Obesity and non-communicable diseases (NCDs) have become a growing concern in Pakistan. With 41.3% of adults being overweight or obese, and 6 out of 10 deaths attributed to NCDs, there is an urgent need for government interventions. To address this, the Global Health Advocacy Incubator’s (GHAI) partner the Pakistan National Heart Association (PANAH) engaged and built a diverse coalition of organizations and advocates to successfully campaign for a stronger sugar-sweetened beverages (SSB) tax, which was passed this February as a part of the country’s 2023 Supplementary Finance Bill. The new policy, effective March 1, 2023, increases the existing excise tax on carbonated beverages from 13% to 20% and established a new 10% tax on fruit juices, syrups and squashes. Syrups and squashes, popular in Pakistan, are thick and viscous liquids with high amounts of sugar used to make a drink by adding water.
The rise in obesity and NCDs in Pakistan has become a significant public health challenge. Pakistan has the 3rd highest number of people living with diabetes globally, increasing from 6.3 million in 2011 to 33 million in 2021. If no immediate policy action was taken, this number was set to increase to 62 million by 2045. This is having an enormous impact on the country’s public health expenditures, as the annual cost of managing diabetes increased to more than $2.6 billion USD in 2021.
PANAH led an advocacy campaign and implemented various activities to increase support for the SSB tax, including building a coalition, engaging media, conducting rallies, writing joint letters to the Prime Minister, Finance Minister, Chairman Federal Board of Revenue and several policy makers and holding a blog competition to highlight the harms of the industry and the need for the tax. The coalition partners, including PANAH, Diabetic Association of Pakistan, International Diabetes Federation, National Commission on the Rights of Children, Ministry of National Health Services, Regulations and Coordination and Federal Tax Ombudsman, also amplified the voices of credible health professionals and championed parliamentarians to push for the tax. GHAI provided invaluable support to PANAH throughout the campaign, assisting in research dissemination, helping brief high level policy makers and communications support ranging from digital advocacy training to messaging. In addition, GHAI worked with PANAH to help counter the fierce industry opposition.
To create a national conversation on the need for the tax, PANAH educated over 200 journalists about the issue, who wrote more than 1,000 articles. The news stories highlighted public support (78% of Pakistani adults) for increasing taxes on SSBs to reduce obesity and NCDs. The coalition hashtag #TaxSugarDrinksNotFuel trended on Twitter during a critical moment in the advocacy campaign. The coalition partners also published a joint appeal in national newspapers and engaged in high level meetings and technical discussions with key policy makers.
Advocates met significant opposition, as there had already been significant influence exerted by the beverage industry over the policy making process. Several politicians in the Senate standing committee on finance aligned with beverage industry interests by recommending halving the Federal Excise Duty (FED) on juices. Unexpectedly, diplomatic channels were used by the beverage industry to pressure the government, including from the commercial consulate of the United States Embassy in Pakistan.
Despite this, PANAH and its coalition partners secured a key victory in the fight to combat diet-related NCDs. While this was an important step, there is a need for improvement in the tax rates to cover all SSB categories. There may be opportunities with the 2023-24 finance bill, set to be presented and voted in the parliament in June 2023, and followed by a health contribution bill that earmarks SSB tax revenue toward health programs. The coalition partners will continue to counter industry opposition and strengthen and expand their partnerships to include more champions. GHAI will continue to support PANAH in their effort to amplify the voices of the youth, health professionals, parliamentarians, economic experts, religious leaders and civil society through earned and digital media to secure a healthier future for all Pakistanis.