Tobacco policy (in)coherence in Mozambique: an examination of national and subnational stakeholder perspectives.

Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur.

Addressing tobacco industry influence in tobacco-growing countries.

Protecting policy-making from tobacco industry influence is central to effective tobacco control governance. The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence. This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance. Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers. Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity. In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobacco-growing countries. In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies. The range of companies that operate in these contexts is particular and so is their engagement within political institutions. For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries. Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts.

Éviter que l'élaboration de politiques soit influencée par l'industrie du tabac est essentiel pour assurer une gestion efficace de la lutte antitabac. L'inclusion d'acteurs de l'industrie comme parties prenantes des processus législatifs demeure l'un des principaux leviers employés par les sociétés. Cette influence est renforcée par l'idée que l'industrie du tabac constitue un partenaire légitime du gouvernement dans le domaine de la gouvernance réglementaire. Pour lutter contre l'ingérence du secteur, il faut se concentrer sur les institutions gouvernementales qui officialisent les relations entre l'industrie et les responsables politiques. L'implication de l'industrie dans les institutions publiques est surtout observée dans les pays producteurs de tabac, où certains niveaux de gouvernement soutiennent activement le tabac en tant que bien économique. Dans le présent document, nous abordons le fait qu'une lutte contre l'influence de l'industrie du tabac requiert une attention particulière dans les pays producteurs, où un large éventail d'entreprises encouragent la production de tabac: approvisionnement en semences, équipements et produits chimiques, mais aussi transport, achat des feuilles, transformation et fabrication. La variété des entreprises œuvrant dans de tels contextes est spécifique, tout comme leur engagement au sein des organes politiques. Pour les gouvernements qui souhaitent privilégier les alternatives à la production de tabac (selon l'article 17 de la Convention-cadre pour la lutte antitabac), nous montrons à quel point l'application de l'article 5.3, qui vise à protéger les politiques de lutte antitabac contre l'ingérence de l'industrie, est fondamentale dans ces pays. Intégrer l'article 5.3 dans l'article 17 permettra (i) de renforcer la cohérence des politiques en vigueur, afin que les politiques relatives à des activités de remplacement ne soient pas contrecarrées par l'industrie du tabac; (ii) de favoriser la collaboration entre les secteurs pour lutter contre l'influence de l'industrie tout en développant des moyens de subsistance; et enfin, (iii) d'accroître la responsabilisation et la transparence dans les efforts menés dans la lutte antitabac.

Proteger la formulación de políticas contra la influencia de la industria tabacalera es fundamental para una gobernanza eficaz del control del tabaco. La inclusión de los actores de la industria como partes interesadas en los procesos políticos sigue siendo una vía crucial para la influencia corporativa. Esta influencia se ve reforzada por la idea de que la industria tabacalera es un asociado legítimo del gobierno en la gobernanza reglamentaria. La lucha contra la influencia de la industria tabacalera exige centrarse en las instituciones gubernamentales que formalizan las relaciones entre la industria y los responsables de formular políticas. La participación de la industria en las instituciones gubernamentales es especialmente relevante en los países productores de tabaco, donde algunos sectores del gobierno apoyan activamente el tabaco como un bien económico. En este documento, se analiza cómo el control de la influencia de la industria tabacalera requiere una consideración especial en los países productores de tabaco. En estos países, existe una gran variedad de empresas que apoyan la producción de tabaco, incluidos los proveedores de semillas, equipos y productos químicos, así como las empresas de transporte, de compra de hojas y de procesamiento y fabricación. La variedad de empresas que operan en estos contextos es particular y también lo es su compromiso dentro de las instituciones políticas. Para los gobiernos que desean apoyar alternativas al cultivo de tabaco (es decir, el artículo 17 del Convenio Marco para el Control del Tabaco), se ilustra cómo la aplicación del artículo 5.3, destinado a proteger las políticas de control del tabaco de la interferencia del tabaco, es fundamental en estos países. La integración del artículo 5.3 con el artículo 17 (i) reforzará la coherencia política, asegurando que las políticas de medios de vida alternativos no se vean perjudicadas por la interferencia de la industria tabacalera; (ii) fomentará la colaboración intersectorial al abordar tanto la interferencia de la industria tabacalera como el desarrollo de los medios de vida; y (iii) mejorará la rendición de cuentas y la transparencia en los esfuerzos de control del tabaco.

Framing policy objectives in the sustainable development goals: hierarchy, balance, or transformation?

