摘要：In Canada, tax incentives have been recently introduced to promote physical activity and reduce rates of obesity. The most prominent of these is the federal government's Children's Fitness Tax Credit, which came into effect in 2007. We critically assess the potential benefits and limitations of using tax measures to promote physical activity. Careful design could make these measures more effective, but any tax-based measures have inherent limitations, and the costs of such programs are substantial. Therefore, it is important to consider whether public funds are better spent on other strategies that could instead provide direct public funding to address environmental and systemic factors. LOW LEVELS OF PHYSICAL activity are an important public health issue in North America and other developed regions. In the United States, just 42% of children (aged 6–11 years), 8% of adolescents (aged 12–19 years), and 49% of adults get the currently recommended 60 minutes per day of physical activity. 1 , 2 In Canada, the situation is similar, with 13% of children and 48% of adults meeting Canadian guidelines. 3 , 4 In a recent nationally representative US survey, just 35% of adults reported any regular leisure-time physical activity. 5 Adding to the concern about low physical activity levels, recently released findings from the Canadian Health Measures Survey suggest that fitness among both children and adults has declined over the past 2 decades. 6 , 7 Reducing sedentary behavior and increasing physical activity could help reduce or prevent obesity and its associated health consequences. 8 Furthermore, evidence shows that increased physical activity has many important health benefits, regardless of weight status. 9 , 10 A wide range of different policies have been implemented or proposed to encourage populations to be more physically active, including disseminating public information, increasing mandatory physical education in schools, enabling the use of school and community facilities for sports and recreation, and designing the built environment to increase opportunities for safe and accessible physical activity. 11 , 12 Dunton et al. describe 4 types of policy strategies to promote or discourage a particular behavior: (1) provide information about the behavior, (2) increase or decrease opportunities for the behavior, (3) offer incentives or disincentives for the behavior, and (4) require or prohibit the behavior. 13 Within the third category, various forms of financial incentives could be used to promote higher levels of physical activity. For example, financial incentives have been implemented to encourage active commuting, such as walking or cycling. 14 Taxes could also be used to provide positive incentives for physical activity (e.g., tax exemptions or rebates on sports equipment or fitness programs) or negative incentives for sedentary behavior (e.g., higher taxes on home entertainment equipment). 15 Federal and provincial governments in Canada have recently introduced tax incentives to promote physical activity and reduce rates of obesity. Tax credits for physical activity programs are offered by the federal government and several provincial governments. Some governments have also provided sales tax exemptions for bicycles or recreational programs. Other countries have looked to these initiatives as models. For example, several state and federal bills have been introduced in the United States that would create tax deductions or credits for fitness programs or health-club memberships, 16 , 17 and similar measures have been proposed in Australia. 18 , 19 Tax-based incentives may be attractive to governments because they offer some administrative efficiencies and the political benefit of offering a tax break. However, given the challenge of choosing effective strategies from among the broad range of policy options available to governments, it is important to assess the potential benefits and limitations of using tax measures to promote physical activity. Ideally, this assessment would be informed by data on the effectiveness of these or similar measures. In the absence of such data, novel policies can be evaluated by reference to criteria such as plausibility and equitable distribution of benefits. 20 – 22
