Improving the Use of Taxation Policy to Address NCD in Tonga Summary from Stakeholders Consultative Workshops Government of Japan TABLE OF CONTENTS 1. Executive Summary 4 2. Introduction 6 3. Nuku’alofa Workshop 7 3.1 Welcome addresses 7 3.2 Opening remarks 7 3.3 Key findings from study 8 3.3.1 Results 8 3.3.2 Q&A session 9 3.4 Special presentation from the Ministry of Finance and National Planning 10 3.5 Group Work 10 3.5.1 Physical activity 10 3.5.2 Tobacco 10 3.5.3 Unhealthy food 10 3.5.4 Healthy food 11 3.5.5 Alcohol 11 3.6 Hard talk: What is next for Tonga? 11 3.6.1 Q&A session 14 3.7 Closing remarks 14 4. Vava’u Workshop 15 4.1 Welcome addresses 15 4.2 Opening remarks 15 4.3. Word of Thanks 15 4.4 Key findings from study 16 4.5 Special presentation from the Ministry of Finance and National Planning 16 4.5.1 Q&A session 16 4.6 Group Work 17 4.6.1 Tobacco 17 4.6.2 Unhealthy food 17 4.6.3 Healthy food 18 4.6.4 Alcohol 18 4.7 Hard talk: What is next for Tonga? 18 4.8 Closing remarks 18 5. Media Coverage 19 Appendix A: Attendance List for Nuku’alofa 20 Appendix B: Attendance List for Vava’u 22 Appendix C: Workshop Agendas 23 1 Executive Summary This report provides an overview of the Government, churches and community “Improving the use of taxation policy on tobacco, can support people to make healthy choices alcohol, unhealthy food and beverages as a by creating an environment in which makes response to the NCD crisis in Tonga” consul- healthy eating the easiest and preferred tative workshop held in Tonga. The purpose option. of the workshop was to present the findings The experience in the Outer Islands differs from the taxation evaluation and garner input to that of Tongatapu. Consideration needs to for the development of the recommendations. be given to how polices might impact Outer The workshop was held in Nuku’alofoa on Island communities and the differing support Monday 3rd September 2018 with approximately that might be needed. 60 in attendance. A second workshop was held Consultation with community, businesses, in Vava’u on Wednesday 5th September 2018 church groups and other stakeholders is key with approximately 35 attending. There were to effective policy and program development. representatives from a range of government Participants were divided into groups agencies, non-government organizations, the to discuss strategies to strengthen existing business community, development partners, policies as well as additional actions that church groups and the community. should be taken to address NCDs. The five The structure of the workshop was topics which were the focus of this session similar for both sessions, however with different was; tobacco, alcohol, unhealthy foods, healthy guest speakers providing the welcome address. foods and physical activity. The recommenda- Furthermore, the ‘Hard Talk’ session in tions made were: Nuku’alofa was video recorded and then high- lights were played during the Vava’u session. Overarching recommendations The workshops were intended to be interactive These recommendations crossed all and encouraged individuals to provide their five focus areas and included: perspectives on the findings from the study Strengthening governance structures and opportunities to improve strategies to ad- such as the National NCD Committee and dress the NCD crises. There were some key associated working groups, discussion points that were raised through Taking a whole-of-government approach both sessions which included: to the NCD crisis, NCDs continue to be a significant Greater engagement with the churches problem in Tonga and across the Pacific and recognizing the important role they play in requiring strong leadership and a concerted shaping community attitudes and behaviors, effort to address not just from the health Utilization of district and town councils sector, but all government agencies, community, to communicate with outer island communities, businesses, church groups and non-govern- Greater consultation on the taxation ment organizations. policy with a community awareness program Taxes are only one mechanism to create to educate people on the purpose of the tax behavior change, but this needs to be supported and what it is attempting to achieve, by complementary programs. Ongoing monitoring of the taxation Consideration needs to be given to the policy and regular feedback to relevant stake- adverse effects increasing taxes may have on holders on the progress, the poorer members in the community and Inclusion of NCDs in school curriculum what support is available to them. which would include issues of healthy eating, The taxation policy is only strong if it exercise, tobacco and alcohol use, can be properly implemented and enforced by Consumer rights education programs the Competent Authority; particularly the regu- to empower the community when purchasing lation of imported fruit prices. products and knowing legislation around alcohol, 4 Vava’u Workshop; Dr Sutayut Osornprasop and Hon. Losaline Ma’asi tobacco and imported fruits, food products to ensure all products meet a Better complaint mechanisms to pro- determined standard, vide consumers with an avenue to report Enforcement of the price ceiling on breaches such as smoke free zones or products imported fruits by the Competent Authority. sold over the price ceiling, Ear-marking revenue raised through Healthy foods the NCD taxation policy to support the inter- Incentive programs to support busi- ventions to address the NCD crisis. nesses to promote and sell healthy local foods, Tobacco Cooking classes for the community Tax Tapaka Tonga to align to the exist- utilizing local healthy foods, ing taxes on imported cigarettes, Supporting agriculture to further Include warnings and graphic images develop the local food industry to be able to on Tapaka Tonga packets aligned to warnings provide healthy alternatives. currently on imported cigarettes, Develop programs to support families Physical activity to transition from growing tobacco to growing Development of local sporting groups other crops. to promote healthy living and exercise, Tax exemptions for sporting equipment, Alcohol Incentives provided to build sports As taxes increase, strategies need to grounds or sporting facilities, be in place to avoid individuals switching from Development of more