Society continues to be confronted with the deep inadequacies of the current global order. Rampant income inequality between and within countries, dramatic disparities in access to resources, as seen during the COVID pandemic, persistent degradation of the environment, and numerous other problems are tied to existing systems of economy and government. Current global economic systems are implicated in perpetuating these problems. The Sustainable Development Goals (SDGs) were born out of the recognition that dramatic changes were needed to address these intersecting challenges. There is general recognition that transformation of global systems and the relationship between sectors is needed. We conduct a structured, theoretically-informed analysis of SDG documents produced by United Nations agencies with the aim of examining the framing of economic policy goals, a historically dominant domain of consideration in development policy, in relation to health, social and environmental goals. We apply a novel typology to categorize the framing of policy goals. This analysis identified that the formal discourse associated with the SDGs marks a notable change from the pre-SDG development discourse. The 'transformational' agenda issued in the SDG documents is in part situated in relation to a critique of previous and existing approaches to development that privilege economic goals over health, social and environmental goals, and position economic policy as the solution to societal concerns. At the same time, we find that there is tension between the aspiration of transformation and an overwhelming focus on economic goals. This work has implications for health governance, where we find that health goals are still often framed as a means to achieve economic policy goals. Health scholars and advocates can draw from our analysis to critically examine how health fits within the transformational development agenda and how sectoral policy goals can move beyond a crude emphasis on economic growth.

Situating Food Industry Influence: Governance Norms and Economic Order Comment on "'Part of the Solution': Food Corporation Strategies for Regulatory Capture and Legitimacy".

Lacy-Nichols and Williams provide important new insights into the ongoing contest over policy space and consumer behavior. I attempt to situate these insights in relation to government mandates and governance norms and situate these norms and mandates in the prevailing economic order. This approach is necessary to understand how corporate practices persist and why governments are receptive to the approaches outlined in the analysis conducted by Lacy-Nichols and Williams. This approach can help explain why governments are often receptive to corporations positioning themselves as 'part of the solution'. Governments want strong economies and big food positions itself as contributor to this end. The point I attempt to articulate is that we often conceive of corporate power as power over, while I suggest that corporate power is rather power within and through a system that is oriented towards profits and economic growth.

Implications for farmers of measures to reduce sugars consumption.

OBJECTIVE: To estimate the impact of reduced consumption of free sugars in line with World Health Organization recommendations, on sugar farmers globally. METHODS: Using multiregion input-output analysis, we estimated the proportional impact on production volumes of a 1% reduction in free sugars consumption by the public. We extracted data on sugar production from the Food and Agriculture Organization of the United Nations database for the top 15 sugar-cane- and beet-producing countries globally, and created a custom multiregion input-output database to assess the proportions of production going to human consumption, drawing on household expenditure surveys and national input-output databases (data valid for years 2000-2015). We also considered the impact on production volumes in relation to countries' gross domestic product. FINDINGS: A high proportion of current sugar production from these countries goes to human consumption, and would thus be impacted by reduced consumption of sugars. The largest impacts on cane sugar production, and thus on farmers, would likely occur in Brazil, China, India and Thailand and on beet production in Belarus, Germany, Russian Federation and United States of America. CONCLUSION: A global opportunity exists for public health leadership to bring together the health, economic, environmental and agriculture sectors to collaborate and build capacity for promotion of alternative livelihoods for sugar farmers. Lessons regarding strategy and the importance of political economy factors can be learnt from tobacco control measures. Further research to quantify the impact of reductions in sugars consumption would provide useful insights for designing policies to complement and strengthen efforts to improve diets and health.

An Overview of the Policy and Market Landscape of Tobacco Production and Control in Mozambique.

Background: Tobacco growing has been considered a mainstay of Mozambique's economy, but there is a dearth of analysis of the tobacco policy landscape in the country. Methods: Review of government and non-government documents and academic papers addressing Mozambique's tobacco-growing history, the changes in the political economy of tobacco, and health policies addressing tobacco use and prevention of noncommunicable diseases. Results: Despite its tobacco growing and exporting history, the contribution of tobacco to the economy has been in steady decline in the past two decades, including in the areas dedicated to growing. At the same time there has been an increase in multinational control of the tobacco economy. In parallel, Mozambique's commitment to addressing the growing burden of noncommunicable disease and accession to the Framework Convention on Tobacco Control indicate a potential for internal government tensions to balance immediate economic interests with long term health goals. Conclusions: With the decline in tobacco share of the overall economy, Mozambique may be well-positioned to explore alternative, sustainable livelihoods for farmers that grow tobacco, but it must overcome inter-sectoral barriers and advocate for a whole of government approach to address the health and economic impact of tobacco.

When a patient's choices entail risks for others: third-party risks, relational ethics, and responsibilities of rehabilitation professionals.

