Global Tobacco Control and Economic Norms: An Analysis of Normative Commitments in Kenya, Malawi And Zambia

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos

Tracking progress of tobacco control in Pakistan against the MPOWER package of interventions : challenges and opportunities

MPOWER is an evidence-based package of the six most effective demand reduction interventions to reduce tobacco use. Global evidence shows that introduction of this package has accelerated and strengthened tobacco control worldwide with over 5 billion people living in 136 countries covered by at least one of these key interventions. This paper comments on how tobacco control laws in a low and middle income country, Pakistan, are meeting the MPOWER package provisions and what the challenges and opportunities for tobacco control are in the country. Pakistan is home to over 24 million tobacco users consuming a variety of tobacco products including 10 million smokeless tobacco users. Pakistan has introduced several laws to meet its international commitments under the framework convention against tobacco control and MPOWER package. However, gaps in existing policies, poor law enforcement, and a conflicting political economy of tobacco in the country pose major challenges for effective tobacco control. The changing political environment with renowned public health activists in current government, an active and independent judiciary, increasing use of social media, and a dynamic civil society offer opportunities to strengthen its efforts for effective policy actions against tobacco use

Developing Capacity, Skills, and Tobacco Control Networks to address Tobacco-related Disparities: Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP)

Priority populations disproportionately experience tobacco-related disparities, despite population level declines in tobacco use. The Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP) recruits and trains African immigrants/African Americans, Asian Americans/Pacific Islanders, American Indians, Chicano/Latinos, and LGBTQ community members to develop leaders to address tobacco harms in their communities. This paper describes and evaluates the LAAMPP Institute, and discusses lessons learned through the Institute and future directions for community-based tobacco-control efforts. The mixed-methods evaluation included qualitative key informant interviews with LAAMPP Fellows and community and project contacts, a Skills Assessment Tool, project case studies, and a social network analysis of the Fellows’ tobacco-control social networks at baseline and follow-up. At follow-up, Fellows’ tobacco control networks were larger, more extensive and diverse, and included more actors perceived to be influential in tobacco control. Fellows’ skills increased in core competencies (tobacco control, advocacy, facilitation, collaboration, cultural/community competence) and Fellows used tobacco, advocacy and cultural/community competencies more frequently. Four of five cohorts successfully passed policies. The results of LAAMPP suggest that a cross-cultural leadership institute contributes to the successful development of capacity and leadership skills among priority populations and may be a useful model for others working toward health equity

Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union

The six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27)

Predicting smokers' non-compliance with smoking restrictions in public places

Objective: The present study aimed to identify the predictors of non-compliance with smoking restrictions among Greek college student smokers. Differences in attitudes to smoking bans and tobacco control policies between current smokers and non-smokers were also examined. Methods: Data were collected from college students (n = 229, mean (SD) age 21.27 (3.15) years). Measures included tobacco dependence, attitudes to tobacco control policies, outcome expectancy and normative beliefs. Results: The majority of current smokers reported noncompliance with existing restrictions. Logistic regression analysis showed that non-compliance was significantly predicted by (less) anticipated regret from tobacco-related health harm, tobacco dependence and perceived prevalence and social acceptability of smoking. Analysis of variance indicated that current non-smokers held significantly more positive attitudes to smoking bans and tobacco control policies than current smokers. Conclusions: Smoking was highly prevalent, and more than half of current smokers reported not complying with existing regulations in public places. Smokers' attitudes to smoking bans and tobacco control policies did not have an effect on compliance behaviour. Future policies to promote compliance with smoking restrictions in Greece should target health-related anticipated regret, and perceived social norms

Global Regulatory Strategies for Tobacco Control

Recent tobacco control regulation in North America and Western Europe has had a salutary effect, even if smoking remains a pressing public health hazard. But in the 21st century, the tobacco industry has quietly moved its locus of activity to lucrative, emerging markets: the vast populations in Africa, Asia, Eastern Europe, and Latin America. The poorest, least educated, and sickest people on earth inhabit these regions. Big Tobacco\u27s new marketing strategy will cause untold morbidity for the world\u27s most vulnerable. However, there are a variety of effective tobacco control policies that nations can and should enact. The World Health Organization treaty, the Framework Convention for Tobacco Control, requires signatory nations to adopt a variety of tobacco control policies to the fullest extent permissible under their constitutions. The Second Conference of FCTC Parties recently set regulatory goals in Bangkok, Thailand, including the first FCTC protocol on illicit trade of tobacco products, a second protocol on cross border advertising regulations. Effective tobacco control policies include: national tobacco regulatory agencies; comprehensive bans on tobacco advertising, promotion, and sponsorship; health warnings on cigarette packets that cover at least half of the packet, convey the risks, rotate messages, and use images; mandating smoke-free environments; and tax and price policies that make smoking prohibitively expensive. This article examines legislation and regulation from all parts of the world in each of these spheres, and evaluates their effectiveness. The imperatives of science, ethics, and human rights oblige society to reduce the burden of smoking, particularly among the most disadvantaged

Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control.

