Targeted taxation and regulation proven to cut health inequalities

Author: Louise Prime

Targeted taxation and restrictions on harmful or unhealthy products are successful and proven ways of addressing health challenges and reducing health inequalities – so the government should challenge critics who dismiss such "nanny state" policies, The King’s Fund argued this morning.

The authors of the charity’s latest briefing*, which examines the long-running ‘heated debate’ over the role of taxes and regulation in health promotion, pointed out that non-communicable diseases are a major health challenge, and policy makers need to better address behavioural risk factors, including poor diet, smoking and excess alcohol consumption.

They argued that although traditional policy approaches tend to see these matters as being about individual responsibility and choice, the evidence suggests that much of people’s behaviour is also strongly shaped by their environment – and that to effectively meet public health challenges, “there is a real need to use policy levers that rely less on personal agency and act at a population level”. And, they said, “fiscal and regulatory levers are among the most promising options for changing behaviour through rebalancing physical, commercial, social, digital and economic environments to moderate over-consumption of unhealthy products and encourage people to choose healthier ones”.

They also noted that despite politicians’ assumption that people will be opposed to "nanny state" policies to improve public health through taxation and regulation, polling has shown that in fact they  are more popular than expected, and that attitudes can change over time – as evidenced by broad public backing for the soft drinks levy and measures to make healthier foods cheaper than unhealthy foods, and the widespread support among most smokers as well as non-smokers for the smoking ban.

The authors suggested that building on previous examples of when taking a bold approach has encouraged people to change unhealthy behaviours, government might now consider, for example, taxing a broader range of products and subsidising healthier options – taking an evidence-based approach and working with industry to understand commercial concerns. 

They concluded: “Fiscal and regulatory policies can be highly effective when used in combination and alongside other complementary policies [and] are essential tools for government if it is to make headway in addressing today’s health challenges and their consequences for individuals, the NHS and society.”

One of the report’s authors Helen McKenna, senior fellow at The King’s Fund, commented: “Dismissing these interventions as ‘nanny state’ unhelpfully polarises the debate when there is good evidence that well-designed fiscal and regulatory measures can play an important role in improving public health and reducing the economic and social costs of poor health. The government should follow this evidence and be bolder in using tax and regulation to improve public health. Surveys find broad public support for such measures, challenging the assumption that these interventions would be unpopular.”

The Royal College of GPs (RCGP) welcomed the report, and agreed that it is essential for any decisions relating to public health to be evidence-based, with initiatives regularly and rigorously evaluated in terms of their benefit. The College added that current evidence shows that taxes have a more significant impact on public health than voluntary regulations.

RCGP vice chair Dr Gary Howsam said: “We agree with The King’s Fund that dismissing these interventions as being too paternalistic is unhelpful as we strive for better public health across society. We have seen these interventions lead to significant improvements in public health, such as fewer people smoking, and the latest Public Health England progress report on the sugar reduction programme found that compulsory levies on soft drinks reduced sugar ten times faster than a request to companies to take sugar out of products.

“Lifestyle factors are the leading causes of non-communicable diseases, including cancer, diabetes and liver disease, which we know can be prevented or improved through addressing diet, physical inactivity, smoking and alcohol consumption – and we know that taxes can dissuade people from making lifestyle choices that can be detrimental for their health.”

*Beech J, Cooper E, Holmes J, McKenna H. What role do taxes and regulation play in promoting better health? The King’s Fund, published online 6 March 2020.