Tamir Orly, Cohen-Yogev Tamar, Furman-Assaf Sharon, Endevelt Ronit
The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
School of Public Health, Haifa University, Haifa, Israel.
Isr J Health Policy Res. 2018 Jul 31;7(1):43. doi: 10.1186/s13584-018-0240-1.
Fiscal policies to fight obesity such as taxation of unhealthy foods or sugar-sweetened beverages (SSBs) have gained considerable attention in recent years. Many studies modelling the impact of various magnitudes of taxes on SSB purchasing and their potential effects on various health outcomes have been published; however, legislation and implementation of such taxes have encountered many obstacles in the countries that have implemented them to date. We investigated the perceptions and views of key opinion leaders, policy makers and various other Israeli stakeholders on taxation of SSBs and unhealthy snacks. We also evaluated the challenges and barriers that may be expected for initiating such a policy.
A qualitative study based on 39 in-depth interviews with Israeli stakeholders in the fields of health, nutrition, economics, public advocacy and policymaking.
All stakeholders viewed obesity as a combined societal and personal issue that should be under government responsibility. Only stakeholders from economic sectors thought that taxation of SSBs and unhealthy snacks would reduce their consumption, while the prevailing notion among non-economists was that such a tax would not be acceptable because the higher price would not decrease consumption. Concerns were raised that the tax would mostly affect individuals from low socioeconomic backgrounds. Some of the stakeholders indicated that they would support such a tax only if its revenue would be directed to specific causes such as health-promoting plans. Potential barriers to taxation include: opposition of various sectors, technical and bureaucratic obstacles impeding tax implementation, difficulties in defining which products to tax, and opposition of the treasury to earmark tax revenue for health education.
Taxation should be a part of a multipronged strategy rather than a sole measure for fighting obesity. Dedicating tax revenues to specific predefined causes should be considered, particularly towards health promotion activities, obesity treatment and prevention, education, and subsidies of healthy food.
近年来，诸如对不健康食品或含糖饮料征税等应对肥胖问题的财政政策受到了广泛关注。许多模拟不同幅度税收对含糖饮料购买行为的影响及其对各种健康结果潜在影响的研究已经发表；然而，迄今为止，此类税收的立法和实施在已实施的国家中遇到了许多障碍。我们调查了关键意见领袖、政策制定者和以色列其他利益相关者对含糖饮料和不健康零食征税的看法和观点。我们还评估了启动此类政策可能面临的挑战和障碍。
一项基于对以色列健康、营养、经济、公共宣传和政策制定领域的利益相关者进行39次深入访谈的定性研究。
所有利益相关者都认为肥胖是一个应由政府负责的社会和个人综合问题。只有来自经济部门的利益相关者认为，对含糖饮料和不健康零食征税会减少其消费，而非经济学家的普遍看法是，这样的税收是不可接受的，因为价格上涨不会减少消费。有人担心该税收将主要影响社会经济背景较低的个人。一些利益相关者表示，只有当税收收入用于特定事业，如促进健康计划时，他们才会支持这样的税收。征税的潜在障碍包括：各部门的反对、阻碍税收实施的技术和官僚障碍、难以界定对哪些产品征税以及财政部反对将税收收入专门用于健康教育。
税收应成为多管齐下战略的一部分，而不是应对肥胖的唯一措施。应考虑将税收收入用于特定的预定义事业，特别是用于促进健康活动、肥胖治疗和预防、教育以及健康食品补贴。
