Significant portions of health care budgets across Africa have vanished. Countries across the continent are grappling with the unprecedented scale and speed of recent reductions in development assistance for health.

In 2021, external financing supported more than a third of health expenditures in half of the countries in sub-Saharan Africa. While multilateral and bilateral development assistance for health, which have historically supported about 30% of health care spending, were expected to decline by 2050, the region was not prepared for a staggering drop from $80 billion in 2021 to $24 billion in 2025. 

The question is this: How will governments address these unplanned deficits, fulfill essential health care needs, and meet new demands created by demographic transitions, climate change, and the non-communicable disease (NCD) epidemic?

Solution in plain sight

There is a solution hiding in plain sight. Taxing harmful commodities to increase government revenue and reduce societal costs is a tool that has been around for centuries, dating back to the 17th century when sin taxes were imposed in England on tobacco.

More recently, the Task Force on Fiscal Policy for Health estimates that raising the price of tobacco, sugary beverages, and alcohol by 50% worldwide through excise taxes could prevent 50 million premature deaths over 50 years. Over five years, this solution would produce an additional $3.7 trillion in tax revenue worldwide, with more than half of that generated in low- and middle-income countries, enough to cover 40% of health budgets.

Over five years, this solution would produce an additional $3.7 trillion in tax revenue worldwide, with more than half of that generated in low- and middle-income countries, which is enough to cover 40% of health budgets. 

With crisis comes opportunity. Despite industry opposition and interference, conflicts of interests, and implementation challenges, now is the time to mobilize action around this solution.

How to mobilise around health taxes – lessons learnt

At Vital Strategies, our partnerships with governments and civil society across more than 35 countries to help implement tobacco, alcohol, and sugary beverages taxes has provided some perspectives on how to overcome these barriers.

Our key message: We can apply lessons from multiple successful efforts to advance health taxes to tackle these barriers. Health taxes are achievable and deliver immense returns for population and financial health. Here are some important steps to success.

Rapid modelling

First, rapid modeling and assessment can create country-specific guidance on projected revenue gains and health benefits — data needed by decision-makers and legislators across health, finance, trade, and other ministries. Painting a picture of how these taxes yield tangible benefits  to make the case to policymakers and the public for action, or to document benefits of a new policy recently undertaken, should be part of this exercise.

In the Philippines, for example, taxes on tobacco and alcohol are helping to fund universal health care, while in Guatemala, revenue from alcohol taxes supports family planning programs. In Philadelphia, a sugary drink excise tax introduced in 2017 had generated more than $500 million by early 2024, helping to fund universal pre-kindergarten education for children across the city.

Prepare for pushback from industry

Secondly, anticipate and prepare for opposition from industry actors, who will inevitably work to block policies that threaten their profits.

Their tactics often include exaggerating claims of economic harm, denying the health harms of their products, and spreading disinformation on taxes’ impact on the economy, jobs, illicit trade, and the well-being of lower-income people.

But in country after country, smart tax policies demonstrate that these claims don’t hold up. When the prices of harmful products increase, worker productivity improves, and people shift their spending to other sectors, resulting in a net impact on employment and economic growth that is neutral or positive.

And taxes are not the primary drivers of illicit trade. Non-price factors, such as governance status, a weak regulatory framework, and the availability of informal distribution networks appear to be far more critical.

Effective dialogue with the public 

The final step is to build broad public support by highlighting how these measures benefit children, families, and communities, creating the momentum needed to overcome industry resistance and drive political buy-in.

We know that public support for health taxes is strong when benefits are clearly communicated. A Gallup study across India, Colombia, and Tanzania found up to 74% of adults supported higher taxes on alcohol, tobacco, and sugary drinks. Effective dialogue with the public fosters trust and aligns fiscal policies with community priorities.

In the Philippines, for instance, a concerted public campaign reframed ‘sin’ taxes as a means to help fund universal health care.

Guatemala’s experience offers a similar lesson. After a law was enacted allocating 15% of alcohol tax revenues to family planning programs, communication campaigns were launched to inform citizens about the benefits of this allocation. 

The introduction of a tax on sugary drinks was strategically communicated as a means to fund universal pre-kindergarten education in Philadelphia. This framing resonated with the public, leading to the tax’s approval and the generation of over $500 million by early 2024, with a portion allocated to early childhood education programs. ​

In December 2024, Brazil’s National Congress approved a tax on tobacco, soft drinks and alcohol. Health taxes in Brazil were framed as a mechanism to address deep-rooted health inequities, designed to shift the burden of harm from society back to the industries profiting from it, and using policy to reduce disease burden where it’s most concentrated: low-income and underserved communities. 

When there are clear benefits to be gained, such as better health and better social services, the public supports taxation on unhealthy products. 

Altering the trajectory of health inequities 

Non-communicable diseases such as cancer, heart disease, and diabetes, once mostly occurring in wealthy nations, is shifting to emerging markets.

Africa is witnessing some of the fastest growth rates in the consumption of unhealthy commodities; this increase is concentrated in lower-income households and among youth. Currently, consumption of these commodities is linked to 3 million deaths a year. NCDs account for an estimated  29% of all deaths in Nigeria, 38.5% in Kenya, and 51% in South Africa. If we allow the status quo to continue, low- and middle-income countries will see about a 50% increase in NCD deaths by 2030, with Africa a major contributor, resulting in $500 billion to $1 trillion in economic losses by 2030.

This does not have to be our future. Young people and lower-income households are especially sensitive to price.

After the implementation of the Health Promotion Levy in 2018, South Africa saw the sugar content of beverage purchases fall by 32%, with greater reductions seen in lower-income households. In Mexico, after the introduction of a soda tax, sales of sugary drinks fell by 6.3% in the first year. Within two years, rates of overweight and obesity among adolescent girls dropped by 3%. With an average population age of 19, price increases on unhealthy commodities can have an outsized impact on Africa’s development trajectory.

In the case of Brazil’s new tax on tobacco, soft drinks and alcohol, rather than taking a piecemeal approach, Brazil’s reform adopted a comprehensive reform grouping  tobacco, alcohol and sugary drinks with other harms like coal and betting. 

The reform established an equity-driven National Basic Food Basket (CBNA) exempt from taxation to promote healthier consumption, including meat, poultry, fish and minimally processed foods. 

The legislation also includes annual tax adjustments tied to inflation to maintain the effectiveness of these taxes over time, and this year, lawmakers will determine the specific tax rates on harmful products. The tax rates it adopts and the resulting changes in consumption, health outcomes and health disparities will be something to watch, as Brazil must establish those rates at levels that significantly reduce consumption to generate real public health benefits.

What are we waiting for?

Health taxes remain an undervalued and underutilized solution to address the triple shocks of contracting donor funding, domestic fiscal tightening, and the growing health care burden, providing governments with a unique opportunity to improve both long-term population and fiscal health. Now, when there is political and economic pressure to establish more stable and sustainable sources of domestic revenue for health, is the time to come together across sectors and mobilize for health taxes. Future generations will thank us.

What are we waiting for?

Dr Mary-Ann Etiebet is the President and CEO of the New York City-based Vital Strategies, a global health non-profit working in more than 80 countries to advance  equitable public health systems, including through stronger action on the drivers of non-communicable diseases. 

Image Credits: Kerry Cullinan, Bllomberg Philanthropies, Alianza por la Salud Alimentaria, Leo Zhuang/ Unsplash, Heala_SA/Twitter.