PURPOSE: Patients receiving rehabilitation care may act in ways that pose risks to the wellbeing of others. There are numerous situations when patients' actions might pose risks to others, including family members, other patients, or society. For example, such risks arise if patients wish to return home to living in an apartment but risk starting a fire while cooking, or if they insist on driving but their health condition makes doing so unsafe. These situations give rise to ethical challenges, including for health professionals as they seek to promote their patient's autonomy while minimizing risks for the patient and others. METHODS: We develop a conceptual analysis examining how relational ethics can inform understanding of rehabilitation professionals' responsibilities in responding to third-party risk. RESULTS: Relational ethics foregrounds the situated, dynamic, and interdependent nature of relationships between people, and supports dialogic approaches to clarify how best to respond. We present a set of 10 questions linked to the concepts of relational autonomy and relational social justice that can contribute to ethical reflection and deliberation among providers, patients, families, and others involved. CONCLUSION: Relational ethics provides a distinctive angle of view on challenging issues of third-party risk in rehabilitation care.Implications for rehabilitationManaging risk is a recurrent source of ethical challenge in rehabilitation care.Risks to third parties give rise to significant ethical tensions.We propose ten questions that can support a relational ethics approach for responding to situations of third-party risk.

Intersectoral policy on industries that produce unhealthy commodities: governing in a new era of the global economy?

Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.

Shifting from tobacco growing to alternatives in Malawi? A qualitative analysis of policy and perspectives.

Tobacco is the primary export commodity in Malawi and an important contributor to foreign earnings. The entrenchment of tobacco interests within government has partly explained why Malawi has lagged in its efforts to address the health consequences of tobacco and has been a vocal opponent of global tobacco control. Despite the extensive historical and entrenched relationship between the economy of Malawi and tobacco production, there have been important shifts at the highest policy levels towards the need to explore diversification in the agricultural sector. There is explicit recognition that alternatives to tobacco production must be pursued. This study provides an analysis of the policies and perspectives that characterize contemporary government approaches to tobacco and alternatives in Malawi by interviewing key government officials working on tobacco policy and reviewing recent policy documents. This research finds that there is openness and movement towards reducing tobacco growing in Malaw, including efforts to reduce tobacco dependency. Rather than a singular tobacco policy discourse in the country, there is a somewhat conflictual set of policies and perspectives on the future of tobacco in Malawi. Informing these policies and perspectives is the interplay between the economics of agricultural production (tobacco vs other crops), global markets (ranging from the ability to generate export earnings to the inability to compete with wealthier countries' non-tobacco crop subsidies) and the lack of developed supply and value chains other than those created by the transnational tobacco industry. The implications for government policy supporting a move away from tobacco dependence are not straightforward: there is a need to fill the supply chain gap for alternative crops, which requires not only strong intersectoral support within the country (and some challenge to the residual pro-tobacco narratives) but also international support.

The Political Economy of Tobacco in Mozambique and Zimbabwe: A Triangulation Mixed Methods Protocol.

Changing global markets have generated a dramatic shift in tobacco consumption from high-income countries (HICs) to low- and middle-income countries (LMICs); by 2030, more than 80% of the disease burden from tobacco use will fall on LMICs. Propelling this shift, opponents of tobacco control have successfully asserted that tobacco is essential to the economic livelihoods of smallholder tobacco farmers and the economy of tobacco-growing countries. This nexus of economic, agricultural and public health policymaking is one of the greatest challenges facing tobacco control efforts, especially in LMICs. To date, there is a lack of comparative, individual level evidence about the actual livelihoods of tobacco-growing farmers and the political economic context driving tobacco production. This comparative evidence is critically important to identify similarities and differences across contexts and to provide local evidence to inform policies and institutional engagement. Our proposed four-year project will examine the economic situation of smallholder farmers in two major tobacco-growing LMICs-Mozambique and Zimbabwe-and the political economy shaping farmers' livelihoods and tobacco control efforts. We will collect and analyze the existing data and policy literature on the political economy of tobacco in these two countries. We will also implement household-level economic surveys of nationally representative samples of farmers. The surveys will be complimented with focus group discussions with farmers across the major tobacco-growing regions. Finally, we will interview key informants in these countries in order to illuminate the policy context in which tobacco production is perpetuated. The team will develop country-level reports and policy briefs that will inform two sets of dissemination workshops in each country with relevant stakeholders. We will also conduct workshops to present our findings to the survey and focus group participants, and other members of these tobacco-growing communities, so they can directly benefit from the research to which they are contributing.

Consequences of policy incoherence: how Zambia's post-FCTC investment policy stimulated tobacco production.

