khan T, Tsipas S, Pesko MF. The effect of cigarette and e-cigarette taxes on prescriptions for smoking cessation medications. Health Serv Res 2023; 58:1245-1255. [PMID: 36271500 PMCID: PMC10622273 DOI: 10.1111/1475-6773.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To test the effect of cigarette and e-cigarette taxes on prescriptions for smoking cessation medications. DATA SOURCE Symphony Health, IDV all-payer prescription claims data for the United States over the period 2009-2017. Prescription fills for smoking cessation products were provided at the patient's age, patient's sex, brand/generic, payment type, year, and quarter levels. STUDY DESIGN We study the effect of state-level cigarette and e-cigarette tax rates on prescriptions for smoking cessation medications using two-way fixed effect modified difference-in-differences regressions. We also use a multiperiod difference-in-differences estimator robust to bias from dynamic and heterogeneous treatment effects with a staggered policy rollout. DATA COLLECTION/EXTRACTION METHODS We use fills for Chantix, Zyban, and their generics, as well as Food and Drug Administration-approved nicotine replacement therapies that are paid for by insurance. PRINCIPAL FINDINGS We observe no statistically significant change in prescription fills following an increase in the e-cigarette tax rate, though we are unable to rule out potentially large effects. However, following a $1.00 increase in the cigarette tax rate, we observe a 1052 increase in prescription fills per 100,000 adults (95% CI: 57, 2046; 4.2% increase). The effect of cigarette taxes on prescription fills was particularly large for 18-34 year-olds. CONCLUSIONS Our findings suggest that, during a period when e-cigarettes are widely available, cigarette tax increases remain effective in increasing use of these medications, but e-cigarette taxes do not increase use of these medications.
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Affiliation(s)
| | - Tamkeen Khan
- Improving Health OutcomesAmerican Medical AssociationChicagoIllinoisUSA
| | - Stavros Tsipas
- Improving Health OutcomesAmerican Medical AssociationChicagoIllinoisUSA
| | - Michael F. Pesko
- Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaGeorgiaUSA
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103
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Smith NR, Hassmiller Lich K, Ng SW, Hall MG, Trogdon JG, Frerichs L. Implementation costs of sugary drink policies in the United States. J Public Health Policy 2023; 44:566-587. [PMID: 37714964 PMCID: PMC10841536 DOI: 10.1057/s41271-023-00435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/17/2023]
Abstract
To support implementation of important public health policies, policymakers need information about implementation costs over time and across stakeholder groups. We assessed implementation costs of two federal sugar-sweetened beverage (SSB) policies of current policy interest and with evidence to support their effects: excise taxes and health warning labels. Our analysis encompassed the entire policy life cycle using the Exploration, Preparation, Implementation, and Sustainment framework. We identified implementation actions using key informant interviews and developed quantitative estimates of implementation costs using published literature and government documents. Results show that implementation costs vary over time and among stakeholders. Explicitly integrating implementation science theory and using mixed methods improved the comprehensiveness of our results. Although this work is specific to federal SSB policies, the process can inform how we understand the costs of many public health policies, providing crucial information for public health policy making.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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104
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Garcia-Bernardo J, Janský P, Tørsløv T. Effective tax rates of multinational corporations: Country-level estimates. PLoS One 2023; 18:e0293552. [PMID: 38019736 PMCID: PMC10686448 DOI: 10.1371/journal.pone.0293552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Effective tax rates (ETRs) estimated from the income statement data of multinational corporations (MNCs) are useful for comparing MNCs' corporate income taxation across countries. In this paper, we propose a new methodological approach to estimate ETRs as reliably and for as many countries as possible using Orbis' unconsolidated data for the 2011-2015 period. We focus on countries with at least 50 available companies, which results in a sample of 47, mostly European, countries. We estimate the ETR of a country as the ratio of corporate income tax to gross income for all affiliates of MNCs in that country, weighted by gross income. We propose four ETR estimations, including lower and upper bounds, which differ by gross income calculation. We find that ETRs substantially differ from statutory tax rates for some countries. For example, we show that despite similar statutory rates of 28% and 29%, MNCs in Luxembourg paid as little as 1-8% of gross income in taxes, while those in Norway paid as much as 46-67%. Despite being the best available, existing data is still imperfect. We therefore call for better data in the form of MNCs' unconsolidated, public country-by-country reporting data.
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Affiliation(s)
- Javier Garcia-Bernardo
- Department of Methodology & Statistics, Utrecht University, Utrecht, The Netherlands
- Centre for Complex Systems Studies, Utrecht University, Utrecht, The Netherlands
| | - Petr Janský
- Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czechia
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105
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Etter-Phoya R, Manthalu C, Kalizinje F, Chigaru F, Mazimbe B, Phiri A, Chimowa T, Ligomeka W, Hall S, O'Hare B. Financing child rights in Malawi. BMC Public Health 2023; 23:2255. [PMID: 37974100 PMCID: PMC10652529 DOI: 10.1186/s12889-023-16319-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Nearly all countries have ratified the United Nations Convention on the Rights of the Child and, therefore, support children having access to their rights. However, only a small minority of children worldwide have access to their environmental, economic, and social rights. The most recent global effort to address these deficits came in 2015, when the United Nations General Assembly agreed to a plan for a fairer and more sustainable future by 2030 and outlined the Sustainable Development Goals (SDGs). One remediable cause is the lack of revenue in many countries, which affects all SDGs. However, illicit financial flows from low-income to high-income countries, including international tax abuse, continue unabated. METHODS Using the most recent estimates of tax abuse perpetuated by multinational companies and tax evasion through offshore wealth, and precise econometric modelling, we illustrate the potential regarding child rights (or progress towards the SDGs) if there was an increase in revenue equivalent to tax abuse in Malawi, a low-income country particularly vulnerable to climate change. The Government Revenue and Development Estimations model provides realistic estimates of government revenue changes in developmental outcomes. Using panel data on government revenue per capita, it models the impact of increased revenue on governance and SDG progress. RESULTS If cross-border tax abuse and tax evasion were curtailed, the equivalent increase in government revenue in one country, Malawi, would be associated with 12,000 and 20,000 people having access to basic water and sanitation respectively each year. Each year, an additional 5000 children would attend school, 150 additional children would survive, and 10 mothers would survive childbirth. CONCLUSIONS More children would access their economic and social rights if actions were taken to close the gap in global governance regarding taxation. We discuss the responsibility of duty bearers, the need for a global body to arbitrate and monitor international tax matters, and how the Government of Malawi could take further domestic action to mitigate the gaps in global governance and protect itself against illicit financial flows, including tax abuse.
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Affiliation(s)
- Rachel Etter-Phoya
- Tax Justice Network, Lilongwe, Malawi.
- University of St Andrews, St Andrews, UK.
| | | | | | | | | | - Ajib Phiri
- Kamuzu University of Health Sciences, (KUHeS), Blantyre, Malawi
| | - Takondwa Chimowa
- Ministry of Health, Lilongwe, Malawi
- Zomba Central Hospital, Zomba, Malawi
| | | | - Stephen Hall
- School of Business, University of Leicester, Leicester, UK
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106
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Sun D, Zhang M, Jung D. Policy evaluation of economic - environmental tradeoffs in regulating industrial water use: An agent-based model. J Environ Manage 2023; 346:118988. [PMID: 37722213 DOI: 10.1016/j.jenvman.2023.118988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/07/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023]
Abstract
Water resource shortage and water pollution are prominent and urgent resource and environment problems. Industrial water consumption and sewage discharges account for a large proportion of the total sewage discharge of China. Therefore, scientifically regulating the water consumption and sewage discharge of industrial enterprises can effectively alleviate water scarcity and pollution problems. By establishing a multi-agent model, this study simulates the water use behavior of industrial enterprises, exploring the responses of industrial enterprises to a different type of scenarios for water management that can coordinate economic and environmental benefits. The purpose is to reduce the water consumption and pollutant emissions of industrial enterprises while achieving economic benefits, so as to provide policy references for water authorities. The results show that: 1) The three policies of water price, water resource tax and emission reduction subsidy can effectively regulate the water consumption and sewage discharge of enterprises. 2) Water price and water resource tax rate need to be controlled within a reasonable range. Appropriate water price and water resource tax rate can encourage enterprises to increase R&D investment. On this basis, it is suggested to emphasize the two-way influence of the government and enterprises, continue to implement water resources management policies such as water resources tax, so as to promote the balance between ecology and economy.
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Affiliation(s)
- Dongying Sun
- School of Management, Jiangsu University, Zhenjiang, 212013, China.
| | - Miao Zhang
- School of Management, Jiangsu University, Zhenjiang, 212013, China
| | - Donghwi Jung
- School of Management, Jiangsu University, Zhenjiang, 212013, China; School of Civil, Environmental and Architectural Engineering, Korea University, Seoul, 02841, South Korea.
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107
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Dzhygyr Y, Dale E, Voorhoeve A, Gopinathan U, Maynzyuk K. Procedural fairness and the resilience of health financing reforms in Ukraine. Health Policy Plan 2023; 38:i59-i72. [PMID: 37963081 PMCID: PMC10645049 DOI: 10.1093/heapol/czad062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/28/2023] [Accepted: 07/26/2023] [Indexed: 11/16/2023] Open
Abstract
In 2017, Ukraine's Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders' participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform's design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty.
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Affiliation(s)
- Yuriy Dzhygyr
- Independent Expert, 54a Pivnichna Str, Kyiv 04213, Ukraine
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Alex Voorhoeve
- Department of Philosophy, Logic and Scientific Method, London School of Economics and Political Science (LSE), Houghton Street, London WC2A 2AE, United Kingdom
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
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108
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Kruger P, Goldstein S, Hofman K. The passage and implementation of a Health Promotion Levy in South Africa as a case study of fair financing procedures. Health Policy Plan 2023; 38:i49-i58. [PMID: 37963079 PMCID: PMC10645051 DOI: 10.1093/heapol/czad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 11/16/2023] Open
Abstract
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.
