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Asadi-Lari M, Ahmadi Teymourlouy A, Maleki M, Afshari M. Opportunities and challenges of global health diplomacy for prevention and control of noncommunicable diseases: a systematic review. BMC Health Serv Res 2021; 21:1193. [PMID: 34736461 PMCID: PMC8567539 DOI: 10.1186/s12913-021-07240-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background and aim The growing globalization has changed the goals and methods of diplomacy. Due to the challenges and complexities of dealing with noncommunicable diseases (NCDs) at the national and international levels, policy makers require global health diplomacy (GHD) to achieve the goals of prevention and control of NCDs. The purpose of this systematic review was to identify the challenges and opportunities in GHD for NCDs. Methods A systematic review of articles was conducted by searching MEDLINE via PubMed, Web of Science, Scopus, and Embase and by using Google and Google Scholar search engines. Additional articles were identified by reviewing reference lists and a number of special journals. The inclusion criteria include literature published in English from 2007 to 2020, and the exclusion criteria are literature published in any language other than English, absence of full text, dissertations, and duplicates. Overall, 32 articles met the requirements for inclusion in this review and were analyzed using content analysis in MAXQDA 10. Findings There are 32 published articles on GHD for NCDs. Identified challenges were classified into three levels: global (global health governance), national (Governance at the state level, health sector, and civil society), and industry. The progress on global health issues has created opportunities for the development of GHD for the prevention and control of NCDs. These opportunities were divided into three levels: international, national, and individual level. Conclusion Various challenges at the global level, national level, and industry led to less engagement of policymakers in GHD for prevention and control of NCDs and, as a consequence, a less coordinated approach to address prevention and control of NCDs worldwide. So, there is a need for more efforts of collective action and negotiation for tackling NCDs. Policymakers and managers of the health system should increase the advocacy, building a coalition with civil society, use negotiation and diplomacy to engage with other sectors and organizations, manage industry conflicts, and leverage foreign policy to promote health and welfare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07240-3.
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Affiliation(s)
- Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Afshari
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Gruszczynski L, Melillo M. The FCTC dilemma on heated tobacco products. Global Health 2020; 16:81. [PMID: 32912239 PMCID: PMC7488438 DOI: 10.1186/s12992-020-00596-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 07/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In October 2018, the Conference of the Parties of the Framework Convention on Tobacco Control (FCTC or Convention) adopted its first decision on novel and emerging tobacco products, including heated tobacco products (HTPs). The decision remains ambiguous, e.g. by making a distinction between tobacco sticks and HTP devices. Against this background, the article seeks to answer two interrelated questions: whether and to what extent HTPs are covered by the FCTC, and whether regime provided by the Convention is suitable for their regulation. RESULTS HTPs need to be classified under the FCTC as tobacco products. The distinction made by the Conference of the Parties between sticks and devices leads however to unsatisfactory results as it creates loopholes in tobacco control standards existing at the international level. A better approach, as argued in this article, is to conceptualize the notion of 'tobacco products' in functional terms as a combination of both a device and stick. While subjecting HTPs to all FCTC disciplines is, in light of our current scientific knowledge, a rational approach, such classification can be modified in the future once a sufficient amount of new evidence on their risk profile is collected. Any decision on the optimal regulatory model for HTPs will need to take into account not only health risks and potential benefits for individual users, but also the specific systemic concerns (e.g. HTPs as a gateway product). The state of scientific research is however not the only factor that will determine the fate of HTPs under the Convention. What is equally important is a conceptualization of the FCTC's objectives. If a complete eradication of the tobacco epidemic is the ultimate goal, reduced levels of risk may not be enough to justify the different (i.e. more lenient) regulatory regime for HTPs. CONCLUSIONS The Conference of the Parties should clarify the definition of tobacco products in light of recent changes in the market. When designing the regulatory regime for HTPs under the FCTC in the future, one has to consider not only scientific evidence but also pay attention to the objective of the Convention (or more generally to the values that underlie the current tobacco control paradigm).
