Evidence and decision making: tobacco control policy and legislation in Vietnam.

The Ministry of Health (MOH) in Vietnam is currently drafting the Tobacco Harm Prevention Law. The government requested the MOH to provide evidence on the strategies proposed in the draft law as part of its submission to the National Assembly. This study examines the availability and strength of evidence and its relationship to policy stakeholders' positions towards policy instruments proposed in the law. Several qualitative methods were employed including documentary analysis, key informant interviews, focus group discussion and a key stakeholders' survey. Contradictory findings were identified over the role of evidence. While there is high demand for local evidence, the availability and strength of evidence are not always aligned with stakeholders' positions with respect to different strategies. Stakeholders' positions are shaped by competing interests on the basis of their perceptions of the socioeconomic implications and health consequences of tobacco control. Claims of limited availability of evidence are often used to justify the maintenance of the status quo, a position that is seen to protect the state-owned tobacco industry and state revenue. Local evidence of the impact of tobacco on population health is argued to be 'one-sided' and evidence of selected interventions discounted. Compelling and comprehensive local evidence, including those addressing economic concerns, is acutely needed in order to proceed with the current legislation process. For evidence to play a critical role, it needs to engage those ministries responsible for the tobacco industry itself and the economic development.

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry.

BACKGROUND: Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. METHODS: Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. FINDINGS: The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. CONCLUSION: The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged.

Population-level approaches to universal health coverage in resource-poor settings: lessons from tobacco control policy in Vietnam.

Population-based health promotion and disease prevention approaches are essential elements in achieving universal health coverage; yet they frequently do not appear on national policy agendas. This paper suggests that resource-poor countries should take greater advantage of such approaches to reach all segments of the population to positively affect health outcomes and equity, especially considering the epidemic of chronic non-communicable diseases and associated modifiable risk factors. Tobacco control policy development and implementation in Vietnam provides a case study to discuss opportunities and challenges associated with such strategies.

Mandatory helmet legislation and the print media in Viet Nam.

With motorcycle ownership high and rising in Viet Nam, and motorcycle riders vulnerable to both fatal and non-fatal injury, the re-introduction of mandatory helmet legislation in 2007 has been a priority for the Vietnamese government. The paper uses a qualitative analysis of web-based versions of the eight most popular newspapers in Viet Nam to track reporting over four phases of the implementation of the legislation, identifying codes and constructing the dominant themes of the media coverage. The study documents the justification and promotion of the legislation, and the mechanisms for preparing for its implementation at a national and local level, developing solutions and encouraging the replication of successful strategies. It records opposition and obstacles to helmet use, and concerns raised around the quality of helmets purchased. In return, the press notes the response of the market in innovative solutions to these problems. With the successful implementation of the legislation, the functions of the print media in promulgating and promoting the legislation, together with the reporting of ongoing resistance to the process, serve to enable a dialogue between the State and population around expressed concerns. In highlighting quality control of helmets as a key issue, the media have identified a potential ongoing role in monitoring the state's initiative in reducing the road toll from traumatic brain injury in motorcyclists.