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Cárdenas-Torres PA, Orozco-Nuñez E, Dreser-Mansilla AC, Torres-de la Rosa CP, Pérez-Tamayo EM. Challenges to the development of taxation policies for sugar-sweetened beverages in Colombia. BMJ Glob Health 2024; 8:e012074. [PMID: 38195156 PMCID: PMC10846850 DOI: 10.1136/bmjgh-2023-012074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/12/2023] [Indexed: 01/11/2024] Open
Abstract
Frequent consumption of sugar sweetened beverages (SSB) is related to the risks of developing overweight, obesity, cavities, diabetes and other diseases. Policies to significantly increase taxes on SSB have proven to be effective in reducing their consumption. The political debate on implementing these taxes in Colombia shows a series of barriers to placing this policy on the political agenda, and therefore, to its approval. This work analyses the political process involved in the struggle for the approval of an SBB tax in Colombia, as well as barriers and opportunities to putting it on the political agenda. This is done through a policy analysis with three research methods: a documentary analysis, political mapping of actors and semistructured interviews with key actors. Among the main findings, we have that actors who are in favour of the SSB tax stated that it is needed due to the health problems caused by SSB consumption, while those who opposed it argue that Colombia regulations are sufficient and already inform and educate consumers on excessive sugar consumption and its health implications. The Colombian political context is a barrier to SSB taxation, as the government favours and has a close connection with the food and SSB industry. In short, the policy issue has been reaching the agenda intermittently throughout the years. Nevertheless, new opportunities are arising after the COVID-19 pandemic and the 2022 administrative changes and further efforts from policy entrepreneurs are required to make this initiative progress in the political agenda.
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Affiliation(s)
| | - Emanuel Orozco-Nuñez
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Abdool Karim S, Kruger P, Mazonde N, Erzse A, Goldstein S, Hofman K. Stakeholder arguments during the adoption of a sugar sweetened beverage tax in South Africa and their influence: a content analysis. Glob Health Action 2023; 16:2152638. [PMID: 36508172 PMCID: PMC9754008 DOI: 10.1080/16549716.2022.2152638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) taxes are recognised as an effective intervention to prevent obesity. More countries are adopting SSB taxes, but the process of the adoption is politically complex. OBJECTIVE This study aimed to analyse how public participation processes influenced the South African tax. METHODS We conducted a content analysis of documents associated with the process of adopting the tax. Records were identified utilising the Parliamentary Monitoring Group database, including draft bills, meeting minutes and written submissions. The records were categorised and then inductively coded to identify themes and arguments. RESULTS We identified six cross-cutting themes advanced by stakeholders: economic considerations, impact on the vulnerable, responsiveness of an SSB tax to the problem of obesity, appropriateness of an SSB tax in South Africa, procedural concerns, and structure of the tax. Stakeholder views and arguments about the tax diverged based on their vested interests. The primary policymaker was most responsive to arguments concerning the economic impact of a tax, procedural concerns and the structure of the tax, reducing the effective rate to address industry concerns. CONCLUSION Both supportive and opposing stakeholders influenced the tax. Economic arguments had a significant impact. Arguments in South Africa broadly echoed arguments advanced in many other jurisdictions.
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Affiliation(s)
- Safura Abdool Karim
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa,College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa,CONTACT Safura Abdool Karim Wits School of Public Health, University of Witwatersrand, York Road, Parktown North, Johannesburg2057, South Africa
| | - Petronell Kruger
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Natasha Mazonde
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Badu E, Hallett J, Vujcich D, Crawford G, Bellringer ME. Setting the scene: a scoping review of gambling research in Ghana. Health Promot Int 2023; 38:daad171. [PMID: 38091619 DOI: 10.1093/heapro/daad171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Ghana, like many other African countries, has seen a rapid expansion in gambling industry activity in the last decade with sports betting becoming a popular pastime among young Ghanaian males. The proliferation of land based, and online gambling operations presents a significant public health threat to the citizenry. Yet little is known about gambling participation and harms, the size of the gambling market and the role of the gambling industry in influencing and perpetuating gambling behaviour in Ghana. The aim of this study was to contribute to understanding the extent of gambling research in Ghana by mapping out what the current literature indicates. Six databases were searched for peer-reviewed journal articles that focused on gambling in Ghana. The findings from this review demonstrate gambling research in Ghana is in a nascent state with a predominant focus on individual factors and limited consideration of public health. The implications for future research are highlighted, including the requirement for a nationally representative study to understand the prevalence of gambling participation and harm, and the role of the gambling industry. Public health action grounded in sound evidence is urgently required to address the individual and community level problems associated with this harmful commodity.
