The 20-year impact of tobacco price and tobacco control expenditure increases in Minnesota, 1998-2017.

INTRODUCTION: Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example. METHODS: Using the HealthPartners Institute's ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population. RESULTS: The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control. CONCLUSION: Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.

Tobacco control in Nepal during a time of government turmoil (1960-2006).

BACKGROUND: Nepal was a monarchy, then a dictatorship, then a democracy. This paper reviews how tobacco control progressed in Nepal in the context of these changes in government from 1950 through 2006. METHODS: We triangulated tobacco industry documents, newspaper articles and key informant interviews. RESULTS: Until 1983, the tobacco industry was mostly state owned. Transnational tobacco companies entered the Nepalese market through ventures with Surya Tobacco Company Private Limited (with Imperial Tobacco Company and British American Tobacco) in 1983 and Seti Cigarette Factory Limited (with Philip Morris International [PMI]) in 1985. Seminars and conferences on tobacco, celebrations of World No Tobacco Day (WNTD) and efforts by WHO helped promote tobacco control in Nepal beginning in the 1970s. Tobacco advocates in Nepal pushed the government to issue executive orders banning smoking in public places in 1992 and tobacco advertising in electronic media in 1998, and to introduce a tobacco health tax in 1993. The tobacco industry lobbied against these measures and succeeded in keeping the tobacco tax low by challenging it in court. Tobacco advocates sued the government in 2003 and 2005, resulting in a June 2006 Supreme Court decision upholding the smoking and advertising bans and requiring the government to enact a comprehensive tobacco control law. CONCLUSIONS: Political instability, conflict, weak governance and the dictatorship significantly affect tobacco control activities in low-income and middle-income countries. Nepal shows that tobacco control advocates can take advantage of global events, such as WNTD, and use domestic litigation to maintain support from civil societies and to advocate for stronger tobacco control policies.

Campanhas educativas de controle do tabagismo: do vício moral ao estilo de vida saudável / Educational smoking control campaigns: from moral addiction to healthy lifestyle / Campañas educativas de control de fumadores: de la adicción moral al estilo de vida saludable

Este artigo é resultado do trabalho de pesquisa sobre a produção das campanhas antitabagistas de governo e sobre a forma com que foram apropriados pela população. Nosso objetivo foi avaliar como essas campanhas foram pensadas em relação aos princípios de comunicação e saúde pressupostos pelo Sistema Único de Saúde. A expectativa foi problematizar a questão numa perspectiva interdisciplinar. Analisamos documentos a partir dos preceitos teóricos e metodológicos da Semiologia dos Discursos Sociais. Concluiu-se que foram criadas campanhas alarmistas, pautadas na imputação do medo e na vigília moral, que acabaram por se distanciar da ideia de uma comunicação em saúde pública dialógica, informativa e participativa.

This article is the result of a research on the use of the concept of aversion in the production of government anti-smoking campaigns and how they were appropriated by the population. Our objective was to evaluate how these campaigns were conceived in relation to the principles of communication and health presupposed by the Unified Health System. The expectation was to problematize the issue from an interdisciplinary perspective. We analyze documents from the theoretical and methodological precepts of Semiology of Social Discourses. It was concluded that alarmist campaigns were created, based on the imputation of fear and on moral vigilance, which eventually distanced these actions from the principles of communication in dialogic, informative and participatory public health.

Este artículo es el resultado del trabajo de investigación sobre la utilización del concepto de aversión en la producción de las campañas antitabaco de gobierno y sobre la forma en que fueron apropiados por la población. Nuestro objetivo fue evaluar cómo estas campañas fueron pensadas en relación a los principios de comunicación y salud presupuestados por el Sistema Único de Salud. La expectativa fue problematizar la cuestión desde una perspectiva interdisciplinaria. Analizamos documentos a partir de los preceptos teóricos y metodológicos de la Semiología de los Discursos Sociales. Se concluyó que se crearon campañas alarmistas, pautadas en la imputación del miedo y en la vigilia moral, que acabaron por distanciarse de la idea de una comunicación en salud pública dialógica, informativa y participativa.

[History of Brazil's tobacco control policy from 1986 to 2016]. / Trajetória da política de controle do tabaco no Brasil de 1986 a 2016.

This study analyzes Brazil's tobacco control policy from 1986 to 2016, seeking to describe the policy's history and discuss its achievements, limits, and challenges. The study adopted a political economics approach and contributions from public policy analysis. Data were based on a search of the literature, documents, and secondary sources and semi-structured interviews with stakeholders involved in the policy. Factors related to the domestic and international contexts, the political process, and the policy's content influenced the institutional characteristics of tobacco control in the country. The study emphasizes the consolidation of Brazil's social rejection of smoking, government structuring of the policy, action by civil society, and Brazil's prestige in the international scenario. Inter-sector tobacco control measures like price and tax increases on cigarettes, the promotion of smoke-free environments, and the enforcement of health warnings contributed to the important reduction in prevalence of smoking. Implementation of the World Health Organization Framework Convention on Tobacco Control in Brazil, beginning in 2006, contributed to the expansion and consolidation of the national policy. However, tobacco-related economic interests limited the implementation of some strategic measures. The challenges feature the medium- and long-term sustainability of tobacco control and the solution to barriers involving crop diversification on current tobacco-growing areas, the fight against the illegal cigarette trade, and interference in the policy by the tobacco industry.

