The recent government decision to impose higher taxes on beers and cigarettes sparked public debate. People have expressed different opinions while others questioned the motives behind the taxes. Much attention, and in fact, the rationale for these taxes, has been on tax revenue to support the achievement of NST 2 objectives. As a public health professional, my concern has been the potential public health implications of these tax changes, particularly taxes on alcoholic beverages, particularly beers, and cigarettes. Smoking and alcohol consumption have several detrimental effects. Alcohol consumption is associated with increased rates of domestic violence, suicide, crime, road traffic injuries and fatalities, while smoking is linked to various respiratory diseases and cancers. From a public health perspective, all cigarettes are equally harmful and there’s no level of alcohol that is considered safe for our health. According to the World Health Organization (WHO), smokers are up to 22 times more likely to develop lung cancer than non-smokers. Unfortunately, smoking also harms non-smokers by exposing them to second-hand smokes, which increases their risk of chronic respiratory diseases and lung cancer. People who use both alcohol and tobacco have a five times higher risk of developing oral, throat, larynx, and oesophageal cancers than those using either alone. For heavy drinkers and smokers, the risk is up to 30 times higher. In 2019, tobacco smoking accounted for 7.7 million deaths, globally, while the harmful use of alcohol claimed 2.6 million lives. It is estimated that 6% and 5.16% of all deaths in Rwanda are linked to alcohol consumption and smoking, respectively. Taxes have been proven to be one of the most effective strategies for reducing tobacco use and alcohol consumption, and the harms associated with their use. Countries that have implemented measures to control the use of alcohol and cigarette use have seen significant improvements in public health outcomes, reduced healthcare costs, and increased government revenue. Rationale for high alcohol and cigarette taxes in Rwanda Tobacco and alcohol, along with sugar-sweetened beverages, are key lifestyle risk factors for non-communicable diseases (NCDs), such as heart diseases, stroke, cancer, diabetes, hypertension, and chronic respiratory diseases. While NCDs were once considered as issues of developed countries, they are now a growing concern in low- and middle-income countries (LMICs), including Rwanda. In fact, more than three-quarters of all NCD deaths occur in LMICs. By imposing higher taxes on health-harming products such as alcohol and tobacco, Rwanda aligns its health policies with global health recommendations from the WHO, which consistently advocates for higher taxes on these products as a cost-effective way to reduce NCDs. This move will not only discourage consumption of alcohol and tobacco but will also generate additional revenues, which can be reinvested into the country’s healthcare systems. Expanding taxation to other unhealthy products? With the increasing burden of NCDs, many countries are implementing various strategies to mitigate their associated risk factors. One of these strategies is imposing higher taxes on products that are perceived unhealthy, such as applied to sugar-sweetened beverages, and foods high in added sugars, salt, and saturated fats. Given this global trend, it would not be surprising if Rwanda considers extending tax policies to include such products that pause significant health risks. However, expanding taxation on such products would require careful deliberation, including consultations with relevant stakeholders, to ensure that the desired tax revenue is generated while maximizing the public health benefits. Ultimately, taxation should not be viewed solely as a means to increase government revenue but as a powerful tool for safeguarding public health. The writer is a Lecturer at the University of Rwanda and a Fellow of the African Food Fellowship.
