Africa faces twin crises today – fiscal and health. Global funding cuts threaten programs that save millions of lives. Healthcare systems battle infectious diseases while non-communicable diseases rise. Half of Africans lack access to essential health services. Out-of-pocket spending pushes more than 150 million Africans into or deeper into poverty. Part of the solution is in plain sight. Tax four products—tobacco, alcohol, sugar-sweetened beverages (SSBs), and junk food. This delivers three wins: more revenue, better health, and lower healthcare costs.
More than 3.3 billion people live in countries that spend more on interest payments than on healthcare or education. Tax revenues average just 16% of GDP in Africa, less than half the 34% in high-income nations. This gap undermines sovereignty and development. Although debt relief and broader fiscal reforms are essential, we cannot count on or wait for international action. Health taxes offer an immediate, practical step forward. Although they cannot fully close budget gaps, these taxes can make a substantial contribution to financial stability and health.

The African Evidence Base
Rwanda used tobacco taxes to cut smoking rates from 13% to 7% since 2014. This prevented thousands of tobacco-related deaths while generating reliable revenue. Other African nations have seen similar success:
• South Africa’s sugar-sweetened beverage tax reduced consumption by 24% among young children, potentially averting thousands of diabetes cases and saving millions in treatment costs.
• Kenya’s alcohol taxes collected 51 billion Kenyan shillings (approximately $400 million) in 2023, funding critical public services while reducing consumption-related harms.
• Ghana’s earmarked health taxes fund the National Health Insurance Scheme, expanding healthcare access to vulnerable populations.

Raising taxes on these products to increase prices by 50% would generate $3.7 trillion globally over five years—including $2.1 trillion in low- and middle-income countries, and would save approximately 50 million lives over 50 years. Of these health benefits, nearly 90% would be in low- and middle-income countries. For Africa, in one estimate, just some of these taxes could provide more than $40 billion in annual revenues, enough to double public spending on health and provide core essential medicines to patients without copayments.

Every $1 raised through tobacco taxes cuts healthcare costs by at least that much, doubling the economic benefit of these life-saving taxes. Alcohol, sugary drink, and junk food taxes have similar effects.

Implementation Matters

Tax structure determines impact. We must:
• Use specific taxes (per stick for tobacco, per gram of alcohol, per ounce for SSBs) and not only percentage-based (ad valorem). Levying only percentage-based taxes encourages consumption of cheaper, higher-volume products and limits the health benefits.
• Set at rates high enough to reduce consumption while raising revenue—aiming for price increases of at least 50%.
• Adjust regularly for inflation.
• Protect from industry interference.
• Use tax stamps and other measures to reduce illicit trade.
Junk food taxes are the newest component of this four-product approach. Chile’s black octagonal warning labels on high-sugar, high-sodium, and high-fat products reduced purchases of unhealthy items by 25-33%. Peru’s similar approach led companies to reformulate and make healthier food products. Colombia links taxes to warning labels: products with one or more warning labels face higher taxation. This approach provides clear guidance to consumers and creates strong incentives for industry to produce healthier foods.

The Equity Reality

Critics claim that health taxes hurt the poor. The evidence shows the opposite. Low-income households suffer most from tobacco-related illnesses, alcohol abuse, and diet-related diseases. When prices rise, these communities reduce consumption most, gaining the greatest health benefits.

When tax revenues fund universal healthcare or targeted social programs—as in Ghana, where tobacco taxes finance health insurance for the poorest citizens—the policy becomes doubly progressive.

Africa’s Path Forward

Health taxes are a path to Africa’s economic independence. These taxes correct market failures, save lives, reduce healthcare costs, and generate revenue.

Commercial interests that sell these harmful products will oppose taxation. But Africa’s health and economic sovereignty cannot be sacrificed for the profits of these industries. These four taxes benefit economies–and every other industry–through higher productivity from healthier workers, reduced healthcare expenses, and increased disposable income redirected from harmful products.

All African governments must implement these four taxes now. The evidence supports them. Our economies need them. And our people’s health depends on them.

Four for three. Four taxes for three wins: more revenue, better health, lower costs.

About the Authors:

Isaac Mwaipopo heads the Centre for Trade Policy and Development in Zambia, guiding trade policies, public finance, extractives, and legislative reviews. His extensive experience ensures the organization remains a key resource for developments in these areas.

Professor Fastone Goma is a distinguished heart specialist and Executive Director of the Centre for Primary Care and Research in Zambia. He drives national efforts to curb preventable deaths from non-communicable diseases (NCDs), with a strong focus on tobacco control. As Chair of the NCD Alliance in Zambia, he plays a key role in shaping health policy, advancing evidence-based strategies, and strengthening resilient health systems.