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Gannon J, Bach K, Cattaruzza MS, Bar-Zeev Y, Forberger S, Kilibarda B, Azari R, Okwor U, Lomazzi M, Borisch B. Big tobacco's dirty tricks: Seven key tactics of the tobacco industry. Tob Prev Cessat 2023; 9:39. [PMID: 38124801 PMCID: PMC10731746 DOI: 10.18332/tpc/176336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Affiliation(s)
- John Gannon
- World Federation of Public Health Associations
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Lwin KS, Koon AD, Rasanathan K, Ahsan A, Erku D, Mialon M, Perez-Leon S, Singh A, Mirza Z, Zuleta M, Adhikari SR, Acharya Y, Dao ST, Rasheed S, Paul J, Marten R. Framing health taxes: learning from low- and middle-income countries. BMJ Glob Health 2023; 8:e012955. [PMID: 37832966 PMCID: PMC10583086 DOI: 10.1136/bmjgh-2023-012955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 10/15/2023] Open
Abstract
Health taxes are effective policy instruments to save lives, raise government revenues and improve equity. Health taxes, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy. Yet, little is known about which frames resonate in which settings and how framing can most effectively advance or limit policies. To fill this gap, we conducted qualitative research in 2022, including focus group discussions, in-depth interviews, document reviews and media analysis on the political economy of health taxes across eight low-income and middle-income countries. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Findings suggest that no single frame dominates; in fact, a plurality of different frames exist and shape discourse and policymaking. There was no clear trade-off between health and economic framing of health tax policy proposals, nor a straightforward way to handle concerns around earmarking. Understanding how to best position health taxes can empower health policymakers with more persuasive framings for health taxes and can support them to develop broader coalitions to advance health taxes. These insights can improve efforts to advance health taxes by better appreciating political economy factors and constraining corporate power, ultimately leading to improved population-level health.
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Affiliation(s)
- Kaung Suu Lwin
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Abdillah Ahsan
- Department of Economics, Facutly of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Daniel Erku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Centre for Applied Health Economics, Griffith University, Gold Coast, Queensland, Australia
| | | | - Silvana Perez-Leon
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arti Singh
- School of Public Health, KNUST, Kumasi, Ghana
| | - Zafar Mirza
- School of Universal Health Coverage, Shifa Tameer-i-Millat University, Islamabad, Pakistan
| | | | | | - Yubraj Acharya
- Department of Health Policy & Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Sabrina Rasheed
- Health Systems and Population Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jeremias Paul
- Fiscal Policies for Health Unit, Department of Health Promotion, WHO Secretariat, Geneva, Switzerland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
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Kumar P, Kamath VG, Kamath A, Kulkarni MM, Britton J. Awareness, attitudes and practices relating to Article 5.3 of the WHO Framework Convention on Tobacco Control among members of tobacco control committees in a southern Indian state. Tob Control 2023:tc-2022-057699. [PMID: 37364924 DOI: 10.1136/tc-2022-057699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND AND OBJECTIVES The tobacco industry (TI) has undermined tobacco control policy for decades. The WHO Framework Convention on Tobacco Control Article 5.3 implementation guidelines provide guidance for preventing TI interference. Government officials responsible for policy implementation must understand these guidelines to manage TI tactics. This study assessed awareness, attitudes and practices of Article 5.3 guidelines among members of District Level Coordination Committees (DLCC) in Karnataka mandated with overseeing tobacco control activity. METHOD A semistructured questionnaire survey of awareness, attitudes and adherence to Article 5.3 guidelines among 102 DLCC members carried out between January and July 2019. RESULT Responses were received from 82 members, comprising 51 (62%) from health and 31 (38%) from non-health departments. Our study demonstrates a lack of understanding of Article 5.3 and its guidelines, even among those actively involved in tobacco control at the district level. Nearly 80% of respondents were aware that corporate social responsibility (CSR) by tobacco companies is an indirect form of promoting tobacco. However, 44% of members felt that CSR funding from the TI should be used to combat tobacco-related harm. A higher proportion (12%) of health respondents agreed that subsidies should be provided to tobacco agriculture compared with non-health (3%). CONCLUSION Awareness of international guidance designed to prevent the TI influence on health policy among policymakers in this Indian state is low. Respondents from non-health departments were less aware of TI CSR. Those in health departments were more receptive towards taking a TI role in the future .