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Affiliation(s)
- Petronell Kruger
- 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
| | - Susan Goldstein
- 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
| | - Karen Hofman
- 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
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109
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Hu A, Zhao X, Room R, Hao W, Xiang X, Jiang H. The effects of alcohol tax policies on alcohol consumption and alcohol use disorders in Mainland of China: an interrupted time series analysis from 1961-2019. Am J Drug Alcohol Abuse 2023; 49:746-755. [PMID: 38059570 DOI: 10.1080/00952990.2023.2280948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
Background: Overwhelming evidence suggests that increasing alcohol taxes is an effective strategy for curbing alcohol consumption. However, research on the effects of such strategies in low- and middle-income nations is limited.Objective: The aim is to explore the temporal effect of alcohol tax policy in China.Methods: We employ interrupted time series analysis to investigate the temporal effects of tax policy changes on alcohol consumption and related consequences in Mainland China from 1961 to 2019. The study population, the total population of mainland region of China, aged more than 15 years.Results: The results show that the volume tax policy, which was announced in 2000 and implemented in 2001, led to an immediate reduction in the alcohol consumption (coefficient = -0.429, p < .001). Following the implementation of higher alcohol taxes in 1998 and 2001, the prevalence of alcohol use disorders (AUDs) and related years lived with disability (YLDs) gradually decreased. The relaxation of tax policy in 2006 led to a significant increase in alcohol consumption, both immediately (coefficient = 0.406, p < .001) and in the middle term (coefficient = 0.495, p < .001), as well as contribute to an immediate or medium term significant increase in the prevalence of AUDs (coefficient = 0.038, p = .010; coefficient = 0.032, p < .001) and YLDs (coefficient = 4.363, p = .001; coefficient = 4.226, p < .001).Conclusion: This study demonstrates that changes in alcohol consumption and related consequences (increase or decrease) have followed corresponding changes in alcohol tax policies (easing or tightening), indicating that increasing alcohol taxes can be an effective strategy in China for controlling alcohol consumption and related harms.
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Affiliation(s)
- Aqian Hu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoxi Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Robin Room
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wei Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaojun Xiang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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110
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Venson AH, Cardoso LB, Santiago FS, de Souza KB, Bielemann RM. Price elasticity of demand for ready-to-drink sugar-sweetened beverages in Brazil. PLoS One 2023; 18:e0293413. [PMID: 37910576 PMCID: PMC10619800 DOI: 10.1371/journal.pone.0293413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
The taxation of sugar-sweetened beverages is a policy that has been adopted in many countries worldwide, including Latin American, to reduce sugar consumption. However, little is known about how taxation on these products may affect their demand. The present study aims to estimate the price elasticity of demand for sugar-sweetened beverages in Brazil. This study advances the literature by proposing a breakdown between ready-to-drink sugar-sweetened beverages and sugar-sweetened beverages that require some preparation before being consumed. With this disaggregation, it is possible to obtain more accurate elasticities for the group of products that will be effectively taxed. We estimated a Quadratic Almost Ideal Demand System (QUAIDS) model using the Household Budget Survey 2017-2018 microdata. The results show that ready-to-drink beverages is more consumed but less sensitive to changes in price than prepared beverages. The price elasticity of demand for ready-to-drink and prepared sugar-sweetened beverages was -1.19 and -3.38. Additionally, we observe heterogeneity in these price elasticities across household incomes, with a more elastic demand among lower-income households for ready to drink beverages. The findings suggest that taxing ready-to-drink sweetened beverages could potentially reduce sugar consumption directly through a decrease in the consumption of sugary drinks and this effect could be reinforced by reducing the consumption of other sugar-rich products. Therefore, the taxation police should effective contribute to minimize health risks associated to the sugar consumption.
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Affiliation(s)
| | - Larissa Barbosa Cardoso
- Faculty of Administration, Accounting and Economic Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Flaviane Souza Santiago
- Faculty of Economics, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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111
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Putri RA, Alemmario R, Melinda G, Audwina AH, Espressivo A, Herlinda O, Meilissa Y, Saminarsih DS. The advocacy coalition of sugar-sweetened beverage taxes in Indonesia. BMJ Glob Health 2023; 8:e012052. [PMID: 37984901 PMCID: PMC10660648 DOI: 10.1136/bmjgh-2023-012052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/09/2023] [Indexed: 11/22/2023] Open
Abstract
The Ministry of Finance of Indonesia has put sugar-sweetened beverages (SSBs) taxation on its agenda since 2020 to address the need for health financing, as outlined in the National Medium-Term Development Plan for 2020-2024. However, the adoption process of this fiscal policy has been slow. This study aims to generate insights into the actors involved in the discourse of SSB tax adoption in Indonesia to inform their advocacy and communication efforts using the Advocacy Coalition Framework and Discourse Network Analysis. The analysis was conducted using data extracted from 1733 statements collected from 200 online web domains and subdomains, divided into three timeframes of the policy process. The analysis identified actors supporting and opposing the adoption of SSB tax. The discourse network also identified key advocacy coalitions and organisations in the discussion on SSB tax adoption in Indonesia. The results indicate that there are diverse network patterns in each timeframe and reveal the process and focus of the policy change. The Ministry of Finance had the most significant influence on the discourse, with actors from civil society organisations and universities involved in the process of policy change through evidence-based policy recommendations. Meanwhile, economic actors contributed to the debate on the potential harm of tax adoption to the industry. These findings can inform the policy process and ensure the successful adoption of the SSB tax in Indonesia.
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Affiliation(s)
- Rayssa Anggraeni Putri
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Reyhan Alemmario
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Gea Melinda
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Ardiani H Audwina
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Aufia Espressivo
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Olivia Herlinda
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Yurdhina Meilissa
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
| | - Diah S Saminarsih
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Indonesia
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112
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Jawad A, Reed E, Severi K, Jenner K, Reed H, Cheeseman H. Development of a framework for action to advocate for a coherent prevention policy for tobacco, alcohol, and foods high in fats, salt, or sugar: a mixed-methods approach. Lancet 2023; 402 Suppl 1:S57. [PMID: 37997100 DOI: 10.1016/s0140-6736(23)02109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Tobacco, alcohol, and foods high in fats, salt, or sugar (HFSS) are health harming products. Limited progress in prevention is partly due to health-harming industry lobbying. Action on Smoking and Health (ASH), Alcohol Health Alliance, and Obesity Health Alliance collaborated with the aim of developing a framework for action to address the saturation of these products in our environment. METHODS We used a mixed-methods approach. Focus groups with academic experts, local government, and national government, recruited through snowball sampling were held in Nov 3, 2022 (14 participants); April 25, 2023 (20 participants); and June 15, 2023 (20 participants). Iteratively, data analysis was presented, and key themes tested. Commissioned economic analysis of national survey datasets quantified consumer spend on tobacco, alcohol, and food products above government recommendations (all tobacco use, >14 units of alcohol, and national dietary guidelines) and industry percentage of revenues (net of tax). Public opinion data from the ASH YouGov Smokefree Survey 2022 on a nationally representative sample of 13 088 adults were descriptively analysed for specific policy options. FINDINGS The framework for action to achieve a coherent prevention approach across products included three key enablers (secure funding for prevention, a comprehensive strategy, and protecting health policy from industry interference). Five key actions were: regulate advertising to limit harm, regulate product use and environments they can be used in, promote healthy messaging, raise the price of health-harming products, and fund treatment services. Economic analysis identified 100% of tobacco usage, 43·4% of alcohol purchased, and 28·8% of food purchased by households was above government recommendations. Post-tax industry revenue was £7·3 billion for tobacco, £11·2 billion for alcohol, and £34·2 billion for HFSS foods. Strong public support for levies (5%, n=8495) and protecting health policy from industry influence (69%, n=9006) was apparent. INTERPRETATION A coherent approach to prevention across health-harming products is effective and has public support. Strengths include the iterative process to develop the framework for action among focus groups and use of nationally representative datasets. Limitations include the snowball sampling. The findings were built into a strategy intended to inform future collaborative work in the area. FUNDING Cancer Research UK (grant PICADV-Feb22\100004).
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Affiliation(s)
- Aalaa Jawad
- Royal Free NHS Foundation Trust, London, UK.
| | - Emily Reed
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Katherine Severi
- Institute of Alcohol Studies, Alcohol Health Alliance, London, UK
| | | | - Howard Reed
- Landman Economics and University of Northumbria, London, UK
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Moore HJ, Connor N, Burrows A, Breeze P, O'Malley CL, Lake AA. Identification of tax options for high fat, sugar, salt foods for the HEALTHEI Project: a mixed-methods study. Lancet 2023; 402 Suppl 1:S70. [PMID: 37997115 DOI: 10.1016/s0140-6736(23)02116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The health economic analysis incorporating effects on labour outcomes, households, environment, and inequalities (HEALTHEI) explores which food taxes would have greatest benefits to health, labour, and work outcomes; household expenditure; environmental sustainability; and inequalities within the UK food system. Work package 1 includes a rapid review and workshops, aiming to explore the effects of price increases in food and non-alcoholic beverages to facilitate the specification of food taxes and research design. METHODS In this mixed-methods study, we first did a rapid review to examine relevant published evidence. A preplanned framework ensured a systematic approach, in which we searched PubMed, HMIC, Scopus, Google, Mintel/Mintel Food and Drink, and Business Source Ultimate for papers published in English from Jan 1, 2010, to Nov 2, 2022. This review was followed by three online workshops (in March, 2023), which used interactive padlets to explore food systems, food taxation policy, tax rationales, and a rapid review infographic. 14 stakeholders from non-governmental organisations (n=10), academia (n=2), the Civil Service (n=1), and a local authority (n=1) took part (gender or ethnicity were not recorded). A stakeholder recruitment grid was developed to ensure representation across public sectors and disciplines of public health, nutrition, environment, and economics. FINDINGS The rapid review identified six tax options with a broadly positive impact on consumption and health (high fat, high sugar, high salt, "junk food", sugar-sweetened-beverages, and meats plus sugar-sweetened beverages). It generated five core rationales for a food tax: change consumption, reduce or prevent harm, change product affordability, raise revenue, and industry impact. Using the workshop feedback, health inequalities, economics, ease of implementation and animal welfare were additional key areas for a so-called real-world application of tax. Stakeholders questioned the taxes in the current economic and political climate. INTERPRETATION The work highlights the need to develop an impactful food tax option that encompasses the five core rationales identified in the findings. The workshops identified key areas to explore further to understand the feasibility, impact, and logistics of implementing future food taxes. Being unable to deliver workshops in person due to difficulties of participants travelling to London was a limitation. However, switching online allowed for varied and well attended workshops. FUNDING National Institute of Health Research (Ref: NIHR133927).
