Governance and planning gaps in sugar-sweetened beverage taxation: A systems-based public health analysis

OBJECTIVES: To examine sugar-sweetened beverage (SSB) taxation through a health planning and governance lens, identifying structural gaps in fiscal design, policy integration, and alignment with contemporary evidence on diet-related chronic disease prevention. STUDY DESIGN: Structured narrative review combined with a systems-based policy analysis. METHODS: A structured narrative review was conducted following the Scale for the Assessment of Narrative Review Articles (SANRA). Evidence was identified through targeted searches of PubMed, Scopus, and Web of Science, complemented by international policy documents, including the World Health Organization Global Report on the Use of Sugar-Sweetened Beverage Taxes (2025). Thematic synthesis was guided by a conceptual framework integrating fiscal policy design, governance arrangements, food environments, and evidence-based prevention models. RESULTS: The analysis identified persistent governance and planning gaps that may limit the preventive impact of SSB taxation. These included low and heterogeneous tax levels, limited adoption of sugar-content-based taxation, absence of inflation-adjustment mechanisms, weak earmarking of revenues, and poor integration with food environment regulation and institutional health policies. The review also highlighted the influence of governance fragmentation and the limited incorporation of contemporary prevention evidence into fiscal policy design. Overall, SSB taxes frequently function as isolated fiscal measures rather than as components of comprehensive chronic disease prevention strategies. CONCLUSIONS: The preventive limitations of SSB taxation appear to reflect governance and planning misalignment rather than insufficient policy adoption. Reframing SSB taxation as a health planning function, integrated with food environment regulation, institutional policies, and evidence-based prevention frameworks, may strengthen its contribution to long-term population health and chronic disease prevention.