Zambia, a tobacco-growing country, provides manufacturing incentives to attract foreign and domestic investment. In an earlier study, we cautioned that these incentives could lead to local tobacco manufacturing, undermining its domestic tobacco control efforts. In 2018, as part of our continuing research program, we conducted key informant interviews (n = 15) and document analyses. Our early caution proved correct. In 2018, taking advantage of tax incentives, British American Tobacco Zambia and Roland Imperial Tobacco opened new cigarette-manufacturing facilities in the Lusaka Multi-Facility Economic Zone. They report capability of producing 25 million cigarettes daily, between 3 and 5 million of which is intended for the domestic market. Zambia's tax incentives for cigarette manufacturing are likely to increase domestic consumption. The 170 new jobs created in the two plants pale when considering long-term health impacts and lost economic productivity of an increase in supply of locally produced cigarette brands.

The Economic Geography of Kenyan Tobacco Farmers' Livelihood Decisions.

INTRODUCTION: The narrative of prosperous economic livelihood of tobacco farmers in Kenya as alleged by the tobacco industry deserves challenge as evidence increasingly suggests that smallholder tobacco farmers are making little or no profits. Article 17 of the World Health Organization Framework Convention on Tobacco Control encourages viable alternative livelihoods for tobacco farmers. There is little evidence, however, on how tobacco farmers make livelihood choice decisions. METHODS: A total of 527 purposefully selected smallholder tobacco farmers in Kenya from three main tobacco-growing regions participated in a 2017 economic livelihood survey. Geo-economic data were matched to surveyed farmers' Global Positioning System coordinates to estimate each farmer's access to nearby economic centers. Ownership of cell phones or radios was also used to estimate farmers' virtual access to nearby economic activities to understand better the role of information. Multivariate logistic regressions were used to control socioeconomic status and self-reported activity in nearby economic centers. RESULTS: Tobacco farmers rarely live within 10 km of an economic center. Results suggest that the further away farmers live from economic centers, the less likely they are to grow tobacco, but more likely to grow tobacco under contract. Also, farmers owning a cell phone or radio are not only less likely to grow tobacco, but also to not engage in farming under contract if they do grow tobacco. CONCLUSIONS: Physical and virtual access to nearby economic activities is significantly associated with tobacco farmers' livelihood choice decision and should be taken into consideration by decision makers while developing interventions for FCTC Article 17. IMPLICATIONS: Smallholder tobacco farmers in lower-income countries are making little or no profits, but few studies have been conducted to illuminate what perpetuates tobacco production, with such studies urgently needed to support governments to develop viable alternative livelihoods for tobacco farmers. This study suggests that geographic and technological factors that shape farmers' economic decisions can help policy makers tailor alternative livelihood policies to different regional contexts and should be a focus of future research in this area.

Costs, contracts and the narrative of prosperity: an economic analysis of smallholder tobacco farming livelihoods in Kenya.

BACKGROUND: The tobacco industry has used the alleged negative impacts on economic livelihoods for tobacco farmers as a narrative to oppose tobacco control measures in low/middle-income countries. However, rigorous empirical evidence to support or refute this claim remains scarce. Accordingly, we assess how much money households earn from selling tobacco, and the costs they incur to produce the crop, including labour inputs. We also evaluate farmers' decision to operate under contract directly with tobacco manufacturers and tobacco leaf-buying companies or to operate as independent farmers. METHODS: A stratified random sampling method was used to implement a nationally representative household-level economic survey of 585 farmers across the three main tobacco growing regions in Kenya. The survey was augmented with focus group discussions in all three regions to refine and enrich the context of the findings. RESULTS: Both contract and independent farmers experience small profit margins per acre, with contract farmers operating at a loss. Even when family labour is excluded from the calculation, income levels remain low, particularly considering the typically large households. Generally, tobacco farmers enter into contracts with tobacco companies because they have a 'guaranteed' buyer for their tobacco leaf and receive the necessary agricultural inputs (fertiliser, seeds, herbicides and so on) without paying cash up-front. CONCLUSIONS: Tobacco farming households enter into contract with tobacco companies to realise perceived economic benefits. The narrative that tobacco farming is a lucrative economic undertaking for smallholder farmers, however, is inaccurate in the context of Kenya.

Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014.