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Affiliation(s)
- Emmanuel Badu
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Daniel Vujcich
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
- School of Population Health, Curtin University, Building 400, Kent Street, Bentley, Western Australia 6102, Australia
| | - Maria E Bellringer
- Gambling and Addictions Research Centre, School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
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Nabyonga-Orem J, Christmals CD, Addai KF, Mwinga K, Karenzi-Muhongerwa D, Namuli S, Asamani JA. The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review. J Glob Health 2023; 13:04153. [PMID: 37962340 PMCID: PMC10644850 DOI: 10.7189/jogh.13.04153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation. Methods We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region. Results Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge. Conclusions Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.
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Affiliation(s)
- Juliet Nabyonga-Orem
- World Health Organization Regional office for Africa, Office of the Regional Director, Brazzaville, Congo
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Christmal D Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Kingsley F Addai
- World Health Organization Ghana country office, Universal Health Coverage Life Course Cluster, Accra, Ghana
| | - Kasonde Mwinga
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Diane Karenzi-Muhongerwa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Sylvia Namuli
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - James A Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
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Mukanu MM, Thow AM, Delobelle P, Mchiza ZJR. Mapping of food environment policies in Zambia: a qualitative document analysis. BMC Nutr 2023; 9:112. [PMID: 37784146 PMCID: PMC10544488 DOI: 10.1186/s40795-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The food environment in which people exercise food choices significantly impacts their dietary patterns. Policies that limit the availability, affordability, and access to unhealthy food while increasing that of healthier alternatives help build healthy food environments, which are required to address the double burden of malnutrition. This study aimed to assess the availability of food environment policies in Zambia. METHOD We applied a two-step qualitative document analysis to identify policy content relating to healthy food environments from global and Zambia-specific nutrition-related policy documents. In the first step, global policy documents were analyzed to develop a reference point for globally recommended policies for healthy food environments. In the second step, Zambia's nutrition-related policies were analyzed to identify content relating to healthy food environments. The identified policy content was then mapped against the global reference point to identify food environment policy gaps. RESULTS Our analysis of global policy recommendations identified five broad categories of policy provisions: information and education based; regulatory and legislative tools; strategies to promote production and access to healthy food production; social protection-based strategies and guiding principles for governments relating to multisectoral collaboration and governance. Our analysis found that Zambian Government policy documents in the health, agriculture, education, and national planning and development sectors have policy provisions for healthy food environments. While these policy provisions generally covered all five reference categories, we found policy gaps in the regulatory and legislative tools category relative to global recommendations. CONCLUSION Zambia's food environment policy landscape must include globally recommended regulatory and legislative policy measures like restricting the marketing of unhealthy foods and non-alcoholic beverages to children. Nutrition policy reforms are required to facilitate the introduction of regulatory and legislative policy measures that effectively address the double burden of malnutrition in Zambia.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505, South Africa