walking tracks imported alcohol to locally made home brews and accessible equipment such as ‘outside or other drugs, gym’. Development of a national awareness The next steps for the taxation policy strategy on the harms of alcohol utilizing radio evaluation was discussed at the workshops. and television. Participants requested the final report feed- back session be pushed back from December Unhealthy foods 2018 to late January 2019 or later due to con- Removal of additional taxes on chicken flicts with staff leave. The recommendations as it has been shown to be regressive, and is and feedback from this consultation sessions not necessarily unhealthy, will be included in the final evaluation report Development of guidelines which all and presented back to stakeholders during imported products are measured against, this 2019 meeting. and those which meet a determined criterion (content of sugar or fat reaches a defined threshold) to be included in the NCD tax, Strengthening regulation of imported 5 2 Introduction This report provides an overview of the “Improving the use of taxation policy on tobacco, alcohol, unhealthy food and beverages as a response to the NCD crisis in Tonga” consultative workshop held in Tonga from Monday 3rd to Wednesday 5th September 2018. This workshop was the final phase in the evaluation of the NCD taxation policy, which aimed to address the growing NCD crisis in Tonga through tax- ation changes. The analysis from the evaluation was presented to relevant stakeholders from across government, non-government, community, business and deve- lopment partners to gain insight and feedback to shape the final recommendations for the evalua- tion. This report will provide commentary on each of the sessions from each of the two workshops. The main purpose of the report is to accurately reflect the comments, questions and concerns raised by participants throughout the workshops to inform the final report. 6 3 Nuku’alofa Workshop This workshop was attended by approximately 60 stakeholders and was held at the Tanoa International Dateline Hotel con- ference room on Monday 3rd September 2018. 3.1 Welcome addresses Welcome addresses were provided by; Mrs. Kilisitina Tuaimei’api- A/CEO, Ministry of Finance & National Planning Mr. Tatafu Moeaki and Dr. Sutayut Osornprasop- World Bank Ms. O’feina Filimoehala- Tonga Health Promotion Foundation Ms. Fiasili Lam- Food & Agricultural Organization Nuku’alofa: His Excellency Andrew Ford His Excellency Andrew Ford- High making his welcoming address Commissioner, Government of Australia’s Department of Foreign Affairs & Trade Her Excellency Tiffany Babington- High Commissioner, Government of New Zealand’s Ministry of Foreign Affairs & Trade. The welcome addresses covered a range of issues, but all focused on the im- portance of this study in helping the Tongan government address the significant challenge of growing NCDs in the country. The welcome addresses demonstrated a strong commit- ment to fighting the NCD crisis and the important role government, non-government, development partners and community play in Nuku’alofa: Her Excellency Tiffany Babington achieving this goal. making her welcoming address 3.2 Opening remarks The workshop was formally opened by Hon. Mr. Mateni Tapueluelu, Acting Minister of Finance and National Planning and Minister for Revenue and Customs. The Hon. Mr. Mateni Tapueluelu reflected on the importance of the study as one of the few countries in the Pacific to implement taxation policies as a response to the NCD crisis. He highlighted that monitoring and evaluating the effectiveness of policies are vital to inform future efforts and identify opportunities for improvement. The Honorable Mr. Tapueluelu outlined Nuku’alofa: Dr. Sutayut Osornprasop the purpose of the consultative workshop presenting evaluation results and encouraged participants to be open and honest to inform the recommendations and to 7 improve the effectiveness of future interven- habits of those in Quintile 1 and Quintile 2 tions and taxation policies. groups which are more sensitive to price change on food purchasing compared to higher 3.3 Key findings from study quintile groups. Tax appears to affect the Dr. Sutayut Osornprasop, Senior Human behaviors of those consuming large amounts Development Specialist World Bank provided of unhealthy foods (mutton flaps). There was an overview of the key findings from the study a noticeable shift from mutton flaps to salted which was followed by a Q&A session. beef as a substitute. The key findings from the study high- Price was reported as the main moti- lighted the long-term consequences of NCDs vator for behavior change rather than health and the impacts on economic opportunities concerns. The increase in price across all for the country, specifically with labor supply foods has led to a decrease in consumption to (quality and quantity) and capital accumulation less frequent consumption of those products. due to reduced spending as a result of higher The behavior change was due to cost change health costs and diverting government spend- not concerns over health. ing from other areas of the budget to health. The study focused on the impacts of Alcohol taxation NCD taxation on: Consumption of beer has decreased Price, with less alcohol consumed by drinker. Two Consumption behaviors, thirds of consumers did not change their be- Government revenues. havior. 