Beyond taxation: a qualitative analysis of policy challenges in controlling sugar-sweetened beverages consumption in Indonesia

Abstract

Abstract Background Nutrition-related non-communicable diseases (NCDs) are major global health challenges, including in Indonesia, where the disease burden continues to rise. Excessive consumption of sugar-sweetened beverages (SSBs) is a well-established contributing factor, with intake levels increasing globally. Despite strong evidence supporting SSB taxation as one of the key policy interventions to reduce consumption, Indonesia has not yet implemented the policy, reflecting a complex interplay of political, economic, and sociocultural factors. This study aimed to examine stakeholder perceptions of the problems, political dynamics, and potential policy actions to control SSB consumption in Indonesia. Methods This study adopted a qualitative design through two semi-structured focus group discussions and five in-depth interviews with 17 stakeholders from government, academics, policy/economics analysts, and civil society organizations, conducted between December 2022 and April 2024. Data were analyzed thematically using a hybrid inductive-deductive approach, in which initial open coding was followed by deductive organization of themes according to the three streams of the Multiple Streams Framework (MSF) — problem, policy, and politics. Results In the problem stream, stakeholders across sectors converged in recognizing SSB consumption as a pressing health issue, shaped by Indonesia’s deep-rooted “sweet culture,” obesogenic environment, and a structural regulatory coverage gap for informal sector. The policy stream identified technically feasible interventions across government, market, and community levels, including tiered SSB excise taxation, mandatory nutrition labelling reform, and culturally grounded community education. However, the politics stream revealed competing inter-sectoral mandates and interests, despite existing regulatory frameworks that already authorize SSB control measures, indicating that a policy window exists. Conclusions While introducing SSB taxation is a promising policy option, taxation alone would not be sufficient to control SSB consumption. Effective control of SSB consumption in Indonesia would require the integration of multilevel (government, market, community), multisectoral, and culturally sensitive approaches, supported by stronger cross-sectoral political commitment to align the politics stream with existing problem recognition and available policy options.