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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] [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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Elliott LM, Waqa GD, Dalglish SL, Topp SM. A sweet deal for domestic industry: the political economy and framing of Vanuatu's sugar-sweetened beverage tax. BMJ Glob Health 2023; 8:e012025. [PMID: 37813448 PMCID: PMC10565185 DOI: 10.1136/bmjgh-2023-012025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/02/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION The Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO's Best Buys recommendations for addressing non-communicable diseases (NCDs), little is known about the tax's adoption process or whose interests it serves. METHODS Using case study methodology, this study examined how and why Vanuatu's SSB tax was introduced. Policy documents, key informant interviews (n=33) and direct observations were analysed using theories of policy analysis, power analysis and postcolonial theory to map the policy's adoption, surrounding political economy and the ideas, interests and institutions that shaped the tax and its framing. RESULTS The SSB tax emerged during a politically and economically unstable time in Vanuatu's history. The tax's links to the national health agenda were tenuous despite its ostensible framing as a way to combat NCDs. Rather, the tax was designed to respond to tightening economic and trade conditions. Spearheaded by several finance-focused bureaucrats, and with limited input from health personnel, the tax targeted less frequently consumed carbonated SSBs (which are mostly imported) without any revenue reinvestments into health. Driven by the desire to generate much-needed government revenue and instal domestic protections via selective implementation and carve-outs for local producers, the Vanuatu SSB tax did meet national objectives, just not the dual health and economic 'win-win' projected by the NCD Best Buys. CONCLUSION Vanuatu's SSB tax adoption process reveals the limitations of decontextualised policy recommendations, such as the NCD Best Buys, whose framing may be overcome by local political realities. This research highlights the need for further political economy considerations in global health recommendations, since contextual forces and power dynamics are key to shaping both how and why policies are enacted and also whose interest they serve.
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Affiliation(s)
- Lana M Elliott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gade D Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji Institute of Pacific Health Research, Fiji National University, Suva, Fiji
| | - Sarah L Dalglish
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Institute for Global Health, University College London, London, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Adeoye I. Sugar-sweetened beverage consumption among pregnant women attending general and teaching hospitals in Ibadan, Nigeria : SSB consumption during pregnancy. BMC Public Health 2023; 23:980. [PMID: 37237281 DOI: 10.1186/s12889-023-15828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) have become a global health concern because of their adverse health effects and their association with the obesity pandemic. It has not received much attention in sub-Saharan Africa, including Nigeria, especially among pregnant women. The pattern, frequency and factors associated with SSBs among pregnant women in Ibadan, Nigeria, were investigated. DESIGN Data were from the Ibadan Pregnancy Cohort Study - a prospective cohort study investigating 1745 pregnant women from four comprehensive obstetric facilities in Ibadan. A qualitative food frequency questionnaire (FFQ) was used to assess the pregnant women's intake of food and drinks over the previous months. Sugar-sweetened beverage variable and scores were also generated using the principal component analysis with varimax rotation. Factors associated with high SSB scores were examined using multivariate logistics regression analyses at a 5% significance level. RESULTS The most commonly consumed SSBs were cocoa-sweetened beverages, soft drinks, malt drinks, and fruit juice. A quarter of the women (75th percentile) consumed SSB more than once weekly. The factors associated with high SSB on multivariate analysis were; being employed (AOR: 1.52, 95% CI 1.02-2.26), maternal obesity (AOR: 0.065, 95% CI 0.47-0.89), high fruit intake (AOR:3.62, 95% CI 2.62-4.99), high green vegetable consumption (AOR:1.99, 95% CI 1.06-3.74), high milk intake (AOR: 2.13, 95% CI 1.65- 2.74), frequent fast food outlet visit (AOR: 2.19, 95% CI 1.53-1.70), all of these remained significant after adjusting for confounding variables. CONCLUSION SSBs were common among our study population. Factors associated with high SSBs intake are crucial for implementing locally relevant public health interventions.
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Affiliation(s)
- Ikeola Adeoye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya.