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Affiliation(s)
- Helen J Moore
- Fuse, The Centre for Translational Research in Public Health, Teesside University, Middlesbrough, UK; School of Health & Life Sciences, University of Sheffield, Sheffield, UK
| | - Natalie Connor
- Fuse, The Centre for Translational Research in Public Health, Teesside University, Middlesbrough, UK; School of Social Sciences, University of Sheffield, Sheffield, UK.
| | - Andrea Burrows
- Fuse, The Centre for Translational Research in Public Health, Teesside University, Middlesbrough, UK; School of Health & Life Sciences, University of Sheffield, Sheffield, UK
| | - Penny Breeze
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Claire L O'Malley
- Fuse, The Centre for Translational Research in Public Health, Teesside University, Middlesbrough, UK; School of Health & Life Sciences, University of Sheffield, Sheffield, UK
| | - Amelia A Lake
- Fuse, The Centre for Translational Research in Public Health, Teesside University, Middlesbrough, UK; School of Health & Life Sciences, University of Sheffield, Sheffield, UK
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Alrubaian F, Mulla Z. Governments policy measures to address obesity among adults: a scoping review of the global evidence. Lancet 2023; 402 Suppl 1:S20. [PMID: 37997060 DOI: 10.1016/s0140-6736(23)02132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/31/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Obesity epidemic is one of the greatest challenges in public health in modern societies. This study aimed to address the main gap by reviewing the effectiveness of nutritional policy measures implemented globally by governments to reduce obesity prevalence among adults. METHODS We developed a scoping review by searching Ovid Medline, PubMed, and Embase from May 5, to July 12, 2022 for papers published in English between Jan 1, 2002 and May 1, 2022. Eligible papers included adults older than 18 years and focused on obesity prevention strategies. No restrictions on study design or geographic location were applied. The search terms included "obesity", "health policy", "government regulation", and "obesogenic environment". FINDINGS 17 articles were eligible for this scoping review across seven countries (USA, UK, France, Mexico, Colombia, Chile, and India). The identified studies were observational, cross-sectional, and systematic reviews, with the majority published in the USA and the UK within the past 5 years. Policies were categorised into three groups: food and beverages taxes (n=6), food labelling (n=6) and national campaigns (n=5). Most policies showed a small magnitude change in obesity reduction metrics such as body-mass index (BMI) and weight outcome (n=10). Two studies found that food labelling did not significantly change weight status. Two other studies targeting national campaigns showed a reduction in risk for obesity and overweight. However, the sugar tax demonstrated promising results compared with all other policies when the tax levy tier was increased. Three studies reported that a higher tax increase was correlated with a greater decline in obesity prevalence when increasing the tax up to 20%. INTERPRETATION Our findings inform recommendations for policy makers of how other countries have implemented and evaluated their food policies. It can also encourage food industries to reformulate their products and promote population health. The limited number of settings included in this study is a main limitation of the review. Further investigation of the tax equity is needed. FUNDING None.
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Affiliation(s)
- Fadwa Alrubaian
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - Zeinab Mulla
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Alnafrah I, Okunlola O, Sinha A, Abbas S, Dagestani AA. Unveiling the environmental efficiency puzzle: Insights from global green innovations. J Environ Manage 2023; 345:118865. [PMID: 37659369 DOI: 10.1016/j.jenvman.2023.118865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
The latest surge of global uncertainty and disruptions in global supply networks put policymakers under pressure to emprise green innovations as a vital tool to address environmental concerns. However, producing green innovations doesn't always help in achieving environment-related sustainable development goals. Therefore, in this study, we endeavour to investigate to what extent green innovations are efficient in improving environmental efficiency. To this end, a network bias-corrected data envelopment analysis and clustering analysis is applied. The data used in this study covers 42 countries from different regions, spanning from 2000 to 2020. The results reveal that most countries have not made major advancements in environmental efficiency signifying the low level of green innovations utilization to achieve environment-related sustainable development goals (SDGs). Additionally, the results demonstrate a U efficiency curve for inputs-oriented green innovations efficiency over time, indicating that the initial stages of green innovations production are associated with a decreased return. However, over time, the efficiency exhibits an upward trend. The benchmarking analysis reveals that South American and European Union nations set the bar for other countries in terms of efficiently leveraging green innovations to achieve SDGs. Our findings also suggest that environmental efficiency is more dependent on green-supporting policies such as green energy production and green taxes. As a result, we conclude that achieving environmental SDGs while utilizing green innovations does not always result in the development of other SDGs. Therefore, policymakers need to prioritize pursuing a green developmental approach and supporting policies to achieve environment-related SDGs and other SDGs.
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Affiliation(s)
- Ibrahim Alnafrah
- Graduate School of Economics and Management, Ural Federal University, Yekaterinburg, Russia.
| | - Olalekan Okunlola
- Department of Economics and International Business, Derby Business School, University of Derby, UK.
| | - Avik Sinha
- Management Development Institute, Gurgaon, India.
| | - Shujaat Abbas
- Graduate School of Economics and Management, Ural Federal University, Yekaterinburg, Russia; Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon.
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Nguyen TM, Tonmukayakul U, Khanh‐Dao Le L, Singh A, Lal A, Ananthapavan J, Calache H, Mihalopoulos C. Modeled health economic and equity impact on dental caries and health outcomes from a 20% sugar sweetened beverages tax in Australia. Health Econ 2023; 32:2568-2582. [PMID: 37477540 PMCID: PMC10946924 DOI: 10.1002/hec.4739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
Dental caries is the most prevalent oral disease across the life course. This study modeled the population health and economic impact of a 20% sugar sweetened beverages tax (SSB) for preventing dental caries compared to no intervention (societal and healthcare perspective). A cost-effectiveness analysis according to quintiles of area-level socioeconomic disadvantage was performed for the 2020 Australian population (0-100 years old) using a closed cohort Markov model. A qualitative assessment of implementation considerations (e.g., acceptability, equity, sustainability) was undertaken. Health outcomes were modeled as decayed teeth prevented and disability-adjusted life years (DALYs) averted. The 10-year and lifetime scenarios were modeled with probabilistic sensitivity analysis (Monte Carlo simulation, 2000 cycles). The 10-year scenario from a societal perspective yielded cost-savings of AUD$63.5M, healthcare cost-savings of AUD$42.2M, 510,977 decayed teeth averted and 98.1 DALYs averted. The lifetime scenario resulted in societal cost savings of AUD$176.6M, healthcare cost-savings of AUD$122.5M, 1,309,211 decayed teeth averted and 254.9 DALYs averted. Modeling indicated 71.5% and 74.5% cost-effectiveness for the 10-year and lifetime scenarios, respectively. A three-fold health benefit for the least advantaged was found compared to the most advantaged. A 20% SSB tax in Australia is cost-effective and promotes health equity.
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Affiliation(s)
- Tan Minh Nguyen
- Public Health & Preventive MedicineFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Utsana Tonmukayakul
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Long Khanh‐Dao Le
- Public Health & Preventive MedicineFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Ankur Singh
- Melbourne School of Population and Global Health & Melbourne Dental SchoolFaculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Anita Lal
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Jaithri Ananthapavan
- Deakin Health Economics and Global Centre for Preventive Health and NutritionInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Hanny Calache
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Cathrine Mihalopoulos
- Public Health & Preventive MedicineFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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Alvarado M, Adams J, Penney T, Murphy MM, Abdool Karim S, Egan N, Rogers NT, Carters-White L, White M. A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective. Nat Food 2023; 4:986-995. [PMID: 37857862 PMCID: PMC10661741 DOI: 10.1038/s43016-023-00856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/08/2023] [Indexed: 10/21/2023]
Abstract
Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development.
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Affiliation(s)
- Miriam Alvarado
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Tarra Penney
- Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | | | - Nat Egan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Nina Trivedy Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Lauren Carters-White
- SPECTRUM Consortium, Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
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Zhou Y, Yang W. Differentiated environmental taxes and high-quality economic development in China: theory and evidence. Environ Sci Pollut Res Int 2023; 30:114222-114238. [PMID: 37858015 DOI: 10.1007/s11356-023-30168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
Environmental tax policy plays an important role in promoting economic efficiency, but it is unclear whether the taxation is well-designed and effective. The differentiated environmental tax and fee policy in China has come a long way in the past 20 years, along with the aim of high-quality economic development that focuses on the harmony of environment and productivity, so it is necessary to evaluate the effectiveness of the differentiated environmental tax and fee policy. This paper constructs a pollution and environmental tax model based on the new economic geography framework to simulate the effect of environmental tax and technological innovation in the eastern and western region on pollution, output, and productivity. Using China's provincial panel data from 2005 to 2020 with difference-in-difference method, empirical evidence shows that differentiated environmental tax and fee adjustments generally boost industrial high-quality development by the industrial sulfur dioxide emission deduction and green total factor productivity improvement. When the adjustment is more differentiated between treatment and control, the effect is greater and more significant. Additionally, high environmental tax standard in high SO2 emission provinces significantly contributes to high-quality development. Progressive adjustments in 2007, 2014, and 2018 lead to heterogeneous policy effect. Technological innovation plays a mediating effect between differentiated environmental tax and high-quality economic development. The results above provide theoretical analysis and empirical study of China's differentiated environmental taxes and high-quality economic development for policy making.
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Affiliation(s)
- Yaxiong Zhou
- School of Economics, Hangzhou Dianzi University, Hangzhou, China
| | - Wenxin Yang
- School of Economics, Hangzhou Dianzi University, Hangzhou, China.
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Kirikkaleli D. Environmental taxes and environmental quality in Canada. Environ Sci Pollut Res Int 2023; 30:117862-117870. [PMID: 37875759 DOI: 10.1007/s11356-023-30616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
This paper aims to capture the effect of environmentally related taxes on environmental quality in Canada while controlling economic growth, financial development, and energy consumption over the period of 1990Q1 to 2020Q4. The present study employs novel econometric approaches, namely, the nonlinear autoregressive distributed lag (N-ARDL) test and the gradual shift causality (GS-C) test. The outcomes of the study reveal that (i) there is long-run cointegration equation between environmental taxes (E-TAX), carbon dioxide emissions (CO2E), economic growth (ECG), financial development (FD), and primary energy consumption (PREC); (ii) E-TAX causes to decrease in environmental degradation in Canada; (iii) PREC and ECG increase (and cause) environmental degradation in Canada; and (iv) financial development also positively affect the environmental sustainability. This effort may also be of great importance for policymakers and decision-makers to better understand the factors of environmental degradation for developing effective tax policies that will alleviate human impacts and contribute to reducing environmental degradation.
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Affiliation(s)
- Dervis Kirikkaleli
- Faculty of Economics and Administrative Sciences, European University of Lefke, Lefke, Northern Cyprus, Turkey.
- Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon.
