Cardiologists Are Begging People To Stop ‘Leaning Too Heavily' on This One Daily Metric
Cardiologists Are Begging People To Stop 'Leaning Too Heavily' on This One Daily Metric originally appeared on Parade.
It's really easy to fall into TikTok rabbit holes, especially when it comes to your health, and heart health is no exception. Whether it's dangerous diet culture and weight loss discourse, supplement shilling or anti-vaccine messaging, it's easy to feel anxious that you aren't doing enough to stay healthy when you're scrolling.Is there yet another thing you should be doing to track your health, or is the latest TikTok wellness trend just a sales tactic to get you to buy a new device or to download another app that may use your data in potentially questionable ways? Below, cardiologists weigh in on the truth about a heart health metric, called , that influencers are insisting you need to measure—you know, along with everything else you're juggling just to exist in this timeline.Just remember: No one knows more about your actual health and what your body needs than you and your doctor, so check with your physician before implementing any changes one way or the other.🩺SIGN UP for tips to stay healthy & fit with the top moves, clean eats, health trends & more delivered right to your inbox twice a week💊
"Heart rate variability, or HRV, is the variation in time between each heartbeat," , cardiologist and vice president of medical affairs at Hello Heart, tells Parade. "It reflects how well your body can adapt to stress, rest and recovery. A higher HRV generally points to better cardiovascular fitness and resilience.""If your heart rate is 60 beats per minute, your heart doesn't beat exactly once per second," , an interventional cardiologist and chief medical officer at VitalSolution, an Ingenovis Health company, explains further. "There is some variability in time measured in milliseconds. Heart rate is controlled by the autonomic nervous system, which plays a key role in regulating your HRV. When you exercise, your heart speeds up, and when you rest, your heart slows down."Related:
Like most other health indicators, there are a lot more factors to HRV than just mere numbers—even sociological and socioeconomic factors play a role."It is influenced by age, race, sex, physical fitness, sleep, medication and health issues," , cardiologist and chief medical officer of L.A. Care Health Plan, says.Dr. Morgan notes that even caffeine intake can play a role in your HRV measurement, so putting too much stock into it may not be the best idea, but in general, there are general ranges. A normal HRV at rest for someone in their 20s is typically around 55 to 105, for example, while for someone in their 60s, it will be more like 25 to 45.Related:
https://www.youtube.com/shorts/avfNWUHWECQ
Influencer Lucie Fink talks about using Heart Rate Variability to track her COVID journey.
That depends on a few factors, experts agree, and it's by far not the most important metric to gauge your cardiovascular health by any means. "For most people, their HRV is stable over time," Dr. Amin tells us. "But some studies have shown a higher risk of heart events or even mortality in those with a reduced HRV."According to Dr. Serwer, a high HRV "means your body can switch efficiently between rest and stress modes which is a sign of good health." Conversely, he notes if you're sick, stressed, fatigued or if you over-exercise, your HRV may be lower.Related:
Chances are you don't have the equipment to get a fully accurate picture here. "The gold standard to measure HRV is by performing an EKG and precisely measuring the time between heartbeats," Dr. Serwer says. "Using advanced software, the HRV can be accurately calculated. This, however, isn't practical on a day-to-day basis."That said, Dr. Serwer and Dr. Morgan each note that certain apps and wearable technology (like fitness trackers or smartwatches) may be able to measure, track and store your values.Related:
Honestly, for most healthy people, the answer is probably no: While it doesn't necessarily hurt, it also doesn't reveal as much about your heart health as you think.
"HRV is a valuable metric which may lead us to identify stress, illness or overtraining earlier than waiting for apparent symptoms," Dr. Serwer notes, adding, "Like any test or vital sign, it is only helpful when you understand the limitations and the meaning of the value. We are often overwhelmed with data and sometimes don't pay attention to the apparent issues. HRV is a tool and when used appropriately, can be helpful."
People who may benefit from HRV monitoring are athletes and anyone worried about over-exerting themselves through exercise, or potentially recovering from an illness, and even then, your doctor will be able to make much more sense of it than most of us laypeople can.
"Monitoring HRV can offer a window into how your body is responding to stress, illness or physical overexertion," Dr. Morgan advises. "It's not all-encompassing, but it's a peek into the performance of your autonomic nervous system. Knowing this information and sharing it with your physician can help you make more informed decisions about your health and wellness."