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Siu E, Thow AM. Linking health and finance ministries to improve taxes on unhealthy products. Bull World Health Organ 2022; 100:570-577. [PMID: 36062244 PMCID: PMC9421554 DOI: 10.2471/blt.22.288104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
The World Health Organization recommends economic measures such as taxes on tobacco, alcohol and unhealthy foods and beverages as part of a comprehensive strategy for prevention of noncommunicable diseases. However, progress in adopting these so-called health taxes has been hampered, in part, by different approaches and perceptions of key issues in different sectors of government. Health promotion is the responsibility of health policy-makers, while taxation is the mandate of finance ministries. Thus, strengthening cooperation between health and finance policy-makers is central to the successful adoption and implementation of effective health taxes. In this paper we identify the shared concerns of finance and health policy-makers about health taxes with the aim of enabling more effective cross-sector cooperation towards both additional financing for health systems and changes in unhealthy behaviours. For example, new approaches to supporting health taxation include the growing priority for health-system financing due to the growing burden of noncommunicable diseases, and the need to address the health and economic damage due to the coronavirus disease 2019 pandemic. As a result, high-level efforts to achieve progress on health taxes are gaining momentum and represent important progress towards using the combined expertise of health and finance policy-makers.
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Affiliation(s)
- Erika Siu
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, Illinois, 60608, United States of America
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
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Erzse A, Karim SA, Foley L, Hofman KJ. A realist review of voluntary actions by the food and beverage industry and implications for public health and policy in low- and middle-income countries. NATURE FOOD 2022; 3:650-663. [PMID: 37118592 DOI: 10.1038/s43016-022-00552-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/14/2022] [Indexed: 04/30/2023]
Abstract
The increasing availability of unhealthy processed food products is linked to rising rates of non-communicable diseases and obesity in low- and middle-income countries. Voluntary actions (VAs) are often adopted in lieu of regulating the composition, production, marketing and sale of unhealthy commodities, but their effectiveness is unclear. This realist review examines VAs adopted by the food and beverage industry in low- and middle-income countries. We developed a conceptual framework and followed a three-stage search to identify literature and VAs and, adhering to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines, we produced a synthesized analysis of VAs. VAs, often initiated in response to governments' efforts to introduce regulations, were difficult to evaluate due to vague language and a lack of enforcement mechanisms. The review found no evidence indicating that VAs are effective in safeguarding public health. Yet their implementation has resulted in weaker responses and policy substitution, and so we suggest that VAs have the potential to negatively influence public health and policy. The United Nations should rescind their endorsement of industry involvement and mandatory measures should be favoured over VAs.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa.
| | - Safura Abdool Karim
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Karen Joanne Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
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New developments with the Health Promotion Levy in South Africa. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Domestic funding opportunities for Tanzania as five new Middle-Income countries brace for reduced Gavi support for immunization. Vaccine 2022; 40:3278-3285. [PMID: 35527062 DOI: 10.1016/j.vaccine.2022.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 01/13/2023]
Abstract
Vaccines have produced remarkable impact in reducing the global burden of disease. Thanks to Gavi-the Vaccine Alliance, which supports eligible countries to increase access to the new and underused vaccines. Gavi support depends on economic growth, whereby low-income countries contribute 0.2 USD per dose of supported vaccines, while middle-income countries contribute by price fraction that increases gradually by 15% annually. A country must become fully self-financing within five years when its economy reaches 1,630 USD GNI per capita. Recently, Tanzania, Benin, Haiti, Nepal, and Tajikistan became middle-income countries triggering gradual reduction in Gavi support. This paper first compares the socio-demographic characteristics, immunization program performance, and health financing strategies of these countries and second, explores domestic financing strategies that Tanzania can use to close the funding gap. Although the five countries are similar economically, they vary in demography, health financing strategies, extent of donor dependency, and strength of immunization programs. Some health indicators are not any better than those in low-income countries. Tanzania receives the largest financial support from Gavi and is projected to be fully self-financing by 2043. The potential domestic funding opportunities include to increase Government budget, use of innovative financing strategies, and health insurance, complemented with enhanced program efficiency.