3.3.1 Results Removal of consumption tax on healthy foods Few people know about the removal Tobacco taxation of the consumption tax and the tax exemption There has been a significant increase was not passed onto the consumer. Behavior in excise taxes on tobacco. This rise in tobacco change did not occur as no price change tax, and therefore price, has led to a decrease occurred to motivate individuals. Stores are in tobacco sales. In the 2016-17 period; there selling oranges and apples higher than the has been a 40.4 percent decrease in retail sales. maximum price set by the government. To continue to be effective, the tax has to be adjusted and increased on a yearly basis Qualitative study findings to enable continued behavior change in the Focus groups with the community community. were held across Tonga. The study found low The tax on imported tobacco has been awareness of the NCD taxation policy, with powerful enough to change the market share most participants learning about the taxation of the most popular cigarette brands. There policy changes through radio broadcasting. was a shift from Pall Mall in 2011 to Palataisi Most individuals interviewed did not know as the most popular brand. the tax changes was for health improvement. The number of manufactured cigarette Affordability was the critical factor for families sticks consumed has decreased across all so- when making consumption decisions. cio-economic groups with an average decrease The qualitative study also asked from 16 per day down to 9 cigarettes per day. for how NCD tax revenue should be spent, However, based on interviews, it is price not respondents provided the following ideas: health that is the main reason for changing Supporting domestic vegetable and smoking habits. chicken farms Over 20 percent of smokers have shifted Support civil servant salaries to smoking Tapaka Tonga which is not taxed, is Subsidizing fish cheap and is widely available in shops. Tapaka Medical facilities Tonga is now the most popular and consumed Sporting facilities product. Factors identified for hindering healthy Food taxation eating included: The foods in scope for the additional Unavailability of fresh vegetables tax included; mutton flaps, turkey tails, ice Lack of knowledge about healthy cream and chicken leg quarters. lifestyles There was a difference in the purchasing Lack of knowledge about healthy 8 cooking Laziness despite having knowledge Other reported factors influencing consumption choices were: Cultural obligations and traditions Church obligations Church camps Communication pathways to raise awareness of policy changes included: Social media Visits to the community by govern- Nuku’alofa: Dr. Viliami Fifita, Government Statistician, ment and ministers. participating in the Q&A session The experience of the tax changes was different between urban and rural communi- ties. There is limited availability of alternative options in rural environment compared with the urban environment in which noodles are a staple. 3.3.2 Q&A session The Q&A session was facilitated by the World Bank and provided an opportunity for workshop participants to provide comments, questions and insights on the findings from the study. Nuku’alofa: Representative of the private sector The following provides a summary of actively participating in Q&A the issues and queries raised by participants: Impact on poorer families in the community substances due to the increased price? Concerns were raised regarding the The reduction of tobacco and alcohol impact of regressive taxes which is driving the use may not only be due to the taxation policy. poor to consume unhealthy foods. A multi- What other programs are occurring which is pronged approach is needed to change the influencing behaviors? mindset of the community through education Local beer and imported beer tax as well as support. policies - a participant asks if there are ways It is important to find a way to reach not to hamper local manufacturing efforts and the poor and their families- that is the best companies that produce these products. approach to create change in the community. Decreasing access to unhealthy foods is a Improving engagement with the community good approach, but what is it replaced with? The government should look at ways There needs to be healthy local substitutes in to enhance the community rather than just place alongside this strategy. prevent things. There should be greater engagement with the business community Alcohol and tobacco when developing policies. The government It is important to educate the public should create incentive programs for busi- on why there is a need to impose additional nesses to market healthy products to encourage taxes. Is it for revenue raising? Is it for health? the commercialization of healthy foods. How the revenues are used? There needs to We need to look at the recommen- be better engagement with the community to dations made and get government agencies ensure they understand the need for the new together and implement findings properly. taxes. There were concerns raised on the rise Other comments of ice, kava, home brew use within Tonga. The Affordability and access are the key question was asked how does the tax policy issues; people are not always driven by cost impact on individuals choosing alternative alone. Further taxation policy may restrict 9 importations on unhealthy products to limit tribute to reducing NCDs. Participants were availability and choice. given an hour to work in their small groups Have the tax changes had an impact on before presenting their findings and ideas inflation? What is the wider economic impact back to the broader group. The following out- of the taxation policy? How does it impact lines the top recommendations determined inflation and how should this be considered by each group. moving forward with future taxation policies? Sustainable health financing- The 3.5.1 Physical activity use of revenue collected to support the 1. Tax exemption for sporting equip- health system moving forward. There is a ment or incentives for building sports grounds gap in health financing preventative care etc.; with greater expenditure for acute care. The 2. Earmark funding raised through NCD size of the problem is increasing, the cost is tax for infrastructure projects which promotes increasing, we need to be efficient in revenue physical activity; collection as well as efficient in prevention. 