State Health Insurance Market Reforms (Routledge International Studies in Health Economics, 2)

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Professor Russell Mannion

Sign in via your Institution. Sign in with your library card. Search within Abstract and Keywords This chapter analyses the political influences that shaped reform of healthcare service provision and financing during four decades of neoliberal capitalist dominance, with its emphasis on individualism, consumerism, competitiveness, and the capitalist market in determining social needs and healthcare priorities. All rights reserved. Sign in to annotate. Delete Cancel Save. Indeed, as health economists have demonstrated, an economic strategy like tobacco taxation has an extremely positive impact on health: first, by markedly bringing down smoking prevalence and intensity; and, second, by generating increased revenues that can be reinvested in public health campaigns and other measures Warner, b ; Townsend, ; Chaloupka and Warner, The present article explored the recent and extensive economisation of global health through a close analysis of one economic strategy — taxation — that has become central to international efforts to curb smoking in developing countries.

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Adopting a genealogical approach, it argued that three developments in particular made it possible for taxation to become so critical to global tobacco control today. The first of these developments was the articulation, by health economists in North America and Europe in the —s, of a body of knowledge that transformed public health thinking about smoking by showing the marked impact of price on the demand for tobacco products. The second development was the problematisation of smoking in the global South from the late s onwards, which made it possible for public health experts to suggest taxation as a solution to curb the tobacco epidemic in developing countries.

The third development was the active promotion of tobacco taxes by World Bank epidemiologists and economists at the turn of the twenty-first century that allowed this strategy to be effectively used in the developing world. As the article also showed, this genealogy does not sit comfortably with the standard story on economics and global health found in the social science literature for example, Thomas and Weber, ; Stuckler et al, ; Rowden, This story reduces the economisation of global health to the structural adjustment policies aimed at stabilisation, liberalisation and privatisation that have been dominant in international development over the past 30 years.

It also argues that these policies, which were the product of the neoliberal counter-revolution in development economics, have been extremely detrimental to health in the global South.

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The genealogy of tobacco taxation presented in this article did not dispute that neo-liberal structural adjustment policies have played a significant and damaging role in international health over the past 30 years. But, it challenged some of the limitations inherent to the standard story about economics and global health. First, it showed that the economisation of global health is not only about the neoliberal critique of development economics and structural adjustment policies but also about health economics, sin taxes and market failures. Second, by stressing how changes in health such as the global South's epidemiological transition have influenced economics and by emphasising the beneficial impact of taxation for health, it also showed that the relation between economics and global health is not necessarily unidirectional and detrimental to the latter.

In doing so, this article contributed to the recent body of work that warns against the inflationary and often unthinking use of neo-liberalism to explain change for example, Ferguson, ; Collier, More broadly perhaps, it calls for researchers to go beyond neoliberal structural adjustment policies and start telling other, different stories about the economisation of global public health. The attraction for these neoliberal policies has recently begun to wane Boseley, ; Elliott, ; Lal, However, see the recent critique by Gerry , who argues that the statistical method used to correlate mass privatisation and higher mortality rates in the ex-Soviet Union is flawed.

Of course, some health economists did advocate market solutions in relation to the production and allocation of health. The work of Michael Cooper and Anthony Culyer, where they argued in favour of using the price mechanism to organise the supply of blood for transfusions and which they carried out in the s with the support of the neoliberal Institute of Economic Affairs, is perhaps the best example Fontaine, I also thank Stefan Collier and Wenzel Geissler for their helpful comments, which substantially improved my argument.

I am also grateful to Hayley MacGregor and Melissa Leach for inviting me to present an earlier version of this article at the Institute of Development Studies, Brighton. This work is licensed under a Creative Commons Attribution 3. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Health economists, tobacco control and international development: On the economisation of global health beyond neoliberal structural adjustment policies. Open Access. First Online: 22 April Introduction Over the past 30 years, economic rationalities have played an increasingly significant role in international efforts to promote health in the developing world Thomas and Weber, ; Brown et al, Over the past 10 years, taxation has become the most important tool in international efforts to curb tobacco consumption in the global South.

As the WHO , p. Similarly, the Framework Convention Alliance — probably the world's largest anti-smoking advocacy group today — argues that: Increasing the price of tobacco products [through taxation] is one of the most effective tobacco control measures available. Tobacco as an economic issue From the s onwards, as smoking was becoming a major public health issue in North America and Europe, some health economists started to apply the questions, concepts and methods that they had developed in relation to health and health care to tobacco Berridge, ; Brandt, This knowledge on tobacco and taxes produced by economists helped to markedly transform the way taxation was perceived by the public health community.

Public health experts had identified taxation as a possible smoking control measure in the s already Fletcher et al, , p. But, until the s, it remained extremely unpopular among the public health community who generally ignored it Scott and Dickert, ; Warner, At best, public health experts considered taxation to be a minor and complementary measure that could be used to support and augment public information and education campaigns, which were the preferred tobacco control strategies at the time WHO, , pp.

The reasons for this perception of taxation were multiple. First, taxation was tainted by its association with economists who were often viewed with suspicion and even hostility by public health activists Fuchs, ; Croxson, Second, most public health experts did not really understand how taxation worked or whether it worked at all, with many believing that price had no impact on addicts for example, Fletcher et al, , p. Third, many in the public health community were uneasy about the regressive nature of tobacco taxes, which meant that they hit the poor the hardest Scott and Dickert, ; Chaloupka et al, The research done by health economists was critical in transforming the perception of taxation among the public health community from a tobacco control policy that was unpopular and ignored to one that has become viewed as the most powerful measure to curb smoking Scott and Dickert, As Kenneth Warner , one of the first economists to work on tobacco taxes, makes clear: There has been a complete change in the way the public health community perceives tobacco taxes ….

The standard story As already alluded to, the usual story about economics and global health equates the economisation of global health with the structural adjustment policies that have been predominant in international development over the past 30 years for example, Whitehead et al, ; Thomas and Weber, ; Maciocco, ; Rowden, ; Schrecker et al, It is also important to note that the fact that tobacco taxes are not related to the neoliberal critique of development economics and its free market agenda does not signify that they are somehow against or outside the market.


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Unlike prohibition or state monopolies, taxation is not an alternative to the market in terms of how to organise the production and exchange of tobacco Thornton, ; Becker, ; cf. Tobacco taxes do not abolish the market by forbidding all production and exchange of tobacco products, as prohibition would do.

Nor do tobacco taxes eliminate the market by allowing one single, state-owned company to control the entire national production, distribution and sale of tobacco products, as a state monopoly would do. Instead, taxation works in combination with the market. Indeed, tobacco taxes assume the existence of a functioning market in tobacco products. But, because of some failures, this market is not working as well as it could. Tobacco taxes are there to help correct these failures and thus allow the market to perform more efficiently.

As Chaloupka explains: The idea is that there is a market that is working at some level … but there are market failures that keep it from working as efficiently as it could …. Abbasi, K. British Medical Journal : — CrossRef Google Scholar. Arrow, K.

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American Economic Review 53 5 : — Google Scholar. Ashmore, M.

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Oxford: Oxford University Press. Boseley, S. The Guardian 1 October. Brandt, A.