Introduction Noncommunicable diseases (NCDs), including cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, have become a critical global health challenge. In 2021, these accounted for approximately 43 million mortalities, representing nearly 75% of all non-pandemic-related deaths. The economic consequences are equally severe, with a cumulative global cost expected to reach $47 trillion by 2030, resulting from lost productivity, increased healthcare expenditure, and premature mortality. The growing burden of NCDs is particularly acute and requires urgent solutions in Asia and the Pacific, as rapid urbanization and increasing consumption of health-harming products accelerate its risk factors and prevalence. Persistent exposure to modifiable and preventable risk factors, such as alcohol, tobacco, and sugary drinks, drives up the number of cases. Health systems that remain under-resourced, inequitable, and inaccessible exacerbate these problems. Such systems are also often underfunded due to limited fiscal space and lack of effort and commitment to scale up health care that supports chronic and long-term health conditions. As a result, there is an urgent need for sustainable and innovative policy interventions that can address both epidemiological risk factors and financing dimensions to tackle the NCD crisis. This policy brief proposes ways to support the implementation of health taxes grounded on the principles of economics and the goal of universal health coverage. Health taxes contribute to reducing morbidity and mortality, and progress toward achieving sustainable development through domestic resource mobilization. It draws upon insights from the webinar Transforming Public Health Through Strategic Taxation organized by the Asian Development Bank (ADB), in collaboration with the Asia Pacific Tax Hub and the Center for Global Development (CGD). Context The persistence of negative but modifiable behavioral risk factors remains a defining component of the global and regional NCD landscape, with alcohol, tobacco, and sugar-sweetened beverages leading to preventable mortalities and long-term health impacts. Tobacco and alcohol consumption are strongly associated with increased cardiovascular and lung diseases, liver injuries, and cancers, that cause over 10.6 million premature mortalities. Meanwhile, excessive intake of sugar-sweetened beverages is accelerating the rise in obesity and diabetes. In 2022, about 16% of adults aged 18 and older worldwide were classified as obese, with global prevalence of obesity more than doubling between 1990 and 2022. In the Pacific Island countries, 15%–24% of the total adult population has diabetes, the highest globally. Health taxes, including excise taxes on alcohol, tobacco, and sugar-sweetened beverages, provide compelling evidence-based policy solutions that can serve both revenue and health objectives. These fiscal measures can decrease the consumption of harmful products, while also generating domestic income that can be reinvested into health systems. Policy Design Overview of the Task Force on Fiscal Policy targeting health In 2018, the Global Task Force on Fiscal Policy for Health convened health, financing, and development partners to confront the growing dual challenges of constrained public finances and the rising burden of noncommunicable diseases through health taxes. As illustrated in its 2019 report, a 50% increase in these excise taxes on alcohol, tobacco, and sugar-sweetened beverages would lead to an infusion of approximately $20 trillion in domestic revenue and avert more than 50 million premature mortalities in the next 50 years (27.2 million, 21.9 million, and 2.2 million from tobacco, alcohol, and sugar-sweetened beverages taxes, respectively). The design Successful implementation of health taxation policies includes the adoption of a clearly defined and product-specific excise tax framework that entails the following: Sugar-sweetened beverages: Taxed based on sugar content per liter. Evidence suggests that content-based taxation has effectively reduced the production of high-sugar products, compelling manufacturers to lower the sugar content in their offerings. Alcohol: Taxed according to alcohol content per liter. This method offers clarity and simplifies rate adjustments. Tobacco: Taxed by the number of sticks or boxes. The tobacco excise tax has been shown to significantly diminish smoking prevalence, while generating substantial revenue for the government. A crucial aspect of the design is the need for annual tax adjustments—taking into account population growth, income growth, and inflation—depending on the country context, to ensure that the price remains high enough to decrease consumption. Limitation Despite the instruments' proven efficacy, challenges persist when it comes to adjusting taxes and interrupting national revenue generation. Some of the most common barriers include competing priorities, strong industry resistance, concerns about tax evasion/smuggling, and concerns of disproportionately impacting low-income populations. Policy Implementation and Outcomes The implementation of health taxes requires coordination and collaboration across different government agencies to ensure alignment and coherence across all sectors, particularly the Ministry of Finance (tax administration and design) and the Ministry of Health (advocating for health and evidence). Several countries in Asia and the Pacific have successfully implemented health tax strategies to improve public health and achieve health-financing goals. Case Study: the Philippines The 2012 Sin Tax reform in the Philippines marked a landmark policy shift by introducing a unitary excise tax with scheduled increases annually on tobacco and alcohol products. The reform was framed as a health policy reform rather than revenue generation. It adopted a strong intergovernmental approach, with active collaboration from the Ministry of Finance and Department of Health. The reform received tremendous support from both the public and government agencies. Between 2012 and 2018, prices of tobacco products increased by 113%, which led to a 30% plunge in smoking prevalence among adults and a 10%–18% drop among young adolescents in 2009–2021. This tax scheme also tripled tax revenues, reaching almost $3 billion in 2022. Despite these gains, the percentage share of health taxes remains limited, and the tobacco products are still relatively affordable due to the stagnant annual tax adjustment. The initial plan to adjust the tax every year according to inflation and population growth has not been applied, leading to limitations in deterring consumption. This emphasizes the importance of adjusting health tax rates in response to inflation, so the real value of the tax is maintained at the appropriate level.