3. Handing over responsibility and Exclusion of fruit taxes: there are a maintenance of sports grounds to village range of reasons prices were not lower as a re- council- training of this group to enable them sult of removal of taxation on imported fruits. to support the ongoing management of the sporting facilities; and 3.4 Special presentation from the Ministry 4. More walking tracks and outdoor of Finance and National Planning sports equipment. Mr. Sione Raleafa, Chief Economist at the Ministry of Finance and National Planning 3.5.2 Tobacco presented the financial impacts of the NCD 1. Apply tax to local tobacco to de- taxation policy. This included the changes in crease smoking; consumer purchasing behavior and the reve- 2. Multi-sector approach to monitoring. nue raised through the changes to taxes over Tonga Health revive the committees to provide the last five years. good advice to the national NCD committees; empower them have input into policies; and 3.5 Group Work 3. Mainstreaming the NCD tax to health Participants were divided into groups department. and provided with a facilitator to answer the following questions: 3.5.3 Unhealthy food 1. How to improve the NCD tax policy 1. Improve on the NCD sub-committees; through design, implementation and monitoring 2. Greater consultation with consumers 2. How to improve Ministry collabora- and relevant stakeholders; tion to address the NCD crisis 3. Inclusion of local food council in Five topics were selected which con- discussions as an advocacy group; Nuku’alofa: Group work; developing recommendations for action 10 4. Whole of government approach once implemented; and to addressing NCD; 4. Stakeholder collaboration at the 5. Inclusion of churches and schools stage of the design not at the point of im- into the interventions; plementation particularly with the Competent 6. Education and consultation with Authority. the community over the purpose and intent of the tax so it isn’t considered punitive or 3.5.5 Alcohol punishment. Clearly articulating why the tax 1. Design- identifying and addressing policy is needed; the unintended consequences of the policy; 7. Spend time and money on preven- 2. Consultation and awareness raising- tative health not just curative; and ongoing process; 8. Bringing all relevant stakeholders 3. Change has to be sustained through together- consider the tax not as a policy from ongoing awareness; Finance but a health policy. 4. Good monitoring using data; 5. Healthy eating at church conferen- 3.5.4 Healthy food ces; and 1. Design- need for government stake- 6. How to change culture within the holders to determine if the policy will work church; “we show appreciation by giving more” before it is implemented; the culture around giving and excess- how do 2. Churches to be included from the we change this to then be translated into the initial stage not informed once the policy has home? been decided; 3. Implementation- gap in communica- tion of the policy with the community. Lack of enforcement and monitoring of the policy Nuku’alofa: Hard Talk Panel members 3.6 Hard talk: What is next for Tonga? This was a facilitated session by Dr. Sutayut Osornprasop who raised a number of key questions with a panel of experts which was then followed by a participant Q&A. Mr. Kelemate Vahe; CEO of Ministry of Revenue and Customs- The key challenge is changing the mindset of the people. When you say tax will improve health it is not a big issue as we have the right to choose what to eat and buy. Difficulty arises with enforcement and monitoring of the tax policies put in place. Taxation policies works- the purpose of taxa- tion is health. Where the gap is now is educa- tion around healthy choices. We should have a Nuku’alofa: Mr. Kelemete Vahe on the Hard Talk panel of experts 11 massive campaign around what foods are healthy. We only have one life. They don’t fully understand that taxation is to promote good health. Taxation policy is not for the sake of the tax but for the health of the population. Dr. Siale ‘Akau’ola; CEO of Ministry of Health- We need to make healthy choices to become easy choices. All departments are responsible to make this happen. Only 30% of NCD management is within the sphere of influence of MoH. Other areas have more ability to influence NCD rates. If we don’t provide people with the best opportunities, healthy food options and infrastructure Nuku’alofa: Dr Siale ‘Akau’ola on to support physical activity they will get NCDs. the Hard Talk panel of experts It is important to taxing commercialized Tapaka Tonga- you don’t need to smoke to live. Learning the impacts of the taxes; we learn from our mistakes and realign our policies to reflect this. We should focus on the goal we are trying to achieve- a healthy society. This is new- we are learn- ing, it’s a part of the process of forming new policies. Mr. Viliami Manu; CEO of Ministry of Agriculture, Food and Forestry- Seeing importations increase as Tonga cannot produce enough proteins to support demand. New industries are developing such as beef and diversifying into pork. There are also new projects to support commercial production of poultry for meat as we need to build a stronger local industry. There are opportunities now, the NCD tax provides a space for local industry to Nuku’alofa: Mr. Viliami Manu on the Hard Talk panel of experts develop. Subsidizing healthy products to make it cheaper? Fish export has been dropping in the last few years, in the past fuel for fishing boats has been subsidized. There needs to be price regulation to ensure any subsidy that is implemented is passed onto the consumer. We need new strategies to build up local markets through the fish unfit for export which are currently thrown back into the ocean rather than selling domestically. Is there a way to access these fish to sell domestically? Agriculture fully support these taxation policies. When tobacco prices increase young people switch to Tapaka Tonga. Mrs. Sandra Fifita- The Revised Bill is close to being developed. Under the revised bill- the Com- petent Authority can determine the measurement the goods can be sold in (aims to address the issues Nuku’alofa: Mrs. Sandra Fifita on the Hard Talk panel of experts with fruit selling). This is in response to the feedback from consumers. Enforcement- stronger enforcement programs are needed, particularly in the outer islands. 