For instance, the Australian state of Victoria established a health promotion agency funded by tobacco taxes, and several US states (California, Massachusetts, Arizona, and Oregon) have hypothecated part of tobacco excise revenues for tobacco-related education and tobacco-control activities; alcohol revenue are used for alcohol-related education and prevention programs in New Jersey, Ohio, Texas (Sassi et al., Local taxes can be an important source of revenues, especially in decentralised health care systems (e.g. Denmark, Finland, Italy, Sweden).17 Local taxes have the advantage of creating a strong link between payers and health care service beneficiaries, thus potentially increasing accountability. In addition the level of local taxation may be set in line with local preferences about the level and quality of medical services. However, in the absence of a centrally managed risk-adjusted transfer mechanism, decentralisation lowers risk pooling and might result in larger interregional health disparities.