Analysis of fiscal policies aimed at reducing dietary risk factors of NCDs in the Islamic Republic of Iran

Recent research shows that the prices of foods and beverages influence purchase and consumption significantly. Therefore, fiscal policy interventions have been recommended primarily as a mechanism to influence consumer behavior at the point of purchase. By incentivizing consumers to purchase healthier food products (or disincentivizing the purchase of less healthy food products), fiscal intervention aims to change the consumption of these products at individual and household levels, thus reducing intake of nutritional risk factors of NCDs (Non-communicable diseases). As taxes increase, the price of certain food products increases and consumers reduce their purchases. As a consequence, the industry may produce less of the food products. Similarly, a subsidy decreases the cost for consumers and can lead to increased consumption, thus triggering increases in supply to meet the rising demand. Taxes and subsidies can also incentivize the food industry to reformulate foods to improve the nutritional quality of their products. This study was aimed at reviewing and documenting the fiscal policies on healthy diet towards reducing dietary risk factors for NCDs in the Islamic Republic of Iran. Methods: This study was conducted in three phases: 1) A meta-review on the current fiscal policies in Iran and extracting their strengths and weakness through qualitative study with major stakeholders. 2) A qualitative study using a profound semi-structured interview with key informants in relevant organizations, covering all fiscal policies related to food and nutrition in Iran and exploring their strengths and weakness. 3) Facilitating a national meeting to advocate and achieve a consensus on the recommendations and future implications. Results:  If subsidization of fruit and vegetables is associated with taxes on unhealthy foods and drinks, a greater impact on energy intake and weight would be observed. Designing a nutrient profile model is an important topic in determining the categories of foods that are taxable. In addition, the threshold for nutrients should also be defined. -In a qualitative study, the most important financial policies related to NCDs in Iran were mentioned in three parts of upstream documents, coping strategies with harmful goods and supportive policies. Factors influencing the formulation of financial policies include facilitators, interveners, barriers, and organizations involved in pricing and sponsoring organizations that are effective in policy development. -After formulating policies, executive barriers were identified in the correct implementation of policies that were categorized into three categories: organizational challenges, industry issues, regulatory deficiencies and lack of enforcement.- The most important point in the formulation of this type of financial policy was to determine the list of unhealthy goods in the Ministry of Health and to sensitize tax systems to determine the taxes and duties associated with these types of products in other to reduce their consumption in the country. The main weaknesses of policies were mentioned as the lack of interest from stakeholders and required studies on policy formulation, inappropriate policy approaches, and policy contradictions. -The implications of developing such policies include positive outcomes such as increased food production and negative consequences such as cheap access to unhealthy commodities such as sugar and oil, corruption and smuggling of goods due to tariff increases and reductions of quality of production. Conclusions: - The necessity of conducting need-based studies to determine the fields of policy required on the basis of evidence and scientific documentation, before formulating a policy - Reviewing existing laws and policies to resolve contradictory, conflicting or controversial issues.- Structuring the path of financial policies from compilation to implementation and evaluation. - Use of scientific methods in determining the list of unhealthy goods. - Strengthen monitoring and evaluation of policies developed in the implementation section. - Studies on the price elasticity of specific products and the cost of their tax effectiveness - Incorporation of taxes on harmful goods in the VAT Act as taxes on specific goods. - Accompanying policymaking by educating the general public, prohibition of advertising and educational campaigns and planning to change the policies of onsumerism.