Academic journal article Bulletin of the World Health Organization

Political Economy of Tobacco Control in Low-Income and Middle-Income Countries: Lessons from Thailand and Zimbabwe

Academic journal article Bulletin of the World Health Organization

Political Economy of Tobacco Control in Low-Income and Middle-Income Countries: Lessons from Thailand and Zimbabwe

Article excerpt

Voir page 917 le resume en francais. En la pagina 917 figura un resumen en espanol.

Policy research for the Tobacco Free Initiative

An intergovernmental working group, involving more than 100 WHO Member States, met in October 1999 and March 2000 to prepare proposed draft elements of the Framework Convention on Tobacco Control and to submit a report to the 53rd World Health Assembly. Formal negotiations are scheduled to begin with the convening of the first meeting of the Intergovernmental Negotiating Body by Dr Gro Harlem Brundtland, the Director-General of the World Health Organization (1). Crucial to the success of the Framework Convention on Tobacco Control will be an understanding of the policy environments for tobacco control policies, particularly in low-income and middle-income countries.

While extensive scientific evidence exists on the tobacco epidemic, international traffic in tobacco is increasing rapidly (2) and anti-tobacco litigation is spreading to more countries (3). However, recently policy research in support of the Framework Convention on Tobacco Control has also received a higher priority (4). Despite these developments, a lack of understanding remains on the policy environments within which tobacco control policies are being introduced and implemented. This deficiency is particularly pronounced in low-income and middle-income countries, where the global epidemic of tobacco smoking is expected to impact hardest and control policies face the greatest political challenge (5).

Since the proposed Framework Convention on Tobacco Control aims to provide legal, scientific and moral impetus at the global level in support of country efforts to control tobacco, the World Health Organization's Tobacco Free Initiative commissioned the development of guidelines for supporting such policy analyses. The project began with a recognition of the highly political nature of the tobacco issue and the complex vested interests concerned with tobacco control policies. Although the configuration of actors and their interests will be unique to individual countries, the global dimensions of the tobacco sector have clear implications for national control strategies. Using the analytical perspective of political economy, country case studies were carried out of tobacco control policies in Thailand (6) and Zimbabwe (7) to explore the responses of stakeholders across the three major areas of tobacco control policy, namely tobacco production, regulation of consumption, and health promotion activities. This paper reports on the lessons learned and the implications for similar country situations.

Studying the political economy of tobacco control

The adoption of political economy as the conceptual framework for the project reflected an acceptance of the basic proposition that politics and economics are inseparable, and recognition that global and regional pressures can condition the policy environment at the national level. Political economy provides an appropriate approach within which to study the wide variety of actors involved in tobacco control policies and to analyse their varied interests (8). During the 1980s, widespread economic changes and the adoption of economic structural adjustment policies led to the application of political economy and public choice approaches to understanding policy reforms (9-12). More recently political-economic models have been constructed for policy reform in developing countries (13-15), which argue that political economy theory combined with empirical studies can help to predict which actors will be active and influential around specific policy issues. This research was supported by developments in the application of political economy to health policy (16, 17) and tobacco (5, 18). The research also viewed policymaking, not simply as the outcome of structural context (e.g. global economy) and contexts, but also of agency -- the way in which individuals and institutions may act to influence policy agendas, decisions and outcomes. …

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