Taxing health
‘BABU’ a colloquial term and a remnant of our colonial past, was used to refer to the British bureaucracy, who would wield the stick to tax the people. Even after independence, our inherited bureaucratic system and ‘babu’ mindset haven’t evolved. Every year before the budget, we hear of tax babus arbitrarily formulating policies, including on health, to decide the fate of the people.
Interesting research published by the British Medical Journal in 2011 chronicles how, in 2003, the Tony Blair government in the UK invited all food companies, secretly, and informed them of the burden of hypertension cases on the National Health Service. The government’s ask was to reduce sodium content by 10 per cent every year for three years. It was an inclusive, well-informed policy directive that didn’t appear out of thin air, but was backed by data and research. After many years, once its impact had taken effect, the study quoted above was published to document this.
Clearly, almost eight decades after leaving the subcontinent, the British have evolved, backing policy measures with authentic data to make informed decisions without disadvantaging any specific stakeholder. But we have not. Take the matter of health tax; there are numerous global examples of health taxes on a myriad of items consumed by the public to save on healthcare costs. Some countries impose duties on beverages (liquor and carbonated drinks) and junk food, and particularly on tobacco. The decisions taken are well-informed and intended for the long term; they are not simply an arbitrary exercise to meet revenue shortfalls.
Last year, the government imposed massive duties on the cigarette sector to discourage consumers. While the decision was correct, it should have also noted that the number of cases of oral cancer exceed those of lung cancer. Gutka consumption is the main reason behind oral cancer, an undocumented area that is not just completely off the tax authorities’ radar but that also doesn’t face any action except for the occasional ‘ban’.
It makes little sense to tax juice.
Meanwhile, it is undeniable that sugar consumption has harmful effects. Yet solely holding fruit juices and drinks responsible for our increasing diabetes burden is to overlook other factors. This is backed by studies. For example, official research published by the US in 2022 on the role of dietary sugars and obesity in type 2 diabetes, conducted a meta analysis of multiple interventional studies. It showed that one can no longer conclude that sugar consumption alone causes type 2 diabetes, and that, instead, a hypercaloric diet — defined as “one in which a person’s energy consumption exceeds their energy expenditure” — achieved by the overconsumption of any type of macronutrients, is a major risk factor.
Diabetes avoidance needs a total lifestyle change; attributing diabetes solely to sugar consumption oversimplifies the complex factors involved in the development of the disease. In Pakistan’s context, the lion’s share of sugar consumption stems from our cultural sweet tooth thanks to halwais (who more often than not evade tax regulations), while the risks of packaged confectionary items are completely overlooked. The easiest sector to drop the anvil on is beverages that have some goodness of fruit in them, and to bracket them with energy drinks and sodas that are caffeinated and full of added sugar.
How can a country that is already facing a malnutrition crisis and needs fortified products tax juice with natural fruit content, which contains essential micronutrients such as Vitamin C, often prescribed by doctors for pat-ients recovering from illness to boost immunity? Multiple resear-ch has suggested the importance of juice as a healthy source of energy, whereas in countries such as the US, the dietary guidelines for 2020-2025 allow for up to half of the recommended daily fruit intake to be replaced with fruit juice.
All this brings me back to the point that any policy decision should be well-thought-out, especially when it comes to one that will have an impact on the health of the common man. It is an unfortunate fact that when those in policymaking circles are not connected with the ground realities and tend to overlook hard facts as well as research, it becomes near impossible to take the correct steps. Invariably, the fallout of uninformed policymaking is suffered by the masses, and not by the decision-makers who will get transfers and postings and will eventually retire with hefty pensions and perks without having to answer any uncomfortable questions about how they exercised their powers.
The writer is an academic medical researcher and a doctor working for a tertiary care hospital in Karachi.
Published in Dawn, June 27th, 2024