Stakeholder response patterns and adaptation strategies to sugar-sweetened beverage taxation in Thailand: Lessons for equitable non-communicable diseases prevention in low- and middle-income countries
1
Leeder Centre for Health Policy, Economics & Data, University of Sydney, NSW, Australia
2
Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
3
School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
Popul. Med. 2026;8(Supplement Supplement 1):A3261
ABSTRACT
BACKGROUND:
Sugar-sweetened beverage (SSB) taxation has been strongly recommended for addressing obesity and non-communicable diseases (NCDs) in resource-constrained settings. Understanding stakeholder response patterns is essential for designing and implementing equitable and sustainable fiscal health policies that can be transferred across diverse contexts. This study aimed to examine how stakeholders responded to the Thai SSB tax policy, adopted in 2017, and its progressive implementation, and to identify factors influencing stakeholder adaptation strategies with implications for equitable policy design.
METHODS:
In-depth interviews were conducted with diverse stakeholders including government officials, academics, civil society organizations, international organizations, private sector, and consumers. Thematic analysis identified response patterns and adaptation mechanisms following the four-phase SSB tax implementation.
RESULTS:
Industry responses revealed strategic heterogeneity, including multinational brand-maintained flagship product formulations despite maximum tax rates, implementing price transmission, and aggressive marketing to preserve market share. Consumer responses demonstrated socioeconomic differentiation with equity implications, for example higher-income groups adapted through healthier substitutions while lower-income consumers showed consumption reduction or resistance to higher price products. We also found a group of ‘observational awareness’ consumer, referring to those noticing price changes without understanding the policy rationale, was common across income groups. This limited equitable access to informed decision-making. The Thai government actors demonstrated adaptive governance by postponing implementation during the COVID-19 pandemic while maintaining the overall timeline, systematically using international evidence to maintain commitment to public health objectives in the face of economic pressure, and establishing multi-sectoral coordination mechanisms.
CONCLUSIONS:
Stakeholders responded to the design and implementation of the Thai SSB tax in diverse ways, shaped by their different levels of economic power, socioeconomic, and institutional capacity. Achieving equitable health outcomes from SSB taxation requires anticipating such differentiated responses, strengthening policy communication, and building adaptive governance mechanisms that can be transferred to diverse low- and middle-income country contexts.
Sugar-sweetened beverage (SSB) taxation has been strongly recommended for addressing obesity and non-communicable diseases (NCDs) in resource-constrained settings. Understanding stakeholder response patterns is essential for designing and implementing equitable and sustainable fiscal health policies that can be transferred across diverse contexts. This study aimed to examine how stakeholders responded to the Thai SSB tax policy, adopted in 2017, and its progressive implementation, and to identify factors influencing stakeholder adaptation strategies with implications for equitable policy design.
METHODS:
In-depth interviews were conducted with diverse stakeholders including government officials, academics, civil society organizations, international organizations, private sector, and consumers. Thematic analysis identified response patterns and adaptation mechanisms following the four-phase SSB tax implementation.
RESULTS:
Industry responses revealed strategic heterogeneity, including multinational brand-maintained flagship product formulations despite maximum tax rates, implementing price transmission, and aggressive marketing to preserve market share. Consumer responses demonstrated socioeconomic differentiation with equity implications, for example higher-income groups adapted through healthier substitutions while lower-income consumers showed consumption reduction or resistance to higher price products. We also found a group of ‘observational awareness’ consumer, referring to those noticing price changes without understanding the policy rationale, was common across income groups. This limited equitable access to informed decision-making. The Thai government actors demonstrated adaptive governance by postponing implementation during the COVID-19 pandemic while maintaining the overall timeline, systematically using international evidence to maintain commitment to public health objectives in the face of economic pressure, and establishing multi-sectoral coordination mechanisms.
CONCLUSIONS:
Stakeholders responded to the design and implementation of the Thai SSB tax in diverse ways, shaped by their different levels of economic power, socioeconomic, and institutional capacity. Achieving equitable health outcomes from SSB taxation requires anticipating such differentiated responses, strengthening policy communication, and building adaptive governance mechanisms that can be transferred to diverse low- and middle-income country contexts.
| eISSN: | 2654-1459 |
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