Perceptions of key stakeholders on taxes on tobacco and alcohol products in Nepal

Abstract

BackgroundNon-communicable diseases (NCDs) are on the rise in Nepal. Consumption of alcohol and tobacco products remains high. Taxes on these products are significantly below the rate recommended by the WHO. In an effort to understand the reasons behind the slow progress towards the adoption of higher health taxes to curb NCDs, we documented the perceptions of key stakeholders on health taxes, including perceived barriers and facilitators to adopting higher health taxes.MethodsWe conducted 45 in-depth interviews with individuals comprising government officials; producers, wholesale distributors and sellers of alcohol and tobacco products; and consumers and representatives from civil society organisations. We conducted a thematic analysis of the resulting data.ResultsRespondents from alcohol and tobacco industries are not supportive of higher health taxes. They argued that higher taxes can increase illicit trade and worsen inequality. Strikingly, several government officials shared the industries’ concerns, arguing that health taxes have limited potential to reduce consumption of alcohol and tobacco products to help curb NCDs. In terms of barriers to adoption of higher health taxes, several local government representatives opined that close ties between industries and politicians at the federal level is a major hindrance.ConclusionsIn order to adopt higher health taxes, the government will need to counter the false narrative pushed by alcohol and tobacco industries on the negative economic effects of such taxes. Health taxes earmarked for NCDs need to reflect the amount of revenue raised, reoriented towards prevention efforts and communicated clearly to the public.

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

“…Acharya et al assessed barriers and facilitators to an effective design and implementation of taxes on tobacco and alcohol products in Nepal. 32 They observed significant regulatory capture with industry exploiting the limitations in the current tax system, including the lack of transparency on how health tax revenues were mobilised. 32 Moreover, in these debates, the cultural context in which consumption was embedded and the demand for harmful products, despite increasing prices, were also framed as insurmountable barriers to health tax policy change.…”

“… 32 Moreover, in these debates, the cultural context in which consumption was embedded and the demand for harmful products, despite increasing prices, were also framed as insurmountable barriers to health tax policy change. 32 …”