Food tax policies in Pacific Island Countries and Territories: systematic policy review.

OBJECTIVE: To systematically identify and review food taxation policy changes in Pacific Island Countries and Territories (PICTs). DESIGN: Food taxation polices, regarding excise taxes and tariffs applied from 2000 to 2020 in twenty-two PICTs, and their key characteristics were reviewed. The search was conducted using databases, government legal repositories and broad-based search engines. Identified documents for screening included legislation, reports, academic literature, news articles and grey literature. Key informants were contacted from each PICT to retrieve further data and confirm results. Results were analysed by narrative synthesis. SETTING: Noncommunicable diseases (NCD) are the leading cause of premature death in PICTs and in many jurisdictions globally. An NCD crisis has been declared in the Pacific, and food taxation policy has been recommended to address the dietary risk factors associated with. Progress is unclear. RESULTS: Of the twenty-two PICTs included in the study, fourteen had food taxation policies and five introduced excise taxes. Processed foods, sugar and salt were the main target of excise taxes. A total of eighty-four food taxation policy changes were identified across all food groups. There was a total of 279 taxes identified by food group, of which 85 % were tariffs and 15 % were excise taxes. Individual tax rates varied substantially. The predominant tax design was ad valorem, and this was followed by volumetric. CONCLUSIONS: A quarter of PICTs have introduced food excise taxes from 2000 to 2020. Further excise taxes, specifically tiered or nutrient-specific designs, could be introduced and more systematically applied to a broader range of unhealthy foods.

Assessing the progress on the implementation of policy and legislation actions to address the Non-Communicable Diseases crisis in the Pacific.

AIM: To assess the progress on the implementation of Non-Communicable Diseases (NCD) related policies and legislations in the Pacific Island Countries and Territories (PICTs). MATERIALS AND METHODS: The Pacific Monitoring Alliance for NCD Action (MANA) Dashboard was used to assess the progress on the implementation. The MANA Dashboard includes 31 indicators across four different domains such as leadership and governance; preventative policies and legislations; health system response programs; and monitoring This progress assessment was conducted between 2019 and 2020 for all 21 PICTs. The data were analyzed and compared with the baseline status (2018) report and presented across four different domains of the MANA dashboard. RESULTS: This progress assessment found that PICTs overall have made advancements in a number of areas, particularly the establishment of a national multi-sectoral NCD taskforce; implementation of referenced approaches to restrict trans-fat in the food supply in national documents; and fiscal measures to affect access and availability to less healthy foods and drinks. However, the strengths of actions varied across PICTs, and most are categorised as low strengths. Measures which had the most limited progress in implementation include policy and legislation that restrict alcohol advertising; tobacco industry interference; marketing of foods and non-alcoholic beverages to children; and marketing for breast milk substitutes. CONCLUSIONS: This progress assessment further highlights that while PICTs continue to make progress, NCD policy and legislation gaps still exist, both in terms of weaknesses of existing measures and areas that have had little attention to-date. These require urgent actions to scale up NCD related policies and legislation at regional and national level.

Barriers and facilitators to the introduction of import duties designed to prevent noncommunicable disease in Tonga: a case study.

BACKGROUND: In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to describe barriers to and facilitators of these import duties from a policy-maker perspective. METHODS: A case study was conducted to analyse implementation of policies originally modelled by the Pacific Obesity Prevention in Communities project to reduce mortality in the Kingdom of Tonga. Policymakers (n = 15) from the Ministries of Revenue, Health, Finance and Labour and Commerce involved in the development and implementation of Tonga's food-related policies participated in key-informant interviews. RESULTS: The main facilitator of import duties were strong leadership and management, cross-sector collaboration, awareness raising and advocacy, nature of the policy, and the effective use of data to model policy impacts and inform the general public. The absence of clear lines of responsibility and a decline in collaboration over time were identified as barriers to implementation of the import duties. CONCLUSION: In a small Island state implementing import duties to prevent non-communicable disease can be straight forward providing policymakers and the community have a shared understanding of the health and economic costs of NCDs.

Progress in the Pacific on sugar-sweetened beverage taxes: a systematic review of policy changes from 2000 to 2019.

OBJECTIVE: To systematically characterise sugar-sweetened beverage (SSB) tax policy changes in Pacific Island countries and territories (PICTs) from 2000 to 2019. METHODS: Medline, Google Scholar, Pacific Islands Legal Information Institute database, Factiva and news and government websites were systematically searched up to October 2019. Information was extracted on the date and SSB tax level change, tax type, included beverages, and earmarking; and checked for consistency with local experts. RESULTS: Three-quarters of PICTs had an SSB tax (n=16/21) and 11 of these were excise taxes that included both imported and locally produced beverages. The level of tax was over 20% in 14 jurisdictions. SSB tax was increased by more than 20 percentage points in eight PICTs. Most taxes were ad valorem or volumetric, three were earmarked and only two taxes targeted sugar-sweetened fruit juices. The majority of countries (14/21) had different tax rates for imported and locally produced beverages. CONCLUSIONS: More than three-quarters of PICTs have SSB taxes. More than one-third increased these taxes since 2000 at an amount that is expected to reduce soft drink consumption. Implications for public health: Despite high-quality tax design elements in some PICTs, SSB control policies could generally be strengthened to improve health benefits, e.g. by targeting all SSBs and earmarking revenue for health.

Assessing the Status of Diabetes Associations in the Pacific: A Starting Point for Strengthening Associations to Manage Diabetes.

This study aimed to assess the status of national diabetes associations in the Pacific Island Countries and Territories as a starting point for strengthening their development and effectiveness in the prevention and control of diabetes. This cross-sectional study was conducted in 21 Pacific Island Countries and Territories using a structured questionnaire that gathered information from national non-communicable diseases prevention and control focal persons on diabetes associations, organizational structure, funding sources, and ongoing activities to address diabetes. The overall status of national diabetes associations was assessed using standardized criteria. Of the 21 countries surveyed, 18 (86%) responded. Of these, 12 (67%; American Samoa, Northern Mariana Islands, Federated States of Micronesia, French Polynesia, Fiji, Guam, Nauru, Papua New Guinea, Marshall Islands, Solomon Islands, Tonga, and Vanuatu) have a national diabetes association. Half of the existing associations are fully functioning, while the remainder is either partially functioning or not functioning. Only 50% of existing associations have a regular funding source, and many lack clear visions and workable governance structures. This study fills a knowledge gap on the current status of associations and forms a baseline from which associations can be strengthened. It also draws attention to the need for Pacific leaders to invest and engage more in civil societies for better and effective diabetes care for all.

Insights in Public Health: COVID-19 Special Column: The Crisis of Non-Communicable Diseases in the Pacific and the Coronavirus Disease 2019 Pandemic.

Globally, coronavirus disease 2019 (COVID-19) is threatening human health and changing the way people live. With the increasing evidence showing comorbidities of COVID-19 and non-communicable diseases (NCDs), the Pacific region, where approximately 75% of deaths are due to NCDs, is significantly vulnerable during this crisis unless urgent action is taken. Whilst enforcing the critical mitigation measures of the COVID-19 pandemic in the Pacific, it is also paramount to incorporate and strengthen NCD prevention and control measures to safeguard people with NCDs and the general population; keep people healthy and minimise the impact of COVID-19. To sustain wellbeing of health, social relationships, and the economy in the Pacific, it is a critical time for all governments, development partners and civil societies to show regional solidarity in the fight against emerging COVID-19 health crisis and existing Pacific NCDs crisis through a whole of government and whole of society approach.