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Bozatli O, Akca H. The effects of environmental taxes, renewable energy consumption and environmental technology on the ecological footprint: Evidence from advanced panel data analysis. J Environ Manage 2023; 345:118857. [PMID: 37657289 DOI: 10.1016/j.jenvman.2023.118857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/26/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
The world faces various challenges in terms of environmental sustainability. An increasing world population, the rigidity of traditional production and consumption patterns, the complexity of economic activities, globalization, and harmful emissions intensify environmental pressures. In this context, the evaluation of various environmental policy instruments is important to alleviate environmental pressures and, thus, combat climate change. This study aims to investigate the impact of environmental taxes, renewable energy consumption, and environmental technology on the ecological footprint in OECD countries by using data from 1994 to 2018 and modern panel data techniques. The results of the AMG estimator indicate that environmental taxation and renewable energy consumption play a role in reducing the ecological footprint; however, results imply that environmental technology does not have a statistically significant effect on the ecological footprint. In addition, we applied DCCE and CS-ARDL estimators to obtain robustness results and observed that the findings remained valid. Therefore, the results of the study suggest that regulations to increase the effectiveness of environmental taxes, renewable energy consumption, and environmental technology should be promoted to ensure environmental sustainability.
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Affiliation(s)
- Oguzhan Bozatli
- Osmaniye Korkut Ata University, Kadirli Vocational School, Department of Accounting and Taxation, Osmaniye, Turkey.
| | - Hasim Akca
- Faculty of Economics and Administrative Sciences, Department of Public Finance, Cukurova University, Adana, Turkey.
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Emmert-Fees KMF, Amies-Cull B, Wawro N, Linseisen J, Staudigel M, Peters A, Cobiac LJ, O’Flaherty M, Scarborough P, Kypridemos C, Laxy M. Projected health and economic impacts of sugar-sweetened beverage taxation in Germany: A cross-validation modelling study. PLoS Med 2023; 20:e1004311. [PMID: 37988392 PMCID: PMC10662751 DOI: 10.1371/journal.pmed.1004311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Taxes on sugar-sweetened beverages (SSBs) have been implemented globally to reduce the burden of cardiometabolic diseases by disincentivizing consumption through increased prices (e.g., 1 peso/litre tax in Mexico) or incentivizing industry reformulation to reduce SSB sugar content (e.g., tiered structure of the United Kingdom [UK] Soft Drinks Industry Levy [SDIL]). In Germany, where no tax on SSBs is enacted, the health and economic impact of SSB taxation using the experience from internationally implemented tax designs has not been evaluated. The objective of this study was to estimate the health and economic impact of national SSBs taxation scenarios in Germany. METHODS AND FINDINGS In this modelling study, we evaluated a 20% ad valorem SSB tax with/without taxation of fruit juice (based on implemented SSB taxes and recommendations) and a tiered tax (based on the UK SDIL) in the German adult population aged 30 to 90 years from 2023 to 2043. We developed a microsimulation model (IMPACTNCD Germany) that captures the demographics, risk factor profile and epidemiology of type 2 diabetes, coronary heart disease (CHD) and stroke in the German population using the best available evidence and national data. For each scenario, we estimated changes in sugar consumption and associated weight change. Resulting cases of cardiometabolic disease prevented/postponed and related quality-adjusted life years (QALYs) and economic impacts from healthcare (medical costs) and societal (medical, patient time, and productivity costs) perspectives were estimated using national cost and health utility data. Additionally, we assessed structural uncertainty regarding direct, body mass index (BMI)-independent cardiometabolic effects of SSBs and cross-validated results with an independently developed cohort model (PRIMEtime). We found that SSB taxation could reduce sugar intake in the German adult population by 1 g/day (95%-uncertainty interval [0.05, 1.65]) for a 20% ad valorem tax on SSBs leading to reduced consumption through increased prices (pass-through of 82%) and 2.34 g/day (95%-UI [2.32, 2.36]) for a tiered tax on SSBs leading to 30% reduction in SSB sugar content via reformulation. Through reductions in obesity, type 2 diabetes, and cardiovascular disease (CVD), 106,000 (95%-UI [57,200, 153,200]) QALYs could be gained with a 20% ad valorem tax and 192,300 (95%-UI [130,100, 254,200]) QALYs with a tiered tax. Respectively, €9.6 billion (95%-UI [4.7, 15.3]) and €16.0 billion (95%-UI [8.1, 25.5]) costs could be saved from a societal perspective over 20 years. Impacts of the 20% ad valorem tax were larger when additionally taxing fruit juice (252,400 QALYs gained, 95%-UI [176,700, 325,800]; €11.8 billion costs saved, 95%-UI [€6.7, €17.9]), but impacts of all scenarios were reduced when excluding direct health effects of SSBs. Cross-validation with PRIMEtime showed similar results. Limitations include remaining uncertainties in the economic and epidemiological evidence and a lack of product-level data. CONCLUSIONS In this study, we found that SSB taxation in Germany could help to reduce the national burden of noncommunicable diseases and save a substantial amount of societal costs. A tiered tax designed to incentivize reformulation of SSBs towards less sugar might have a larger population-level health and economic impact than an ad valorem tax that incentivizes consumer behaviour change only through increased prices.
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Affiliation(s)
- Karl M. F. Emmert-Fees
- Professorship of Public Health and Prevention, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Research Center for Environmental Health, Neuherberg, Germany
| | - Ben Amies-Cull
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Oxford Health Biomedical Research Centre, National Institute of Health and Care Research, Oxford, United Kingdom
| | - Nina Wawro
- Institute of Epidemiology, Helmholtz Zentrum München, Research Center for Environmental Health, Neuherberg, Germany
| | - Jakob Linseisen
- Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Staudigel
- TUM School of Management, Technical University of Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Research Center for Environmental Health, Neuherberg, Germany
| | - Linda J. Cobiac
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Martin O’Flaherty
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Oxford Health Biomedical Research Centre, National Institute of Health and Care Research, Oxford, United Kingdom
| | - Chris Kypridemos
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | - Michael Laxy
- Professorship of Public Health and Prevention, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Cisneros AB, Headings R, Wells R, Reynolds C, Vogel C, Breeze P. Understanding the use of media analysis in public health research through food tax debates (HEALTHEI Project): a scoping review. Lancet 2023; 402 Suppl 1:S9. [PMID: 37997136 DOI: 10.1016/s0140-6736(23)02060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Poor diet is a major public health concern. In 2021, 63·8% of adults and 22·2% of reception-age children were either overweight or obese in England. Fiscal interventions have become a popular policy measure to reduce obesity and encourage healthy eating. Such measures are highly controversial, leading to media debate promoting pro-tax and anti-tax arguments. To better understand food tax debates and the use of media analysis in public health research, we conducted a scoping review of media analyses using food taxes as a case study. METHODS In this scoping review, we searched SCOPUS, PubMed, and EBSCOhost databases on Feb 14-22, 2023, using keyword variations for "food", "tax", and "media analysis". Results were restricted to English-only, peer-reviewed journal articles. The initial results were manually screened through an iterative process to exclude articles that did not analyse a food tax, were non-English language, were not peer-reviewed, or did not use media analysis as the primary method. Modelled on Arksey and O'Malley's (2005) five-stage review protocol, two researchers used a coding framework to independently code all articles and checked result quality through regular discussion. Extracted data included article title, author, year, country, tax type, media sources used, identified media frames, and research aims, methods, results, and conclusions. Results are reported according to PRISMA guidelines and data files submitted to FigShare Repository (non-accessible). FINDINGS Of 1087 articles reviewed, 19 were eligible to be included in the study. Articles were published between 2013 and 2023, with 2021 having the highest concentration of studies carried out mainly in UK and USA. Despite search terms encompassing a range of food products, the retrieved media analyses focused on three types of food product taxes: sugar-sweetened beverages, meat, and groceries. Most articles explored arguments for and against policy implementation, with some investigating stakeholder representation. Results demonstrate that stakeholders' arguments, both positive and negative, are consistent across countries and food products. INTERPRETATION The consistency of how both pro-tax and anti-tax arguments are presented in the media demonstrates the importance of coordination between stakeholder groups to influence policy adoption. To our knowledge, this is the first study to investigate media analysis across a diverse range of food products. FUNDING National Institute for Health and Care Research (NIHR).
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Affiliation(s)
| | - Rachel Headings
- Centre for Food Policy, City, University of London, London, UK.
| | - Rebecca Wells
- Centre for Food Policy, City, University of London, London, UK
| | | | - Christina Vogel
- Centre for Food Policy, City, University of London, London, UK; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Penny Breeze
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
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Guo B, Wang Y, Zhou H, Hu F. Can environmental tax reform promote carbon abatement of resource-based cities? Evidence from a quasi-natural experiment in China. Environ Sci Pollut Res Int 2023; 30:117037-117049. [PMID: 36287368 DOI: 10.1007/s11356-022-23669-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
China is entering a new period characterized by reaching peak and carbon neutralization, and environmental taxes are increasingly crucial for breaking the "carbon curse" of resource-based cities. Accordingly, using the implementation of China's Environmental Protection Tax Law (EPT Law) as a quasi-natural experiment, this study utilizes the DID model to assess this environmental tax reform's effect in terms of reducing carbon emissions. The research results are as follows: (1) The environmental tax reform (ETR) reduced the intensity of carbon emissions; it additionally promoted reducing total carbon emissions from resource-based cities. (2) The carbon abatement effect can also be achieved by upgrading industrial structures and improving innovation in the area of green technology. (3) The ETR has impacted carbon abatement in resource-based cities more significantly in China's eastern region than in the central or western regions. In contrast, it had less effect on resource-based cities in the regenerative stage than on cities in other stages. (4) The spatial spillover effect of the ETR was significantly positive, aggravating the level of carbon emissions in neighboring cities. Thus, the "pollution haven hypothesis" was tested. Overall, this study deepens the knowledge of ETR and carbon emissions and provides theoretical support and policy suggestions for supporting resource-based cities in a green transformation.
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Affiliation(s)
- Bingnan Guo
- School of Humanity & Social Science, Jiangsu University of Science and Technology, Zhenjiang, 212000, China
| | - Yu Wang
- School of Humanity & Social Science, Jiangsu University of Science and Technology, Zhenjiang, 212000, China
| | - Haiyan Zhou
- Institute of Digital Economy and Green Development, Chifeng University, Chifeng, 024000, China
| | - Feng Hu
- Institute of International Business and Economics Innovation and Governance, Shanghai University of International Business and Economics, Shanghai, 201620, China.