12 Ms. O’Feina Filimoehala; CEO of Tonga Health Promotion Foundation- The Foundation are partnering with Health Promotion, Ministry of Education, Health and Internal Affairs to develop interventions to address NCDs. The Foundation are always willing to support interventions which will improve health and are interested to fund a healthy cooking program as suggested. Open to applications to promote healthy cooking and Tonga Health is open to applications to promote healthy cooking and eating local ingredients. Mr. Saia Vea; President of SDA- Healthy life choices an important part of the SDA church. The church can play an important role in promoting health. In line with the King’s stance on healthy eating- the Nuku’alofa: Ms. O’Feina Filimoehala on church conference aligned to this principle and leading the Hard Talk panel of experts by example to both promote health as well as saving the resources of the family. From this, the foundation is already laid with expectations with the community and the role of the Church in educating our mem- bers on healthy food choices and promoting healthy lifestyles. Some strategies the Church has undertaken includes serving healthy breakfasts at the square and getting the right to import Sanitarium products into Tonga to make it more cost effective for the com- munity. The Church has a Health Officer working collaboratively with MoH and Tonga Health for NCD screening and clinics. Churches are adopting more healthy catering options as well as exercise programs run through the church. There are not enough healthy food outlets here in Tonga. Limiting options for eat- ing at church events is one strategy to address Nuku’alofa: Mr. Saia Vea on NCDs that has been implemented. This was met with the Hard Talk panel of experts resistance from the community as it was a significant change from traditional feasts. The government should utilize the taxes from the NCD tax and use it to improve services. Mr. Silongo Samuela; representative from LDS- The Church has established a course promot- ing healthy eating and physical exercise which will be starting next year. The Church are actively aligning to Government policies on tackling NCDs. One es- tablished program includes a demonstration garden, teaching local women how to establish a garden and become more self-sufficient and also adopt healthy eating. Working collaboratively with Agriculture and partnering with other groups and churches to share resources to get healthy and stay active. Nuku’alofa: Mr Silongo Samuela speaking for Hard Talk 13 3.6.1 Q&A session Participants were able to questions of the Expert Hard Talk Panel as well as provide comments on anything from the previous sessions. The following outlines the key areas of discussion Taxes Need to use other strategies to raise revenue, not only taxation. Must be careful that tax policies don’t become regressive and have too many negative impacts on the community. Price controls- price controls with fruits- no tax only benefits importers but does not benefit the consumers. Alcohol and other drugs Need to ensure the impact of increase in alcohol and tobacco taxes does not lead to an increase in the use of ice and illegal drugs. There should be greater focus from MoH on people with addictions- alcohol, gambling, drug use as a health issue not a justice issue. Healthy diet at school Children in schools should be a specific focus. By educating them on healthy eating, quality and quantity of food and active lifestyles we are giving them life skills and normalizing healthy eating. Other opportunities to integrate with schools, such as gardens, donations and healthy foods at school driven by the PTA. Other comments Importance of awareness training to educate church communities, Importance of working together, there is a breakdown within the government and through- out the country with healthy living, Promotion and utilization of traditional and local foods healthy foods in the community. Local and traditional foods are healthier and better quality- promoting traditional meals as an approach to improving health, Change of mindset around physical activity, Creating an environment which supports healthy choices and makes ‘bad’ choices more difficult. 3.7 Closing remarks Closing remarks were provided by Dr. Siale ‘Akau’ola; CEO of Ministry of Health and Mr. Yutaro Setoya; World Health Organization (WHO). Dr. ‘Akau’ola focused on the other health strat- egies currently in place to address NCDs such as WHO Pacific Island Monitoring Framework for NCD action and the Early Childhood Obesity (ECHO) project to address childhood obesity. The Ministry of Health is working on a range of other projects and capacity building initiatives to sustain the work currently undertaken to better prevent and treat NCDs in Tonga. Mr. Setoya highlighted that Tonga is leading the Pacific and the world with their approaches to managing NCDs. At the international No Tobacco Day Tonga was a winner of WHO award for public health campaign for the Nuku’alofa: Mr. Setoya from WHO national quit line. providing closing remarks Health policies are all about changing behavior. There always needs to be a balance and a focus on how to increase knowledge that there is a benefit but also a consequence with choices we make. WHO is happy to support Tonga with the fight against NCD with World Bank and other partners. 14 4 Vava’u Workshop The Vava’u Workshop was held on Wednesday 5th September 2018 at the Governor’s Office in Vava’u with approximately 35 participants in attendance. 4.1 Welcome addresses The welcome addresses were presented by the following special guests: Mr. Sione Faleafa; Ministry of Finance and National Planning Dr. Sutayut Osornprasop; World Bank Ms. Fiasili Lam; Food & Agricultural Organization The welcome addresses covered a range of issues, but all focused on the importance of this study in helping the Tongan government address the significant challenge of NCDs in the country. The welcome addresses demonstrated a strong commitment to fighting the NCD crisis and the important role government, non-government, development partners and Vava’u: Ms. Fiasili Lam giving the welcome address community play in this project. 4.2 Opening remarks Opening remarks were provided by the Hon. Losaline Ma’asi; Minister of Internal Affairs. The Honorable Ms. Mas’asi reflected on the importance of the study as one of the few countries in the Pacific to implement taxation policies as a response to the NCD crisis. She also highlighted the importance of considering the impacts of taxation policy on Outer Islands and remote communities. The Honorable Ms. Mas’asi outlined the purpose of the consultative workshop and encouraged participants to be open and honest Vava’u: Hon. Losaline Ma’asi providing to inform the recommendations to improve the the opening remarks for the workshop effectiveness of future interventions and taxation policies. 4.3. Word of Thanks The Governor of Vava’u Lord Fakatulolo spoke about the importance of consultation in the development of government policy. He spoke on behalf of the chiefs of Vava’u to offer thanks and appreciation on being included in this workshop to provide the Vava’u perspective and experience. 