Journal of public health policy
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The Commission on Social Determinants of Health recognized the important role of health services as a determinant of health. While asserting that health was not a tradable commodity but rather a right, the Commission missed an opportunity to address how such a concept might remove a health care system from market forces. ⋯ While the Commission was appropriately sceptical of privileging efficiency as a principle for prioritization, it missed an opportunity to address how equity concerns can be incorporated into resources allocation decision making. A social justice orientation to the delivery of health care could serve as an important catalyst for equity-oriented health service change but the process is more complicated and political than that outlined in the Commission's report.
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J Public Health Policy · Jul 2009
The tobacco excise system in Indonesia: hindering effective tobacco control for health.
Comprehensive tobacco control policies include high taxes. This paper describes the tobacco excise structure in Indonesia from 2007 to 2009. The design of the tobacco excise system contributes to neutralizing the effect of a tax increase on consumption. ⋯ Firms can reduce their prices at point of sale and absorb the tax increase instead of passing it onto consumers. Tiered tax rates by production scale allow firms to evade paying the highest tax brackets legally, thereby increasing profit margins while reducing prices at point of sale. Increases in tobacco excise rates in Indonesia may not have a large health impact under the current system of tax administration.
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J Public Health Policy · Apr 2009
Comparative Study Controlled Clinical TrialRestricting the retail supply of tobacco to minors.
To examine the impact of enforcement of age-restricted tobacco sales on adolescent tobacco purchasing and smoking, we compared the Central Coast intervention area to the rest of New South Wales (NSW) and Australia. We collected data on students in school years 7-12 from triennial health surveys at baseline in 1993 through 2002. Attempts by minors to purchase tobacco in the intervention area declined by 73.6 per cent between 1993 and 2002. ⋯ Between 1993 and 2002, the prevalence of current smoking in the intervention area was reduced by half. Effective enforcement of an age-restricted tobacco sales law was accompanied by a substantial reduction in attempted purchases of tobacco and of smoking by youth. The long-term follow-up in this study allows us to observe that the impact of the intervention was not only sustained but also increased with time.
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J Public Health Policy · Dec 2008
Tobacco farmers and tobacco manufacturers: implications for tobacco control in tobacco-growing developing countries.
Assisting tobacco farmers to transition to non-tobacco alternatives is a key element of comprehensive tobacco control's end-game strategy and specifically required by the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC). We examine the historical relationship between tobacco manufacturers and tobacco farmers in the United States, where the duration of the relationship has been longest and use information obtained to inform possible end-game strategies for tobacco control advocates working with tobacco farmers in developing countries. ⋯ Findings support WHO FCTC articles aimed at helping developing country tobacco farmers adversely affected by tobacco control efforts and highlight difficulties in discouraging tobacco cultivation as long as it remains relatively profitable. We conclude that successful end-game strategies should take a long-term approach aimed at building alliances with tobacco farmers and at creating mechanisms for tobacco farmer investment in local infrastructure.