INTRODUCTION: Every year, more than 6,000 Kenyans die of tobacco related diseases (79 men and 37 women die per week), while more than 220,000 children and more than 2,737,000 adults continue to use tobacco each day. Some suggest that these numbers will rise without concerted efforts to strengthen the implementation of tobacco control measures. To date, there remains much to be learned about what contributes to tobacco consumption in Kenya. This study analyses the socio-economic and demographic determinants of tobacco use in Kenya. METHODS: To analyze the determinants of tobacco use in Kenya, this study uses the 2014 Kenya Demographic and Health Survey. A logistic regression is used to estimate the probability of an individual smoking, given a set of socio-economic and demographic characteristics. RESULTS: Results suggest that the overall smoking and smokeless prevalence rate is 17.3% and 3.10% respectively among men. Women have low rates with smoking and smokeless prevalence standing at 0.18% and 0.93% respectively. However, for both genders, tobacco use is influenced by age, marital status, residence, region, educational status and gender. CONCLUSION: Socio-economic, demographic and geographic disparities on tobacco use should be explored in order to ensure prudent allocation of resources used for tobacco control initiatives. Allocation of resources for tobacco control including monitoring advertisements, sales to underage persons and general distribution of human resource for tobacco control should be based on socio-economic and demographic dynamics.

The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals.

The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.

Fostering the Catalyst Role of Government in Advancing Healthy Food Environments.

Effective approaches to non-communicable disease (NCD) prevention require intersectoral action targeting health and engaging government, industry, and society. There is an ongoing vigorous exploration of the most effective and appropriate role of government in intersectoral partnerships. This debate is particularly pronounced with regards to the role of government in controlling unhealthy foods and promoting healthy food environments. Given that food environments are a key determinant of health, and the commercial sector is a key player in shaping such environments (eg, restaurants, grocery stores), the relationship between government and the commercial sector is of primary relevance. The principal controversy at the heart of this relationship pertains to the potential influence of commercial enterprises on public institutions. We propose that a clear distinction between the regulatory and catalyst roles of government is necessary when considering the nature of the relationship between government and the commercial food sector. We introduce a typology of three catalyst roles for government to foster healthy food environments with the commercial sector and suggest that a richer understanding of the contrasting roles of government is needed when considering approaches NCD prevention via healthy food environments.

Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia.

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos.

The institutional context of tobacco production in Zambia.

BACKGROUND: Tobacco production is said to be an important contributor to Zambia's economy in terms of labour and revenue generation. In light of Zambia's obligations under the WHO Framework Convention of Tobacco Control (FCTC) we examined the institutional actors in Zambia's tobacco sector to better understand their roles and determine the institutional context that supports tobacco production in Zambia. METHODS: Findings from 26 qualitative, semi-structured individual or small-group interviews with key informants from governmental, intergovernmental and non-governmental organisations were analysed, along with data and information from published literature. RESULTS: Although Zambia is obligated under the FCTC to take steps to reduce tobacco production, the country's weak economy and strong tobacco interests make it difficult to achieve this goal. Respondents uniformly acknowledged that growing the country's economy and ensuring employment for its citizens are the government's top priorities. Lacklustre coordination and collaboration between the institutional actors, both within and outside government, contributes to an environment that helps sustain tobacco production in the country. A Tobacco Products Control Bill has been under review for a number of years, but with no supply measures included, and with no indication of when or whether it will be passed. CONCLUSIONS: As with other low-income countries involved in tobacco production, there is inconsistency between Zambia's economic policy to strengthen the country's economy and its FCTC commitment to regulate and control tobacco production. The absence of a whole-of-government approach towards tobacco control has created an institutional context of duelling objectives, with some government ministries working at cross-purposes and tobacco interests left unchecked. With no ultimate coordinating authority, this industry risks being run according to the desire and demands of multinational tobacco companies, with few, if any, checks against them.

The context and quality of evidence used by tobacco interests to oppose ANVISA's 2012 regulations in Brazil.

Evidence is an important resource for policy makers. Alongside its practical utility, evidence is a persuasive strategic and rhetorical tool. This study scrutinises the information used by tobacco interests in opposition to Brazil's National Health Surveillance Agency's (ANVISA) 2012 regulations. We analysed one prominent document widely cited in the policy discourse, produced by Fundação Getulio Vargas (FGV) in 2010 when ANVISA initiated public consultations. The FGV document formed the basis of opposition to the regulations. We conducted four levels of analysis of the FGV document: (1) identifying the main arguments, (2) linking the arguments with evidence, (3) analysing the quality of evidence and (4) a contextual analysis, examining how evidence was interpreted and represented. Three of five arguments were supported by information produced by an external source. Sixty eight percent of evidence sources were supported by the tobacco industry and only 31% were peer-reviewed. Information was often misrepresented in the arguments. Tobacco interests continue to draw from sources they claim are scientific to legitimise their opposition to tobacco regulation. The information from these sources are often misrepresented, used to distract from the health objectives of policy and receive direct or indirect support from the tobacco industry.