Smart Public Health Policies Can Help Close Health Gaps Caused By COVID-19 – And Raise Revenue
South Africa introduced a sugar tax in 2018 in support of a strategic plan for the prevention and control of obesity.

A sugar tax that generated R3-billion in revenue for South Africa in one year and a mandatory minimum unit price for alcohol products that contributed to a 10% decrease in alcohol-related deaths in Scotland are two examples of proven  successful policies governments have adopted for products that negatively impact health and that have helped raise revenue.

Speaking on the sidelines of the 74th World Health Assembly during a Vital Strategies and NCD Alliance virtual ‘VitalTalks’, health advocates called on governments to implement “concrete policies” to help save lives and prevent Non-Communicable Diseases (NCDs), to phase out incentives for unhealthy commodities and invest in social programs to improve lives.

Lynn Moeng-Mahlangu, SA health department’s chief director for health promotion and nutrition, pointed out that measures like a sugar tax are one part of combatting illnesses. She explained how her government introduced the health promotion levy on sugary beverages in support of a strategic plan for the prevention and control of obesity. The objective was to reduce obesity by 10% by 2020 and other non-communicable diseases.

The tax that came into effect in April 2018 was a triumph, but at about 11% is below a World Health Organization-recommended 20% increase. The WHO recommends that taxes on sugary drinks help to reduce consumption and prevent obesity. The global health body previously said that : “Taxation on sugary drinks is an effective intervention to reduce sugar consumption. Evidence shows that a tax on sugary drinks that rises prices by 20% can lead to a reduction in consumption of around 20% thus preventing obesity and diabetes.”

Moeng-Mahlangu however said the sugar tax had proven that fiscal measures contribute to reducing consumption on unhealthy foods and beverages, but said there was a need for more investment in research that will support policy making decisions.

She called for greater awareness programmes on issues that contribute to NCDs. “It’s also important to educate communities so that they can buy into the policy decisions that governments have taken.”

Scotland’s Fight Against Alcohol Abuse

The introduction of a mimum unit price on alcohol resulted ina a 10% drop in alcohol-related deaths in Scotland in 2019, with 1,020 fatalities compared to 1,136 the previous year.

Scotland became the first country to introduce a minimum unit pricing on alcohol after “it literally became cheaper to buy a cider than a bottle of water”,  said Allison Douglas, chief executive of Alcohol Focus Scotland. 

The primary purpose of minimum unit price (MUP) was to save lives and improve health. It was introduced in May 2018 after years of delays from legal challenges and targeted low-cost, high-strength products, seen as a source of problem drinking, by setting a minimum unit price of 50p per unit of alcohol.

The introduction of the public health measure was to save lives, said Douglas, revealing a 10% drop in alcohol-related deaths in Scotland in 2019, with 1,020 fatalities compared to 1,136 the previous year. The amount of alcohol sold in Scotland also dropped by 3% during the first year of introducing minimum pricing.

The COVID-19 pandemic has accentuated the need to act on NCD prevention and Douglas believes that interventions similar to the MUP are needed now “more than ever”.

“Public health prevention works and has never been more badly needed, Every country needs to look at the best ways of  increasing price controlling availability and reducing marketing to improve and save lives.”

Stop Incentivising Unhealthy Commodities

In the context of post COVID-19 recovery, governments should phase out incentives to unhealthy commodities, reinvest in social protection and use fiscal policies to prevent NCDs, said Nandita Murukutla, Vice President, Global Policy and Research, Vital Strategies.

Murukutla said billions of dollars is given to the alcohol industry every year through tax breaks, tax rebates, marketing subsidies and other incentives, particularly in low-and middle-income countries. This despite alcohol being a “a major public health and societal issue responsible for more than 3 million deaths annually”.

“And we know that it costs society. In the US alone,  It’s responsible for nearly $250 billion a year in social and other health costs.”

 A recent report by Vital Strategies, The Sobering Truth: Incentivizing Alcohol Death and Disability examined how the industry interferes in government policies that are aimed at reducing consumption of alcohol products. “As we seek to build resilient health systems, we have to urge governments, policymakers and health advocates to actively monitor the alcohol industry’s interference in policy and to question the cost and benefits of economic incentives, ”  the report states.

“(It) comes at a time when governments are grappling with the fallout of the COVID-19 pandemic, strained budgets, and an increased risk of people under COVID-19 restrictions turning to alcohol in ways that can harm health and increase mortality.”

Public Health Policies Save Lives

Nina Renshaw, NCD Alliance policy and advocacy director, said the COVID-19 pandemic had “accentuated the need to act on NCD prevention” and that the policy examples cited during the webinar proved that legislative tools  vital to save lives and improve people’s health.

A key message from the Vital Talks session, she said, was that important results were delivered for population health where solid measures and policies were implemented.

“And we heard from South Africa that these instruments can raise significant revenue, which can be reinvested into promoting and protecting health and bring further equity gains,’ she said.

Referencing an OECD report published on 19 May that details efforts over the past year to help developing countries create better tax policy measures, maximize revenue collection, and navigate the challenges of the COVID-19 pandemic, Renshaw said governments should implement robust pricing policies for alcohol as “the return on investment is $16 for every dollar spent on alcohol policies”.

Going forward, Renshaw called on governments to better understand NCDs as a vital part of health security and preparedness for health threats. “ A healthy population is the bedrock of resilience.” 

Image Credits: rawpixel/unsplash.

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