The global tobacco control ‘endgame’: Change the policy environment to implement the FCTC

Abstract

The WHO Framework Convention for Tobacco Control has prompted major change in global tobacco control. However, policy implementation has been uneven, producing the possibility of 'smoke free' outcomes in some countries but not others. We identify the factors that would improve implementation. We produce an ideal-type of 'comprehensive tobacco control regimes', in which countries have policy environments conducive to the implementation of tobacco control measures designed to eradicate tobacco use. It requires these policy processes in each country: their department of health takes the policy lead; tobacco is 'framed' as a public health problem; public health groups are consulted at the expense of tobacco interests; socioeconomic conditions are conducive to policy change; and, the scientific evidence is 'set in stone' within governments. No country will meet these criteria in the short term, and the gap between the ideal-type and reality is wide in many countries. However, the WHO experience provides a model for progress.

MPOWER, needs and challenges: trends in the implementation of the WHO FCTC in the Eastern Mediterranean Region

“…Cairney and Mamudu (19) report that the best approach to tobacco control in a country requires specific policy processes, namely: the department of health takes the policy lead; tobacco is 'framed' as a public health problem; public health groups are consulted at the expense of tobacco control interests; socioeconomic conditions are conducive to policy change; and the scientific evidence is 'set in stone' within governments. No country can meet all these requirements in a short period and there is a wide gap between the expectations of implementing such programmes and the actual situation in many countries, particularly in the EMR.…”

Introduction

“…Theories can inform the characteristics of such environments (Cairney & Mamudu, 2014), but a general problem in public policy is that there are almost as many models and approaches to the complex reality of policy formation as there are scholars. Each scholar takes a specific perspective, such as emphasising the context, or focusing on institutional factors, or emphasising the role of lobbyists as in the MSA, or starting with changes in policy core beliefs such as in the ACF.…”

“…Indeed, progress in tobacco control is a function of the internal dynamics of the policy process itself, and it has been argued that a more profound understanding of the political dimensions of health policy will help "to better anticipate opportunities and constraints on governmental action and design more effective policies and programs" (Oliver, 2006). Understanding these dimensions is crucial for those who want to contribute to more effective policies, including to so-called endgame strategies that may eventually eradicate the sale and consumption of tobacco products (Cairney & Mamudu, 2014;McDaniel, Smith, & Malone, 2016).…”

Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review

“…These actions require the “ideal policy environment” for tobacco control within each FCTC Party, as described by Cairney and Mamudu (2014): 1) each country’s department of health is responsible for tobacco control policies and monitoring; 2) tobacco control is presented as a solvable public health problem; 3) public health groups are included, while tobacco interest groups are excluded from tobacco control activities; 4) the environment itself begets policy implementation; and 5) scientific evidence for tobacco control policies is widely accepted by government entities.…”