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Abstract
OBJECTIVE To evaluate the common industry claim that higher tobacco taxation leads to higher levels of smuggling, particularly in a limited state capacity setting. DESIGN This paper evaluates the effects of a tobacco tax increase in Sierra Leone on smuggling by using gap analyses. Its models are based on multiple rounds of the Demographic and Health Survey and customs data as well as newly collected data on cigarette prices. RESULTS The paper shows that despite a substantial increase in cigarette taxation, and despite the absence of other formal tobacco control policies, smuggling has not increased in Sierra Leone. Its primary model shows a decrease in cigarette smuggling by 16.74% following the tax increase, alongside a decrease in cigarette consumption more widely and an increase in tax revenue. CONCLUSIONS By presenting a low income and lower enforcement capacity case study, this paper provides novel and critical evidence to the debate on the tax-smuggling link. Furthermore, it points to new questions on how states in these contexts can limit cigarette smuggling.
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Affiliation(s)
- Max Gallien
- Governance Cluster, Institute of Development Studies, Brighton, UK
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125
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Pomeranz JL. Expanded policy rationales support sugar-sweetened beverage taxes. Nat Food 2023; 4:931-932. [PMID: 37857861 DOI: 10.1038/s43016-023-00854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Jennifer L Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA.
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Palacios A, Alcaraz A, Casarini A, Rodriguez Cairoli F, Espinola N, Balan D, Perelli L, Augustovski F, Bardach A, Pichon-Riviere A. The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade. Health Econ 2023; 32:2655-2672. [PMID: 37525366 DOI: 10.1002/hec.4741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 03/15/2023] [Accepted: 06/12/2023] [Indexed: 08/02/2023]
Abstract
Tobacco tax increases, the most cost-effective measure in reducing consumption, remain underutilized in low and middle-income countries. This study estimates the health and economic burden of smoking in Argentina and forecasts the benefits of tobacco tax hikes, accounting for the potential effects of illicit trade. Using a probabilistic Markov microsimulation model, this study quantifies smoking-related deaths, health events, and societal costs. The model also estimates the health and economic benefits of different increases in the price of cigarettes through taxes. Annually, smoking causes 45,000 deaths and 221,000 health events in Argentina, costing USD 2782 million in direct medical expenses, USD 1470 million in labor productivity loss costs, and USD 1069 million in informal care costs-totaling 1.2% of the national gross domestic product. Even in a scenario that considers illicit trade of tobacco products, a 50% cigarette price increase through taxes could yield USD 8292 million in total economic benefits accumulated over a decade. Consequently, raising tobacco taxes could significantly reduce the health and economic burdens of smoking in Argentina while increasing fiscal revenue.
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Affiliation(s)
- Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, UK
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Casarini
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Natalia Espinola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Lucas Perelli
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires (UBA), Buenos Aires, Argentina
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127
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Zhou X, Zhai Y, Zhang T, Li Z, Cheng Z, Li C, Xu T, Hong J. Uncovering the energy-carbon-water footprint of waste rubber recycling: Integrated environmental and economic perspectives. J Environ Manage 2023; 345:118916. [PMID: 37690244 DOI: 10.1016/j.jenvman.2023.118916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/12/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
The commitment to waste management has gained increasing momentum as global waste generation continues to skyrocket and threaten the environment. However, detailed assessments and clear insights remain absent to address the global waste utilization conundrum. This study evaluated the impact-oriented energy, carbon, and water (ECW) footprints of three typical scenarios for a waste recycling activity (i.e., waste rubber recycling) from environmental and economic dimensions, and explored key factors, nexus characteristics, and optimization measures. Results indicated that the rubber powder as an asphalt modifier scenario had a 93% greater environmental impact and 87% higher economic cost compared with the pyrolysis and reclaimed rubber production scenarios. Key processes, such as direct processes, electricity generation, and transportation, were identified as the major contributors to the ECW footprints, with the internal costs of raw materials, equipment, and taxes coupled with the external costs of human health dominating the economic impact. The nexus analysis results highlighted the urgent need to optimize the energy system for waste rubber recycling. Greening the production process revealed the benefits, with natural additives mitigating 85% of the environmental burden and 97% of the external costs compared with conventional additives. Industrial green microgrids, clean energy generation, proximity waste management, and electrified transportation were explored to foster sustainable optimization of waste rubber recycling systems. Moreover, a joint tax-subsidy mechanism for rubber production-recycling systems can stimulate recycling-oriented product design and increase the motivation to recycle waste rubber.
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Affiliation(s)
- Xinying Zhou
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China
| | - Yijie Zhai
- Shandong Academy of Macroeconomic Research, Jinan, 250014, China
| | - Tianzuo Zhang
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China
| | - Ziheng Li
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China
| | - Ziyue Cheng
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China
| | - Changting Li
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China
| | - Tianshu Xu
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China
| | - Jinglan Hong
- Shandong Key Laboratory of Environmental Processes and Health, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China; Shandong University Climate Change and Health Center, Public Health School, Shandong University, Jinan, 250012, China.
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128
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Huang X, Kim JS, Hong KR, Kim NH. How do carbon trading price and carbon tax rate affect power project portfolio investment and carbon emission: An analysis based on uncertainty theory. J Environ Manage 2023; 345:118768. [PMID: 37619387 DOI: 10.1016/j.jenvman.2023.118768] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
Responding to the social, economic, and environmental call to resolve current sustainability challenges, the concern about carbon dioxide emission reduction should be incorporated into the power investment decision process. Reflecting the low carbon emission requirement, this paper proposes a new optimization model for power project portfolio selection that simultaneously considers both of carbon emission trading scheme and carbon tax imposition. In this model, the initial investment outlay, the power sale price, the carbon trading price, and carbon tax rate are treated as uncertain variables considering the fast-changing environment and complex market situation. Incorporating the constraint on whether the carbon quota is exceeded into the model, two investment strategies are proposed for investors. Using the proposed model, the impact of the rises in carbon trading price and carbon tax rate on the investor's investment strategy selection and the carbon emission is simulated and analyzed through a case study. When the expected carbon price is 203.50 RMB/tCO2-eq or less, a company should invest based on the strategy that annual emissions exceed the quota to obtain a maximum expected NPV which is larger than 408588 million RMB. When future carbon prices are 352.00, 500.50 and 649.00 RMB/tCO2-eq, the government should impose carbon tax rates of 30, 30, and 40 RMB/tCO2 on a power company, respectively, to obtain carbon emission reduction effect. At last, to see the contrast effect of the results from simultaneous implementation of both carbon trading and carbon tax, the results considering the carbon trading alone or carbon tax alone are discussed, respectively.
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Affiliation(s)
- Xiaoxia Huang
- School of Economics and Management, University of Science and Technology Beijing, 100083, China.
| | - Jang Su Kim
- School of Economics and Management, University of Science and Technology Beijing, 100083, China; Institute of Information Technology, High-Tech Research and Development Centre, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea.
| | - Kwon Ryong Hong
- School of Economics and Management, University of Science and Technology Beijing, 100083, China; Institute of Natural Sciences, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea.
| | - Nam Hyok Kim
- School of Economics and Management, University of Science and Technology Beijing, 100083, China; Faculty of Information Science, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea.
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Salgado Hernández JC, Basto-Abreu A, Junquera-Badilla I, Moreno-Aguilar LA, Barrientos-Gutiérrez T, Colchero MA. Building upon the sugar beverage tax in Mexico: a modelling study of tax alternatives to increase benefits. BMJ Glob Health 2023; 8:e012227. [PMID: 37963607 PMCID: PMC10649495 DOI: 10.1136/bmjgh-2023-012227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION In 2014, Mexico implemented a one peso-per-litre tax to sugar-sweetened beverage (SSB). Even though this tax reduced household purchases and predicted population health gains, the magnitude is lower compared with taxes implemented in other settings. In this study, we assessed what would happen if Mexico modified its existing tax to get higher benefits based on currently implemented taxes elsewhere. METHODS For each tax scenario, we estimated net benefits as the difference between healthcare savings and lost jobs. We created hypothetical scenarios in which the current tax doubled or would be modified based on existing tax designs around the world including specific taxes (sugar-density or volumetric) and ad-valorem taxes. RESULTS We found that the largest benefits would correspond to a tax increase of 7.4 Mexican pesos (0.45 US dollars (USD)) per SSB litre, following the current tax in Bahrain (the highest tax rate option). This tax is predicted to yield net benefits equivalent to USD 24.7 billion after 10 years of the tax redesign. We also found that sugar-density taxes can result in larger net benefits since, in addition to reductions in consumption associated with responses to prices, they induce product reformulation. Middle-income households are the most benefited group because they reported the highest baseline prevalence of obesity and the largest price elasticity. CONCLUSION Policymakers should consider pursuing a tax reform adding to the current tax, with significant increases in prices linked to a sugar-density strategy to reach a higher benefit.
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Affiliation(s)
- Juan Carlos Salgado Hernández
- National Council for Science and Technology and Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Basto-Abreu
- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Isabel Junquera-Badilla
- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - M Arantxa Colchero
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Mexico
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130
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Kleiman-Lynch LJ, McCullough ME. When it comes to taxes, ownership intuitions abide by the law. Behav Brain Sci 2023; 46:e341. [PMID: 37813429 DOI: 10.1017/s0140525x23001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Boyer suggests that laws cannot account for ownership intuitions, but there may be situations when intuitions hew to laws almost perfectly. Laws granting governments taxation powers provide an interesting case study. We report data here suggesting that people's intuitions track law very closely, and are unaffected by manipulating a P() tag input. We propose two hypotheses to explain this finding.
