College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
BMJ Glob Health. 2023 Oct;8(Suppl 8). doi: 10.1136/bmjgh-2023-012025.
The Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO's Best Buys recommendations for addressing non-communicable diseases (NCDs), little is known about the tax's adoption process or whose interests it serves.
Using case study methodology, this study examined how and why Vanuatu's SSB tax was introduced. Policy documents, key informant interviews (n=33) and direct observations were analysed using theories of policy analysis, power analysis and postcolonial theory to map the policy's adoption, surrounding political economy and the ideas, interests and institutions that shaped the tax and its framing.
The SSB tax emerged during a politically and economically unstable time in Vanuatu's history. The tax's links to the national health agenda were tenuous despite its ostensible framing as a way to combat NCDs. Rather, the tax was designed to respond to tightening economic and trade conditions. Spearheaded by several finance-focused bureaucrats, and with limited input from health personnel, the tax targeted less frequently consumed carbonated SSBs (which are mostly imported) without any revenue reinvestments into health. Driven by the desire to generate much-needed government revenue and instal domestic protections via selective implementation and carve-outs for local producers, the Vanuatu SSB tax did meet national objectives, just not the dual health and economic 'win-win' projected by the NCD Best Buys.
Vanuatu's SSB tax adoption process reveals the limitations of decontextualised policy recommendations, such as the NCD Best Buys, whose framing may be overcome by local political realities. This research highlights the need for further political economy considerations in global health recommendations, since contextual forces and power dynamics are key to shaping both how and why policies are enacted and also whose interest they serve.
2015 年，瓦努阿图政府对含糖饮料（SSB）征收消费税。尽管此举符合世界卫生组织（WHO）提出的最佳购买建议，以应对非传染性疾病（NCDs），但对于该税收的采用过程或服务对象却知之甚少。
本研究采用案例研究方法，考察了瓦努阿图 SSB 税是如何以及为何被采用的。利用政策分析、权力分析和后殖民理论，对政策文件、关键知情人访谈（n=33）和直接观察进行了分析，以绘制该政策的采用、周围政治经济以及塑造该税收及其框架的思想、利益和机构。
SSB 税是在瓦努阿图历史上政治和经济不稳定时期出台的。尽管该税表面上是为了应对非传染性疾病而征收的，但它与国家卫生议程的联系并不紧密。相反，该税旨在应对日益紧张的经济和贸易条件。该税由几位专注于财政的官僚机构牵头，卫生人员的参与有限，针对的是消费频率较低的碳酸 SSB（主要是进口产品），而没有将任何税收收入再投资于卫生领域。受政府急需增加收入的驱动，以及通过有选择地实施和对本地生产商的豁免来建立国内保护的愿望，瓦努阿图 SSB 税确实实现了国家目标，但并没有实现 NCD 最佳购买所预期的双重健康和经济“双赢”。
瓦努阿图 SSB 税的采用过程揭示了脱离背景的政策建议的局限性，例如 NCD 最佳购买建议，这些建议可能会被当地政治现实所克服。本研究强调了在全球卫生建议中进一步考虑政治经济因素的必要性，因为背景力量和权力动态是塑造政策实施方式和原因以及服务对象的关键。