15 4.4 Key findings from study Dr. Sutayut Osornprasop presented the key findings from the study which was followed by a Q&A session. The key comments, feed- back and questions were as follows: Agriculture Need to highlight how greater access locally to nutritious produce is vital. We also need longer term plans such as development of local fruit and vegetable industry. Lifestyle and overconsumption Vava’u: Dr. Sutayut Osornprasop presenting the key findings We need to consider a feasibility study into the lifestyle of Tongans and the way in which they consume. There needs to be an understanding as to what the behavior change challenges exist in order to inform policy inter- ventions. Need to focus on young people in the schools to change lifestyle early on. There is a need to train people and create an under- standing of NCDs and health and how to make lifestyle changes. Tax policy Equal application of taxes on unhealthy Vava’u: Mr. Sione Hufanga presenting products such as Tapaka Tonga and home further findings from the study brews. There was general support for tax exemption on healthy food products. But it Make fruit and vegetable sellers pay needs to ensure the benefits are felt by the taxes as they are not passing on the tax people. exemption on to the customers. The Honorable Ms. Ma’asi stated the Price control is the main problem, the importance of policy need for education, Competent Authority needs to impose higher training and enforcement of existing legislation. penalties and enforce legislation. There should There needs to be stronger coordination, be greater consumer education on their rights enforcement and coordination of interventions by raising awareness through churches. across Tonga and greater involvement of local Need to consider the complete supply communities in both program development chain for produce and the role of the ‘mid- as well as implementation and coordination. dle-men’; there should be greater scrutiny on As with all programs of this scale there needs this role and how it operates including the to be a process of both training and ongoing significant mark ups that occur. monitoring. Food choices 4.5 Special presentation from the Ministry Addressing the change of mindset of Finance and National Planning at the primary school level and through Mr. Sione Faleafa, Chief Economist at the churches. Kids are preferring imported the Ministry of Finance and National Planning unhealthy foods over healthy options. What presented the financial impacts of the NCD strategies are there to address this? taxation policy. This included the changes in Some churches are more active in consumer purchasing behavior and the revenue supporting non-consumption of alcohol and raised through the changes to taxes over the tobacco as a policy for addressing health issues. last five years. Need to emphasis/notice the challenges for meals; there is a preference for meat within 4.5.1 Q&A session the home. Within home gardens; funding needs to be in the outer islands not just the capital. Tax policy There are many gaps due to lack of facilities. 16 Vava’u: Mr. Sione Faleafa presenting the fi- Vava’u: Group work to develop recommendations nancial impacts from the tax policy. Vava’u: Group work to develop recommendations The quantitative and qualitative survey the replacement of tobacco crops with should have included non-Tongans, this is vegetable or other produce to support families particularly important for tobacco and alcohol dependent on this as an income; consumption. 4. Training people on their rights. The enforcement of rules against smoking in public 4.6 Group Work places; Participants were divided into groups 5. Checking prices of goods; enforce- and provided with a facilitator to answer the ment of policy; following questions: 6. Education and training on the dangers 1. How to improve the NCD tax policy of tobacco; through design, implementation and monitoring 7. Better and more prompt response 2. How to improve Ministry colla- to complaints from the public to town councils boration to address the NCD crisis or the police; and Four topics were selected which 8. Greater collaboration on national contribute to reducing NCDs. Participants were NCD actions. given an hour to work in their small groups before presenting their findings and ideas 4.6.2 Unhealthy food back to the broader group. The following out- lines the top recommendations determined Implementation: by each group. 1. Raise taxes further; 2. Run community cooking programs to 4.6.1 Tobacco reduce unhealthy eating; 1. Tax Tapaka Tonga, increase tax on imported cigarettes; Design 2. Graphic warning on packs includ- 1. Look at the selection of unhealthy ing Tapaka Tonga; food for taxing, is it the right food? 3. Workshop in the villages to encourage 2. Implement a scientific model to 17 determine taxes; but fluctuates in outer islands); 3. How does the tax differentiate 2. Give other options and alternatives between healthy and unhealthy meats? like sports; 3. Who will organize social activities? Is Monitoring this something that can be achieved through 1. People need to be made aware of MIA using the money raised through the NCD the tax; tax; 2. All stakeholders are consulted on 4. District Officers role and how they the taxes (such as shop and business owners); can be leveraged to share information and knowledge of policies through these roles; Multi-sectorial collaboration 5. Local realistic solutions; 1. Stronger role of the Church in pro- 6. What are the rates of drinking when moting healthy eating; tourists and ex-pats are excluded; and 2. Greater collaboration between the 7. Kava plantations just commenced government and businesses; in Vava’u which is an alternative to alcohol, 3. Inclusion of schools and education but consideration of the health outcomes in discussions on nutrition; and needs to be given. 4. Government need to ensure ongoing dialogue with community on the issue, especially with churches. 