Fiscal policies and regulations for healthy diets in Sri Lanka: an analysis of the political economy of taxation and traffic light labelling for sugar-sweetened beverages

ABSTRACT

Background

Unhealthy dietary patterns significantly contribute to rising non-communicable diseases (NCDs) in Sri Lanka. The government has implemented policy measures to promote healthy dietary patterns, including the traffic light labelling (TLL) system for sugar-sweetened beverages (SSBs) in 2016 and taxation on SSBs in 2017.

Objectives

To analyse how ideas, institutions, and power dynamics influence the formulation and implementation of these two interventions, and to identify strategies for public health actors to advocate for more effective food environment policies in Sri Lanka.

Methods

This study drew on Kingdon’s theory of agenda-setting and Campbell’s institutionalist approach to develop the theoretical framework. We examined the political economy at the policy development and implementation stages, adopting a deductive framework approach for data collection and analysis. Data were collected from documents and key informants.

Results

NCDs and nutrition are recognised and framed as important policy issues in health-sector policy documents, and the SSB tax and TLL system are seen as means of improving diets and health. Sri Lanka’s commitment to addressing NCDs and nutrition-related issues is evident through these policies. The Ministry of Health led policy development, and key stakeholders were involved. However, there are opportunities to learn and strengthen policy in Sri Lanka and elsewhere. Limited involvement and commitment of some stakeholders in developing national policies, industry interferences, and other gaps resulted in weaker policy design. Gender considerations were also given minimal attention in policy formulation and implementation.

Conclusions

To enhance the effectiveness of the policies and regulations to promote healthy diets in Sri Lanka, comprehensive policy coverage, multistakeholder involvement and commitment to national policies, balanced power dynamics, technical feasibility, government commitment backed with high-level political support, awareness, and knowledge creation, managing industry interferences, integrating gender considerations are crucial factors.

KEYWORDS:

• Public health
• NCD prevention
• nutrition
• SSB tax
• TLL system

Responsible Editor Stig Wall

Responsible Editor Stig Wall

Acknowledgment

The authors acknowledge the International Development Research Centre for their funding support for this study. The authors also acknowledge the key informants who participated in the study. Additionally, they are grateful for the support received from government officials in locating policy documents. Special thanks go to Priyanka Jayawardena and Ashani Abayasekara for their contributions to the initial conceptualisation of this study.

Author contributions

The study was conceptualised by SM and NA. SM, KK, AMT, and NA contributed to the literature search and research design. AMT, SM and NA designed the theoretical framework and methodology. SM constructed the key interview guide with the inputs of AMT. Data were collected and analysed by SM and KK. SM led the drafting of the manuscript with substantial inputs from AMT, and other authors reviewed and provided inputs. All authors have read and approved the final draft.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Ethical clearance for the study was obtained from the Ethics Review Committee of the Sri Lanka Medical Research Institute (Project No. 07/2021).

Paper context

We examined the political economy of taxation and traffic light labelling for sugar-sweetened beverages in Sri Lanka. Despite stakeholder involvement in these cases, their engagement and commitment were limited in broader national policy development. Industry’s interference and other policy gaps resulted in weaker policy designs. Gender considerations were also overlooked. For effective fiscal policies promoting healthy diets in Sri Lanka, ensuring comprehensive policy coverage and government commitment, involving stakeholders, maintaining technical integrity, addressing industry interference and considering gender considerations are crucial.

Additional information

Funding

This work was conducted with support from the International Development Research Centre, under grant number [109265-001]. The views expressed do not necessarily represent those of IDRC or its Board of Governors.