Bridging Trade, Culture and Taxation in Addressing Non-communicable Diseases in Polynesian Samoa and Tonga

Abstract

Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, cancers, and chronic respiratory conditions, are a global health crisis, responsible for 74 per cent of all deaths worldwide in 2019. In the Pacific nations of Samoa and Tonga, the NCD mortality rates are even more alarming, at 82 per cent and 79 per cent, respectively. NCDs impose severe economic and social burdens, exacerbating poverty, depleting public health resources, and threatening sustainable development. Central to this crisis in Polynesia is the dietary transition from traditional, nutrient-rich foods to highly processed, unhealthy imports – a consequence of globalisation and trade liberalisation.

While the World Health Organization (WHO) has advocated fiscal interventions to combat NCDs, over 75 per cent of Pacific Island nations have implemented these measures with limited success. Fiscal policies using excise taxes on harmful products have been adopted to address NCDs, but cultural factors and the lack of a holistic policy framework have limited their effectiveness. The rising prevalence of NCDs in Samoa and Tonga underscores the insufficiency of fiscal policies when isolated from broader cultural and contextual considerations, including trade obligations. Samoa and Tonga’s integration into global trade agreements has restricted their ability to regulate unhealthy imports effectively. Simultaneously, cultural norms surrounding food and body image, deeply embedded in Polynesian society, complicate public health efforts.

This article examines the intersection of fiscal policy, economic factors and cultural dynamics on NCDs in Samoa and Tonga. It analyses the effectiveness of current fiscal approaches and how fiscal measures can be undermined by cultural and contextual factors influencing food consumption. It argues for a more integrative, culturally responsive policy framework, where fiscal tools are complemented by interventions attuned to their specific societal and cultural norms. This holistic approach, which blends economic measures with culturally informed public health initiatives, offers a more robust pathway to mitigating the NCD crisis and addressing its significant socioeconomic impacts.