Public health ethics, sin tax and NCDs

The growing concern about non-communicable diseases (NCDs) is taking centre stage for public health officials, policy makers and individuals. As we know, NCDs are the leading cause of mortality and morbidity globally. According to the World Health Organization (WHO), NCDs, including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70 per cent of all deaths worldwide. Almost three quarters of all NCD deaths, and 82 per cent of the 16 million people who died prematurely, or before reaching 70 years of age, occur in low and middle-income countries.{{more}}

The rise of NCDs has been driven by primarily four major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets. These diseases are often referred to as lifestyle diseases, because they result from personal choices. Because the evidence has shown that changes in these lifestyle choices diminishes or reduce the risk of NCDs, public health officials have for years focused on health education and health promotion measures to make people aware of the risk factors, in order to reduce morbidity and mortality.

Over the last 10 years or so, public health officials have taken a new approach. They have decided to impose taxes on products like tobacco, alcohol, and high sugar content food, like sodas, in order to limit the ability to pay for these products. This is then expected to lead to a decrease in consumption with the hope of reducing the burden from these diseases. These taxes are referred to as “sin taxes;” that is, once you “sinfully” engage, you will pay.

These taxes have been applied to tobacco, alcohol, and unhealthy foods. These taxes are applied across the board and are not limited to people who abuse or consume these products in excessive quantities. These taxes do not only limit one’s ability to pay for these products, but in some cases are supposed to be earmarked to go into the health funds in order to care for people who suffer from NCDs. However, studies have shown that money generated from these taxes does not end up in the health budget in some countries, or is significantly less than what was expected to treat persons who suffer from these diseases.

Public health ethics is based on solidarity and so despite some tax burden falling on us, we should be able support these public health strategies to protect our brothers. Because they may limit someone’s ability to pay, o­­­ne will be inclined to consume at the level that they are currently doing and so avoiding the excessive use of these products. This may be a protective mechanism. Public health ethics generally tries to strike a balance between individual choices and protecting the public. We have seen that although we have individual rights and choices sometimes these choices may be restricted for the public good. Although we may not like to pay the taxes, we have a collective duty to protect others and ourselves. By protecting others, we reduce the burden they have on the health sector and thus the burden on our own pockets to fund the health care system.

Dr Rosmond Adams, MD is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is the Head of Health Information, Communicable Diseases and Emergency Response at the Caribbean Public Health Agency (CARPHA). (The views expressed here are not written on behalf of CARPHA).

Dr Rosmond Adams is a medical doctor and a public health specialist.