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Affiliation(s)
- Lukasz Gruszczynski
- Kozminski University, College of Law, Jagiellonska St. 57/59, 03-301 Warsaw, Poland
- Institute for Legal Studies of the Centre for Social Sciences , Tóth Kálmán St. 4, Budapest, H-1097 Hungary
| | - Margherita Melillo
- Law Department, European University Institute, Via Bolognese 156, 50139 Florence, Italy
- Max Planck Institute Luxembourg for International, European and Regulatory Procedural Law, rue Alphonse Weicker 4, L-2721 Luxembourg, Luxembourg
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Afshari M, Ahmadi Teymourlouy A, Asadi-Lari M, Maleki M. Global Health diplomacy for noncommunicable diseases prevention and control: a systematic review. Global Health 2020; 16:41. [PMID: 32375804 PMCID: PMC7201808 DOI: 10.1186/s12992-020-00572-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and solutions, such as global health diplomacy (GHD), which involves the participation of a wide range of actors and stakeholders and innovative international health partnerships. This review aimed to draw lessons for strengthening linkages with a wide range of actors and stakeholders from the GHD literature for NCDs, and how policymakers and political leaders can effectively use international health partnerships to beat NCDs. METHODS This research was a systematic review of the literature on GHD for NCDs. All relevant articles published in English were identified by searching PubMed, Web of Science, Scopus, and Embase databases, Google and Google Scholar search engines, and the reference lists of identified articles as well as a number of special journals. 30 articles that met the inclusion criteria were analyzed using content analysis in MAXQDA 10. The Global Health Diplomacy Pyramid and Blouin and Dubé's (2010) analytical framework for examining negotiations were used to classify the data. FINDINGS 30 articles have been published on GHD for NCDs. Five key themes, i.e. the specific problem requiring global collective action, key actors, their interests in the problem, potential negotiation process, and potential scenarios for collective action and 46 sub-themes were identified. Moreover, given the importance of collaboration on NCDs in the international arena, actors were categorized into three groups based on the GHD Pyramid: (1) core diplomacy, (2) multi-stakeholder diplomacy, and (3) informal diplomacy. CONCLUSION Development and adoption of a global policy to tackle the rise in NCDs in developed and developing countries require policymakers and political leaders that participate in GHD. Successful developments in global health policy depend on the performance of and respectful relationships among the stakeholders, and global health diplomats need to understand the complexities of the institutional structures and functional relationships of the international institutions involved in health.
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Affiliation(s)
- Mahnaz Afshari
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Paek YJ. Tobacco control policy on the electronic cigarette. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.2.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yu-Jin Paek
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Shields PG, Song MA, Freudenheim JL, Brasky TM, Mathe E, McElroy JP, Hummon AB, Wewers MD. Electronic Cigarettes and the Lung Proteome. Am J Respir Crit Care Med 2019; 198:1350-1351. [PMID: 30153045 DOI: 10.1164/rccm.201806-1151le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter G Shields
- 1 The Ohio State University Comprehensive Cancer Center Columbus, Ohio.,2 The Ohio State University College of Medicine Columbus, Ohio
| | - Min-Ae Song
- 1 The Ohio State University Comprehensive Cancer Center Columbus, Ohio.,3 The Ohio State University College of Public Health Columbus, Ohio
| | - Jo L Freudenheim
- 4 University of Buffalo School of Public Health and Health Professions Buffalo, New York and
| | - Theodore M Brasky
- 1 The Ohio State University Comprehensive Cancer Center Columbus, Ohio.,2 The Ohio State University College of Medicine Columbus, Ohio
| | - Ewy Mathe
- 1 The Ohio State University Comprehensive Cancer Center Columbus, Ohio.,2 The Ohio State University College of Medicine Columbus, Ohio
| | - Joseph P McElroy
- 1 The Ohio State University Comprehensive Cancer Center Columbus, Ohio.,2 The Ohio State University College of Medicine Columbus, Ohio
| | - Amanda B Hummon
- 5 The Ohio State University College of Arts and Sciences Columbus, Ohio
| | - Mark D Wewers
- 1 The Ohio State University Comprehensive Cancer Center Columbus, Ohio.,2 The Ohio State University College of Medicine Columbus, Ohio
