Hard to Avoid but Difficult to Sustain: Scotland's Innovative Health Tax on Large Retailers Selling Tobacco and Alcohol

The Scottish government’s Public Health Supplement (a levy on large retailers selling alcohol and tobacco) was an innovative tax that was successful in generating predictable revenues but failed to stimulate substantial behavioral change among retailers (eg, decisions to stop selling alcohol or tobacco). A tax may be considered a “health” tax on the basis that it raises revenue for health spending and/or is intended to achieve health aims (eg, behavioral change among suppliers or consumers of health-damaging products), but there is likely to be tension between these goals in terms of policy design. Although framing a tax as a “health” measure may increase public support, where the substantive health content is limited, or questionable, such a measure may be difficult to sustain in the face of industry criticism and a lack of competing support from health interests.