Related:
For one, it's just not that useful, Dr. Amin says. "In general, I wouldn't suggest leaning too heavily on this measurement," he explains. "Generally, it would be best to focus on tracking more traditional markers of increased heart risk, including blood pressure, cholesterol and diabetes control."
Dr. Morgan notes that it's easy for people to get too obsessive over their heart rate variability when it can change for purely benign reasons.
"The main downside is over-interpreting the data and, frankly, worrying too much about it," she says. "HRV can fluctuate due to many factors, like sleep, hydration or even caffeine intake. It's a useful tool, but it shouldn't be the sole measure of your health. Don't worry too much if one or two readings are off—that's not good for your heart, either."
"Think of HRV as part of the bigger picture," she adds. "Trends matter more than single readings, and HRV should be viewed alongside other metrics like blood pressure, cholesterol and lifestyle habits (for example, getting eight hours of sleep per night, standing up and moving at least once per hour, taking any heart medications as prescribed, etc.). Always consult your physician if you notice concerning changes or have questions about your heart rate."
Up Next:Dr. Sameer Amin, MD
Dr. Jayne Morgan, MD
Dr. Bradley Serwer, MD
How to Use Heart Rate Variability Data In Your Training, HSS
Cardiologists Are Begging People To Stop 'Leaning Too Heavily' on This One Daily Metric first appeared on Parade on Jun 19, 2025
This story was originally reported by Parade on Jun 19, 2025, where it first appeared.
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Yahoo
an hour ago
- Yahoo
UnitedHealth's Rebound: Hidden Strength or Hiding Weakness?
Recently, UnitedHealth Group (UNH, Financial) has been the subject of many headlines because of DOJ probes, kickback accusations in nursing homes, and a shocking departure of its CEO. In addition, the value of its shares has dropped by almost 50%. Yet, underneath the news, the business is still strong. Health insurance remains important and strong throughout economic downturns and doesn't react to changes in global trade. In the aftermath, a clear development can be noticed as Stephen Hemsley was appointed CEO again and bought a large amount of stock which fueled a quick increase in share prices. Warning! GuruFocus has detected 4 Warning Sign with UNH. This is real conviction. UnitedHealth is focusing more on Medicaid-managed care, widening value-based care with Optum, and looking into growing its business in dual-eligible and long-term care. The company's financials confirm the trend since earnings have quadrupled in ten years, cash flow is strong, and insiders are buying in. In short, UnitedHealth is using the uncertainty to its advantage. Long-term investors may find the current price as an attractive chance to enter a company that has shown lasting and solid growth. UnitedHealth Group is the biggest health insurer in the United States and ranks highly internationally in healthcare. Its two key segments, UnitedHealthcare and Optum, give people health benefits, pharmacy services, data analysis, and healthcare. More than 150 million people are helped by this company, which is continuing to expand by combining operations and offering value-based care. The company provides insurance through commercial, Medicare, and Medicaid markets, and Optum sparks new ideas in care coordination and pharmaceutical services. UnitedHealth is smartly diversified. The company is doing well due to managed care growth, making money from healthcare improvements, and strategically serving top segments thanks to Optum doing the main work. Medicaid managed care expansion capturing state-level shifts: The move of Medicaid recipients from fee-for-service to managed care can bring huge benefits to UnitedHealth. According to industry statistics, UNH and four other large insurers cover over 50% of people in Medicaid-managed care across the nation. So, when several hundred thousand to millions switch plans, it has a huge effect on the company's finances. Since monthly premiums for complex patients in these states are $600$800, New York, Pennsylvania, and Michigan could add hundreds of millions of dollars to their annual premium earnings. Because of its connections with states, UNH is in a good position to win a major share of this revenue. Value-based care & optum scale turning outcomes into profit: Optum, which drives UNH's value-based approach, recorded $253 billion in revenue in 2024, which was 12% higher than the previous year, and $16.7 billion in operating income. Currently, Optum Health works with close to 4.7 million people in value-based contracts and plans to add another 650k in 2025. Focus on patient care and cost savings are the main aims of these models, and UNH supports this. When Optum grows its care