Process and strategies for achieving legislative change

Common campaign features for the introduction of earmarked tobacco taxes are: 

  1. Finding the policy opportunity
    The impetus for sustainable funding has typically been driven by the international political context or a national initiative to introduce tobacco control (particularly in recent years by Parties to the WHO FCTC). A common component of the campaign for earmarked taxes for health programmes was framing the taxes as both a fiscal and health benefit for the country in question. While most countries sought to introduce more comprehensive tobacco control measures, in Egypt, the Ministry of Health proposed an earmarked tax on cigarette sales to supplement the budget for student health insurance fees.
  2. Presenting a sound rationale and evidence
    In each country, the rationale for earmarking tobacco (and alcohol) excise taxes – in addition to improving public health – was also that it would provide a new source of funding rather than tapping into existing resources. Evidence for the validity of this argument, often with evidence of an increase in fiscal revenue, generally persuaded legislators. The case for reform in the Philippines was that an earmarked tax would significantly increase both the budget for health and the general level of taxation, thus extending the overall fiscal space. The political momentum or readiness to increase excise taxes largely came from understanding that the increased tax would be used for a defined policy outcome or priority. In Thailand and Vietnam, the argument used in their campaigns for earmarking tobacco taxes was for a continuous, regular source of revenue for underfunded preventive public health programmes.
  3. Policy synergies and building consensus between finance and health sectors
    Another common strategy was building collaboration between the financial and the health sectors for joint advocacy on earmarking taxes for health. Often, only a Ministry of Finance can decide to increase taxes. Earmarked taxes give ministers of health an incentive to support their finance ministers, hence creating synergy between the two portfolios. Limited funding for health and low tax revenues led to policy synergies between the two sectors in most countries. The earmarking of tobacco (and alcohol in some countries) taxes was a politically saleable means for meeting two objectives; the win–win policy measure protects both public health and the revenue requirements of a country. For example, the Fiscal and Financial Master Plan (1997–2001) of Thailand’s Ministry of Finance made it possible to earmark tobacco and alcohol taxes for a health promotion fund.
  4. Strategic partnerships and leadership
    Strategic partnerships between policymakers, health professionals, researchers, advocates, civil society and the media were essential for achieving earmarked taxes for health. Many countries now recognize the importance of ministries of health in innovative partnerships, particularly with the finance sector, to generate a sustainable source of revenue for health-related prevention programmes and treatment. For instance, a partnership between the ministries of Health and Finance was the basis for establishing the Viet Nam Tobacco Control Fund. The process was initiated by a group of health professionals and tobacco control advocates, led by the Steering Committee on Smoking and Health. Many partnerships were required to achieve the desired outcome, with coordination across government, civil society, the media, local leaders, special interest groups, and donors.

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