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Mounsey S, Vaka AK, Cama T, Waqa G, McKenzie B, Thow AM. Strengthening Sugar-Sweetened Beverage Taxation for Non-Communicable Disease Prevention: A Comparative Political Economy Analysis Case Study of Fiji and Tonga. Nutrients 2022; 14:nu14061212. [PMID: 35334867 PMCID: PMC8949109 DOI: 10.3390/nu14061212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023] Open
Abstract
Diet-related fiscal policy is an effective NCD prevention strategy. However, current sugar-sweetened beverage (SSB) taxes in Fiji and Tonga have not had the desired effect; SSB consumption in Fiji, for example, contributes to mortality more than double the global rates and is highest in the WHO Western Pacific Region. We therefore aimed to better understand the perceived underlying political economy drivers that have and continue to affect change in each country. Our study design utilised a comparative case study that triangulated documentary policy and stakeholder analysis with semi-structured stakeholder interviews in both countries and an in-depth corporate political activity analysis in Fiji. We drew on theoretical frameworks relevant to political economy to collect and analyse policy and stakeholder data, and utilised established corporate political activity frameworks to analyse industry activity. Common findings to both Fiji and Tonga suggested that the SSB tax impact could be increased through multisectoral engagement, embracing a whole-of-society approach, strengthened institutional structures and leveraging off competing priorities across sectors towards more common goals. These findings provide opportunities and lessons for Fiji and Tonga as well as other similar settings seeking to strengthen or upscale the impact of diet-related fiscal policy.
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Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia;
- Correspondence: ; Tel.: +44-741-598-1365
| | - Aspasia Katrina Vaka
- Queen Salote Institute of Nursing and Allied Health, Ministry of Health, Vaiola Hospital, Nuku’alofa, Tonga; (A.K.V.); (T.C.)
| | - Tilema Cama
- Queen Salote Institute of Nursing and Allied Health, Ministry of Health, Vaiola Hospital, Nuku’alofa, Tonga; (A.K.V.); (T.C.)
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji National University, Tamavua Campus, Suva, Fiji;
| | - Briar McKenzie
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia;
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia;
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Allen LN, Wild CEK, Loffreda G, Kak M, Aghilla M, Emahbes T, Bonyani A, Hatefi A, Herbst C, El Saeh HM. Non-communicable disease policy implementation in Libya: A mixed methods assessment. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000615. [PMID: 36962549 PMCID: PMC10021530 DOI: 10.1371/journal.pgph.0000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022]
Abstract
The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya's NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya's complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.
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Affiliation(s)
- Luke N Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cervantée E K Wild
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Mohini Kak
- World Bank Middle East and North Africa, Tunisia
| | | | | | | | - Arian Hatefi
- World Bank Middle East and North Africa, Washington, DC, United States of America
| | | | - Haider M El Saeh
- Libya National Centre for Disease Control, Tajoura, Libya
- University of Tripoli, Tripoli, Libya
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15
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Analysis of the policy process for the implementation of nutritional warning labels in Uruguay. Public Health Nutr 2021; 24:5927-5940. [PMID: 34313211 DOI: 10.1017/s1368980021002469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyse the process for the development and implementation of mandatory nutritional warning labels in Uruguay, in order to inform future nutrition policy making and strategic engagement by public health actors. DESIGN The study design drew on policy analysis methodology and case study research methodology. Two main sources of information were selected and analysed for the current study: eighteen official documents from the Uruguayan government and 259 news reports, published between June 2017 and February 2021. SETTING Uruguay, Latin America. RESULTS The Uruguayan Ministry of Public Health led a cross-sectoral working group composed of diverse governmental stakeholders, international organisations and the academia to develop the front-of-package nutrition labelling policy. A robust evidence-based approach, based on rigorous scientific knowledge generated in the country, was followed. However, changes in the systemic governing coalition as a consequence of a change in government led to a delay in the entry into force and changes in the regulation. The food industry was the main opponent to the warning label regulation and relied on widely reported corporate political activities to influence the policy process: information and messaging, legal action, policy substitution, opposition, fragmentation and destabilisation. CONCLUSIONS Key insights to inform future policy action in Uruguay and other jurisdictions were derived. Results stressed the importance of an evidence-based approach for policy design and the early engagement with actors from all the political system.
