Health Policy and Management Unit, University of Zambia School of Public Health, Lusaka, Zambia.
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.
Glob Health Action. 2021 Jan 1;14(1):1872172. doi: 10.1080/16549716.2021.1872172.
: Taxation on unhealthy products is recommended as a cost-effective intervention to address the global burden of non-communicable diseases. Taxation of sugar-sweetened beverages dis-incentivize consumption of unhealthy products. Implementation of such policies is difficult in Sub-Saharan African countries, which are targets for global corporate expansion by the sugar-sweetened beverages industry.: To identify opportunities to strengthen policies relating to sugar-sweetened beverage taxation in Zambia, through: (1) understanding the policy landscape and political context in which policies for nutrition-related non-communicable diseases are being developed, particularly sugar-sweetened beverage taxation, and exploring the potential use of revenue arising from sugar-sweetened beverage taxation to support improved nutrition.: We conducted a retrospective qualitative policy analysis with a review of nutrition-related non-communicable diseases policies and key informant interviews (n = 10) with policy actors. Data were coded and analyzed data using pre-constructed matrices based on the Kingdon's Policy Agenda Framework.: Government responses to nutrition-related non-communicable diseases were developed in an incoherent policy environment. The health sector's commitment to regulate sugar-sweetened beverages conflicted with the manufacturing sector's priorities for economic growth. Increased regulation of sugar-sweetened beverages was a priority for the health sector. Economic interests sought to grow the manufacturing sector, including the food and beverage industries. Consequently, incoherent policy objectives might have contributed to the adoption of a weakened excise tax. The general public were poorly informed about nutrition-related non-communicable diseases.: The tension between the Government's economic and public health priorities is a barrier for strengthening fiscal measures to address nutrition-related non-communicable diseases. However, this did not prevent the introduction of a differential sugar tax on sugar-sweetened beverages. Opportunities exist to strengthen the existing taxation of sugar-sweetened beverages in Zambia. These include a more inclusive consultation process for policy formulation and comprehensive monitoring of risk factors.
对不健康产品征税被推荐作为应对非传染性疾病全球负担的一种具有成本效益的干预措施。对含糖饮料征税会抑制不健康产品的消费。撒哈拉以南非洲国家实施此类政策存在困难,因为这些国家是含糖饮料行业全球扩张的目标。
为了确定在赞比亚加强与含糖饮料征税相关政策的机会,我们通过以下方式进行了研究:(1)了解正在制定与营养相关的非传染性疾病政策(特别是含糖饮料征税)的政策背景和政治背景,并探讨利用含糖饮料征税所产生的收入支持改善营养的潜力。
我们对营养相关非传染性疾病政策进行了回顾性定性政策分析,并对政策制定者进行了 10 次关键信息访谈。对数据进行了编码,并根据 Kingdon 的政策议程框架预先构建的矩阵对数据进行了分析。
政府对营养相关非传染性疾病的反应是在不协调的政策环境中制定的。卫生部门对监管含糖饮料的承诺与制造业部门对经济增长的优先事项相冲突。加强对含糖饮料的监管是卫生部门的优先事项。经济利益集团希望发展制造业,包括食品和饮料行业。因此,不协调的政策目标可能导致采用较弱的消费税。公众对营养相关非传染性疾病的了解程度很低。
政府的经济和公共卫生优先事项之间的紧张关系是加强解决营养相关非传染性疾病的财政措施的障碍。然而,这并没有阻止对含糖饮料征收差别糖税。赞比亚加强对含糖饮料征税的机会依然存在。这些机会包括为政策制定制定更具包容性的协商过程,以及对风险因素进行全面监测。