coordination and home services, shared-savings revenue plays a bigger role, already bringing in hundreds of millions and capable of much more. High-Value segments target the dual-eligible and long-term care markets: Instead of raising its volume, UNH is focusing on high-paying customer groups, such as those with both Medicare and Medicaid and patients needing long-term care. Dual-eligibles may receive $2,500 monthly, which means each person will get $30,000 annually. Currently, UNH serves about 500k people, but if it could capture just 2 million of the national enrollments, it could earn $45 billion in annual premiums. Vertical integration with optum: Thanks to Optum, UNH has all its services combined, including pharmacy (over 1.62 billion scripts were handled by OptumRx in 2024), care delivery, data analysis, and provider management. Because of this integration, UNH is ahead in long-term care, managing care effectively, reducing expenses, and boosting results, which other organizations don't have. Overall, UnitedHealth is a leader that is making steady earnings now and is prepared to capture the future of healthcare and population wellness. Now, let's investigate the financial side of UnitedHealth Group. The company had good first-quarter earnings, but it sent a cautious message for the coming months. UnitedHealth Group's quarterly revenue of $109.6 billion was $10 billion higher than the same period last year, showing how much both UnitedHealthcare and Optum are growing. While adjusted EPS of $7.20 surpassed $6.91 from the earlier period, the company adjusted its full-year forecast down to expect adjusted EPS of $26.00 to $26.50. So, what leads to this change of tone? While UnitedHealthcare welcomed 780,000 new members, increased use of health services in Medicare Advantage by its customers caused the company's medical costs to increase above expectations. Because more people needed outpatient and physician care, the medical care ratio rose to 84.8%. For healthcare delivery, this is not necessarily an issue, yet it can still hurt business if prices fall short. Meanwhile, Optum Health experienced challenges with a more diverse member group and reduced payments due to less involvement among members in 2024. Even so, Optum achieved a $63.9 billion revenue thanks to its Rx division, which filled 408 million adjusted scripts. UNH is also operating efficiently, with its operating cost ratio now 12.4%, free cash flow at $5.5 billion, and a high 26.8% return on equity. The company also gave $5 billion back to its shareholders. All in all, UNH's basics are solid, but it has to deal with some short-term problems first. UnitedHealth Group has consistently improved its earnings over the years. In the year 2015, diluted earnings per share was only $6.01. Looking at the trailing twelve months, the number has reached $23.88. Over the past decade, the amount has almost quadrupled. It is even more impressive that the growth has been steady over the years. For many years, UnitedHealth kept increasing its profits, demonstrating the power of its varied businesses and strict management. The only major drop in EPS happened in 2024, with the figure reaching $15.51. Although this was an unusual dip in the company's history, it is on track for a solid recovery in 2025, and first-quarter adjusted EPS was $7.20. Looking into the future, analysts believe the trend will not stop. Even though 2025 is, in some ways, a year of recovery with a projected EPS of $22.59, the company's growth kicks in afterward. By 2026, analysts predict EPS will increase to $26.40, and then keep growing at double-digit rates, aiming for $45.83 by 2030. Source: Author generated based on historical data All in all, despite some occasional setbacks, UnitedHealth's future growth is steady, so patient investors are still in a position to be rewarded. The increase in EPS matches the upward trend in revenue per share. It highlights the company's steady growth and increased success. In the year 2015, the company's revenue per share was $162.47. Now, that figure is $443.16 TTM. That's a 170% jump in ten years, which clearly shows the company is making better use of its growth to help shareholders. What's most promising is that this growth keeps happening consistently. Revenue per share has increased year after year and stayed strong through different economic conditions and impacts on the industry. It is a result of the company attracting more members and expanding its main businesses, UnitedHealthcare and Optum. Once more, this trend keeps happening in the future. Revenue forecasts keep going up from $449.81 billion in 2025 to more than $591 billion by 2030. Minor changes in growth do not stop the company from expanding and creating more value for its shareholders. Source: Author generated based on historical data UnitedHealth Group's free cash flow per