Taxing soft drinks in the Pacific: implementation lessons for improving health

Abstract

A tax on soft drinks is often proposed as a health promotion strategy for reducing their consumption and improving health outcomes. However, little is known about the processes and politics of implementing such taxes. We analysed four different soft drink taxes in Pacific countries and documented the lessons learnt regarding the process of policy agenda-setting and implementation. While local social and political context is critically important in determining policy uptake, these case studies suggest strategies for health promotion practitioners that can help to improve policy uptake and implementation. The case studies reveal interaction between the Ministries of Health, Finance and Revenue at every stage of the policy making process. In regard to agenda-setting, relevance to government fiscal priorities was important in gaining support for soft drink taxes. The active involvement of health policy makers was also important in initiating the policies, and the use of existing taxation mechanisms enabled successful policy implementation. While the earmarking of taxes for health has been widely recommended, the revenue may be redirected as government priorities change. Health promotion practitioners must strategically plan for agenda-setting, development and implementation of intersectoral health-promoting policies by engaging with stakeholders in finance at an early stage to identify priorities and synergies, developing cross-sectoral advocacy coalitions, and basing proposals on existing legislative mechanisms where possible.

Advanced policy options to regulate sugar-sweetened beverages to support public health

“…Governments and advocates can share lessons, 46 review past hearing testimony to anticipate industry arguments, 78 and learn from each others' experiences. 49 SSBs are 'non-necessities' associated with a decline in health.…”

“…46 In Samoa and Nauru, the availability of less expensive bottled water may have contributed to reductions in sweetened drink consumption. 46 Several US states and cities, including Hawaii, 47 Kansas 48 and Philadelphia, 49 attempted to pass SSB taxes, unsuccessfully. In the United States, the federal government, states, and some cities have the power to tax SSBs.…”

“…In the Pacific Islands, large revenues were reported but there were insufficient data to calculate the impact of SSB taxes on population consumption. 46 For tobacco, manufacturers use trade discounts, coupons, and other promotions to counteract the effects of excise taxes. 51 To establish a minimum price at which SSBs can be sold to consumers, countries and states can institute minimum price laws and expressly prohibit trade discounts.…”

“…52 Earmarking for a popular cause can help legislators pass an unpopular tax. 46 For SSB taxes, earmarking to support public health programs, such as obesity prevention, can mitigate concerns about the regressivity of taxing low-income consumers. Program proponents favor earmarking because it can ensure continuous funding, although depending on the revenue source, funding may fluctuate and decline over time.…”

Population-level changes to promote cardiovascular health

“…43 Subsidies for fruit and vegetables increase affordability. 44 The EU school fruit scheme has been widely adopted, with some benefit.…”