Sugar, tobacco, and alcohol taxes to achieve the Sustainable Development Goals

In a new Lancet Comment, experts from the London School of Hygiene & Tropical Medicine (LSHTM) have joined colleagues from other leading institutions and national global health leaders in calling for a more integrated approach and action on sugar, tobacco and alcohol taxes (STAX) to achieve the Sustainable Development Goals.
Caption: whisky and coca cola. Credit: Pixabay

Building on the best available evidence and legacy of previous social movements, the Sugar, Tobacco, and Alcohol Taxes (STAX) Group, say ‘that despite their potential, taxes on sugar, tobacco, and alcohol are underused by policymakers’ and ‘STAX should top the list of recommendations from this year’s World Health Organization’s Independent High-Level Commission on Non–Communicable Diseases and the G7 Summit in Canada’.

The 26 authors of the article include experts from the World Health Organization (WHO), UNICEF, the World Bank, UNAIDS and United Nations Development Programme as well as civil society leaders and other academics.

Worldwide, tobacco is estimated to kill more than seven million people and alcohol more than three million people each year. The global number of young people aged 5–19 years who are overweight and/or obese has increased from 11 million in 1975 to 124 million in 2016, with sugar consumption is a major contributor.

Led by LSHTM’s Robert Marten, the article explains that more than a decade after the adoption of the WHO Framework Convention on Tobacco Control, there is compelling evidence that raising tobacco prices substantially through taxation is the single most effective way to reduce tobacco use and save lives. Similarly, alcohol taxation is a cost-effective way to reduce alcohol consumption and harm. With growing evidence, sugar taxes are another fiscal tool to promote health and nutrition.

Mexico’s sugar tax reduced sugar-sweetened beverage sales by 5% in the first year, with an almost 10% further reduction in the second year. Tobacco taxes in South Africa contributed to tobacco consumption decreases of about 40% between 1993 and 2003. When Finland reduced taxes on alcohol in 2003, alcohol-related mortality increased by 16% among men and by 31% among women.

The authors say ‘as part of a broader public health approach to promote a life-course approach to prevention and to address commercial determinants of health, it is now time for governments to adopt sugar, tobacco, and alcohol taxes (STAX)’, adding ‘that despite industry efforts, taxation is gaining more attention from policy makers as a win–win–win policy.’

The Comment also highlights that STAX could mitigate risk factors for health and NCDs that disproportionately affect people with low socioeconomic status and low-income countries, but existing efforts are inconsistently applied, and ‘scaled-up country support is needed to accelerate and implement STAX as a cost-effective fiscal policy to contribute to the Sustainable Development Goals.’

The authors conclude that ‘STAX are not a magic bullet but instead are indispensable policy tools to improve public health, save millions of lives, and generate resources to invest in health, nutrition, and other development priorities, and ‘health professionals and civil society should unite a broad coalition and call on governments to enact a more synergistic STAX approach.’


Members of the Sugar, Tobacco, and Alcohol Taxes (STAX) Group are: Robert Marten (London School of Hygiene & Tropical Medicine), Sowmya Kadandale (UNICEF), John Butler (NCD Child), Victor M Aguayo (UNICEF), Svetlana Axelrod (WHO), Nicholas Banatvala (WHO), Douglas Bettcher (WHO), Luisa Brumana (UNICEF), Kent Buse (UNAIDS), Sally Casswell (Massey University), Katie Dain (NCD Alliance), Amanda Glassman (Center for Global Development), David L Heymann (London School of Hygiene & Tropical Medicine), Ilona Kickbusch (Global Health Centre, Graduate Institute), Patricio V Marquez (World Bank), Anders Nordström (Swedish Ministry of Foreign Affairs), Jeremias Paul Jr (WHO), Stefan Peterson (UNICEF), Johanna Ralston (World Obesity Federation), Kumanan Rasanathan (WHO), Srinath Reddy (Public Health Foundation India), Richard D Smith (London School of Hygiene & Tropical Medicine), Agnès Soucat (WHO), Kristina Sperkova (IOGT International), Francis Thompson (Framework Convention Alliance), and Douglas Webb (UNDP). Sugar, tobacco, and alcohol taxes to achieve the SDGs. The Lancet. DOI: 10.1016/S0140-6736(18)31219-4