share is a reliable sign of how well the company is financially and operationally. The amount of free cash flow per share in 2015 was $8.46. Afterward, the company increased this number, reaching $26.82 for the TTM, which is more than three times higher than its value a decade back. What stands out about this growth is that it follows closely in line with the company's earnings trajectory. Therefore, we see that UnitedHealth's profits are being turned into cash that can be used to strengthen the business, cut debt, or be given back to its shareholders. Being that efficient is not common in an industry that relies heavily on capital like healthcare. UnitedHealth Group gives investors a good dividend since the dividend yield is 2.92% and the payout ratio is only 30%, which suggests that dividends could increase in the future. It's worth noting that over the past 5 years, the company has seen a 14.6% growth in its dividend, which tops inflation and profits long-term investors. Through ten years of constant raises, the yield on cost increases to 15.38%. Although UNH is offering a high yield now, low buybacks mean most capital is shared through dividends. UnitedHealth Group looks deeply undervalued right now. According to GuruFocus, the stock is trading about half its worth, as the fair value is $633.16 but it is currently trading at $303.22. There is a massive disconnect here, and it's very unusual for a company as stable as UNH to deviate so much from its fair value estimate. Valuation multiples are also telling the same story. The forward P/E of this stock is 13.42, which is much lower than the average of 17.66, giving a discount of 23.98%. The company's forward EV/EBITDA of 9.61 is better than the sector's ratio of 11.79. On a price-to-sales ratio, UNH is trading at 0.61 times its projected sales, while the healthcare industry is pricing in at 3.43xa discount of 82%. All in all, UNH gives you both quality and value. Almost all of the valuation measures suggest that the company is undervalued in terms of its earnings, sales, and cash flow. Even though the stock is built on solid foundations and pays out more in dividends each year, it still trades at a lower price than its competitors. As a result, long-term investors can take advantage of acquiring a leader in healthcare at a much lower price than its actual value. When measured against companies like Humana (HUM, Financial) and HealthEquity (HQY, Financial), UnitedHealth Group is still a good buy. Because its forward P/E is lower than HUM's 14.1 times and much lower than HQY's 30 times, it attracts those who want to invest for growth as well as value. Considering price-to-sales, UNH trades at 0.68 times, making it more valuable than HQY's 7.8 while being slightly higher than HUM's very low 0.23. On the EV/EBITDA ratio, UNH stands at 9.6x forward, quite similar to HUM's 9.2x and much less than HQY's 19.2x. All in all, UNH is well-balanced by giving investors scale, profits, dividend growth, and a reasonably attractive price. HUM also does well in various areas, especially when it comes to managing expenses and the way the company works. But in the long run, investors admire UNH for its consistent results and potential to increase. Source: Author generated based on data Going forward, I feel UnitedHealth Group (NYSE:UNH) is well-positioned to achieve a price target of $395$410 in the next year and possibly surpass $525$550 by 2027. Despite the stock's recent volatility, the numbers, the company's health, and the outlook seem to fit together nicely. Let's begin our discussion with the short term. Despite many years of increasing earnings and a high rate of cash conversion, UNH is only valued at 13.4 times its future earnings when the stock is trading at $303. Healthcare companies, on the other hand, have a forward P/E of about 17.6, and UNH has generally had a forward P/E between 18x and 20x during calm times. If UNH is valued at just 17 times the expected FY2025 EPS of $22.59, the price would come to $384. At 18x, If stability comes back and the new leaders reassure everyone, the stock could increase to $406. The story gets even better as you look further into the future. Analysts are predicting that EPS will rise to $45.83 by 2030, meaning it will be about double the current earnings in just five years. Multiply the earnings by 15, and the share price comes out to $687. But, let's narrow our focus to conservatism, and for 2027, the predicted EPS is about $34.50. At this multiple of 15x, the price comes out to $517if the market recovers, shares could climb to $550 or more due to the 16x or 17x rating. If the DOJ investigation ends well and Hemsley's efforts to cut costs are successful, the company should do well over the next few quarters. We are not just discussing theory here. Since 2015, UNH's free cash flow per share has more than tripled, its revenue