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Affiliation(s)
- Leo J Kleiman-Lynch
- Department of Psychology, University of California, San Diego, CA, USA ; https://www.michael-mccullough.com/
| | - Michael E McCullough
- Department of Psychology, University of California, San Diego, CA, USA ; https://www.michael-mccullough.com/
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131
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Salgado Hernandez JC, Ng SW, Stearns SC, Trogdon JG. Cost-benefit analysis of alternative tax policies on sugar-sweetened beverages in Mexico. PLoS One 2023; 18:e0292276. [PMID: 37788248 PMCID: PMC10547152 DOI: 10.1371/journal.pone.0292276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
In 2014, Mexico implemented a tax on sugar-sweetened beverages (SSB) equivalent to one Mexican peso (MP) per liter to address the high obesity prevalence. This tax has effectively reduced SSB purchases and yielded healthcare savings; however, it remains unknown whether SSB taxes lead to net benefits at the societal level in Mexico. Moreover, public health experts recommend increasing the tax. The objective of this study is to estimate the net benefits of SSB taxes compared to a scenario of no tax in urban Mexico. Taxes include the one-MP tax and alternative higher taxes (two and three MP per SSB liter). Thus, we conducted a cost-benefit analysis from the perspective of the government, producers, and consumers for a simulated closed cohort of adults in a life-table model. We defined net benefits as the difference between economic benefits (the value of statistical life, healthcare savings, and tax revenue) and costs (consumer surplus and profit losses). We found that, at the societal level, all simulated taxes will eventually generate benefits that surpass costs within ten years. Overall net benefits can reach USD 7.1 billion and 15.3 billion for the one-MP and the three-MP tax, respectively. Hence, these benefits increased at a declining rate compared to taxes. The government and consumers will experience overall positive net benefits among society's members. Policymakers should consider time horizons and tradeoffs between health gains and economic outcomes across different society members.
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Affiliation(s)
- Juan Carlos Salgado Hernandez
- National Institute of Public Health, National Council of Humanities, Science and Technology, Mexico and Center for Research in Nutrition and Health, Cuernavaca, Mexico
| | - Shu Wen Ng
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sally C. Stearns
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Garcia K, Mejia P, Perez-Sanz S, Dorfman L, Madsen K, Schillinger D. Pro- and Anti-Tax Framing in News Articles About California Sugar-Sweetened Beverage Tax Campaigns from 2014-2018. J Health Commun 2023; 28:658-668. [PMID: 37682070 PMCID: PMC10592108 DOI: 10.1080/10810730.2023.2251913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Sugar-sweetened beverages (SSB) contribute to illness, especially among marginalized communities and children targeted by the beverage industry. SSB taxes can reduce consumption, illness burden, and health inequities, while generating revenue for health programs, and as one way to hold the industry responsible for their harmful products and marketing malpractices. Supporters and opponents have debated SSB tax proposals in news coverage - a key source of information that helps to shape public policy debates. To learn how four successful California-based SSB tax campaigns were covered in the news, we conducted a content analysis, comparing how SSB taxes were portrayed. We found that pro-tax arguments frequently reported data to expose the beverage industry's outsized campaign spending and emphasize the health harms of SSBs, often from health professionals. However, pro-tax arguments rarely described the benefits of SSB taxes, or how they can act as a tool for industry accountability. By contrast, anti-tax arguments overtly appealed to values and promoted misinformation, often from representatives from industry-funded front groups. As experts recommend additional SSB tax proposals, and as the industry mounts legislative counter-tactics to prevent them, advocates should consider harnessing community representatives as messengers and values-based messages to highlight the benefits of SSB taxes.
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Affiliation(s)
- Kim Garcia
- Berkeley Media Studies Group, Berkeley, United States
| | - Pamela Mejia
- Berkeley Media Studies Group, Berkeley, United States
| | | | - Lori Dorfman
- Berkeley Media Studies Group, Berkeley, United States
| | - Kristine Madsen
- School of Public Health, University of California, Berkeley, United States
| | - Dean Schillinger
- School of Medicine, University of California, San Francisco, United States
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133
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Hong Q, Su J, Hong P. Tobacco excise tax reform: From the perspective of "tax to control tobacco" policy in China. Health Econ 2023; 32:2260-2277. [PMID: 37365696 DOI: 10.1002/hec.4728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
The consumption of tobacco is harmful to health and has huge social costs. "Tax to control tobacco" is a widely implemented tobacco control measure all over the world. In order to examine the achievements of two tobacco excise tax reforms in China in 2009 and 2015 on controlling tobacco consumption, we first establish an intertemporal consumption model for addictive goods, and then validate the effectiveness of the two tobacco excise tax reforms using a Continuous Difference-in-Differences Model based on the panel data from 294 cities in China from 2007 to 2018. The results show that the tobacco excise tax reform in 2015 considerably reduced tobacco consumption, while the reform in 2009 did not, providing empirical evidence on the importance of "price links to tax" for tobacco control. Additionally, the study discovers that the tax reform has a heterogeneous effect on the age of smokers, the price of cigarettes, and city size.
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Affiliation(s)
| | - Jie Su
- Peking University, Beijing, China
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Erku D, Yigzaw N, Tegegn HG, Gartner CE, Scuffham PA, Garedew YT, Shambel E. Framing, moral foundations and health taxes: interpretive analysis of Ethiopia's tobacco excise tax policy passage. BMJ Glob Health 2023; 8:e012058. [PMID: 37813449 PMCID: PMC10565163 DOI: 10.1136/bmjgh-2023-012058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In 2019-2020, the Ethiopian government ratified a suite of legislative measures that includes levying a tax on tobacco products. This study aims to examine stakeholders' involvement, position, power and perception regarding the Ethiopian Food and Drug Authority (EFDA) bill (Proclamation No.1112/2019). This includes their meaning-making and interaction with each other during the bill's formulation, adoption and implementation stages. METHODS We employed a mixed-methods design drawing on three sources of data: (1) policy documents and media articles from government and/or civil society groups (n=27), (2) audio and video transcripts of parliamentary debates and (3) qualitative stakeholder interviews. RESULTS Policy actors in both the public health camp and tobacco industry employed several framing moves, engaged in distinctive patterns of moral rhetoric, and strategically invoked moral languages to galvanise support for their policy objectives. Central to this framing debate are issues of public health and the danger of tobacco, and the protection of 'the economy and personal freedom'. The public health camp's arguments and persuasiveness-which led to the passage of the EFDA bill-centred around discrediting tobacco industry's cost-benefit assessments through frame disconnection, or by polarising their own position that the financial, psychological and lost productivity costs incurred by tobacco use outweighs any tax revenue. CONCLUSIONS A successful cultivation of an epistemic community and engagement of policy entrepreneurs-both from government agencies and civil society organisations-was critical in creating a united front and a compelling affirmative policy narrative, thereby influence excise tax policy outcomes.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, Griffith University, Southport, Queensland, Australia
- Menzies Health Research Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Nigusse Yigzaw
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Centre for Applied Health Economics, Griffith University, Southport, Queensland, Australia
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Coral E Gartner
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Griffith University, Southport, Queensland, Australia
- Menzies Health Research Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Yordanos Tegene Garedew
- Health Policy and Systems Research, EPIC Research and Training Institute, Addis Ababa, Ethiopia
| | - Ehetemariam Shambel
- Pharmaceutical and Medical Equipment Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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Zuleta M, Perez-Leon S, Mialon M, Delgado-Zegarra J. Political and socioeconomic factors that shaped health taxes implementation in Peru. BMJ Glob Health 2023; 8:e012024. [PMID: 37813443 PMCID: PMC10565308 DOI: 10.1136/bmjgh-2023-012024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In 2016 and 2018, the Peruvian Ministry of Economy and Finance (MoEF) significantly reformulated taxes on tobacco products, alcohol and sugar-sweetened beverages (SSBs). During these processes, different actors advanced arguments supporting or opposing the taxes. This study examines Peru's political and socioeconomic factors, the role of other actors and framing strategies, shaping health taxes introduction. METHODS We conducted qualitative analysis by collecting information from three sources, such as: (1) media material (n=343 documents), (2) government documents (n=34) and (3) semistructured interviews (n=11). That data allowed us to identify and characterise the actors involved in implementing health taxes in Peru. We combined the data from these sources, synthesised our findings and conducted a stakeholder analysis. RESULTS Key actors supporting taxes were the MoEF and civil society organisations, while trade associations and the alcohol, SSBs and tobacco industries opposed them using economic, trade-related arguments and criticised the policy process. The supporting group used arguments related to the economy and health to legitimate its narrative. The framing strategies employed by these stakeholders shaped and determined the outcome of the policy process. CONCLUSION Peruvian stakeholders against health taxes demonstrated a strong capacity to convey their messages to the media and high-level policy-makers. Despite these efforts, attempts to interfere with health taxes were unsuccessful in 2016 and 2018 and failed to overcome state institutions, particularly the MoEF. Strong institutions and individual decision-makers in Peru also contributed to the successful implementation of health taxes in Peru in 2016 and 2018.
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Affiliation(s)
- Mario Zuleta
- Centre for Food Policy, City University, London, UK
| | - Silvana Perez-Leon
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
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136
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Laar A, Amoah JM, Massawudu LM, Pereko KKA, Yeboah-Nkrumah A, Amevinya GS, Nanema S, Odame EA, Agyekum PA, Mpereh M, Sandaare S. Making food-related health taxes palatable in sub-Saharan Africa: lessons from Ghana. BMJ Glob Health 2023; 8:e012154. [PMID: 37813441 PMCID: PMC10565179 DOI: 10.1136/bmjgh-2023-012154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
Amidst high burden of infectious diseases, undernutrition and micronutrient deficiencies, non-communicable diseases (NCDs) are predicted to become the leading cause of death in Ghana by 2030. NCDs are driven, to a large extent, by unhealthy food environments. Concerned, the Ghana Ministry of Health (MOH) has since 2012 sought to garner the support of all to address this challenge. We aimed to support the MOH to address the challenge through public health policy measures, but would soon be reminded that longstanding challenges to policy development such as data poverty, and policy inertia needed to be addressed. To do this, the we generated the needed evidence, curated the evidence, and availed the evidence to Ghanaian policymakers, researchers and civil society actors. Thus, we addressed the problem of data poverty using context-relevant research, and policy inertia through advocacy and scholar activism. In this paper, we share how a public interest coalition used context-relevant research, evidence-informed advocacy and scholar activism to valorise and increase demand for healthy food policy (including food-related health taxes) in Ghana.