4.6.3 Healthy food 1. How are healthy and unhealthy foods defined and considered? (i.e. the use of pesticides etc. on imported fruits is also unhealthy). The Taskforce should make this determination; 2. Strengthen regulation on importa- tion foods to reflect more global standards (prevent the Pacific from being a dumping ground for goods banned from other countries); 3. Healthy schools with healthy food- integrate into the curriculum as well as healthy Vava’u: Group work to develop recommendations lunches funded through tax raised; 4. Regular training at a community 4.7 Hard talk: What is next for Tonga? level; A short video of the Hard Talk from the 5. Promotion of local foods and reducing Nuku’alofa workshop was played to provide processed foods; participants an understanding of the key 6. Promoting local foods and whole issues, comments and considerations that foods as health intervention. Utilization of tra- were raised in the initial workshop. ditional medicines; 7. Tax credits for the promotion of local 4.8 Closing remarks healthy industry. Make healthy production Mr. Setoya from WHO highlighted that achievable/financially beneficial for businesses; Tonga is leading the Pacific and the world with 8. Greater sports and exercise facili- their approaches to managing NCDs. At the ties; international No Tobacco Day Tonga was a 9. Promoting collaboration and engag- winner of WHO award for public health cam- ing with all stakeholders; paign for the national quit line. 10. Provide incentives for collabora- Health policies are all about changing tion- through the PMS as a staff KPI; and behavior. There always needs to be a balance 11. Highlight the role of district and and a focus on how to increase knowledge town officers and utilize for reaching the com- that there is a benefit but also a consequence munity. with choices we make. WHO is happy to support Tonga with 4.6.4 Alcohol the fight against NCD with World Bank and 1. National awareness strategy- TV, other partners. radio, ngaueaki kotia e mita (TV most effective, 18 5 Media coverage The workshop gathered extensive media coverage both within Tonga and in the region. The findings from the study and the recommendations for the future were the main focus of the local media coverage which is listed below. Additional stories were also published through Australian based media outlets and social media Local Media Tax increase on tobacco drives Tonga’s smokers to local ‘tapaka’: https://matangitonga.to/2018/09/03/tax-increase-tobacco-drives-ton- gas-smokers-cheaper-alternatives New NCD crisis study recommends tax on local tobacco: https://matangitonga.to/2018/09/05/new-ncd-crisis-study-recom- mends-tax-local-tobacco Consider a “fat” food tax, study recommends: https://matangitonga.to/2018/09/18/consider-fat-food-tax-study-rec- ommends Government press release Minister for Internal Affairs attends NCD taxation policy assessment in Vava’u: http://www.gov.to/press-release/minister-for-internal-affairs-at- tends-ncd-taxation-policy-assessment-in-vavau-2/ Australian media NCD taxes in Tonga: http://mpegmedia.abc.net.au/radioaustralia/radioaustralia/au- dio/201809/pba-2018-09-06-pacislfor-ncd.mp3 Tonga’s tobacco taxes: http://www.devpolicy.org/tongas-tobacco-taxes-20180924/ Social media Minister for Internal Affairs attends NCD taxation policy assess- ment in Vava’u: https://www.facebook.com/TongaGovtPortal/ posts/931454673721399 19 Appendix A: Attendance List for Nuku’alofa No Name Designation CABINET MINISTERS 1 Hon. Semisi Fakahau Minister for Agriculture, Fisheries, Forestry & Food 2 Hon. Losaline Ma’asi Minister for Internal Affairs MEMBERS OF PARLIAMENT 3 Hon. Siaosi SOVALENI Tongatapu 3 HEADS OF DIPLOMATIC MISSIONS 4 H.E. Mr. Andrew FORD Australia 5 H.E. Ms. Tiffany BABINGTON New Zealand 6 H.E. Mr. Tetsuya ISHII Japan 7 Yasushi Hayaki JICA Resident Representative DEVELOPMENT PARTNERS 8 Debra Allen Department of Foreign Affairs and Trade 9 Madeleine Scott Department of Foreign Affairs and Trade 10 Elena PROCUTA MFAT Deputy High Commissioner CHURCH LEADERS 11 Pastor Saia VEA President, Seventh Day Adventist Church 12 Rev. Siamelie Latu Free Constitution Church of Tonga 13 Rev. Samuela Fakafou Free Constitution Church of Tonga 14 Silongo Samani LDS NON – GOVERNMENT ORGANIZATIONS 15 Mrs. Mele Amanaki Chairperson National Food Council 16 Ms. Fuiva KAVALIKU Director, Women & Children’s Centre 17 Mrs. Papiloa FOLIAKI Board Mamber, Tonga Trust Technical Staff 18 Mr. Metuisela Falesiva Food Division, Ministry of Agriculture 19 Mrs. Sandra Fifita Ministry of Labor and Commerce 20 Mr. Eva Mafi Ministry of Health 21 Mr. Sione Faleafa Ministry of Finance and National Planning 22 Mrs. Natalia Palu Latu Ministry of Finance and National Planning 23 Mrs. Monica Tu'ipulotu Program Coordinator, Tonga Health Promotion Foundation 24 Mr. Sione Lolohea Government Statistics Department 25 Dr. Siale Akauola Ministry of Health CEO 26 Viliami Fifita Department of Statistics: Government Statistician (CEO) 27 Jeanie McKenzie NCD Adviser, TongaHealth Civil Society, Academia, Businesses and Community Groups 28 Sione Taumoefolau Red Cross Tonga Assistance Treasurer, Tonga Chamber of Commerce & Industry 29 Ms. Elizabeth Cowley Inc. & Council Member (+ Owner of Waterfront Lodge & Restau- rant) Position Community Education (disability), Tonga Family Health 30 Rheema Misa Association (TFHA) 31 Mele 'Amanaki National Food Council 20 No Name Designation Additional Participants Monitoring and Evaluation Health Promotion Officer, Ministry of 32 Ms. Tinalasa Vunipola Health 33 Ms. 'Ana Soakai Takai Senior Manager Economics, National Reserve Bank of Tonga 34 Semisi Fukofuka MOH 35 Rev 'Etuate Manuofetoa FWC 36 Amilini TFHA 37 Sione Fifita Community Development & Research Officer 38 Sione Lolohea Statistics Dept 39 Ana Ika MOFNP 40 Semisi Faupula MOFNP 41 Toakase Peteli MOFNP 42 Sivoki Lavemaau MOFNP 43 Latu Fusimalohi MOH 44 Tupou Tu'ilautala MOH 45 Fuiva Kavaliku TNCWC 46 Winston Fainga'anuku Statistics Dept 47 Maude Ruest World Bank 48 Dr Sutayut Orsonprasop World Bank 49 Mr. Sione Hufanga World Bank 50 Dr Cathy Latu Tekiteki World Bank 51 Mr. Erling Ve'etutu World Bank 52 Mrs Sela Latailakepa World Bank 53 Mr. Pita Feimoeafi World Bank 54 Mr. Sione Saumaki World Bank 55 Mr. Uikilifi Lolohea World Bank 56 Mrs Jodie Brabin World Bank Please note additional attendees arrived late and therefore did not sign in. This list is not reflective of the total attendance number. 