per share has nearly tripled too, and it still has some of the top dividend growth rates in healthcare. Such consistency, size, and under-valuation are hard to find in one company. Let's look at how Wall Street views this area. Looking at the chart, analysts foresee that the price of Apple shares might rise by 26.2% to $382.80 in the next 12 months. It is estimated that the cost can fall anywhere from $270 to $677. To conclude, although there may be short-term ups and downs, it looks like disciplined, patient investors will find more favorable long-term conditions. When Andrew Witty suddenly left his CEO post in May because of profit problems and dropped 2025 guidance, UNH shares fell over 12% to their lowest point in five years and wiped out more than $250 billion in market value. As a consequence, the board brought back former CEO Stephen Hemsley (who headed the company from 2006 to 2017). Within only a few days, Hemsley made a big step by buying nearly 86,700 shares worth about $25 million for $288.60 per share. Hemsley, together with the CFO and several directors, voted to keep the company's value high, and shares rose by about 8% the following trading day. What does it imply? It is clear that the management views the falling share price of UNH as a good time to purchase. The fact that Hemsley has invested his money shows how much he believes in the company after all it has achieved. Yet, this is not a case of blind faith: the company is dealing with an ongoing investigation, higher medical costs in Medicare Advantage, and a cyberattack it suffered recently. From a strategic point of view, all this buying in UNH suggests that the company's leaders believe the worst has passed and risks for the stock are low. The guru trading chart has an interesting narrative. Although UnitedHealth's stock has gone down recently, gurus have been buying it more frequently. Many green bars are appearing, both early in 2024 and again later in 2025, showing that some informed investors are looking at the dip as an opportunity to buy instead of a warning sign. This trend can be seen in the investor's stock portfolio. Vanguard is still the biggest shareholder, but it slightly reduced its holdings. I'm also paying attention to Ken Fisher (Trades, Portfolio) , who bought much more, a solid 52%, and Jeremy Grantham (Trades, Portfolio) , who increased his holding by over 7%. Though there is selling and shares are reduced as well, institutions tend to be cautiously upbeat. Even though UnitedHealth's future looks bright, investors should still pay attention to the risks in the near term. The DOJ is currently investigating the business for possible Medicare Advantage fraud, such as upcoding and billing errors, which is a very serious matter that could result in being fined or charged in court. At the same moment, Washington is paying more attention to supervision. Should reforms reduce the inflation of risk scores or Medicare allowance for nurse practitioners, it could affect the profitability of Medicare Advantage. Q1 faced some issues because the higher use of medical services caused the medical loss ratio to increase to around 85%, and Optum is still learning to handle CMS's updated risk model. Because of these pressures, there could be more budget reductions for guidance. However, the bad news appears to be mostly factored into share prices. For careful investors who believe the company will survive, this could present an opportunity to buy long-term. The headlines can be very tempting, but stepping back, it appears that UnitedHealth is still a powerhouse lurking in plain sight. It is the same old stuff but with a different sentiment. The long-term story is still in place with the reinstatement of Stephen Hemsley, a recent insider purchase, and a long history of expertise in Medicaid-managed care and the Optum platform in value-based care. Most of that bad news, including the increases in care costs, and regulatory noise, appears to be reflected in price. Sentiment can change at any minute as long as we hear a resolution to the DOJ investigation, a slowdown in the trend of rising Medicare costs, or upbeat guidance in coming quarters. Any of those may be the spark. In the meantime, the stock is currently trading at one of the most attractive valuations it has seen in years, and the set-up is of the sort long-term investors tend to reflect back on with gratitude. If you are waiting to have a clear picture, you may miss the opportunity. However, to the patient and longer-term investors, this may be one of those times when interceding in soreness results in actual payoff. In other words, this just might be a smart time to lean in and buy the stock. This article first appeared on GuruFocus. Effettua l'accesso per consultare il tuo portafoglio
Forbes
an hour ago
- Forbes
Can Improving Taxation In Africa Help Meet Health Needs?
