Health taxes in Indonesia: a review of policy debates on the tobacco, alcoholic beverages and sugar-sweetened beverage taxes in the media

Abstract

IntroductionOne of the WHO’s ‘best buys’ in controlling non-communicable diseases and their risk factors is to impose health taxes. While the Indonesian political process inhibits the implementation of health tax policy, studies to discuss the issue remain limited.MethodsWe employed media analysis to document health tax policy dynamics, for example, the changes in policy timeline and key actors’ statements. We conducted an article search in the Open-Source Intelligence database using appropriate terminology on three commodities, for example, tobacco, alcoholic beverages and sugar-sweetened beverages (SSB).ResultsThroughout the 15 years of implementation (2007–2022), tobacco has received the most policy attention compared with the other two commodities. This is mainly related to the increasing tariff and reforming the tax structure. As Indonesia is a Muslim-majority country, alcohol consumption is low, and a tax on alcoholic beverages was nearly unchanging and lacked media coverage. Ministry of Finance (MoF) officials are key opinion leaders often cited in the media for health taxes. MoF’s support for health taxes is important to pass and implement health taxes. While SSB taxation is emerging, key opinion leaders’ media statements imply policy contestation, leading to delayed implementation. The policy debates on tobacco taxation implied election years as a major challenge for health tax passages. During the political years, anti-health tax arguments emerged from politicians. While the political contestation on SSB concluded that accentuating the health tax arguments in favour of public health generates the strongest opposition against taxation from the industry.ConclusionsPolitics of tobacco tax implementation are complex—compared with the other two commodities. The political context drives the divided views among policy-makers. Policy recommendations include generating public allies with key religious opinion leaders, continuing capacity building for politicians and Ministry of Health, and generating evidence-based arguments in favour of public health for MoF.

Framing health taxes: learning from low- and middle-income countries

“…In Indonesia, Ahsan et al conducted a review of media policy debates on the tobacco, alcoholic beverages and SSBs taxes. 30 They found that while tobacco tax policy has changed significantly, there has been little policy movement on alcohol and SSB taxes. 30 Leading up to the elections of 2019, media framing intensified, with many political figures adopting clear positions in opposition to taxation.…”

“… 30 They found that while tobacco tax policy has changed significantly, there has been little policy movement on alcohol and SSB taxes. 30 Leading up to the elections of 2019, media framing intensified, with many political figures adopting clear positions in opposition to taxation. 30 Policy debates on tobacco and e-cigarette taxation in Indonesia prioritised economic interests over health interests.…”

“… 30 Leading up to the elections of 2019, media framing intensified, with many political figures adopting clear positions in opposition to taxation. 30 Policy debates on tobacco and e-cigarette taxation in Indonesia prioritised economic interests over health interests. 30 This was seen as important, given that Indonesia is one of the tobacco industry’s most important markets.…”

“… 30 Policy debates on tobacco and e-cigarette taxation in Indonesia prioritised economic interests over health interests. 30 This was seen as important, given that Indonesia is one of the tobacco industry’s most important markets. Key opinion leaders’ statements in the media reflected policy contestation surrounding a potential SSB tax, which led to delayed tax implementation.…”

“…Key opinion leaders’ statements in the media reflected policy contestation surrounding a potential SSB tax, which led to delayed tax implementation. 30 Support by and leadership from the Ministry of Finance (MoF) was seen as central to the implementation of health tax legislation. 30 …”