Department of Economics, University of Indonesia Faculty of Economics and Business, Depok, Jawa Barat, Indonesia
Department of Economics, Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
BMJ Open. 2024 Aug 6;14(8):e085863. doi: 10.1136/bmjopen-2024-085863.
Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This investigates the challenges and opportunities surrounding health tax implementation, with a particular focus on subnational government in Indonesia, where the decentralisation context of health tax remains understudied.
Employing a qualitative methodology using a problem-driven political economy analysis approach.
We are collecting data from a total of 12 focus group discussions (FGDs) conducted between July and September 2022 in three provinces-Lampung, Special Region of/ Yogyakarta and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs) and alcoholic beverages-we explore the multifaceted dynamics of health tax policies.
These FGDs involved a mean of 10 participants in each FGD, representing governmental institutions, non-governmental organisations and consumers.
Our findings reveal that health tax policies have the potential to contribute significantly to public health. Consumers understand tobacco's health risks, and cultural factors influence both tobacco and alcohol consumption. For SSBs, the consumers lack awareness of long-term health risks is concerning. Finally, bureaucratic complexiting and decentralised government hinder implementation for all three commodities.
Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardised packaging. Addressing these challenges is critical for realising the full potential of health tax policies.
实施健康税收政策以控制有害商品消费并增强公共卫生成果的努力在全球范围内得到了广泛认可。然而，成功实施这些政策仍然是一项复杂的任务。本研究探讨了实施健康税收政策所面临的挑战和机遇，特别关注印度尼西亚的次国家政府，因为其健康税收的分权背景仍未得到充分研究。
采用定性方法，运用问题驱动的政治经济学分析方法。
我们正在从总共 12 次焦点小组讨论（FGD）中收集数据，这些讨论于 2022 年 7 月至 9 月在三个省份进行，即楠榜、日惹特别行政区和巴厘岛，每个省份选择一种特定的商品进行代表：烟草、含糖饮料（SSB）和酒精饮料——我们探索了健康税收政策的多方面动态。
这些 FGD 中每个 FGD 平均有 10 名参与者，代表政府机构、非政府组织和消费者。
我们的研究结果表明，健康税收政策有可能对公共卫生做出重大贡献。消费者了解烟草的健康风险，文化因素影响烟草和酒精的消费。对于 SSB，消费者缺乏对长期健康风险的认识令人担忧。最后，官僚主义的复杂性和分权政府阻碍了所有三种商品的实施。
此外，本研究强调了有效政策沟通的重要性。它突出了将健康税收收入专门用于公共卫生倡议的重要性。它还强调了将健康税视为综合公共卫生方法的一部分的必要性，包括互补的非财政措施，如广告限制和标准化包装。解决这些挑战对于充分发挥健康税收政策的潜力至关重要。
