Alliance for Health Policy and Systems Research, Geneva, Switzerland.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
BMJ Glob Health. 2023 Oct;8(Suppl 8). doi: 10.1136/bmjgh-2023-012955.
Health taxes are effective policy instruments to save lives, raise government revenues and improve equity. Health taxes, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy. Yet, little is known about which frames resonate in which settings and how framing can most effectively advance or limit policies. To fill this gap, we conducted qualitative research in 2022, including focus group discussions, in-depth interviews, document reviews and media analysis on the political economy of health taxes across eight low-income and middle-income countries. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Findings suggest that no single frame dominates; in fact, a plurality of different frames exist and shape discourse and policymaking. There was no clear trade-off between health and economic framing of health tax policy proposals, nor a straightforward way to handle concerns around earmarking. Understanding how to best position health taxes can empower health policymakers with more persuasive framings for health taxes and can support them to develop broader coalitions to advance health taxes. These insights can improve efforts to advance health taxes by better appreciating political economy factors and constraining corporate power, ultimately leading to improved population-level health.
健康税是挽救生命、增加政府收入和提高公平性的有效政策工具。然而，健康税直接与商业行为者的利益发生冲突。支持征税的健康倡导者和反税产业代表都试图构建健康税收政策框架。然而，对于哪些框架在哪些情况下产生共鸣，以及框架如何最有效地推动或限制政策，我们知之甚少。为了填补这一空白，我们于 2022 年进行了定性研究，包括在八个低收入和中等收入国家进行了焦点小组讨论、深入访谈、文献回顾和媒体分析，研究了健康税的政治经济学。研究报告捕捉到了多个行为者构建特定背景的框架，这些框架往往与更广泛的经济、健康和行政考虑有关。研究结果表明，没有一个单一的框架占主导地位；实际上，存在多种不同的框架，并塑造了话语和决策制定。健康税政策提案的健康和经济框架之间没有明显的取舍，也没有简单的方法来处理专用性问题。了解如何最好地定位健康税，可以使卫生政策制定者更有说服力地制定健康税框架，并支持他们发展更广泛的联盟来推进健康税。这些见解可以通过更好地理解政治经济因素和限制企业权力来改善推进健康税的努力，最终提高人口健康水平。