Waiting for malaria vaccination in Uganda's Apac District (Photo by Hajarah Nalwadda) In Sierra Leone, there was a time when 'people were so happy to pay' local taxes, says Joanna Favour Tom-Kargbo, an economic justice manager for the NGO Christian Aid. For instance, her council would make a documentary to show where the money was being spent, such as road or market construction. In that kind of situation, 'you don't need to coerce people to pay. Citizens were willing.' The situation changed when the government used tax revenue to put on a lavish concert, Tom-Kargbo reports. It was poorly attended, and people considered it a waste of money. Trust in the tax system was broken. But this kind of trust can be repaired—and it may be more crucial than ever now. After the U.S. rapidly shut down its main foreign aid agency and eliminated over 80% of aid projects, many countries were left in the lurch. This was especially pressing for those that depended on U.S. assistance for basic health services, from vaccination to malaria prevention. Researchers have estimated that nearly 300,000 people, most of them children, have died from the resulting vacuum of healthcare. One of those is Bukar Mohammed, a 7-year-old boy living with sickle cell disease in Northern Nigeria. After he developed a fever in February, his mother raced with him to their usual clinic—only to be told it had closed the week before due to an abrupt cutoff of funds. The Trump administration, development officials in other wealthy countries, and aid critics around the world have called for nations receiving foreign assistance to find more of their own funds for development programs. This is partly out of necessity. 'If the general overseas development system freezes or decreases, then taxes become even more important than what they currently are,' notes Giovanni Occhiali, a development economist at the International Centre for Tax and Development. The Africa Centres for Disease Control and Prevention, which itself faces dozens of layoffs amidst a shrinking pool of money for global health, is urging African countries to fund their health sectors through improved and increased taxation. This could include solidarity levies, including taxes on airline tickets, imports, and cell phone services (though taxes on mobile financial transactions have proven very unpopular in countries including Ghana and Uganda). One UN proposal is for all low- and middle-income countries to tax revenue amounting to at least 15% of their GDP. To some extent, this turn toward domestic taxation is now happening. According to a World Health Organization survey, at least 24 countries are increasing domestic public funding for health. (However, more countries are cutting costs.) Governments are looking to increased taxation for areas beyond health. The Ethiopian government has proposed an organizational tax that to support disaster response, for instance. But in general, earmarking tax revenue for a specific purpose can risk making a country less responsive to emergencies. While governments may be able to temporarily reallocate some resources based on need, it's no simple task to find more domestic money to plug the gaps. Many people are calling for new taxes on unhealthy products like tobacco, alcohol, and sugar-sweetened beverages, both to increase public revenue and strengthen public health. Such 'sin taxes' already exist in South Africa and Botswana. In Zimbabwe, the finance minister recently introduced them in order to dedicate the proceeds to health projects. Yet there will be a lag as these taxes are rolled out. Thus, the World Health Organization is advising countries affected by the foreign assistance cuts to start the sin taxes right away, while rolling out health insurance in the longer term. Overall, improving tax collection sustainably and equitably takes a long time. It took Togo about 12 years to increase the tax–GDP ratio by 5%, according to Occhiali; for most African countries, growing taxation by half a percentage point a year is ambitious. 'Increasing domestic revenue mobilization is always a long-term endeavour,' Occhiali cautions. 'Any type of tax reform really needs to be carefully planned and executed over a number of years.' Indeed, tax changes that seem abrupt or unjust can have tragic consequences. Kenya was shaken by protests last year against proposed taxes on basic goods, following a string of other new taxes. Security forces killed at least 80 demonstrators, by one estimate. The outcry led to a government pledge to avoid new taxes. In Sierra Leone, 'most of the things have been taxed' already, says Tom-Kargbo. Particularly harsh for women feeding their families has been a 2024 tax of 5% on imported rice. This is aimed at bolstering Sierra Leone's own rice production, but the upshot is that many families have simply been forced to eat less rice. There are also now taxes on phone calls and text messages. In the context of waning foreign assistance around the world, Occhiali says, 'there is a risk that governments facing immediate cuts…might be incentivized to take short-term action that might prove counterproductive in the long term.' He advises focusing on better administering the taxes that already exist, rather than raising new ones. It may not be as glamorous as a rushed new tax, but strengthening the foundations of tax systems would ultimately be more helpful. According to the International Monetary Fund (IMF), many countries could increase their tax-to-GDP ratios, by up to 9 percentage points, by improving tax design and public institutions. Rice for sale at the Lumley Market in Freetown, Sierra Leone (Photo by Saidu Bah) There are many reasons that tax is under-collected in some African countries. One is insufficient resourcing of tax agencies, which creates a vicious circle of not enough money for the overall public purse. When it comes to sufficiently taxing wealthy Africans, the difficulty tends to not be the legal system, but gaps in data and administrative capacity, says Ronald Waiswa, who worked for the Uganda Revenue Authority before joining the African Tax Administration Forum. Corruption is also a problem. And there's a more amorphous factor as well: low trust in governments to fairly collect tax and use it properly. If residents don't see the benefits of taxation, they have little reason to support it. They can even see their own governments as parasitic. As in many African nations, more tax collected in Sierra Leone goes to paying off external debt (primarily to the World Bank and IMF) than is spent on education and health. Sierra Leoneans aren't necessarily seeing the benefits of the tax they're increasingly being asked to pay, which often doesn't even remain in the country. 