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Affiliation(s)
- Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Veena Ganesh Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar M Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - John Britton
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Jongenelis MI. Challenges and opportunities associated with e-cigarettes in Australia: A qualitative study. Aust N Z J Public Health 2023; 47:100006. [PMID: 36693288 DOI: 10.1016/j.anzjph.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/14/2022] [Accepted: 10/30/2022] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The use of e-cigarettes in Australia has increased significantly in recent years. To assist with identifying policy and practice priorities, this study sought to provide a greater understanding of the population-level challenges and opportunities associated with these products. METHODS Semi-structured interviews were conducted with 34 public health experts working in tobacco- and/or nicotine-related policy, practice and research. Interview transcripts were subject to reflexive thematic analysis. RESULTS Several challenges associated with e-cigarettes were identified, with uptake of use among youth, the potential for use to lead to smoking and industry interference the most frequently mentioned. Recommended means of addressing these challenges included improved regulation and increased enforcement of existing laws. Most interviewees acknowledged some potential for e-cigarettes to assist with smoking cessation. CONCLUSIONS Despite strong restrictions on e-cigarettes in Australia, experts working in this field reported that these products, and the companies behind them, present several challenges to public health. IMPLICATIONS FOR PUBLIC HEALTH Tighter regulation and increased enforcement are needed to address the challenges posed by e-cigarettes. Controlled access to liquid nicotine under a pharmaceutical model offers an opportunity for smokers to access the behavioural support that may help them to quit while also restricting e-cigarette availability.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia.
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Affiliation(s)
- Stella Bialous
- Social and Behavioral Sciences, UCSF, San Francisco, California, USA
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Goel S, Kar SS, Verma M, Sivanantham P, Naik BN, Gupta D. Evidence on article 5.3 of FCTC (tobacco industry interference in tobacco control activities) in India- a qualitative scoping study. BMC Public Health 2021; 21:1855. [PMID: 34649546 PMCID: PMC8515702 DOI: 10.1186/s12889-021-11773-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Tobacco Industry (henceforth TI) yearns to portray itself as being "socially responsible" and fights for the decision-making positions; that are it used to deter, delay or dilute tobacco control measures. There is little documented evidence of Tobacco Industry Interference (henceforth TII) from India, the scope of their interference and challenges faced by the experts for effective tobacco control. This research study seeks to cover this significant gap in the literature on the TI of India. METHODS A cross-sectional qualitative research design, based upon in-depth interviews (N = 26), was used to explore the key stakeholders' opinions regarding TII in India. The interviews used a set of questions to collect information about the participant's roles and responsibilities in tobacco control, the nature of TII faced by the participants, means of influence by TI, barriers and challenges to tobacco control efforts. RESULTS Most of the respondents were engaged in tobacco control, training, advocacy and awareness generation activities for 5-10 years or more. The respondents defined the TI and its scope as per their experience with the help of the power ranking methodology. Most of them perceived TI as 'manufacturers' while others consider them as 'advertisers', 'public relation companies', 'wholesalers', 'vendors', and 'Government firms with TI stocks. The research team identified six significant domains: influencing the policy and administrative decisions, Interference in the implementation of tobacco control laws and activities, false propaganda and hiding the truth, manipulating front action groups (FAG), rampant tobacco advertising and promotion activities and others under which TII activities were classified. Most respondents believed that TI players were interfering in the policy decisions, implementing the tobacco control laws and activities and manipulating the FAG. A detailed taxonomic classification of the TII strategies that emerged from our analysis was linked to article 5.3 of FCTC. CONCLUSIONS The study documented a significant level of TII in different domains, with stakeholders acting at various hierarchical levels. Thus providing insight into the tactics of the TI in order to enable stakeholders to anticipate and pre-empt the kinds of alliances the TI may attempt to build; stimulating academicians and researchers to undertake in-depth analysis into various strategies and therefore underscoring the need to ensuring transparency in official interaction with the TI and its representatives.
