Course introduction for HPF Hub e-Learning

1. Limited budgets for health promotion and tobacco control, particularly in low- and middle-income countries
In most low and middle-income countries, a health promotion budget is a very low priority. External sources of funding are limited and insufficient to address NCD prevention and control. Many of these countries rely on irregular and unbalanced distribution of donor funds that support programmes or projects that may not always meet the need or priority of the recipient country. 

Despite the recognized benefit of promoting health and the need to reduce NCD risk factors such as tobacco and alcohol use, health promotion and tobacco control programmes are often low on the list of national priorities. Consequently, health promotion and tobacco control receive little to no funding through regular channels, having to compete with other health budget distributions for treatment of diseases at the country level. In most cases, the existing budget is predominantly for health care services with very little allocated to health promotion activities. 

2. To diminish health, social and economic costs from non-communicable diseases
Governments and their people are facing unsustainable health, social and economic costs caused by the increasing incidence of mortality and morbidity of NCDs. National accounts are already burdened by enormous health care budgets, which need to be offset by developing integrated systems for preventative and holistic health care.

Tobacco control programmes do reduce health care costs as can other effective health campaigns. A health promotion fund is an effective budget and administrative mechanism for governments to work on reducing the cost of curative care and the individual and social burdens of chronic diseases.

3. Securing long-term investment for improving health
Secure funding is needed to develop innovative long-term strategies across all levels and sectors within a society to support the desired policy, environmental and individual behavior changes. A health promotion fund is also a resource that is available for rapid response in the event of unanticipated health risks emerging in communities.

4. To supplement health insurance or universal health care policy
Presently, many countries are adopting universal health insurance or universal health care coverage as a means for improving public health. This will greatly increase a government’s health care expenditure as it absorbs the costs previously shouldered by individuals.

Health promotion is a vital component of universal health coverage policy. The Thai Parliament enacted the Thailand Health Promotion Foundation Act in 2001 and the National Health Security Act in 2002 based on this rationale. In 2012, ThaiHealth’s budget from 2% of tobacco and alcohol products surcharge taxes was about 1% of the total national health budget. Despite the national health budget increased between 7% and 10% annually, the ThaiHealth budget is very important to be used in supporting health promotion programmes.

5. Funding a range of health-related initiatives
Stable funding generated from dedicated tax revenues enables implementation of short- and long- term health promotion projects, including research and sports/recreation activities.

6. Making the polluter pay
Adopting the “polluter pays” principle means holding the manufacturers of harmful products – like tobacco companies – responsible for the harm they inflict. The social, economic, and health costs of the consumption of harmful products is shifted to the entity producing and marketing the products. A portion of the funds collected from the polluter can then be allocated to programmes that support individuals to quit these harmful products (e.g. smoking cessation programmes).

Governments would suffer no fiscal losses or reduction in revenue (assuming implementation of  a surcharge tax). But over time, the gains from health care cost savings would be significant.

7. International obligations: WHO FCTC/UN Declaration/SDGs
In line with the recommendations of Article 6 of the WHO Framework Convention on Tobacco Control (WHO FCTC), “Price and tax measures to reduce demand for tobacco”, and its guidelines for implementation, which recommend that countries dedicate revenue to fund tobacco control and other health promotion activities. Article 26 of the WHO FCTC requires all Parties to secure and provide financial support for the implementation of various tobacco control programmes and activities to meet the objectives of the Convention. 

Both price and tax measures on tobacco are recognised as an effective and important means to reduce tobacco consumption and health-care costs, and represent a revenue stream for financing for development in many countries, according to Declaration of the United Nations 3rd International Conference on Financing for Development, Addis Ababa in July 2015. Tobacco excise taxes have also been identified as a revenue stream for financing the post-2015 Sustainable Development Goals (SDGs). The SDGs determined by the United Nations acknowledged the primacy of health promotion in the implementation of health programmes as specified in its Goal 3. Ensure healthy lives and promote well-being for all at all ages. 

In addition to that, Political Declaration of the High-level Meeting of the UN General Assembly on the Prevention and Control of NCDs also stresses the provision of identifying and mobilizing adequate, predictable and sustained financial resources and the necessary human and technical resources, and to consider support for voluntary, cost-effective, innovative approaches for a long term financing of non-communicable disease prevention and control, taking into account the Millennium Development Goals.