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Affiliation(s)
- Amos Laar
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | | | | | | | - Annabel Yeboah-Nkrumah
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Gideon S Amevinya
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Silver Nanema
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Emmanuel Ankrah Odame
- Ghana Ministry of Health, Accra, Greater Accra, Ghana
- Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Mary Mpereh
- National Development Planning Commission, Accra, Greater Accra, Ghana
| | - Sebastian Sandaare
- Parliament of Ghana, Accra, Accra, Ghana
- Coalition of Actors for Public Health Advocacy, Accra, Ghana
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137
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Nyantakyi G, Gyimah J, Sarpong FA, Sarfo PA. Powering sustainable growth in West Africa: exploring the role of environmental tax, economic development, and financial development in shaping renewable energy consumption patterns. Environ Sci Pollut Res Int 2023; 30:109214-109232. [PMID: 37770735 DOI: 10.1007/s11356-023-30034-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
Over time, the economy's growth, financial development, and environmental taxes have become vital tools in countering ecological degradation and promoting clean energy. However, there needs to be a research gap in assessing these policies' collective impact on renewable energy adoption, especially in developing West African countries. This study addresses this gap by evaluating the effectiveness of these policies from 1990 to 2020, using the Generalized Method of Moments (GMM), fixed effect, and pooled Ordinary Least Squares (OLS) models. The Dumitrescu-Hurlin panel causality test reveals bidirectional causality between economic growth and renewable energy consumption, as well as between financial development and renewable energy use. Unidirectional causality is found from environmental tax to renewable energy consumption. GMM results highlight the positive influences of economic growth and environmental taxes on renewable energy consumption, while financial development negatively affects it. These outcomes are consistent with fixed effect and pooled OLS models. Sectorial heterogeneity analysis indicates better results for countries with strong institutions, advanced technology, and strict regulations. In conclusion, this study's insights can guide policies for sustainability in West Africa, leveraging economic growth, environmental taxes, and technology for effective renewable energy integration.
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Affiliation(s)
- George Nyantakyi
- School of Accounting, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Justice Gyimah
- College of Economics and Management, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Francis Atta Sarpong
- School of Finance, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Philip Adu Sarfo
- School of Management, Zhengzhou University, Zhengzhou, 45001, China.
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138
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Tozzi A. Laws of taxation for multicellular organisms: The economics of sleep. Biosystems 2023; 232:105018. [PMID: 37666410 DOI: 10.1016/j.biosystems.2023.105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
In macro-public finance, the Ramsey rule (RR) concerns variable taxation to maximize social welfare and economic efficiency in a purely competitive monopolistic system. To extract tax revenue with the least loss of utility to the representative individual, RR dictates that optimal, proportionate taxes should be such as to diminish in the same proportion the production of each commodity taxed. The sources of supply that are inelastic, i.e., necessities/utilities, must be taxed more. We hypothesize that the Ramsey's economical approach might provide a general mechanism to investigate far-flung biological issues, such as preys/predators dynamics, food restriction in ecological niches, local changes in blood flow in rival or complementary organs of multicellular organisms. In particular, RR suggests a quantifiable relationship between the physiological decrease in cortical spike frequency occurring during sleep and energy consumption. Since small decreases in spike frequency during sleep are correlated with large decreases in the amount of consumed ATP, the brain could be considered an inelastic commodity which can be "taxed" more than other organs, allowing the whole organism to spare energy. Shedding light on the energy budget of the central nervous system, RR improves our knowledge of cerebral perfusion during sensory-evoked responses and tissue hypoxia caused by decreased blood flow, suggesting that energy from outside can be provided to counteract brain ischemia. In sum, the economical approach provided by Ramsey stands for a useful methodological tool that could be used in biological contexts to investigate the dynamical correlations among different organs in multicellular organisms.
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Affiliation(s)
- Arturo Tozzi
- Center for Nonlinear Science, Department of Physics, University of North Texas, 1155 Union Circle, #311427, Denton, TX, 76203-5017, USA.
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139
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Yao C, Xi B. Does environmental protection tax improve green total factor productivity? Experimental evidence from China. Environ Sci Pollut Res Int 2023; 30:105353-105373. [PMID: 37710060 DOI: 10.1007/s11356-023-29739-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Abstract
Enhancing green total factor productivity (GTFP) is essential for achieving the objective of green development, and the effect of environmental protection tax (EPT), a crucial instrument for addressing environmental challenges, on green TFP is crucial. Based on provincial panel data from 2004 to 2020 in China, this study uses inter-provincial differences in environmental protection tax rates as a quasi-natural experiment and utilizes a synthetic control method to assess the impact of the "changing sewage charge to tax" on regional GTFP. The empirical results suggest that EPT can help enhance GTFP, a finding that still holds after regional placebo tests, time placebo tests, and difference-in-differences robustness tests. The mechanism test demonstrates that EPT influences GTFP via the industrial structure impact and the green technological innovation effect. According to heterogeneity research, regions with a high level of marketization and financial growth are more significantly affected by environmental protection tax policy. This paper offers crucial empirical data for assessing the efficacy of environmental protection tax policy and enhancing the environmental tax system.
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Affiliation(s)
- Chaoxia Yao
- School of Economics and Trade, Henan University of Technology, Zhengzhou, 450001, China.
| | - Bin Xi
- School of Economics and Trade, Henan University of Technology, Zhengzhou, 450001, China
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140
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Khan H, Dong Y, Nuţă FM, Khan I. Eco-innovations, green growth, and environmental taxes in EU countries: a panel quantile regression approach. Environ Sci Pollut Res 2023; 30:108005-108022. [PMID: 37749473 DOI: 10.1007/s11356-023-29957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
The purpose of this study is to examine how environmental taxation, green growth, and eco-innovations contribute to a more sustainable environment. This study examines the influence of green growth, environmental taxes, and eco-innovations on carbon dioxide emissions in 26 environmentally responsive European Union (EU) countries from 2000 to 2020. The analysis was conducted using the second-generation panel unit root test, cross-sectional dependence, panel cointegration, and panel quantile regression. Theoretical and empirical research has demonstrated that both linear and non-linear green growth strategies are effective in reducing CO2 emissions. There is evidence that CO2 emissions can be reduced through the implementation of environmental taxes, eco-innovations, the use of renewable energy sources, and enhanced energy efficiency. In contrast, economic growth has a positive effect on carbon emissions, and its square term verifies the environmental Kuznets curve. Nevertheless, our research findings provide empirical support for the hypothesis that sustainable development contributes to the maintenance of stringent environmental standards. For the sampled countries, the study's findings have significant policy implications. These results encourage governments to prioritize green growth over traditional economic growth and to encourage eco-innovations in renewable energy technology.
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Affiliation(s)
- Hayat Khan
- School of Economics and Management, Zhejiang University of Science and Technology, Hangzhou, China
| | - Ying Dong
- School of Economics and Management, Zhejiang University of Science and Technology, Hangzhou, China
| | - Florian Marcel Nuţă
- Human and Social Sciences Doctoral School, Ştefan cel Mare University of Suceava, Suceava, Romania
| | - Itbar Khan
- College of Economics, Shenzhen University, Shenzhen, China.
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141
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Ghebreyesus TA, Clark H. Health taxes for healthier lives: an opportunity for all governments. BMJ Glob Health 2023; 8:e013761. [PMID: 37857436 PMCID: PMC10603522 DOI: 10.1136/bmjgh-2023-013761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
| | - Helen Clark
- Chair of the Board, The Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
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142
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Pravosud V, Holmes LM, Lempert LK, Ling PM. Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices. Eval Rev 2023; 47:763-785. [PMID: 36943027 PMCID: PMC10542911 DOI: 10.1177/0193841x231164908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.
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Affiliation(s)
- Vira Pravosud
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Louisa M. Holmes
- The Pennsylvania State University, Departments of Geography and Demography, University Park, PA, USA
| | - Lauren K. Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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143
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Johnson Curtis C, Marklund M, Saxena A, Goyena E, P Desnacido J, Koon AD, Warren B, Cobb LK, E Henry M, Appel LJ, Angeles-Agdeppa I. Considerations for modelling a broad food tax in the Philippines and other low-income and middle-income countries. BMJ Glob Health 2023; 8:e012068. [PMID: 37813445 PMCID: PMC10565299 DOI: 10.1136/bmjgh-2023-012068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 10/13/2023] Open
Abstract
Fiscal policies to improve diet are a promising strategy to address the increasing burden of non-communicable disease, the leading cause of death globally. Sugar-sweetened beverage taxes are the most implemented type of fiscal policy to improve diet. Yet taxes on food, if appropriately structured and applied across the food supply, may support a larger population-level shift towards a healthier diet. Designing these policies and guiding them through the legislative process requires evidence. Equity-oriented cost-effectiveness analyses that estimate the distribution of potential health and economic gains can provide this critical evidence. Taxes on less healthy foods are rarely modelled in low-income and middle-income countries.We describe considerations for modelling the effect of a food tax, which can provide guidance for food tax policy design. This includes describing issues related to the availability, reliability and level of detail of national data on dietary habits, the nutrient content of foods and food prices; the structure of the nutrient profile model; type of tax; tax rate; pass-through rate and price elasticity. Using the Philippines as an example, we discuss considerations for using existing data to model the potential effect of a tax, while also taking into account the political and food policy context. In this way, we provide a modelling framework that can help guide policy-makers and advocates in designing a food policy to improve the health and well-being of future generations in the Philippines and elsewhere.
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Affiliation(s)
| | - Matti Marklund
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Akshar Saxena
- School of Social Sciences, Economics, Nanyang Technological University, Singapore
| | - Eva Goyena
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Josie P Desnacido
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Adam D Koon
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Megan E Henry
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
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144
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Lwin KS, Koon AD, Rasanathan K, Ahsan A, Erku D, Mialon M, Perez-Leon S, Singh A, Mirza Z, Zuleta M, Adhikari SR, Acharya Y, Dao ST, Rasheed S, Paul J, Marten R. Framing health taxes: learning from low- and middle-income countries. BMJ Glob Health 2023; 8:e012955. [PMID: 37832966 PMCID: PMC10583086 DOI: 10.1136/bmjgh-2023-012955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 10/15/2023] Open
Abstract
Health taxes are effective policy instruments to save lives, raise government revenues and improve equity. Health taxes, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy. Yet, little is known about which frames resonate in which settings and how framing can most effectively advance or limit policies. To fill this gap, we conducted qualitative research in 2022, including focus group discussions, in-depth interviews, document reviews and media analysis on the political economy of health taxes across eight low-income and middle-income countries. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Findings suggest that no single frame dominates; in fact, a plurality of different frames exist and shape discourse and policymaking. There was no clear trade-off between health and economic framing of health tax policy proposals, nor a straightforward way to handle concerns around earmarking. Understanding how to best position health taxes can empower health policymakers with more persuasive framings for health taxes and can support them to develop broader coalitions to advance health taxes. These insights can improve efforts to advance health taxes by better appreciating political economy factors and constraining corporate power, ultimately leading to improved population-level health.
