Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia.
Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia.
Health Policy Plan. 2022 May 12;37(5):543-564. doi: 10.1093/heapol/czac004.
Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016-19) in 16 countries. This study aimed to analyse the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on 'diffusion of innovation' and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analysed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident 'diffusion networks' included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries' taxes, particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy-making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.
对含糖饮料 (SSB) 征税被建议作为预防与饮食相关的非传染性疾病 (NCD) 的综合政策行动的一部分，但只有四分之一的世界卫生组织 (WHO) 成员国采取了这一措施。本文对 16 个国家最近 (2016-19 年) 的 SSB 税进行了比较政策分析。本研究旨在分析影响 SSB 税采用和实施的因素的特征和模式，以及国家之间的政策学习情况，为未来的 SSB 税提供经验教训。数据收集和分析是根据一个分析框架进行的，该框架借鉴了“创新扩散”和政策学习理论。除了国家统计数据外，还从政策文件和媒体中收集了定性数据。对定性数据进行了主题分析，并采用叙述综合方法进行综合案例研究分析。我们发现，在 SSB 征税方面，所采用的方法存在适应性和异质性，大多数国家都采用了消费税，并且在媒体和政策文件中都有一致的健康框架。支持这些税收的常见公共框架包括减少肥胖/非传染性疾病和增加收入(政府行为者)以及随后的卫生系统节省(非政府行为者)。反对的框架则集中在倒退性和与其他经济政策的不协调性上(政府行为者)，并认为税收对健康的益处有限，对食品行业的经济影响也不利(行业)。明显的“扩散网络”包括世界卫生组织，主要是在中等收入国家，以及一些区域经济组织。我们发现，通过卫生行为者与决策过程的战略性接触、考虑经济背景、跨部门联盟使用一致的健康框架，以及对 SSB 税收进行强有力的评估和报告，可以促进 SSB 税收的采用。
