Correspondence
increase in carbon taxes in response Governments must establish tangible
to a strong popular reaction from so-
called yellow vest protesters.
The Lancet Taskforce on non-
communicable diseases (NCDs)
and economics provided evidence
supporting the use of fiscal policies
Vincent Kessler/Reuters
to address NCDs, which challenges
the view that taxes on unhealthy
consumption are inequitable.1,2 Health
benefits of environmental taxes,
similar to taxes on tobacco, alcohol,
unhealthy foods, and non-alcoholic
beverages, often benefit individuals
whose consumption is reduced, and
generally benefit poor people the
most. Environmental and health taxes
are backed by a solid economic, public
health, and social justice rationale,
but governments can no longer
afford to be naive about their use.
Thomas Piketty,3 from the Paris School
of Economics in Paris, France, exposed
the French Government’s fundamental
mistake of increasing fuel taxes
following a substantial drop in wealth
taxes while concerns rise about social
inequality.
One way forward is for governments
to establish a stronger link between
taxes and the purpose they serve, and
there is no better way of achieving
this than directing the revenues
generated towards the same purpose.
This process, known as earmarking,
has a crucial role in making taxes
acceptable to the public and has the
potential to make taxes an even more
powerful tool for promoting health.4
Additionally, health policy makers
must realise that there is more to
fiscal policies than excise taxes, and
they should explore a much broader
spectrum of fiscal and price regulation
policies. For example, policy makers
should direct more attention to
incentivising healthy consumption,
rather than simply attempting to
target unhealthy products. Another
important way forward is to mitigate
any regressive financial impacts by
enhancing the progressive nature
of a country’s fiscal system, chiefly
through income and wealth taxes.
746
compensatory measures to ensure
new policies are not to the detriment
of fiscal justice.
The case for using fiscal and pricing
policies designed to improve health
is strong, and the evidence base
is growing. 5 Many governments
have been able to overcome strong
opposition to these measures from
industry, but they will need to sharpen
their fiscal policy tools to avoid
disenfranchising taxpayers, whose
support they need the most.
I declare no competing interests.
Franco Sassi
f.sassi@imperial.ac.uk
Centre for Health Economics and Policy Innovation,
Imperial College London, London SW7 2AZ, UK
1 Nugent R, Bertram MY, Jan S, et al. Investing in
non-communicable disease prevention and
management to advance the Sustainable
Development Goals. Lancet 2018;
391: 2029–35.
2 Sassi F, Belloni A, Mirelman AJ, et al.
Equity impacts of price policies to promote
healthy behaviours. Lancet 2018; 391: 2059–70.
3 Piketty T. Gilets jaunes et justice fiscale.
Dec 11, 2018. http://piketty.blog.lemonde.
fr/2018/12/11/gilets-jaunes-et-justice-fiscale/
(accessed Jan 24, 2019).
4 Cashin C, Sparkes S, Bloom D. Earmarking for
health. From theory to practice. Geneva:
World Health Organization, 2017.
5 Pimpin L, Sassi F, Corbould E, Friebel R,
Webber L. Fiscal and pricing policies to
improve public health: a review of the
evidence. 2018. https://assets.publishing.
service.gov.uk/government/uploads/system/
uploads/attachment_data/file/743118/Fiscal_
and_Pricing_Policies_report_FINAL.pdf
(accessed Jan 24, 2019).
www.thelancet.com Vol 393 February 23, 2019
Department of Error
Schadendorf D, van Akkooi ACJ, Berking C, et al.
Melanoma. Lancet 2018; 392: 971–84—In this
Seminar, figure 2 incorrectly contained only
male incidence trends in both the panel for
men (left) and women (right). The data in the
right-hand panel (women) have been replaced
with the incidence trends for women.
This correction has been made to the online
version as of Feb 21, 2019.
Garas G, Cingolani I, Panzarasa P, Darzi A,
Athanasiou T. Beyond IDEAL: the importance of
surgical innovation metrics. Lancet 2019;
393: 315—In this Correspondence,
the affiliations should read “Department of
Surgery and Cancer, St Mary’s Hospital
(GG, AD, TA), and Centre for Health Policy (IC),
Imperial College London, London W2 1NY, UK;
and School of Business and Management,
Queen Mary University of London, London, UK
(PP)”. This correction has been made as of
Feb 21, 2019.
Betron M, Bourgeault I, Manzoor M, et al.
Time for gender-transformative change in the
health workforce. Lancet 2019; 393: e25–26—
In this Correspondence, reference 6 has been
corrected. This correction has been made to
the online version as of Feb 21, 2019.
Swinburn BA, Kraak VI, Allender S, et al. The Global
Syndemic of Obesity, Undernutrition, and Climate
Change: The Lancet Commission report. Lancet
2019; 393: 791–846—In this Commission,
the affiliations for Bagher Larijani and Ali Tootee
should read “Endocrinology and Metabolism
Research Center (Prof B Larijani MD), Diabetes
Research Center (A Tootee MD), Tehran
University of Medical Sciences, Tehran, Iran”,
and in the sixth paragraph of the “Five sets of
feedback loops” subsection, the final sentence
should have read “Eventually, a degraded
natural environment will have a negative
feedback on businesses and consumers, but this
is often a delayed effect on health (shown by
the parallel lines across the arrow in figure 2C)
that will be felt by future generations of land
and business.” These corrections have been
made to the online version as of Feb 21, 2019,
and the printed version is correct.