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Affiliation(s)
- Kaung Suu Lwin
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Abdillah Ahsan
- Department of Economics, Facutly of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Daniel Erku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Centre for Applied Health Economics, Griffith University, Gold Coast, Queensland, Australia
| | | | - Silvana Perez-Leon
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arti Singh
- School of Public Health, KNUST, Kumasi, Ghana
| | - Zafar Mirza
- School of Universal Health Coverage, Shifa Tameer-i-Millat University, Islamabad, Pakistan
| | | | | | - Yubraj Acharya
- Department of Health Policy & Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Sabrina Rasheed
- Health Systems and Population Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jeremias Paul
- Fiscal Policies for Health Unit, Department of Health Promotion, WHO Secretariat, Geneva, Switzerland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
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145
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Mostafa A, Chalak A, Nakkash R, Abla R, Khader YS, Abu-Rmeileh NM, Salloum RG, Jawad M. Health and economic impacts of introducing specific excise tax to waterpipe tobacco in Egypt: a simulation model of simple and mixed tax policy approaches. BMJ Glob Health 2023; 8:e012048. [PMID: 37813447 PMCID: PMC10565201 DOI: 10.1136/bmjgh-2023-012048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Waterpipe tobacco is taxed at half the rate of cigarettes in Egypt and, unlike cigarettes, does not have a specific excise component. We aimed to simulate the introduction of a specific excise tax on waterpipe tobacco consumption, premature deaths and government waterpipe tobacco revenue in Egypt. METHODS We took model inputs from the latest available data on consumption, market shares and market share prices, price elasticities of demand, tax structure and from discussions with government officials. We modelled increases to specific excise to produce a 45%, 55%, 65% and 75% tax burden and compared a simple (specific only) structure with a mixed (specific and ad valorem) structure. RESULTS Under the simple approach, introducing a US$2.1 specific tax would result in a 75% tax burden with 67% fewer waterpipe tobacco units smoked, 1 004 604 averted premature deaths and a 236% increase in government revenue relative to the current tax structure. At the 75% tax burden, the simple approach resulted in 1.5% fewer waterpipe tobacco units consumed, 9000 more averted premature deaths and 12.7% more government revenue compared with the mixed approach. Results for other tax burdens are presented and remained robust to sensitivity analyses. CONCLUSIONS Introducing a specific excise tax on waterpipe tobacco in Egypt can yield considerable government revenue and public health gains. We recommend the simple approach, in line with the WHO recommendations, which produces greater economic and public health gains than the mixed approach and is easier to administer for the Egyptian government.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Global and Community Health Department, George Mason University, Fairfax, Virginia, USA
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Yousef S Khader
- Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Niveen Me Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
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146
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Ahsan A, Amalia N, Rahmayanti KP, Adani N, Wiyono NH, Endawansa A, Utami MG, Yuniar AM. Health taxes in Indonesia: a review of policy debates on the tobacco, alcoholic beverages and sugar-sweetened beverage taxes in the media. BMJ Glob Health 2023; 8:e012042. [PMID: 37813444 PMCID: PMC10565181 DOI: 10.1136/bmjgh-2023-012042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION One of the WHO's 'best buys' in controlling non-communicable diseases and their risk factors is to impose health taxes. While the Indonesian political process inhibits the implementation of health tax policy, studies to discuss the issue remain limited. METHODS We employed media analysis to document health tax policy dynamics, for example, the changes in policy timeline and key actors' statements. We conducted an article search in the Open-Source Intelligence database using appropriate terminology on three commodities, for example, tobacco, alcoholic beverages and sugar-sweetened beverages (SSB). RESULTS Throughout the 15 years of implementation (2007-2022), tobacco has received the most policy attention compared with the other two commodities. This is mainly related to the increasing tariff and reforming the tax structure. As Indonesia is a Muslim-majority country, alcohol consumption is low, and a tax on alcoholic beverages was nearly unchanging and lacked media coverage. Ministry of Finance (MoF) officials are key opinion leaders often cited in the media for health taxes. MoF's support for health taxes is important to pass and implement health taxes. While SSB taxation is emerging, key opinion leaders' media statements imply policy contestation, leading to delayed implementation. The policy debates on tobacco taxation implied election years as a major challenge for health tax passages. During the political years, anti-health tax arguments emerged from politicians. While the political contestation on SSB concluded that accentuating the health tax arguments in favour of public health generates the strongest opposition against taxation from the industry. CONCLUSIONS Politics of tobacco tax implementation are complex-compared with the other two commodities. The political context drives the divided views among policy-makers. Policy recommendations include generating public allies with key religious opinion leaders, continuing capacity building for politicians and Ministry of Health, and generating evidence-based arguments in favour of public health for MoF.
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Affiliation(s)
- Abdillah Ahsan
- Department of Economics, Faculty of Economics and Business, University of Indonesia, Depok, West Java, Indonesia
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Nadira Amalia
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Krisna Puji Rahmayanti
- Department of Public Administration, Faculty of Administrative Science, University of Indonesia, Depok, Indonesia
| | - Nadhila Adani
- Center for Research in Islamic Economics and Business, Universitas Indonesia Faculty of Economics and Business, Depok, West Java, Indonesia
| | - Nur Hadi Wiyono
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Althof Endawansa
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Maulida Gadis Utami
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Adela Miranti Yuniar
- Center for Research in Islamic Economics and Business, Universitas Indonesia Faculty of Economics and Business, Depok, West Java, Indonesia
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147
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Abstract
Health taxes are increasingly positioned as effective policy instruments for curbing non-communicable disease, improving health and raising government revenues. Their allure has caused many health advocates to look beyond tobacco and alcohol to other harmful products such as sugar-sweetened beverages (SSBs), salty foods, fatty foods and fossil fuels. These efforts, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy in favourable ways. Yet, little is known about which types of frames resonate in which settings, or how they deploy morals and values in their attempts to persuade. To fill this gap, we conducted a scoping review on framing health taxes using six databases in 2022. A total of 40 peer-reviewed empirical research articles, from 2006 to 2022, were identified from 20 different countries. Most research was conducted in high-income countries, published in the last 4 years and increasingly focused on excise taxes for SSBs. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Actors also engaged in a range of political activities in addition to framing. We found some evidence that anti-tax framing strategies potentially incorporated a broader array of morals and social values. More in-country comparative research, particularly from low/middle-income countries, is needed to understand the politics of framing health taxes. We argue that these insights can improve efforts to advance health taxes by constraining corporate power, improving population level health and promoting greater social harmony.
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Affiliation(s)
- Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert Marten
- Secretariat, WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
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148
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Carriedo A, Cairney P, Barquera S, Hawkins B. Policy networks and competing interests in the development of the Mexican sugar-sweetened beverages tax. BMJ Glob Health 2023; 8:e012125. [PMID: 37813438 PMCID: PMC10565318 DOI: 10.1136/bmjgh-2023-012125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Sugar taxes threaten the business models and profits of the food and beverage industry (F&BI), which has sought to avert, delay or influence the content of health taxes globally. Mexico introduced a sugar-sweetened beverage (SSB) tax in 2014 and other regulatory measures to improve population diets. This paper examines how policy networks emerged within and affected the development and implementation of the Mexican SSB tax. METHODS This qualitative study analyses 31 interviews conducted with key stakeholders involved in the soda tax policy process and 145 documents, including grey literature and peer-reviewed literature. The policy network approach was used to map contacts, interconnections, relationships and links between the state, civil society and commercial actors involved in the SSB tax. These findings were used to examine the responsiveness, participation and accountability of the soda tax policy formulation. RESULTS Complex interconnections were identified between state and non-state actors. These included advisory relationships, financial collaborations and personal connections between those in high-level positions. Relationships between the government and the F&BI were not always disclosed. International organisations and academics were identified as key financial or technical supporters of the tax. Key governance principles of participation, responsiveness and accountability were undermined by some of these relationships, including the participation of non-state actors in policy development and the powerful role of the F&BI in evaluation and monitoring. CONCLUSION This case study exemplifies the importance of links and networks between actors in health policymaking. The F&BI influence endangers the primary aim of the SSB tax to protect health. The identified links highlight the normalisation of connections among actors with competing aims and interests toward health, thereby jeopardising attempts to tackle obesity rates.
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Affiliation(s)
| | - Paul Cairney
- Division of History, Heritage, and Politics, University of Stirling, Stirling, UK
| | - Simón Barquera
- Centre of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Benjamin Hawkins
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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149
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Alvarado M, Marten R, Garcia L, Kwamie A, White M, Adams J. Using systems thinking to generate novel research questions for the evaluation of sugar-sweetened beverage taxation policies. BMJ Glob Health 2023; 8:e012060. [PMID: 37813450 PMCID: PMC10565209 DOI: 10.1136/bmjgh-2023-012060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Miriam Alvarado
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
| | - Robert Marten
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Aku Kwamie
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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150
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Mirza Z, Munir D. Conflicting interests, institutional fragmentation and opportunity structures: an analysis of political institutions and the health taxes regime in Pakistan. BMJ Glob Health 2023; 8:e012045. [PMID: 37844957 PMCID: PMC10583104 DOI: 10.1136/bmjgh-2023-012045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/14/2023] [Indexed: 10/18/2023] Open
Abstract
Pakistan is the world's fifth most populous country, with large segments of its population at risk from non-communicable diseases caused by consumption of harmful products, including tobacco and sugar-sweetened beverages. Even though evidence exists that increased taxes on harmful products leads to consumption reductions as well as increased revenues, Pakistan's health taxes remain low. We seek to understand the reasons for the deficient health tax regime. Much of the existing literature emphasises industry tactics, resources and motivations. We take a different approach and instead focus on political institutions in Pakistan which could help explain deficiencies in the health taxes regime. We employed a mixed method design. We conducted: (1) a detailed analysis of media content, (2) semistructured interviews with key stakeholders (and attended relevant meetings) and (3) an analysis of primary and secondary literature, including legal and policy documents. We identify two key aspects of Pakistan's political institutions which may help explain deficiencies in health taxes. First, we identified structural issues in the design and functioning of key institutions responsible for health taxes, including with respect to federalism, intraelite conflict, interagency coordination and intra-agency fragmentation. Second, we found evidence of an entrenchment of industry interests within governmental institutions, which are characterised by weak frameworks for regulating conflicts of interest. We conclude that gaps and conflict within political institutions, owing to weak design, instability and fragmentation, create political opportunity for industry actors to influence the system to advance their interests. The findings of this research indicate towards needed interventions.
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Affiliation(s)
- Zafar Mirza
- Professor of Health System and Population Health, School of Universal Health Coverage (Global Institute of Human Development), Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Onto Global Ltd (A Global Development Consultancy Firm), Vancouver, British Columbia, Canada
| | - Daud Munir
- Partner, Axis Law Chambers, Islamabad, Pakistan
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