Health system suffers as cigarette tax left untouched

The federal budget for 2025-26, announced amidst a backdrop of fragile economic recovery, signals a continuation of fiscal restraint.

While the government has rightly focused on maintaining macroeconomic stability and ensuring essential current expenditures, the significant reduction in the health sector’s development allocation raises serious concerns about the country’s long-term human development and economic resilience.

According to the budget documents released by the Ministry of Finance, the Public Sector Development Programme (PSDP) allocation for health has been reduced by 16 percent, from approximately Rs 54.7 billion in the previous year to Rs 46.1 billion in the current fiscal cycle. This is not just a numerical adjustment; it has real and immediate implications.

Development allocations typically fund the expansion of healthcare infrastructure, procurement of new equipment, training programmes, and the rollout of disease prevention and surveillance systems. A cut of this magnitude effectively means that many of these critical initiatives will be scaled back or shelved.

From an economic standpoint, this trend is deeply concerning, because health is not just a social good, it is a foundational pillar of economic productivity. A healthy population is more capable, more employable, and less financially burdened.

Countries that underinvest in health eventually pay the price in terms of lost productivity, increased poverty, and heightened vulnerability to public health emergencies. In Pakistan’s case, where over 50% of health expenditure is still borne out-of-pocket by households, reducing development spending can further widen inequalities and push more families into financial hardship due to medical costs.

What makes this budget decision even more concerning is that it comes at a time when Pakistan faces a dual disease burden: persistent infectious diseases on one hand, and rapidly increasing non-communicable diseases such as diabetes, cardiovascular conditions, and mental health disorders on the other. Development funding is crucial to building the institutional capacity needed to tackle this complex mix of health challenges, especially in under-served rural and peri-urban areas.

The budget also misses an important opportunity to introduce health-related fiscal reforms. Despite strong evidence linking ultra-processed foods and sugary drinks to growing rates of non-communicable diseases, the government has chosen not to impose any new taxes on these items. This is a missed opportunity to both generate additional revenue and steer consumer behaviour toward healthier choices. Globally, such taxes have proven effective in improving public health outcomes while creating fiscal space for investment in health systems.

Additionally, the budget maintains the existing two-tier Federal Excise Duty (FED) structure on cigarettes, with no increase in tax rates. The upper-tier remains at Rs 16,500 per 1,000 sticks, and the lower-tier continues near Rs 12,500 per 1,000 sticks. This effectively keeps cigarette prices static in real terms, despite inflation and rising disposable incomes. From a public health standpoint, this decision represents a clear deviation from evidence-based fiscal strategy.

Maintaining cigarette excise rates at current levels ignores a growing body of economic and health research suggesting that increasing tobacco taxes not only reduces consumption but also substantially increases government revenue. For example, a targeted increase of Rs 39 per pack, raising the average rate to around Rs 140 for economy brands and Rs 369 for premium brands, could reduce cigarette consumption by nearly 7 percent and bring in an estimated Rs 67 billion in additional revenue. This revenue could be directly reinvested in health services, disease prevention programs, and infrastructure.

The government’s decision to hold back on increasing cigarette taxes, despite the health risks and economic opportunity, reflects a worrying pattern of inaction. It suggests that political considerations or lobbying pressures may have outweighed long-term fiscal and health imperatives. In a country where tobacco consumption contributes to over 160,000 deaths annually and disproportionately affects the poor, failing to revise cigarette taxes is a missed chance to use fiscal tools to improve both public health and equity.

Similarly, the absence of new taxes on sugary beverages and processed foods, despite their well-documented contribution to Pakistan’s growing non-communicable disease crisis, reinforces the perception that the government has shied away from confronting powerful industry interests. This reluctance undermines broader efforts to promote preventive health and reduce long-term medical costs, which are increasingly borne by low- and middle-income households.

From a macroeconomic perspective, the budget’s overall trajectory leans toward short-term fiscal stability but lacks the bold, forward-looking investments needed to address structural vulnerabilities. While allocations for debt servicing and defense remain protected, social sector development, particularly in health, continues to be deprioritized. This imbalance suggests a recurring policy bias that views health as a discretionary expense rather than a strategic investment.

In times of economic constraint, governments face difficult choices. However, smart fiscal policy does not mean cutting essential development expenditures, it means spending more wisely and protecting sectors that yield long-term returns. Health is one such sector. Delayed infrastructure, inadequate surveillance systems, and a weakened public health response capability may not show immediate consequences in budget sheets, but they will manifest in slower human capital development and greater costs down the line.

Conclusively, while the Budget 2025-26 reflects a certain degree of fiscal discipline, the decision to reduce health sector development spending and to leave cigarette taxation untouched is both short-sighted and economically risky. Pakistan cannot afford to treat health as a secondary priority.

A more strategic and balanced approach is needed, one that protects and promotes public health as a critical enabler of sustained economic growth and national resilience.

Copyright Business Recorder, 2025