[1] Case Study: Thailand Thailand’s sugar-sweetened beverages tax, reformed in 2017 by the Ministry of Health, Ministry of Finance, and Thailand Health Promotion Foundation, represents another benchmark. It introduced a tiered-tax approach, where specific tax rates on sugar content and ad valorem (based on value) taxes were applied. The new ad valorem tax was reduced from 20% to a range of 0%–14% based on the type of beverage (e.g., 10% for fruit-related drinks). An additional specific tax rate was also used to adjust for sugar content, where beverages with more than 6 grams of sugar per 100 milliliters are taxed at higher rates than those with lower sugar content. During the first phase of implementation, average sugar content in beverages significantly dropped from 16.7g to 10.6g per 100ml. However, concerns have been raised regarding the impact of this tax on low-income populations. This situation emphasizes the need for clear and strategic communication to ensure transparency in monitoring and evaluation. Recommendations Five main areas can be strengthened to better address the challenges in health tax financing and to ensure its resilience against barriers to successful implementation. Adopt a comprehensive government approach toward tobacco control and taxation. This extends beyond coordination as it aligns institutional mandates and policy objectives. Establishing a robust interministerial collaboration is essential to ensure coherence, consistency, and sustainability. A unified national agenda helps streamline implementation, fosters accountability, and amplifies both public health outcomes and revenue generation. Maintain high standards in tax design. Policymakers can set a baseline level for the initial health tax standard, grounded on international best practices and guidelines. Also, tax has to be applied across similar products to prevent substitution. By harmonizing excise taxes across cigarettes, e-cigarettes, smokeless tobacco, and sugar-sweetened beverages, governments can enhance revenue generation and minimize unintended behavioral shifts. Adopt a transparent and evidence-based communication strategy. Effective communication for health tax reform must combine clear, concise, and consistent messaging with credible evidence of public health benefits. Health taxes may need to be reframed as a public health reform rather than financial reform. Communication efforts can focus on how the community will benefit from such reform to foster rapport, understanding, and support from the general population. A two-way participatory approach can strengthen transparency and trust. Leverage international partner support: Engage technical and financing support from international institutions, such as ADB, to assist in bridging gaps and sharing lessons learned and best practices. Invest in data collection for monitoring and evaluation: Robust data collection systems can provide real-time feedback on the health tax system's effectiveness and help ensure its relevance, effectiveness, and efficiency. Note: Findings in this Policy Brief were based on Transforming Public Health through Strategic Taxation jointly organized by Asian Development Bank Public Sector Management and Governance Sector Office (PSMG) and Human and Social Development Sector Office (HSD Health). This article is part of ADB Knowledge and Support Technical Assistance (56072-001) to mitigate impacts of noncommunicable diseases, with support from ADB Public Health Consultant Polin Ly Dy. [1] ADB. 2023. Excise Tax Policy and Cigarette Use in High-Burden Asian Countries. Resources C. Lane. Meeting Health Challenges in Developing Asia with Corrective Taxes on Alcohol, Tobacco, and Unhealthy Foods. Background paper prepared for the report Asian Development Outlook 2022: Mobilizing Taxes for Development. K. Klemperer and P. Baker. 2024. Health Taxes in the Polycrisis Era. CGD Policy Paper 331. Center for Global Development. M. Ahmed and M. Shafik. 2025. The Case for Health Tax. International Monetary Fund. Task Force on Fiscal Policy for Health. 2019. Health Taxes to Save Lives: Employing Effective Excise Taxes on Tobacco, Alcohol, and Sugary Beverages. Bloomberg Philanthropies. World Health Organization. 2025. Promoting Taxation on Tobacco Products. Ask the Experts Vasoontara Sbirakos Yiengprugsawan Senior Universal Health Coverage Specialist (Service Delivery), Human and Social Development Office, Sector Department 3, Asian Development Bank Vasoontara Sbirakos Yiengprugsawan oversees ADB’s technical assistance on strengthening primary healthcare and management of chronic noncommunicable diseases and mental health. She has held senior health research positions in Australia, a WHO Fellowship with the Asia Pacific Observatory on Health Systems and Policies, and worked in policy and research with a UN Migration Agency in Geneva. She holds a PhD in Epidemiology, Economics and Population Health from Australian National University and MA in International Development from Syracuse University. Follow Vasoontara Sbirakos Yiengprugsawan on Jayati Nigam Health Specialist, Human and Social Development Office, Sector Department 3, Asian Development Bank Jayati focuses on supporting ADB’s efforts to improve health outcomes in Mongolia and the PRC. Prior to ADB, Jayati worked for the World Bank in India where she gained extensive health sector experience in the South Asia region. Jayati is passionate about health equity, maternal and child health, improving health outcomes for the urban poor, and incorporating health in all policies. Follow Jayati Nigam on Sandeep Bhattacharya Senior Public Management Specialist (Tax), Public Sector Management and Governance Sector Office, Sector Department 3, Asian Development Bank Sandeep Bhattacharya has more than 30 years of experience in tax policy and administration, consulting, and academia. Prior to joining ADB, he taught classes in taxation, public economics, statistics, and econometrics, as well as supervised student research at Duke University. He has a PhD in Economics from Georgia State University and has degrees from Duke University (Master of Public Policy), Delhi School of Economics (MA in Economics), and St. Stephen's College, Delhi University (BA Honors in Economics). Leave your question or comment in the section below: View the discussion thread.