'We're seeing the impact of poor-quality health services. We are seeing the impact of poverty continue,' Tom-Kargbo notes. 'People are saying, 'Where even are our tax monies going?'' Sierra Leone has already tried earmarking taxes for free healthcare services, Tom-Kargbo reports. The problems have been implementation, accountability, and transparency—and inadequacy in these areas also lowers trust in the revenue authorities. In Ghana, transparency related to tax reforms makes people more likely to support them. In Somalia, focusing on services makes people especially comfortable with paying taxes. Systems are currently stacked against poorer consumers. In Uganda, 'Our domestic tax system now is really regressive,' comments Africa Kiiza, an economic justice adviser for Christian Aid. High earners are paying the same tax on salt, soap, and sugar as unemployed people, he says. Yet ordinary Ugandans aren't seeing those consumption taxes necessarily translate into public services like education and health. In South Africa, the Institute of Economic Justice is calling in the short term not for increased sales taxes, but increased corporate taxes and reduced tax breaks (though some economists believe that South Africa's VAT taxes can be designed well to not be regressive). Occhiali is not in favor of further increasing consumption taxes either. Sales tax is 'already the main source of government revenue across most of the continent,' he points out. 'It sounds a bit perverse to imagine that we should focus on taxes that are already performing relatively ignore the two main sources of revenue that are clearly underperforming': property tax and income tax. In the interest of equality, the Africa CDC recommends 'tiered tax structures to protect low-income populations while ensuring wealthy individuals and corporations contribute more.' Concretely, this could involve not taxing women selling tomatoes informally, for instance, but high earners. This may seem like a straightforward principle, but it's actually been the subject of much debate. One reason that so many African workers' incomes aren't taxed is that many of these workers are operating outside the formal system of labor contracts and official payments. 'Only about 4% of the population on average in the continent pays personal income tax,' according to Occhiali. Yet they are paying a variety of other charges, such as value-added taxes, import taxes and market stall fees. 'There has been, for a very long time, a lot of focus on getting onto the tax registry the vast majority of the informal sector, thinking that they were a gold mine,' Occhiali says, 'rather than pursuing the smaller number of well-off individuals within a country who are often evading a significant amount of their tax liability.' As a spectrum, informality can encompass both unregistered vegetable sellers and high-earning lawyers who don't declare all their income. It would be more productive to focus on the latter, he argues. The good news is that it shouldn't be logistically challenging to properly gather property tax and the income tax of high earners. Technology and data collection are improving in ways that can ease this, such as GIS-based assessments of building materials and structure sizes, which can be used to tax higher-value properties more. In Sierra Leone, Occhiali says, the size of the property register doubled with improved data collection. The bad news is that political will can be hard to amass. 'Political pressure plays an important role in this, arguably more than technical reasons,' Occhiali believes. Many politically connected people are reluctant to declare their own taxes or to target high earners, which has contributed to the current situation where wealthy Africans pay less in tax than the average. Progress can sometimes feel slow, but it's going in the right direction, according to Occhiali. In Uganda, a decade ago, only one of the 71 top government officials had ever paid individual income tax. And fewer than 30% of top lawyers were paying it. Since then, with a dedicated unit, the Uganda Revenue Authority has collected a significant amount of tax from rich people. So inequality within a country's tax system can be addressed. But it intersects with inequality in the global tax system. 'The reason why we pay so much in terms of interest,' Kiiza argues, 'is because our powers to negotiate fair loans and fairer terms of repayments are constrained at the global level, because of our poor representation or under-representation on the IMF boards and the key decision-making bodies.' These aspects are expected to be discussed at the Financing for Development conference that begins at the end of June. But countries including the U.S., where the IMF and World Bank are based, are blocking potential reforms. The current system is evidently stacked against Africa. According to the NGOs Christian Aid, Bond, and the Center for Economic and Social Rights, all of Africa holds only 4.7% of voting shares at the IMF and World Bank, slightly more than the U.K. (at 4.03%) and substantially less than the U.S. (at 16.5%). Unfairness within and between countries is linked, Kiiza stresses. 'Our governments are under capture, just like we are also under capture by these governments.'
Washington Post
an hour ago
- Washington Post
In Uganda, a tougher bicycle offers hope for better health coverage in rural areas
LIRA, Uganda — The bicycle parked in Lucy Abalo's compound doesn't belong to her. Any one of the hundreds of people in her village can show up and ask to use it. A man might wish to take his pregnant wife for a checkup. A woman might need transport to pick up HIV medication. An injured child might need a trip to a hospital.
