From global agenda-setting to domestic implementation: successes and challenges of the global health network on tobacco control

Abstract

Global policy attention to tobacco control has increased significantly since the 1990 s and culminated in the first international treaty negotiated under the auspices of the World Health Organization--the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC's progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member countries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990 s, in translating countries' commitment to the FCTC into domestic policy change. By comparing the network's influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network's effectiveness around the FCTC's implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buy-in, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network's success than the evidence base for the effectiveness of tobacco control interventions. The network's variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment.

Four Challenges That Global Health Networks Face

“…a Sources of information on network recent form and on problem definition, positioning, coalition-building and governance: alcohol harm 9 ; early childhood development 12 ; maternal mortality 6 ; neonatal mortality 7 ; pneumonia 5 ; surgically-treatable conditions 13 ; tobacco control 8 ; tuberculosis. 4 …”

“…b Sources for information on priority: alcohol harm 9 ; early childhood development 12 ; maternal mortality 25 ; neonatal mortality 7,26 ; pneumonia 27 ; surgically-treatable conditions 13 ; tobacco control 8 ; tuberculosis. 25,28 …”

“…Coalition members share a common problem definition and have advanced a cohesive public positioning of the issue: tobacco use as a public health threat, the industry as the vector of disease and governments as having an obligation to enact anti-tobacco legislation. 8,10 The current form of the network had its origins in the 1990s, when tobacco control proponents from around the world augmented their activities surrounding negotiations of a global treaty on tobacco control. During the treaty negotiations, proponents brought together dozens of NGOs working on the issue, leading to the creation of a formal network organization in 1999—the Framework Convention Alliance (FCA)—that has exercised effective governance surrounding the issue.…”

“…During the treaty negotiations, proponents brought together dozens of NGOs working on the issue, leading to the creation of a formal network organization in 1999—the Framework Convention Alliance (FCA)—that has exercised effective governance surrounding the issue. 8 Since the adoption of the 2003 Framework Convention on Tobacco Control (FCTC), the first treaty negotiated under the auspices of the WHO, network members have made deliberate efforts to expand beyond an original core. They have brought in and built regional and national networks and extensive civil society involvement, 8 leading to an expansion in formal network membership of the FCA from 60 organizations in 1999 to approximately 500 presently.…”

“…8 Since the adoption of the 2003 Framework Convention on Tobacco Control (FCTC), the first treaty negotiated under the auspices of the WHO, network members have made deliberate efforts to expand beyond an original core. They have brought in and built regional and national networks and extensive civil society involvement, 8 leading to an expansion in formal network membership of the FCA from 60 organizations in 1999 to approximately 500 presently. By pushing for and monitoring country compliance with the FCTC, tobacco network members helped to marginalize the tobacco industry and to facilitate a doubling in the number of people protected by comprehensive smoke-free laws—to 787 million—between 2008 and 2010.…”