21 Appendix B: Attendance List for Vava’u No Name Organization 1 Hon. Losaline Ma'asi Minister for Internal Affairs 2 Lord Fakatulolo Governor of Vava’u 3 Dr. John Lee Taione Ministry of Health 4 Leody Vainikolo Ministry of Agriculture 5 Vehitau Ma’ukie Customs Department, Ministry of Revenue and Customs 6 Bruno Toke Ministry of Tourism 7 Taulango Tapueluelu Ministry of Police 8 Siosifa Lauti Fe’iloakitau Ministry of Finance and National Planning 9 Father Pauli Ta’ai Parish Priest – Catholic 10 Pastor Havili Sefesi City Impact 11 Vava Fifita ‘Ofisakolo – Neiafu 12 Paea Uasike Pule Fkvahe- Leimatu’a 13 Falahola Tupou Senior Accountant, Sub-Treasury Vava’u 14 Mr. Viliami Talivakaola Latter Day Saints 15 Mr. Sione Tokoma'ata Ministry of Education and Training 16 Mr. Tupou Latavao Ministry of Customs and Revenue 17 Mr. Petelo Sanele Ulupano Ministry of Infrastructure 18 Ms. Kakau Leander Ministry of Agriculture and Forestry 19 Ms. Lisa Fanua VEPA 20 Mrs Melenaite Ma'ukie MORC 21 Mrs Eva Tu'uholoaki MIA 22 Mr. Siaosi Moala Mizpah HS 23 Dr Sutayut Orsonprasop World Bank 24 Dr Cathy Latu Tekiteki World Bank 25 Mr. Sione Hufanga World Bank 26 Mrs Jodie Brabin World Bank 27 Mrs Sela Latailakepa World Bank 28 Mr. Pita Feimoefiafi World Bank Please note additional attendees arrived late and therefore did not sign in. This list is not reflective of the total attendance number. 22 Appendix C: Workshop Agendas Stakeholders Consultation Workshop “Improving the use of taxation policy on tobacco, alcohol, food and beverages as a response to the NCD crisis in Tonga” (Tentative Program) September 3, 2018 Tanoa International Hotel, Nuku’alofa Master of Ceremony: Mrs. Natalia Palu Latu Time Session Lead 08:30am Registration Rev. Etuate Manuofetoa Assistant Finance Secretary, Free Wesleyan Church of 09:00am Opening prayer Tonga Mrs. Kilisitina Tuaimei’api A/CEO, Ministry of Finance and National Planning Mr. Tatafu Moeaki and Dr. Sutayut Osornprasop World Bank Ms. ‘Ofeina Filimoehala Tonga Health Promotion Foundation 09:10am Welcome Address Ms. Fiasili Lam Food and Agricultural Organization (FAO) His Excellency Andrew Ford, High Commissioner Government of Australia’s Department of Foreign Affairs and Trade Her Excellency Tiffany Babington, High Commissioner Government of New Zealand’s Ministry of Foreign Affairs and Trade Hon. Mr. Mateni Tapueluelu 09:45am Opening remarks by the Chair Acting Minister of Ministry of Finance and National Planning and Minister of Revenue and Customs 10:00am Group Photo and Morning Tea Presentation on key findings Dr. Sutayut Osornprasop and World Bank Team from the study Senior Human Development Specialist, 10:30am Global Practice on Health, Nutrition, and Population Q&A World Bank Special Presentation from Mr. Sione Faleafa 12:00 the Ministry of Finance and Chief Economist National Planning Ministry of Finance and National Planning 12:30pm Working Lunch – Group Work Presentations of key recom- 1.40 pm mendations from the group Workshop participants work 23 Time Session Lead Group Work Facilitators: Ms. Fiasili Lam, FAO Mr. Pau Likiliki, FAO Mr. Sione Hufanga, World Bank Dr. Catherine Latu, World Bank 1.40 pm Q&A Ms. Jodie Brabin, World Bank Ms. Sela Latailakepa, World Bank Mr. Pita Feimoefiafi, World Bank Mr. Kilifi Lolohea, World Bank Mr. Sione Saumaki, World Bank Panelists: Mr. Kelemete Vahe, CEO of Ministry of Revenue and Customs Dr. Siale ‘Akau’ola, CEO of Ministry of Health Mr. Viliami Manu, CEO of Ministry of Agriculture, Food, Hard Talk: What is next for and Forestry Tonga? (moderated session) Ms. ‘Ofeina Filimoehala, CEO of Tonga Health Promotion Foundation 2:30pm Mrs. Sandra Fifita, Ministry of Commerce, Consumer, Trade, Innovation, and Labour: Mr. Saia Vea, President SDA, Church Leader Q&A Moderator: Dr. Sutayut Osornprasop, World Bank Mrs. Kilisitina Tuaimei’api A/CEO, Ministry of Finance and National Planning 3.45 pm Summary and next steps Dr. Sutayut Osornprasop, World Bank Dr. Siale ‘Akau’ola CEO of Ministry of Health Closing remarks Dr. Yutaro Setoya 4.10 pm World Health Organization Rev. Etuate Manuofetoa Closing Prayer Assistant Finance Secretary, Free Wesleyan Church of Tonga 4:30pm Afternoon tea and end of workshop 24 Appendix C: Workshop Agendas Stakeholders Consultation Workshop “Improving the use of taxation policy on tobacco, alcohol, food and beverages as a response to the NCD crisis in Tonga” (Tentative Program) September 5, 2018 Governor Office, Vava’u Master of Ceremony: Mrs. ‘Evaipomana Tu’uholoaki, Deputy Director, Ministry of Internal Affairs Time Session Lead 08:30am Registration Ministry of Internal Affairs 09:00am Opening prayer Lord Fakatulolo Governor of Vava’u Mr. Sione Faleafa Ministry of Finance and National Planning Dr. Sutayut Osornprasop 09:10am Welcome Address World Bank Ms. O’feina Filimoehala Tonga Health Promotion Foundation Ms. Fiasili Lam Food and Agricultural Organization (FAO) Hon. Losaline Ma’asi Opening remarks by the Chair Minister of Ministry of Internal Affairs 09:45am Mr. ‘Onetoto ‘Anisi Word of Thanks A/Chief Executive Officer, Ministry of Internal Affairs 10:00am Group Photo and Morning Tea Presentation on key findings from Dr. Sutayut Osornprasop and World Bank Team the study Senior Human Development Specialist, 10:30am Global Practice on Health, Nutrition, and Population Q&A World Bank Special Presentation from the Mr. Sione Faleafa 12:00 Ministry of Finance and National Chief Economist Planning Ministry of Finance and National Planning 12:30pm Working Lunch – Group Work Presentations of key recommen- Workshop participants dations from the group work Group Work Facilitators: Ms. Fiasili Lam, FAO Mr. Pau Likiliki, FAO 1.30 pm Mr. Sione Hufanga, World Bank Dr. Catherine Latu, World Bank Q&A Ms. Jodie Brabin, World Bank Ms. Sela Latailakepa, World Bank Mr. Pita Feimoefiafi, World Bank Mr. Kilifi Lolohea, World Bank Mr. Sione Saumaki, World Bank 25 Time Session Lead Summary from Hard Talk: Mr. Sione Hufanga and Dr. Catherine Latu, 2:30pm What is next for Tonga? World Bank Session in Nukua’lofa Mr. Sione Faleafa, Chief Economist Ministry of Finance and National Planning 3.30 pm Summary and next steps Dr. Sutayut Osornprasop, World Bank Mr. Sione Faleafa, Chief Economist Ministry of Finance and National Planning Closing remarks 4.00 pm Dr. Yutaro Setoya World Health Organization Closing Prayer Ministry of Internal Affairs 4:30pm Afternoon tea and end of workshop 26