BACKGROUND: Zambia is facing a growing burden of non-communicable diseases (NCDs), necessitating policies targeting risk factors such as alcohol, tobacco, and sugar-sweetened beverages (SSBs). Health taxes on these products can reduce consumption and improve public health outcomes. This study examines Zambia’s health tax policy, focusing on tobacco, alcohol, and SSBs, using a case study approach and the Policy Analysis Triangle Framework to explore political, economic, and social barriers to effective implementation, alongside the role of evidence in shaping these policies.
METHODS: Data were collected through document reviews of government priorities, public health policies, and parliamentary reports, complemented by semi-structured interviews with stakeholders from government, business, and civil society. Thematic analysis was applied to interview data, while document analysis combined keyword frequency analysis and qualitative content review.
RESULTS: The study finds that Zambia’s policies align with some international best practices, such as including e-cigarettes in the tax framework. However, tax exemptions for locally produced cigarettes and differentiated alcohol tax rates raise equity concerns and may undermine health goals. Despite a growing focus on health in national development plans, tobacco, alcohol, and SSBs receive limited attention in public health policies, with economic considerations often outweighing health concerns.
Political will and leadership have facilitated health tax reforms, such as the adoption of the SSB tax. However, industry influence, policy incoherence, and the framing of health taxes as punitive hinder their full implementation. Evidence use in policy decisions is limited, relying more on international data than local evidence, further misaligning policies. Effective stakeholder engagement and clearer communication of local evidence are essential for improving policy outcomes.
CONCLUSIONS: This study offers recommendations to enhance cross-ministerial coordination, counter industry interference, and promote evidence-based policymaking for more effective health tax policies.