When is Subnational, Supralocal Tobacco Control “just right”? A Qualitative Study in England

Abstract

Introduction Subnational, supra-local (or “regional”) approaches to tobacco control are often central federal nation tobacco control and can be superfluous for very small nations. However, their relevance to countries with weak intermediate tiers of governance are less clear. This study explores expert and policymaker perceptions on the function, form, footprint and funding of regional tobacco control in England. Methods One-to-one semi-structured interviews (n=16) and four focus groups (n=26) exploring knowledge and perceptions of the past, present and future of regional tobacco control in England were conducted with public health leaders, clinicians, tobacco control practitioners, civil servants and politicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Participants reported several key functions for regional tobacco control, including illicit tobacco control, media campaigns, advocacy, policy development and network facilitation for local actors. A small minority of participants reported little role for regional tobacco control. Broader perceived features of effective regional tobacco control included subject expertise, strong regional ties, systems leadership, and a distinctive programme of work. Views varied on whether regional programmes should be developed nationally or locally, and their optimal footprint. Participants generally agreed stable funding was a prerequisite for success, although there was lesser agreement on funding sources. Conclusions Pooling resources at the regional level in countries with weak intermediate tiers of governance may increase reach, cost-effectiveness and impact of campaigns, policy interventions and advocacy, whilst retaining the ability to tailor approaches to regional populations. Implications There are likely to be greater funding and governance challenges associated with introducing or strengthening regional tobacco control in countries with weak intermediate tiers of governance. Despite this, evidence from England shows it is possible to develop regional tobacco control approaches reported as effective by key stakeholders. Possible benefits of regional approaches in this context include cost-effective delivery of illicit tobacco control, media campaigns, advocacy, research, policy development, and co-ordinated support for local action on tobacco.