Health taxes are a cost effective opportunity for progress in public health. Yet decision making processes on such policies lack the diligence routinely used in appraising other health interventions, and this limits their use, say Vageesh Jain and colleagues

The group of health services a government chooses to provide is known as a health benefits package.1 Current discussions on such packages are centred on curative health services but can and should do more for prevention. Given budgetary constraints, a compromise must be reached between investing in curative and preventive health interventions.

Cost effectiveness is central to decisions that seek to negotiate this. Its increasing importance to governments, keen to make smart investments in health, is reflected in the global proliferation of health technology assessment (HTA)—an evidence based approach to evaluating the costs, benefits, and wider effects of health technologies.2

Many public health interventions are evaluated through HTA and some are included in health benefits packages.3 But health taxes, though potentially cost effective, are not routinely included in either HTA or health benefits packages. Table 1 shows the cost effectiveness of taxes on sugar sweetened beverages, alcohol, and tobacco in various countries, compared with the cost effectiveness of cancer treatments. This shows that health taxes are an extremely cost effective yet neglected area compared with areas traditionally focused on by HTA agencies such as the National Institute for Health and Care Excellence (NICE) in the United Kingdom.

Health taxes don’t just generate revenue but can also be a powerful tool for improving health.18 There is a ubiquity of interest in this globally, with Mexico introducing a tax on sugar sweetened beverages in 2013, followed by several others, including the UK in 2018. Governments in low and lower middle income countries can also benefit. The World Health Organization (WHO) has identified a set of evidence based “best buy” interventions19 that are not only highly cost effective but also feasible and appropriate to implement within the constraints of such health systems. With many of the best buys in health being provided by international donors, taxation is one of the few remaining cost effective interventions available that is exclusively under government remit.