Mapping alcohol and tobacco tax interventions for health in the UK: a qualitative framework analysis

Abstract

BackgroundAlcohol and tobacco use undermine population health, generating substantial costs. Increasing price is an effective means to reduce consumption and tax is a key harm reduction tool. In the UK, alcohol and tobacco tax are managed within fiscal policy, which does not necessarily prioritise health promotion. We aimed to map the objectives and options for alcohol and tobacco tax change in the UK, including the potential for greater coordination to improve health. MethodsWe did five semi-structured interviews with ten participants selected for their expertise in alcohol or tobacco tax policy. Interviews occurred in pairs (ie, one alcohol and one tobacco expert in each interview) to elicit comparison between substances and were supported by a rapid literature review of tax options. Participants were from government, arms-length governmental organisations, and advocacy groups. Informed by a rapid literature review, comparative framework analysis of alcohol and tobacco tax policy objectives, options, and factors pertaining to coordination between tobacco and alcohol was done. FindingsParticipants raised common health objectives (reducing consumption, harm, inequalities) and fiscal objectives (raising revenue, mitigating societal costs). Drawing on options identified in the rapid review, participants discussed common tax options to achieve these objectives: tax rate increases (sudden rises, annual increases, minimum thresholds), changing tax structures (taxing products differently, tax proportional to harm), levies (taxing retailers and manufacturers), and revenue hypothecation (for prevention or treatment of addiction, local services). Participants were positive about policy exchange across alcohol and tobacco and modelling the combined effect of tax changes, but uncertain about formally linking tax policy across substances. InterpretationRaising tax is often considered to improve health by making products less affordable, but a tax regime that raises additional revenue can support prevention and treatment services and mitigate the social and economic costs of consumption. An unresolved issue for policy debate is who should pay this revenue and how revenue would be maintained if the health objective of falling consumption were met. Although more input from fiscal policymakers would deepen findings, our rapid review and interview approach facilitated discussion across alcohol and tobacco, and use of the framework approach ensured consistent analysis. FundingNational Institute of Health Research Public Health Research programme.