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The potential global gains in health and revenue from increased taxation of tobacco, alcohol and sugar-sweetened beverages: a modelling analysis
  1. Amit Summan1,
  2. Nicholas Stacey2,
  3. Johanna Birckmayer3,
  4. Evan Blecher4,
  5. Frank J Chaloupka4,
  6. Ramanan Laxminarayan1,5
  1. 1Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, USA
  2. 2Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  3. 3Bloomberg Philanthropies, New York, New York, USA
  4. 4Health Policy Center, University of Illinois at Chicago, Chicago, Illinois, USA
  5. 5Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
  1. Correspondence to Professor Ramanan Laxminarayan; ramanan{at}


Introduction Globally, a growing burden of morbidity and mortality is attributable to lifestyle behaviours, and in particular to the consumption of tobacco, alcohol and sugar-sweetened beverages (SSB). In low-income and middle-income countries, this increased disease burden falls on already encumbered and resource-constrained healthcare systems. Fiscal policies, specifically taxation, can lower consumption of tobacco, alcohol and SSB while raising government revenues.

Methods We simulated the health and economic effects of taxing cigarettes, alcohol and SSB over 50 years for 30–79 years old populations using separate mathematical models for each commodity that incorporated country-level epidemiological, demographic and consumption data. Based on data availability, national-level health effects of higher tobacco, alcohol and SSB taxes were simulated in 141, 166 and 176 countries, respectively, which represented 92%, 97% and 95% of the global population, respectively. Economic effects for tobacco, alcohol and SSB were estimated for countries representing 91%, 43% and 83% of the global population, respectively. These estimates were extrapolated to the global level by matching countries according to income level.

Results Over 50 years, taxes that raise the retail price of tobacco, alcoholic beverages and SSB by 20% could result in a global gain of 160.7 million (95% uncertainty interval (UI): 96.3 to 225.2 million), 227.4 million (UI: 161.2 to 293.6 million) and 24.3 million (UI: 15.7 to 35.4 million) additional life years, respectively.

Conclusion Excise tax increases on tobacco, alcohol and SSB can produce substantial health gains by reducing premature mortality while raising government revenues, which could be used to increase public health funding.

  • health economics
  • health policy
  • prevention strategies
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Seye Abimbola

  • Correction notice This article has been corrected since it was published online. Author name and affiliation corrected.

  • Contributors All authors conceived the study. AS and NS constructed the mathematical model and ran the analyses. AS drafted the initial manuscript, while all coauthors reviewed, edited and approved the final draft.

  • Funding The study was funded by Bloomberg Philanthropies (#51247) and the Bill and Melinda Gates Foundation (#OPP1098574).

  • Competing interests JB is an employee of the funding organisation.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request. Model files and data available on request.

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