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Policy lessons from health taxes: a systematic review of empirical studies
Background
Taxes on alcohol and tobacco have long been an important means of raising revenues for public spending in many countries but there is increasing interest in using taxes on these, and other unhealthy products, to achieve public health goals. We present a systematic review of the research on health taxes, and aim to generate insights into how such taxes can: (i) reduce consumption of targeted products and related harms; (ii) generate revenues for health objectives and distribute the tax burden across income groups in an efficient and equitable manner; and (iii) be made politically sustainable.
Methods
Six scientific and four grey-literature databases were searched for empirical studies of ‘health taxes’ – defined as those intended to increase the costs of manufacturing, distributing, retailing and/or consuming health-damaging products. Since reviews already exist of the evidence relating to traditional alcohol and tobacco excise taxes, we focus on other taxes such as taxes on retailers and manufacturers of unhealthy products, and consumer taxes targeting unhealthy foods, such as sugar-sweetened beverages.
Results
Ninety-one peer-reviewed and 11 grey-literature studies met our inclusion criteria. The review highlights a recent, rapid rise in research in this area, most of which focuses on high-income countries and on taxes on food products or nutrients. Findings demonstrate that high tax rates on sugar-sweetened beverages are likely to have a positive impact on health behaviours and outcomes, and, while taxes on products reduce demand, they add to fiscal revenues. Common concerns about health taxes are also discussed.
Conclusions
If the primary policy goal of a health tax is to reduce consumption of unhealthy products, then evidence supports the implementation of taxes that increase the price of products by 20% or more. However, where taxes are effective in changing health behaviours, the predictability of the revenue stream is reduced. Hence, policy actors need to be clear about the primary goal of any health tax and frame the tax accordingly – not doing so leaves taxes vulnerable to hostile lobbying. Conversely, earmarking health taxes for health spending tends to increase public support so long as policymakers follow through on specified spending commitments.
Systematic review registration number
CRD42016048603
Journal Article
Inflammatory Bowel Disease: A Review of Pre-Clinical Murine Models of Human Disease
Crohn’s disease (CD) and ulcerative colitis (UC) are both highly inflammatory diseases of the gastrointestinal tract, collectively known as inflammatory bowel disease (IBD). Although the cause of IBD is still unclear, several experimental IBD murine models have enabled researchers to make great inroads into understanding human IBD pathology. Here, we discuss the current pre-clinical experimental murine models for human IBD, including the chemical-induced trinitrobenzene sulfonic acid (TNBS) model, oxazolone and dextran sulphate sodium (DSS) models, the gene-deficient I-kappa-B kinase gamma (Iκκ-γ) and interleukin(IL)-10 models, and the CD4+ T-cell transfer model. We offer a comprehensive review of how these models have been used to dissect the etiopathogenesis of disease, alongside their limitations. Furthermore, the way in which this knowledge has led to the translation of experimental findings into novel clinical therapeutics is also discussed.
Journal Article
Medieval England, 500-1500 : a reader
\"This popular primary source reader spans several centuries in over one hundred documents. In addition to constitutional highlights and standard texts such as the Magna Carta and Froissart's Chronicles, the editors include narrative sources on the lived experiences of an array of historical actors. All sources fit into thematic clusters on the Anglo-Saxon monarchy, lay piety, late medieval commercial life, queenship, and Jewish communities. The new edition begins in 500 CE with sources on the Gregorian mission and Viking invasions. Thirty new sources have been added, covering significant events such as the conquest of Wales and important themes and genres such as miracle collections, material culture, and archaeology. Introductions and thought-provoking questions situate each source in the historical landscape, paying attention to the circumstances of composition, the author's concerns, intended audience, and the conventions of the genre.\"-- Provided by publisher.
Book
Global review of tobacco product flavour policies
ObjectiveWe determined which countries prohibit flavoured tobacco products and the details of those restrictions in order to identify possible gaps and opportunities for these and other countries to address.MethodsWe reviewed the grey literature, scanned news articles and consulted with key informants and identified 11 countries and the European Union (EU) that ban or restrict tobacco product flavours. We reviewed policy documents for their stated policy rationale, terms and definitions of flavours, tobacco products covered and restrictions on the use of flavour imagery and terms on tobacco product packaging.ResultsCountries with a tobacco product flavour policy include the USA, Canada, Brazil, Ethiopia, Uganda, Senegal, Niger, Mauritania, EU (28 Member States), Moldova, Turkey and Singapore. Most of the countries’ policies provide a rationale of dissuading youth from taking up tobacco use. Ten of the 12 policies use the terms ‘flavours’ (n=6) or ‘characterising flavours’ (n=4). Six policies cover all products made entirely or partly of tobacco leaf. Countries consistently prohibit flavours associated with fruits, vanilla and spices. The USA and Niger make an exception for menthol, while Mauritania and Uganda do not specify the scope of flavours or ingredients covered by their policies. Eight policies make no specific reference to restricting flavour descriptors on tobacco product packaging.ConclusionCountries looking to implement policies restricting flavours in tobacco products can build on existing comprehensive policies. Future research could examine the implementation and impacts of these policies, to inform other countries interested in acting in this policy domain.
Journal Article
We Need to Talk about Impact: Why Social Policy Academics need to Engage with the UK's Research Impact Agenda
Of all the social sciences, social policy is one of the most obviously policy-orientated. One might, therefore, expect a research and funding agenda which prioritises and rewards policy relevance to garner an enthusiastic response among social policy scholars. Yet, the social policy response to the way in which major funders and the Research Excellence Framework (REF) are now prioritising ‘impact’ has been remarkably muted. Elsewhere in the social sciences, ‘research impact’ is being widely debated and a wealth of concerns about the way in which this agenda is being pursued are being articulated. Here, we argue there is an urgent need for social policy academics to join this debate. First, we employ interviews with academics involved in health inequalities research, undertaken between 2004 and 2015, to explore perceptions, and experiences, of the ‘impact agenda’ (an analysis which is informed by a review of guidelines for assessing ‘impact’ and relevant academic literature). Next, we analyse high- and low-scoring REF2014 impact case studies to assess whether these concerns appear justified. We conclude by outlining how social policy expertise might usefully contribute to efforts to encourage, measure and reward research ‘impact’.
Journal Article
Development of the Canadian Marginalization Index: A New Tool for the Study of Inequality
Objectives: Area-based measures of socio-economic status are increasingly used in population health research. Based on previous research and theory, the Canadian Marginalization Index (CAN-Marg) was created to reflect four dimensions of marginalization: residential instability, material deprivation, dependency and ethnic concentration. The objective of this paper was threefold: to describe CAN-Marg; to illustrate its stability across geographic area and time; and to describe its association with health and behavioural problems. Methods: CAN-Marg was created at the dissemination area (DA) and census tract level for census years 2001 and 2006, using factor analysis. Descriptions of 18 health and behavioural problems were selected using individual-level data from the Canadian Community Health Survey (CCHS) 3.1 and 2007/08. CAN-Marg quintiles created at the DA level (2006) were assigned to individual CCHS records. Multilevel logistic regression modeling was conducted to examine associations between marginalization and CCHS health and behavioural problems. Results: The index demonstrated marked stability across time and geographic area. Each of the four dimensions showed strong and significant associations with the selected health and behavioural problems, and these associations differed depending on which of the dimensions of marginalization was examined. Conclusion: CAN-Marg is a census-based, empirically derived and theoretically informed tool designed to reflect a broader conceptualization of Canadian marginalization.
Journal Article