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Affiliation(s)
- Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
- Public Health Masters Program at School of Medicine, University of Limerick, Limerick, Ireland
- Faculty of Human and Health Sciences, Swansea University, Swansea, United Kingdom
| | - Sitanshu Sekhar Kar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Education & Research, Puducherry, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab India
| | - Parthibane Sivanantham
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Education & Research, Puducherry, India
| | - Bijay Nanda Naik
- Community & Family Medicine, All India Institute of Medical Sciences Patna, Patna, India
| | - Deepti Gupta
- Department of English and Cultural Studies, Panjab University, Chandigarh, India
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Hawkins B, Durrance-Bagale A, Walls H. Co-regulation and alcohol industry political strategy: A case study of the Public Health England-Drinkaware Drink Free Days Campaign. Soc Sci Med 2021; 285:114175. [PMID: 34388623 DOI: 10.1016/j.socscimed.2021.114175] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/15/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
This article examines the Drink Free Days (DFD) campaign run by Public Health England and the industry funded alcohol education charity, Drinkaware, in eight English regions in 2018-2019. More specifically, it examines uses, and usefulness, of the campaign to the alcohol producers which fund Drinkaware. It draws on 36 semi-structured interviews with policy actors and a framing analysis of industry social media accounts and news coverage of the campaign. Industry-associated bodies such as Drinkaware have been identified as key components of alcohol industry strategies to influence policy and shape the regulatory contexts in which they operate in three ways. First, funding such bodies forms part of corporate social responsibility programmes which allow companies to position themselves as legitimate policy actors and 'part of the solution' to alcohol related harms. Second, reliance on industry funding incentivises governments to co-operate with industry actors and provides leverage in policy debates. Third, their programmes absorb policy bandwidth and deflect from more effective, evidence based interventions (e.g. on pricing and advertising) which affect industry sales and profits. This is particularly effective if the perception of independence from the industry is created. The analysis presented below suggests that the DFD was not used explicitly by the industry actors for public relations purposes. However, it was useful to their broader strategic aims. It reinforced the position of Drinkaware as a key policy actor and promoted the particular, industry-favoured understanding of alcohol harms and their solutions which it promotes. This is in keeping with the previous insights from international research literature on corporate political activity in health harming industries which finds that policy influence is often subtle, indirect and designed to embed organisations within the policy architecture. It suggests that government agencies should proceed with great caution in entering into such partnerships with industry associated bodies.
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Affiliation(s)
| | - Anna Durrance-Bagale
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
| | - Helen Walls
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
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Ikegwuonu T, Hilton S, Smith KE, Buckton CH, Wong M, Weishaar HB. Understanding commercial actors' engagement in policy debates on proposed e-cigarette regulation in Scotland. Tob Control 2021; 31:511-519. [PMID: 33771932 DOI: 10.1136/tobaccocontrol-2020-056084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION There is growing concern about transnational tobacco corporations' (TTCs) and other commercial actors' involvement in e-cigarette policy development. Previous analyses suggest that TTCs used e-cigarette debates to demonstrate alignment with public health and re-gain policy influence. Less is known about the engagement of other types of commercial actors in e-cigarette policy debates. METHODS This paper is the first to empirically analyse commercial actors' engagement in an e-cigarette policy consultation process and to examine their views on proposed regulation. It applies mixed methods, drawing on policy consultation submissions (n=32), semi-structured interviews (n=9) and a social network analysis of website links among 32 commercial actors. RESULTS The results show that commercial actors' positions on e-cigarette regulation aligned with business interests. TTCs, independent e-cigarette manufacturers and other non-licensed commercial actors were opposed to most aspects of potential e-cigarette regulation (except for age of sale restrictions), whereas licensed commercial actors, including pharmaceutical companies, supported more stringent regulation. While collaboration was viewed as strategically important to gain policy influence, distinct commercial interests and concerns about TTC credibility led to strategic distancing and to collaboration being largely confined to sector boundaries. In addition to reiterating arguments employed by TTCs in previous regulatory debates, commercial actors focused on highlighting the technical complexity and harm reduction potential of e-cigarettes. CONCLUSION Awareness of the various commercial interests and strategic positioning of commercial actors in e-cigarette policy should inform public health advocacy and policy development, including managing conflicts of interest in the context of Framework Convention on Tobacco Control Article 5.3.
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Affiliation(s)
- Theresa Ikegwuonu
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Katherine E Smith
- Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Christina H Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mark Wong
- Urban Studies, School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Heide B Weishaar
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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