Can tax breaks help Thailand take on NCDs?

In the heart of Southeast Asia lies one nation among many that is grappling with the rise of noncommunicable diseases and investing in innovative ideas to tackle them.

Known as the Land of Smiles, Thailand is home to alarmingly high rates of cancer, cardiovascular disease, diabetes, and chronic obstructive pulmonary disease. Collectively these cause 74% of the country’s deaths. Approximately 400,000 people die each year from NCDs in Thailand and over 15% of adult women are obese as well as close to 10% of men. Experts blame high NCD prevalence on a culture of high tobacco and alcohol use, low levels of physical activity, high levels of air pollution, and the consumption of traditional Thai foods — which contain high levels of sugar, salt, and saturated fats.

“The number one [risk factor] is high blood sugar and diabetes. Number two is smoking. Number three is alcohol, and then number four is hypertension. These are all causing NCD morbidity and premature mortality in Thailand,” said Dr. Prakit Vathesatogkit, tobacco control adviser to the Thai government.

This group of diseases is placing a heavy burden on the country’s health systems while also diminishing productivity as more people are unable to work. According to the World Health Organization, NCDs cost the Thai economy 1.6 trillion Thai baht (about $47 billion) annually, equating to 9.7% of the country's gross domestic product.

NCDs are the No. 1 burden on the health system, said Dr. Wannee Nitiyanant, a consultant at the Faculty of Medicine Siriraj Hospital at Mahidol University in Bangkok and president of the Diabetes Association of Thailand. “Another burden on the health care budget is dialysis because we have more patients with kidney disease that require either hemodialysis or peritoneal dialysis,” she said. In Thailand, estimates put the national prevalence of chronic kidney disease as high as 17.5%, whereas the global rate is 13.4%.

Well aware of the strain such diseases are causing, the Thai government has long been working on how to address NCDs. It introduced a sugar tax in 2017, implemented plain packaging for tobacco in 2019, and added surcharges for alcohol and tobacco. Most recently the health system began tracking high blood sugar and high blood pressure as a preventative measure. However, despite these measures, Vathesatogkit warned that the government is still “not invested enough” in prevention. “The Public Health Ministry needs to obtain or be given more budget to control the risk factors,” he said.

A health incentive

One forthcoming initiative could help with that. The public health ministry announced in September plans to explore tax incentives for individuals who volunteer to participate in a nationwide NCD prevention campaign, as well as for those who can maintain good health — although details on how that would be measured are yet to be shared. The initiative aims to educate the public on self-care to reduce the number of patients with NCDs, saving the government money on health expenses. Those savings would then be used to fund the proposed tax breaks, health minister Somsak Thepsutin told local media at the time of the announcement. “We should aggressively campaign so the public will know how to avoid NCDs,” he said.

Prevention is the most cost-effective method of tackling NCDs, Nitiyanant said. “But it's difficult to do,” she said, explaining that it involves both behavior change and taking on the food industry.

Volunteers would disseminate information within their locality on healthy eating and exercise, specifically promoting a diet dubbed: “Eat wisely and don’t get sick.” Using members of the public to lead that campaign is a way the government can save money while also aiming to improve the country’s health.

The idea is in a consultation phase with its viability yet to be tested. Whether it will show significant results is up for debate. Vathesatogkit is unsure but agrees that implementing public policy to deal with NCD risk factors is a priority, “rather than getting more budget for the curative side.”

Alison Cox, policy and advocacy director at NCD Alliance, sees this outcomes-based approach as “a twist” on social impact bonds. “They would be incentivizing the actual deliverers of the service if they have good outcomes and that sounds like a really interesting idea,” she said. “Obviously there's a massive problem with health worker shortages in the world.”

It would, however, require some careful thought around design given there can be quite a long time between a preventative action and a health outcome, she said. Instead, she suggested a focus on quantifiable interventions.

Other methods of prevention

The idea comes as the country's Department of Disease Control collects ideas on how to draft the country's first NCD bill. Additional tax incentives have already been proposed for food and beverage manufacturers which reduce the amount of salt and sugar in their products. These measures are being considered alongside restrictions around the marketing of unhealthy food to children and a potential tax on foods high in sodium.

Over 50 countries, such as Barbados, Saudi Arabia, and the United Kingdom, have similar taxes in place. A report by Bloomberg Philanthropies found that increasing excise taxes on tobacco, alcohol, and sugary beverages by 50% globally could prevent over 50 million premature deaths within 50 years while raising over $20 trillion in additional revenue.

Research from 2024 found that revenue from alcohol and tobacco taxes in Thailand has been effectively used to fund health promotion initiatives, reducing risk factors for NCDs. The Thai Health Promotion Foundation, a public organization working with the government and the private sector, is entirely funded by additional taxes on tobacco and alcohol.

Increased revenue from taxes on unhealthy foods that contribute to NCDs gives governments options to increase spending on health, Cox said. As it stands, funding for NCDs is lacking, she added. “Over the past 30 years of official development assistance for health, only about 2% has gone to NCDs,” she said. In contrast, the industries producing unhealthy commodities, such as cigarettes and sugary drinks, have substantial financial resources to promote and market their products, Cox explained. She called for more data that track investments into NCDs and efforts to better integrate NCD care into universal health coverage plans.

In Thailand, Nitiyanant believes other methods could also be further utilized to tackle NCDs. She suggested investing more in infrastructure, such as sheltered walkways, that would allow people to exercise outside despite the country’s year-round heat, and imposing more regulations on what goes into street food in particular — which many rely on as an affordable source of food. “So many things have to be changed to make people practice what we think is better for health,” she said.

Whether a volunteer NCD prevention army could help with that remains to be seen.

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