Conflicting interests, institutional fragmentation and opportunity structures

Pakistan is the world’s fifth most populous country, with large segments of its population at risk from non-communicable diseases caused by consumption of harmful products, including tobacco and sugar-sweetened beverages. Even though evidence exists that increased taxes on harmful products leads to consumption reductions as well as increased revenues, Pakistan’s health taxes remain low. We seek to understand the reasons for the deficient health tax regime. Much of the existing literature emphasises industry tactics, resources and motivations. We take a different approach and instead focus on political institutions in Pakistan which could help explain deficiencies in the health taxes regime. We employed a mixed method design. We conducted: (1) a detailed analysis of media content, (2) semistructured interviews with key stakeholders (and attended relevant meetings) and (3) an analysis of primary and secondary literature, including legal and policy documents. We identify two key aspects of Pakistan’s political institutions which may help explain deficiencies in health taxes. First, we identified structural issues in the design and functioning of key institutions responsible for health taxes, including with respect to federalism, intraelite conflict, interagency coordination and intra-agency fragmentation. Second, we found evidence of an entrenchment of industry interests within governmental institutions, which are characterised by weak frameworks for regulating conflicts of interest. We conclude that gaps and conflict within political institutions, owing to weak design, instability and fragmentation, create political opportunity for industry actors to influence the system to advance their interests. The findings of this research indicate towards needed interventions

Economics · Political economy · Political science · Politics · Public economics · Global Economic and Social Development · Global Public Health Policies and Epidemiology · International Development and Aid · Law · Public Administration

• Framing health taxes

  Open Access•Kaung Suu Lwin, Adam D Koon et al.•BMJ Global Health•2023

  Añadir item

• Sugar, power and policy

  Open Access•Lana Elliott, Gade Waqa et al.•Globalization and Health•2025

  Añadir item

• The Architecture of Government

  Open Access•Daniel Treisman•The Architecture of Government•2007

  Añadir item

• Policy lessons from health taxes

  Open Access•Alexandra Wright, Katherine E Smith et al.•BMC Public Health•2017

  Añadir item

• Why Nations Fail

  Daron Acemoglu, James A Robinson•Asean Economic Bulletin•2012

  Añadir item

• The Oxford Handbook of Political Institutions

  Sarah A Binder, Rod A W Rhodes et al.•The Oxford Handbook of Political…•2008

  Añadir item

• Anti-corruption, transparency and accountability in health

  Open Access•Taryn Vian•Global Health Action•2020

  Añadir item

• Estimating the price elasticity for cigarette and chewed tobacco in Pakistan

  Durr-e- Nayab, Durre Nayab et al.•Tobacco Control•2020

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