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Thow AM, Erzse A, Asiki G, Ruhara CM, Ahaibwe G, Ngoma T, Amukugo HJ, Wanjohi MN, Mukanu MM, Gaogane L, Abdool Karim S, Hofman K. Study design: policy landscape analysis for sugar-sweetened beverage taxation in seven sub-Saharan African countries. Glob Health Action 2021; 14:1856469. [PMID: 33475471 PMCID: PMC7833028 DOI: 10.1080/16549716.2020.1856469] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This paper reports on the design of a study to examine the policy landscape relevant to sugar-sweetened beverage taxation in seven sub-Saharan African countries. The study responds to the need for strong policy to address the rising burden of non-communicable diseases in the region. Sugar-sweetened beverage taxation has been widely recommended as a key component of a comprehensive policy approach to NCD prevention. However, it has proved a contentious policy intervention, with industry strongly opposing the introduction of such taxes. The aim was to identify opportunities to strengthen sugar-sweetened beverage taxation-related policy for the prevention of nutrition-related NCDs in a subset of Eastern and Southern African countries: Kenya, Tanzania, Botswana, Rwanda, Namibia, Zambia, Uganda. The study was conducted as a collaboration by researchers from nine institutions; including the seven study countries, South Africa, and Australia. The research protocol was collaboratively developed, drawing on theories of the policy process to examine the existing availability of evidence, policy context, and stakeholder interests and influence. This paper describes the development of a method for a policy landscape analysis to strengthen policies relevant to NCD prevention, and specifically sugar-sweetened beverage taxation. This takes the form of a prospective policy analysis, based on systematic documentary analysis supplemented by consultations with policy actors, that is feasible in low-resource settings. Data were collected from policy documents, government and industry reports, survey documentation, webpages, and academic literature. Consultations were conducted to verify the completeness of the policy-relevant data collection. We analysed the frames and beliefs regarding the policy ‘problems’, the existing policy context and understandings of sugar-sweetened beverage taxation as a potential policy intervention, and the political context across relevant sectors, including industry interests and influence in the policy process. This study design will provide insights to inform public health action to support sugar-sweetened beverage taxation in the region.
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Affiliation(s)
- Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney , Sydney, Australia
| | - Agnes Erzse
- SAMRC Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), University of the Witwatersrand, School of Public Health , Johannesburg, South Africa
| | - Gershim Asiki
- School of Economics, University of Rwanda , Butare, Rwanda
| | | | - Gemma Ahaibwe
- Economic Policy Research Centre (EPRC), Makerere University , Kampala, Uganda
| | - Twalib Ngoma
- Oncology Department, Muhimbili University of Health and Allied Sciences , Dar Es Salaam, Tanzania
| | - Hans Justus Amukugo
- Community Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia , Windhoek, Namibia
| | - Milka N Wanjohi
- Health and Systems for Health Unit, African Population and Health Research Center , Nairobi, Kenya
| | - Mulenga M Mukanu
- Health Policy and Management Unit, University of Zambia School of Public Health , Lusaka, Zambia
| | - Lebogang Gaogane
- Department of Health Promotion & Education, Boitekanelo College , Gaborone, Botswana
| | - Safura Abdool Karim
- SAMRC Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), University of the Witwatersrand, School of Public Health , Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), University of the Witwatersrand, School of Public Health , Johannesburg, South Africa
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17
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Ndlovu N, Swinburn B. Readiness for sugar sweetened beverage taxation in sub-Saharan Africa. Glob Health Action 2021; 14:1917801. [PMID: 33877015 PMCID: PMC8079043 DOI: 10.1080/16549716.2021.1917801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ntombizodwa Ndlovu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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