We are confronting a dual crisis: rising health needs and shrinking health budgets.
Healthcare is too often described as expensive. But what is rarely acknowledged is that the cost of inaction is far greater – measured in lives lost, communities weakened, futures cut short and economic growth.
The aid crisis we face is not only a threat, but also an opportunity: an opportunity to reduce dependence on aid and to build stronger, self-reliant and resilient health systems, funded through domestic resources.
Among some of the most effective tools at our disposal are health taxes and health insurance schemes.
Health taxes on products like tobacco, alcohol, and sugar-sweetened beverages do more than generate revenue. They help reduce consumption of harmful products, change behaviour, and improve health. In some cases, they even encourage companies to reformulate their products.
The evidence is clear. Since 2022, at least 116 countries have introduced or increased health taxes. Yet progress is uneven. Today, 86 per cent of smokers still live in countries where cigarettes have become just as affordable, or even cheaper, in the past 10 years.
Public support is strong. A 2022 Gallup poll found majorities in several countries favour higher taxes on alcohol, tobacco, and sugary drinks. And the health benefits are undeniable: fewer cases of cancer, heart disease, diabetes and chronic lung disease, the very conditions that now account for seven of the world’s ten leading causes of death.
Quite simply, health taxes are a triple win: fewer preventable deaths, more funding for health, and greater equity across society.
That is why, in July this year, WHO launched the “3 by 35” initiative, supporting countries to raise the real prices of tobacco, alcohol, and sugary drinks by at least 50 per cent by 2035.
We know this approach works. Between 2014 and 2024, one in four countries raised tobacco taxes enough to increase cigarette prices by at least 50 per cent in real terms. The result: fewer smokers, healthier people, families and populations, and reduced healthcare costs.
Thailand offers a powerful example. A modest 2 per cent surcharge on tobacco and alcohol generated an additional $131 million (£98m) per year between 2001 and 2021, which was then used to directly fund health promotion and research.
If more countries take this proven step, the world can reach ambitious targets that were proposed this week at the UN General Assembly of 150 million fewer tobacco users and 150 million more people with controlled hypertension by 2030. These goals go hand in hand: quitting smoking dramatically reduces the risk of high blood pressure, heart attack, and stroke.
But despite the evidence, too few governments are seizing the opportunity. Only 15 per cent of the global population is covered by best-practice tobacco taxation. In many countries, taxes on alcohol and sugary drinks remain minimal. And in some cases, progress is undermined by investment agreements that protect corporate profits over public health.
This must change.
Here too, we see the challenges of global negotiations. The first draft of the UN political declaration called for ambitious, time-bound increases in taxation on tobacco, alcohol and sugary drinks, aligned with WHO recommendations. After weeks of debate, the proposed text called for countries to “consider introducing or increasing taxes on tobacco and alcohol.”
This reflects the political and corporate pressures at play. But we must also recognise what an incredible step forward this political declaration would be. For the first time, a UN political declaration would include language on health taxes, this reflects growing recognition of their power to save lives and strengthen health systems. Now we must build on that momentum.
Countries like Mexico, the Philippines, Tonga, and Colombia are showing leadership. They are reducing harmful consumption, mobilising domestic funds, and building healthier societies.
If every country acted, we could:
● Prevent millions of premature deaths
● Raise billions of dollars to reinvest in health and development
● Reduce inequities and build fairer, more resilient societies.
The path forward is clear. But it requires political courage.
Governments must resist industry interference and stop granting tax breaks to harmful products. Ministries of health and Finance must work hand in hand in a whole of government approach, that recognises health taxes not as a political liability, but a fiscal and social solution with public support. Civil society must continue to mobilise, emphasising the human and economic benefits of reform.
Health taxes are not about punishment, they are about protection. They are not austerity measures, they are investments: in people, in health systems, in our shared future.
This is a paradigm shift: seeing health not as a cost to be contained, but as a foundation for progress and prosperity.
In a world marked by fragility and inequality, we must choose policies that are proven, fair, and effective. Policies that improve health for all and enhance equitable economic opportunity.
Let us choose health.
Dr Jeremy Farrar is assistant director-general for health promotion and disease prevention and care at the World Health Organisation (WHO)
This comment piece was produced as part of The Independent’s Rethinking Global Aid project
