Advocacy The use of “sin taxes” to fund heath promotion foundations: introducing the debate addressed in Karen Slama’s article Commentary by Michel O’Neill Finding ways to fund health promotion infrastructures and interventions is a constant and major problem, most countries devoting an extremely low percentage of their health budget to these endeavors. In order to alleviate this problem, a few innovative countries have decided to earmark certain tax monies for health promotion purposes, these monies being sometimes channeled into public Foundations totally or partially dedicated to health promotion interventions. The Australian state of Victoria led the way, followed by other Australian States and after that by several other countries as diverse as Switzerland, Thailand or Poland, to name but a few. These foundations are now organised in the International Network of Health Promotion Foundations <www.hpfoundations.net/>. These public foundations are quite different from private ones, like the Melinda and Bill Gates Foundation for instance <http://www.gatesfoundation.org/defaul t.htm>, which can work rather independently <http://www.gih.org/usr_doc/2003_Co nversion_Report.pdf> or in close partnership (see the Fondation Lucie et André Chagnon for instance <http://www.fondationchagnon.org>) with governments. In many instances, these public foundations get their funding through mechanisms involving the utilization of taxes levied on products potentially harmful to health like tobacco or alcohol, often labeled “sin taxes”. In order to reflect on this complex topic and eventually take a position on these issues, the Board of Trustees (BOT) of the International Union for Health Promotion and Health Education (IUHPE) has commissioned an important paper1 which has been presented to its executive in Paris in
December 2005. Looking at several countries, the paper first documents how the taxation of alcohol and tobacco can be utilized as a policy instrument to promote the health of populations, reviewing the potential harms and benefits of doing so and showing that the impact of taxing tobacco is quite different than taxing alcohol. The paper then goes on to discuss the issue of earmarking (i.e. specifically dedicate) taxes for health purposes and some of the ethical, social justice and economic dilemmas that this practice can raise. Finally, the question of channeling earmarked taxes into Health Promotion Foundations is treated and lessons learnt in doing so over the past decade are exposed. The paper has generated significant interest and debate at the IUHPE Executive Committee meeting of December 2005. Even if it is of common use in certain quarters, the expression “sin taxes” seemed very moralistic, culturally specific and inappropriate to many. The fact that the paper was commissioned to make the case that earmarking and health promotion foundations were appropriate mechanisms, rather than asking in a less committed way if we had sufficient evidence to actually make the case, was questioned by others. Finally, the fact that the utilisation of taxation as a policy instrument to promote health was covered in the same paper than earmarking taxes for health promotion foundations seemed a bit confusing to some. Consequently, it was decided that two sets of reactions would be sought on the paper in order to provide additional input to IUHPE Board of Trustees, for discussion and eventual adoption of a position. On the one hand, under the guidance of IUHPE Vice-President for
Websites of Health Promotion Foundations Austrian Health Promotion Foundation: www.fgoe.org BC Coalition for Health Promotion: www.vcn.bc.ca/bchpc/ Health 21 Foundation (Hungary): www.health21.hungary.globalink.org Health Promotion Switzerland: www.promotionsante.ch Health Promotion Foundation (Poland): www.promocjazdrowia.pl Healthway: www.healthway.wa.gov.au ThaiHealth: www.thaihealth.or.th VicHealth: www.vichealth.vic.gov.au/
Advocacy Marilyn Wise, a more internal discussion would be undertaken on the BOT electronic discussion list. On the other hand, and it is what we are doing here, a call would be made to the general membership of IUHPE to contribute its reflections and reactions through Reviews of Health Promotion & Education Online – RHP&EO (www.rhpeo.org). IUHPE members are thus invited to react, using the usual guidelines to do so that can be found in the RHP&EO website. Even if you do not want to react, reading this paper is surely a very useful endeavor for anybody concerned with funding health promotion infrastructures and interventions, because it raises quite successfully most of the issues and dilemmas involved in using tobacco and alcohol taxes (and eventually the taxation of other products with a high detrimental potential to health like fastfood, weapons, etc.) to do so.
Michel O’Neill Editor in Chief, RHP&EO Laval University Quebec, Canada Email: Michel.ONeill@fsi.ulaval.ca
1. Slama, K. (2006) “Background information for adopting a policy encouraging earmarked tobacco and alcohol taxes for the creation of health promotion foundations” Promotion & Education. XIII (1): 30-35.
IUHPE – PROMOTION & EDUCATION VOL. XIII, NO. 1 2006
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