O estudo analisa a política brasileira de controle do tabaco entre 1986 e 2016, buscando caracterizar a trajetória da política e discutir os seus avanços, limites e desafios. Adotaram-se a perspectiva da economia política e contribuições do referencial de análise de políticas públicas. Realizou-se análise bibliográfica, documental, de dados secundários e de entrevistas semiestruturadas com atores envolvidos na política. Fatores relacionados ao contexto nacional e internacional, ao processo político e ao conteúdo da política influenciaram a institucionalidade do controle do tabaco no país. Ressaltam-se a consolidação da rejeição social ao tabagismo, a estruturação governamental da política, a atuação da sociedade civil e o prestígio do Brasil no cenário internacional. Medidas intersetoriais de controle do tabaco, como o aumento de preços e impostos de cigarros, a promoção de ambientes livres do fumo e a adoção de advertências sobre os malefícios do tabagismo contribuíram para a expressiva redução da prevalência de fumantes no período. A implementação da Convenção-Quadro para Controle do Tabaco da Organização Mundial da Saúde no Brasil, a partir de 2006, contribuiu para a expansão e consolidação da política nacional. No entanto, interesses econômicos relacionados ao tabaco limitaram a implementação de algumas ações estratégicas. Entre os desafios, destacam-se a sustentabilidade do controle do tabaco a médio e longo prazos e a superação das barreiras relacionadas à diversificação em áreas plantadas de fumo, ao combate ao comércio ilícito de cigarros e à interferência da indústria do fumo na política.

El estudio analiza la política brasileña de control al tabaco entre 1986 y 2016, procurando determinar la trayectoria de la política en este sentido, además de discutir sus avances, límites y desafíos. Se adoptaron la perspectiva de la economía política y contribuciones dentro del marco referencial del análisis a las políticas públicas. Se realizó un análisis bibliográfico, documental, de datos secundarios y de entrevistas semiestructuradas con actores involucrados en la política. Los factores relacionados con el contexto nacional e internacional, proceso político y contenido de la política influenciaron la institucionalidad del control al tabaco en el país. Se resaltan la consolidación del rechazo social al tabaquismo, la estructuración gubernamental de la política, la actuación de la sociedad civil y el prestigio de Brasil en el escenario internacional. Las medidas intersectoriales de control al tabaco, como el aumento de precios e impuestos de cigarrillos, la promoción de ambientes libres de tabaco y la adopción de advertencias sobre los perjuicios del tabaquismo contribuyeron a una expresiva reducción de la prevalencia de fumadores durante el período. La implementación de la Convención-Marco para el Control del Tabaco de la Organización Mundial de la Salud, en Brasil, a partir de 2006, contribuyó a la expansión y consolidación de la política nacional. No obstante, los intereses económicos, relacionados con el tabaco, limitaron la implementación de algunas acciones estratégicas. Entre los desafíos, se destacan la sostenibilidad del control al tabaco a medio y largo plazo y la superación de las barreras relacionadas con la diversificación en áreas plantadas con tabaco, el combate al comercio ilícito de cigarrillos y la interferencia de la industria del tabaco en la política.

[The national anti-opium-smoking campaigns across the country in the Republican Period].

Anti-opium-smoking had been the key policy of successive central and local governments from the late Qing Dynasty to the Republican Period. Since the establishment of the Nanjing Provisional Government in January 1912, the Anti-opium-smoking campaign had culminated across the country. Under the support of the government, the "National Anti-Opium Association of China" and "Association of Chinese People Rejecting Opium" were established which made an important contribution to China's anti-opium-smoking campaign.Yunnan, Shaanxi, Heilongjiang, Zhejiang, Shanghai and other local governments also combined with local specific circumstances to make anti-opium-smaking policy for punishing severely the opium cultivation, trade and opium smoking, thus, the overrun of opium began to be brought under an overall control.

History and the future: Looking back to look forward?

History is often dismissed as of little utility in the analysis of policy. This paper provides a justification for its use as evidence. It surveys the rise of the use of history, including public history and history and policy. It looks at two issues which draw on the author's own work: the relationship between regulation and culture for smoking and alcohol; and the response to electronic cigarettes in the light of smoking and public health history. It analyses what history can contribute. Responses are time dependent and change is an essential parameter in understanding policy. Historical research can challenge stereotypes, for example that prohibition was abandoned because it 'failed'. It also forms the bedrock of historical interpretation, which is mutable and often misunderstood outside the profession. History provides policy analysis rather than policy prescription and is a challenging approach, not just a convenient support for established positions. The paper concludes that history is far from moribund as a policy science.