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Jenssen BP, Boykan R. Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels). CHILDREN-BASEL 2019; 6:children6020030. [PMID: 30791645 PMCID: PMC6406299 DOI: 10.3390/children6020030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Abstract
E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the Surgeon General has called a public health “epidemic”—the precipitous increase in youth use of e-cigarettes and the health consequences of this behavior. Further, we review tobacco control policy efforts (e.g., Tobacco 21, banning flavors, advertising restrictions, and clean indoor air laws)—efforts proven to be critical in reducing cigarette smoking and smoking-related disease and death among US children and adults—including their potential and challenges regarding managing and mitigating the emergence of e-cigarettes. Finally, we close with a discussion of the efforts of transnational tobacco companies to rebrand themselves using e-cigarettes and other new products.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania School of Medicine and PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Rachel Boykan
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
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de Andrade M, Angus K, Hastings G, Angelova N. Hostage to fortune: an empirical study of the tobacco industry's business strategies since the advent of e-cigarettes. CRITICAL PUBLIC HEALTH 2018; 30:280-293. [PMID: 32536808 PMCID: PMC7254526 DOI: 10.1080/09581596.2018.1552778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/20/2018] [Indexed: 11/27/2022]
Abstract
The tobacco market has been transformed by the arrival of e-cigarettes and array of alternative nicotine delivery systems (ANDS). Public health has struggled to cope with these changes and clear divisions are apparent, but less is known about the tobacco industry (TI) response. This first empirical study to examine TI and independent ANDS companies' business strategies fills this gap. Primary data were collected through 28 elite interviews with senior/influential TI and independent stakeholders, triangulated with a documentary analysis of company reports, investor analyses, market research, and consultation responses (1022 documents). A deliberately emic analysis shows that tobacco multinationals were initially disconcerted by ANDS, but logic provided by the fiduciary imperative is enabling them to turn a potential threat into profitable opportunities. Interviewees argue market changes played to their strengths: customer links, expertise in nicotine, and enormous financial resources. This enabled portfolio diversification in which combustible and ANDS coexist; providing potential to develop robust scientific and regulatory positions and hope of retrieving corporate reputations. The principal threat for major tobacco players comes from the independent sector, which is prepared and able to satisfy bespoke consumer needs. Multinationals by contrast need to turn ANDS into a genuinely mass-market product appealing to its global customers. They are making progress. Given the continued buoyancy of the combustibles market, they have extensive resources to continue their efforts. Disruptive innovations are not unique to tobacco control. Equivalent technological solutions - with concomitant business opportunities - are emerging in obesity and alcohol fields with implications for public health.
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Affiliation(s)
- Marisa de Andrade
- School of Health in Social Science, Counselling, Psychotherapy and Applied Social Sciences, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), UK
- Group for Research on Inequalities and Tobacco (GRIT), University of Edinburgh, Edinburgh, UK
| | - Kathryn Angus
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), UK
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Gerard Hastings
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), UK
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Centre for Tobacco Control Research, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- The Open University Business School, Milton Keynes, UK
- Ecole des hautes études en santé publique (EHESP), Rennes, France
| | - Nikolina Angelova
- School of Health in Social Science, Counselling, Psychotherapy and Applied Social Sciences, University of Edinburgh, Edinburgh, UK
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Carroll AJ, Labarthe DR, Huffman MD, Hitsman B. Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review. Prev Med 2016; 93:189-197. [PMID: 27717667 PMCID: PMC5125629 DOI: 10.1016/j.ypmed.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/18/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States.
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