There has been a global decline in tobacco consumption that, if continued, will negatively impact the tobacco industry's profits. This decline led the industry to invent and market new products, including heated tobacco products (HTP). HTP are an extension of the industry's strategies to undermine government's tobacco regulatory efforts as they are being promoted as part of the solution for the tobacco epidemic. Under the moniker of 'harm reduction', the tobacco companies are attempting to rehabilitate their reputation so they can more effectively influence governments to roll back existing tobacco control policies or create exemptions for their HTP. Rolling back tobacco control policies will make it easier for the companies to renormalise tobacco use to increase social acceptability for all their products. When regulations are absent or when loopholes exist in classifying HTP as a tobacco product (thus subject to all tobacco control regulations), the industry's marketing of HTP is making these products more visible to the public and more accessible. Governments need to ensure that HTP are regulated as tobacco products or drugs and reject partnerships with the tobacco companies to promote 'harm reduction'. The tobacco companies remain the vector of the tobacco-caused epidemic and cannot be part of the global tobacco control solution

The United States\u27 Engagement in Global Tobacco Control: Proposals for Comprehensive Funding and Strategies

Tobacco use kills more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, tobacco-related diseases will kill hundreds of millions more in coming decades, mostly in low- and middle-income countries. Beyond its effects on morbidity and mortality, tobacco use has dramatic social and economic consequences, consuming healthcare budgets, robbing families of their primary wage earners, and hindering economic development. Tobacco consumption is shifting from industrialized to developing countries, spurred by rising incomes, trade liberalization, and intensive marketing. Although Congress empowered the U.S. Food and Drug Administration to regulate tobacco domestically, the United States has failed to lead globally. The United States is among a small minority of countries that has signed, but not ratified, the World Health Organization (WHO) Framework Convention on Tobacco Control. A tiny percentage of U.S. funding for global health is dedicated to international tobacco control. U.S. trade policy has supported and enabled the industry to expand tobacco use overseas. In this Commentary, we argue for robust U.S. engagement in global tobacco control, first explaining why it is in the national interest of the United States and then suggesting a comprehensive strategy for supporting tobacco control in low- and middle-income countries

WHO Framework Convention on Tobacco Control

Annotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical Medicine. First published by Queen Mary, University of London, 2012. ©The Trustee of the Wellcome Trust, London, 2012. All volumes are freely available online at www.history.qmul.ac.uk/research/modbiomed/ wellcome_witnesses/Annotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical MedicineAnnotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical MedicineAnnotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical MedicineAnnotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical MedicineAnnotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical MedicineAnnotated and edited transcript of a Witness Seminar in collaboration with the Department of Kowledge Management and Sharing, WHO, held in Geneva, 26 February 2010. Introduction by Professor Virginia Berridge, London School of Hygiene and Tropical MedicineThe World Health Organization (WHO)’s Framework Convention on Tobacco Control (FCTC) is the first global convention on public health. Comprehensive tobacco control had been the subject of 20 resolutions – consensus statements of all the member states – passed by the World Health Assembly beginning in 1970. This was 20 years after Sir Richard Doll and Sir Austin Bradford Hill suggested a link between smoking and cancer. The idea of a legally binding international convention, proposed by the late Dr Ruth Roemer and supported by a report from Dr Judith Mackay, was given priority by the new WHO Director-General Dr Gro Brundtland in 1998 when she elevated tobacco control as one of WHO’s three flagship programmes and created the Tobacco Free Initiative. The idea took wing with the publication of a review of tobacco company strategies to undermine tobacco control activities at WHO, which drew on 13 million documents released by the US courts to the public in 1998. This Witness Seminar, held in Geneva on the fifth anniversary of the WHO FCTC in 2010, heard from key individuals actively involved with the treaty negotiations, held between 2000 and 2003, and which came into force on 27 February 2005.The History of Modern Biomedicine Research Group is funded by the Wellcome Trust, which is a registered charity, no. 210183