The Tobacco ‘Endgame’

The journal Tobacco Control has a section discussing the idea of an endgame. Previously, the focus was on controlling the tobacco market and reducing smoking. Now, the focus is often on eradicating both. So far, there are two main types of paper:

  • Those which propose new, harder, policy instruments – from introducing new regulations on tobacco products (including nicotine content) and the sales practices of the industry, to a ban on the sale of cigarettes altogether or to people born after a particular date.
  • Those which discuss politics and policymaking – including discussions about the level of consensus on the scientific and ethical case for endgame policies. Some papers consider the most-likely organisations to foster an endgame approach, although most are examining the peculiarities of the US.
  • One paper by Myers argues that the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) remains a key means to ensure global tobacco control: the problem is not a lack of new policy instruments, but the ‘political will’ to implement the ones we have.

This is where our (soon to be submitted) paper comes in. Hadii Mamudu and I aim to draw on the insights from the public policy literature (and interviews with policymakers and advocates across several countries) to (a) demonstrate the importance of this focus on politics and policymaking; and (b) explain in detail how and why that is important.

I won’t post the paper yet (to address concerns by the Journal ) but here is the draft abstract, followed by a draft set of bullet points which will accompany the submission:

The tobacco ‘endgame’ represents a major shift in focus, from controlling the tobacco market and reducing smoking, to eradicating both. Yet, the uneven spread of effective global tobacco control suggests that this outcome is far more likely in some countries than others.  We analyse the implementation of the FCTC to identify this problem, and synthesis the public policy literature to present a solution. The aim is to come as close as possible to the ideal-type of ‘comprehensive tobacco control regimes’, in which countries have policy environments conducive to the introduction of a wide range measures to reduce the demand for, and supply of, tobacco products. This would require the following policy processes in each country: their department of health takes the policy lead (replacing trade and treasury departments); tobacco is ‘framed’ as a pressing public health problem, not an economic good; public health groups are consulted at the expense of tobacco companies; socioeconomic conditions (including the value of tobacco taxation, and public attitudes to tobacco control) are conducive to policy change; and, the scientific evidence on the harmful effects of smoking and secondhand smoking are ‘set in stone’ within governments.

Why the issues discussed are important in terms of controlling tobacco use:

  • It makes a crucial contribution to Tobacco Control’s endgame debate.
  • Too many academic articles recommend policy instruments alone, to solve problems, without considering how effective they will be implemented
  • The policy process is not a ‘black box’. Instead, it is a system or environment that has to be understood in considerable depth – using the wealth of policy sciences literature.
  • The scientific research on tobacco control will not be fully evidence-based if we focus solely on the evidence on smoking related behaviour, or the efficacy of some policy instruments in isolation.
  • Instead, we need to consider the global context and use country comparisons to learn lessons about policy progress.
  • So far, most endgame papers in Tobacco Control have focused on instruments or the politics and policymaking of the US.
  • Only one paper supports the combination of the FCTC and ‘political will’.
  • Our paper supports and goes well beyond that argument. It gives more meaning to the vague idea of ‘political will’, which could relate (for example) to exceptional individual policymakers or organisation at various levels and types of government. It often represents vague criticism of the political process in general without trying to understand how it works.
  • We show that the policy environment, in which governments implement international agreements such as the FCTC (containing a combination of major tobacco control instruments), is just as important as the FCTC itself.
  • We suggest that the effective implementation of the FCTC could take decades – an outcome that may be frustrating, but not should not come as a surprise or necessarily prompt a shift of approach.

1 Comment

Filed under Evidence Based Policymaking (EBPM), Public health, public policy, tobacco, tobacco policy

One response to “The Tobacco ‘Endgame’

  1. Pingback: Why does public health policy change? | Paul Cairney: Politics & Public Policy

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