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Abstract：
BACKGROUND: Taxation of tobacco, food, alcohol and other beverages has gained renewed attention in responding to non-communicable diseases (NCDs). While largely built on evidence from high-income countries (HICs), the projected economic and health benefits of these measures have increased calls for their use in price-sensitive low- and middle-income countries (LMICs). However, uptake has been sporadic and there remains little research on why and how LMICs utilise fiscal measures in response to NCDs.
METHODS: This scoping review analyses factors influencing the design and implementation of health-related fiscal measures in LMICs. Utilising Arksey and O\'Malley\'s scoping review methodology and Walt and Gilson\'s policy triangle, we considered the contextual, procedural, content and stakeholder-related factors that influenced measures.
RESULTS: We identified 75 papers focussing on health-related fiscal measures, with 47 (63%) focused on tobacco, 5 on alcohol, 6 on soft drink and 4 studies on food-related fiscal regulation. Thirteen papers analysed multiple measures and most papers (n = 66, 88%) were less than a decade old. Key factors enabling the design and implementation of measures included localised health and economic evidence, policy championing, inter-ministerial support, and global or regional momentum. Impeding factors encompassed negative framing and retaliation by industry, vested interests and governmental policy disjuncture. Aligning with theoretic insights from the policy triangle, findings consistently demonstrated that the interplay between factors - rather than the presence or absence of particular factors - has the most profound impact on policy implementation.
CONCLUSIONS: Given the growing urgency to address NCDs in LMICs, this review highlights the need for recognition and rigorous exploration of political economy factors influencing the design and implementation of fiscal measures. Broader LMIC-specific empirical research is needed to overcome an implication noted in much of the literature: that mechanisms used to enact tobacco taxation are universally applicable to measures targeting foods, alcohol and other beverages.
METHODS: This scoping review analyses factors influencing the design and implementation of health-related fiscal measures in LMICs. Utilising Arksey and O\'Malley\'s scoping review methodology and Walt and Gilson\'s policy triangle, we considered the contextual, procedural, content and stakeholder-related factors that influenced measures.
RESULTS: We identified 75 papers focussing on health-related fiscal measures, with 47 (63%) focused on tobacco, 5 on alcohol, 6 on soft drink and 4 studies on food-related fiscal regulation. Thirteen papers analysed multiple measures and most papers (n = 66, 88%) were less than a decade old. Key factors enabling the design and implementation of measures included localised health and economic evidence, policy championing, inter-ministerial support, and global or regional momentum. Impeding factors encompassed negative framing and retaliation by industry, vested interests and governmental policy disjuncture. Aligning with theoretic insights from the policy triangle, findings consistently demonstrated that the interplay between factors - rather than the presence or absence of particular factors - has the most profound impact on policy implementation.
CONCLUSIONS: Given the growing urgency to address NCDs in LMICs, this review highlights the need for recognition and rigorous exploration of political economy factors influencing the design and implementation of fiscal measures. Broader LMIC-specific empirical research is needed to overcome an implication noted in much of the literature: that mechanisms used to enact tobacco taxation are universally applicable to measures targeting foods, alcohol and other beverages.
摘要：
背景：烟草税，食物,酒精和其他饮料在应对非传染性疾病方面获得了新的关注。虽然主要建立在高收入国家(HIC)的证据上，这些措施的预期经济和健康益处增加了对价格敏感的低收入和中等收入国家(LMICs)使用这些措施的呼声。然而,吸收是零星的，关于低收入国家为什么以及如何利用财政措施来应对非传染性疾病的研究很少。
方法：本范围综述分析了影响低收入国家卫生相关财政措施设计和实施的因素。利用Arksey和O'Malley的范围审查方法以及Walt和Gilson的政策三角，我们考虑了上下文，程序,影响措施的内容和利益相关者相关因素。
结果：我们确定了75篇论文，重点关注与健康相关的财政措施，47（63%）专注于烟草，5酒精，6项关于软饮料的研究和4项关于食品相关财政监管的研究。13篇论文分析了多种指标，大多数论文（n=66，88％）的历史不到十年。能够设计和实施措施的关键因素包括局部健康和经济证据，政策拥护，部际支持，以及全球或区域势头。阻碍因素包括行业的负面框架和报复，既得利益和政府政策脱节。与政策三角的理论见解保持一致，研究结果一致表明，因素之间的相互作用-而不是特定因素的存在或不存在-对政策执行产生最深远的影响。
结论：鉴于解决低收入国家非传染性疾病的紧迫性日益增加，这项审查强调需要认识和严格探索影响财政措施设计和实施的政治经济因素。需要更广泛的针对LMIC的实证研究来克服许多文献中指出的含义：用于制定烟草税的机制普遍适用于针对食品的措施，酒精和其他饮料。
方法：本范围综述分析了影响低收入国家卫生相关财政措施设计和实施的因素。利用Arksey和O'Malley的范围审查方法以及Walt和Gilson的政策三角，我们考虑了上下文，程序,影响措施的内容和利益相关者相关因素。
结果：我们确定了75篇论文，重点关注与健康相关的财政措施，47（63%）专注于烟草，5酒精，6项关于软饮料的研究和4项关于食品相关财政监管的研究。13篇论文分析了多种指标，大多数论文（n=66，88％）的历史不到十年。能够设计和实施措施的关键因素包括局部健康和经济证据，政策拥护，部际支持，以及全球或区域势头。阻碍因素包括行业的负面框架和报复，既得利益和政府政策脱节。与政策三角的理论见解保持一致，研究结果一致表明，因素之间的相互作用-而不是特定因素的存在或不存在-对政策执行产生最深远的影响。
结论：鉴于解决低收入国家非传染性疾病的紧迫性日益增加，这项审查强调需要认识和严格探索影响财政措施设计和实施的政治经济因素。需要更广泛的针对LMIC的实证研究来克服许多文献中指出的含义：用于制定烟草税的机制普遍适用于针对食品的措施，酒精和其他饮料。
