Non-communicable diseases (NCDs) represent a significant and escalating global health crisis, accounting for over 41 million deaths annually and contributing to 71% of global mortality. A substantial 80% of this NCD burden is linked to preventable conditions such as cancer, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease, which are largely driven by risk factors like smoking, alcohol consumption, insufficient physical activity, and poor diet. This alarming trend poses a severe threat not only to population health but also to the stability of health systems and the economic viability of nations, being recognized by the World Economic Forum as a major global threat to economic development.
In response to this growing burden, the taxation of health-harming commodities, including tobacco, alcohol, food, and other beverages, has garnered renewed attention as a crucial policy intervention. While much of the foundational evidence for the effectiveness of these fiscal measures originates from high-income countries (HICs), there are increasing calls for their adoption in the more price-sensitive markets of LMICs, given their projected economic and public health benefits. However, the actual implementation of these measures in LMICs has been sporadic, and there remains a notable lack of research specifically exploring the “why” and “how” these countries utilize fiscal measures to combat NCDs.
To address this critical gap, a comprehensive scoping review was conducted to analyze the factors influencing the design and implementation of health-related fiscal measures in LMICs. Employing Arksey and O’Malley’s methodology and Walt and Gilson’s policy triangle, the review systematically examined contextual, procedural, content, and stakeholder-related factors that shape these interventions. The study identified 75 relevant papers, with the majority (63%) focusing on tobacco, and considerably fewer on alcohol (5 papers), soft drinks (6 papers), and food (4 papers), indicating a relative infancy and concentration in the field of policy analysis for health taxes in LMICs.
The review’s findings highlight several key factors that either enable or impede the successful design and implementation of these measures. Enabling factors included the availability of localized health and economic evidence, strong policy championing by governmental elites, robust inter-ministerial support, and a favorable global or regional political momentum. Conversely, impeding factors frequently involved negative framing and retaliatory actions by industry, the presence of vested interests, and disjuncture within governmental policy efforts. A particularly insightful conclusion from the review is that the interplay and dynamic interaction between these various factors—rather than the isolated presence or absence of any single factor—exerts the most profound impact on policy implementation outcomes. This underscores the complex political economy considerations that are central to advancing effective NCD prevention strategies in LMICs. The review strongly advocates for more rigorous, LMIC-specific empirical research to understand these political economy factors, emphasizing that the mechanisms successful in tobacco taxation may not be universally applicable to other harmful commodities like foods and beverages.
APA Reference for the article: Elliott, L. M., Dalglish, S. L., & Topp, S. M. (2022). Health taxes on tobacco, alcohol, food and drinks in low- and middle-income countries: A scoping review of policy content, actors, process and context. International Journal of Health Policy and Management, 11(4), 414–428. https://doi.org/10.34172/ijhpm.2020.170
