Cost-free Policies to Improve Public Health
By Lykke E. Andersen, La Paz, 26 June 2006

It does not necessarily have to be expensive to improve the health of the population. It could be free - or even revenue generating!

Here are two ideas:

1)       Slap a substantial tax on distinctly health-damaging products such as cigarettes:

According to the World Health Organization, tobacco use is the leading cause of preventable death in the world today. With almost 5 million tobacco-related deaths per year, no other consumer product is as dangerous, or kills as many people, as tobacco (1). In a poor country like Bolivia, a cigarette tax may actually work as a deterrent to smoking. In addition, in contrast to richer countries, such a tax would be progressive in Bolivia, as smoking is more common among the rich than among the poor. It would also help if the US stopped subsidizing the export of cigarettes to developing countries.

2)       Exercise and nutrition:

Considering the high levels of poverty in Bolivia, it is amazing that problems of overweight and obesity are so widespread. An amazing 46% of the women surveyed in the National Demographic and Health Survey of 2003 were overweight or obese, while less than 2% were thin or underweight. The obesity problem is probably decreasing all by itself, as fatness is less of a status symbol now than it has been. However, the drop could be further promoted by relatively inexpensive public policies, such as more sports classes in school and high school, and maybe a tax on those sugary, carbonated drinks with absolutely no nutritional value.

That said, there is still a need for massive health spending on maternal and child health, which have no obvious cost-free solutions. Probably the cheapest way to reduce maternal and infant mortality is to avoid the risky and generally unwanted higher order births (5^th, 6^th, 7^th, 8^th … child) through access to inexpensive, safe and convenient family planning methods. Too bad many donors (and many Bolivian men) are opposed to this.

(1) See scary poster on the body of a smoker from WHO.

Ó Institute for Advanced Development Studies 2006.

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