The ways that social spending policies are run by fiscal welfare through the tax system remain relatively neglected, while the costs and impact of public expenditure are constantly under scrutiny. Mostly means-enhancing in contrast to much means-tested public spending, the costs of social tax reliefs are little examined, their distributional impact even less so. This article considers what is needed to provide a better basis for the development of robust and flexible policies for establishing, managing and evaluating fiscal welfare that can contribute to building a more open and equal society. Particular attention is given to increasing accountability and assessing tax and public spending activities together when they benefit the same target group; and to reducing inconsistencies of treatment in comparable tax and public schemes.

The article reviews the limited existing social policy literature on taxation and sets out a case for the incorporation of the study of taxation into the accepted remit of social policy. Social policy has historically been concerned with the services and benefits which flow from public expenditure, and people’s experiences of them, rather than with taxation, and the contributions by individual researchers have tended to remain marginal to the main focus of social policy. The article offers a speculative account as to why taxation has remained peripheral to social policy and presents three arguments for the mainstreaming of tax in social policy’s domain of study. These concern the role of taxation in shaping the distribution of resources, a fundamental pre-occupation of social policy; the contribution social policy scholars can make to shaping a new discourse surrounding taxation, foregrounding issues of equity and need; and how social policy’s engagement with taxation can influence the politics of the welfare state.

Stable iodine tablets are effective in reducing internal exposure to radioactive iodine, which poses a risk for thyroid cancer and other conditions. After the Fukushima Daiichi nuclear power plant accident, the Japanese government shifted its policy on stable iodine tablet distribution from “after-the-fact” to “before-the-fact” and instructed local governments to pre-distribute stable iodine tablets to residents living within a 5-km radius of nuclear facilities. The nation’s first pre-distribution of stable iodine tablets was carried out in June and July of 2014 in Kagoshima Prefecture. Health surveys were conducted so that the medication would not be handed out to people with the possibility of side effects. Of the 4715 inhabitants in the area, 132 were found to require a physician’s judgment, mostly to exclude risks of side effects. This was considered important to prevent the misuse of the tablets in the event of a disaster. The importance of collective and individualized risk communication between physicians and inhabitants at the community health level was apparent through this study. Involvement of physicians through the regional Sendai City Medical Association was an important component of the pre-distribution. Physicians of the Sendai City Medical Association were successfully educated by using the Guidebook on Distributing and Administering Stable Iodine Tablets prepared by the Japan Medical Association and Japan Medical Association Research Institute with the collaboration of the National Institute of Radiological Sciences and the Japanese government. Thus, the physicians managed to make decisions on the dispensing of stable iodine tablets according to the health conditions of the inhabitants. All physicians nationwide should be provided continuing medical education on stable iodine tablets. (Disaster Med Public Health Preparedness. 2017;11:365–369)