8 World Health • SOth Yeor, No. 3, Moy-June 1997
Taxing harm for health
Rhonda Galbally
In Victor ia, Australia, a percentage o f the tax levied on tobacco products i s dedicated to funding health promotion that goes well beyond underlining the benefits of not smoking.
utting a tax on tobacco and using the funds for tobacco control and health promotion achieves many positive health pro- motion benefits at once. A small percentage tax imposed on tobacco products by the government of the Australian State of Victoria has allowed the Victorian Health Promotion Foundation (VicHealth) to serve as a pioneer. The State taxes the product that causes most disease and spends this tax revenue on promoting good health. The move raises the price of cigarettes and thus provides a disincentive for smokers. A percentage of the to- bacco tax is then dedicated to fund- ing health promotion throughout the country in areas much wider than tobacco control - noncommunicable disease prevention, preventing mental illness, and environmental health promotion.
Victoria was one of the first places in the world to realize the possibilities of using taxes on to- bacco to fight for health. In 1987 the Victorian anti-smoking movement took a step beyond staging demon- strations and writing graffiti by working with politicians and lawyers to establish a statutory Health
The Australian State of Victoria was the first in the world to use taxes an tobacco to improve health.
Victorian Premier, Jeff Kennett {right), accepts the WHO Commemorative Tobacco or Health Award from Dr S. T Han, WHO Regional Director for the Western Pacific, in 1996.
Photo WHO/Victorian Health Promotion Foundation, Australia
Promotion Foundation. It was
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Longer-term investment in health funded by a dedicated levy of 5% on promotion initiatives is possible sales of tobacco products, which because there can be security of now brings in Aus. $22 million per funding. Because health promo- year. Of those funds, 20% go to tion does not come from the research, 20%- 30% to sports and health budget, it is more likely to arts, 40% to community, health and be protected from year-by-year schools activities, and 10% to ad- fluctuations.ministration. Surplus funds are used
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All sectoral interests - not only for consulting, development and the health sector but also the evaluation. Over the past decade economic and education sectors, VicHealth has worked with govern- housing, transport, sports and ment, health agencies and commu- arts, local governments and nity groups to establish an community organizations - are integrated, intersectoral health catered for through their repre- promotion programme that has sentation on Foundation boards lowered smoking, drinking and and committees.injury rates in the State through a
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A Health Promotion Foundation combination of social marketing, can operate with a small adminis- government regulation, community trati ve budget (10% of the total, development, and organization and rather than the 25% of more environmental change. bureaucratic administrations).The use of a dedicated levy for
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Speedy, responsive and flexible health promotion has many advan- funding arrangements can betages. made.
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Funding for the Health Promo-•
Community interest can become tion Foundation does not come a part of the decision-making from the general health budget, process, ensuring that funding and thus does not have to compete decisions remain responsive and with other claims from health accountable to the community.services and high technology.
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Rigorous accountability mea-World Health • SOth Year, No. 3, Moy-June 1997
In Victoria, over 1 OOO sports and arts organizations receive funding to sponsor health messages and encourage public participation
Photo WHO/Victorian Health Promotion Foundation, Australia
sures can be established, based on public scrutiny as well as bureau- cratic review.
• The Foundation can act as a buffer between Government and the tobacco interests.
A popular tax
VicHealth sponsors sports and cul- tural events that the tobacco industry has traditionally found attractive.
Instead of these events being used to recruit smokers, VicHealth promotes the benefits of not smoking and of adopting a healthy lifestyle, includ- ing healthy food and exercise, safe drinking, avoiding sunburn, cervical smear tests, mental health, safety promotion, and safe sex. The tax itself becomes popular because of its association with health, and the government is thus able to raise the price of cigarettes still higher!
More than 1 OOO sports and arts organizations receive funding to sponsor health messages and encour- age participation. The gains for tobacco control, health research, sports, arts, schools, workplaces, local communities and hospitals are considerable, but the biggest winners of all are the millions of people whose lives have been enriched and enlivened by VicHealth sponsored programmes.
agency (probably a cancer or heart disease organization or the medical association) should be identified and agreed to by all the different inter- ests. A person with excellent organi- zational skills, a capacity to inspire others, and credibility in the area of public health should be employed to run the campaign, and someone else with significant credibility in the medical and health world should be appointed as a prestigious public chairperson.
The next steps will be to build links with the print and broadcast media, and to convince them that the establishment of a Foundation will ensure that health promotion cam- paigns will compensate for any lost revenue following tobacco advertis- ing bans. Model legislation should be drafted in collaboration with key people inside the Department of
Health. The rate of the levy should be fixed in legislation, should pro- duce an income that is at least 1 % of the total annual health budget, and should be in addition to existing tobacco taxation.
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The tobacco industry will inevitably mount an expensive, long-term campaign against the levy, using such arguments as civil rights (freedom to choose to smoke), loss of funding for sports and arts, the unim- portance of advertising in promoting smoking, painting Health Promotion Foundations as corrupt, inefficient, unaccountable (and socialist!). The Foundation must have its arguments ready to counter such a campaign. It should use high-profile role models from sports and the arts, as well as politicians.
Even if t~e first attempt to push legislation through Parliament fails, it is important to keep the impetus going and maintain energy and enthusiasm. If the sponsors put sufficient time, energy and long-term commitment into a campaign to achieve a dedicated levy for a Health Promotion Foundation, it will even- tually achieve its goal. •
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Dr Rhonda Galbally is Chief Executive .Officer of the Victorian Health Promo/ion Foundation, 333 Drummond Street, Car/ion', Victoria 3053,
Australia. · · ' ·
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The first step towards establish- ing a Health Promotion Foundation is a vigorous and high-profile tobacco-control movement. A lead
Health promotion in areas quite unrelated to tobacco, such as healthy food and exercise, can benefit from programmes financed through tobacco fax.
Photo WHO/Victorian Health Promotion Foundation, Australia
