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Case study report: global analysis project on the political economy of tobacco control in low- and middle-income countries. J Patrick Vaughan, Jeff Collin, and Kelley Lee, eds. London: London School of Hygiene and Tropical Medicine, 2000. ISBN 0 902657 67 4 . 150 pages. Project sponsored by the Tobacco Free Initiative, WHO Geneva.
One should not miss the chance to understand processes of strong policy formulation. These two books give ample opportunity for comparison and thoughtfulness about policy making. Both deal with tobacco control policy issues and Thailand, making them particularly useful in Asia and for low to middle income countries. Hatai Chitanondh has put together a personal retrospective tracing events over the nearly three years (1989-92) it took to pass two Thai comprehensive tobacco control laws. This occurred during and after Thailand resisted the 301 provision on the US Trade Act threatening trade retaliation if Thailand failed to open its market to US cigarettes. When the General Agreement on Tarrifs and Trade (GATT) decision required Thailand to open its market, there was an unwritten understanding in Thailand that there would be immediate legislation to limit the impact of the resulting market expansion. It was far from clear what kind of tobacco control legislation could be passed, considering limited past legislation and the political circumstances of the time.
Thailand's long fight to resist entry of foreign cigarettes was primarily a defensive effort, while the passage of the two laws was a visible, positive initiative reflecting strong resolve and an emerging tobacco control direction. Chitanondh's book shows who the players in this effort were and how they succeeded in passing two complementary tobacco control measures with sweeping articles on advertising, sales and marketing as well as environmental provisions prohibiting or limiting public smoking.
The main thrust of the book involves the processes of political education and strategising. While provisions of the two laws are mentioned, the specific content of the legislation is not discussed in detail except when it is controversial—that is, contested by opponents.
The second book was written by researchers from the London School of Hygiene and Tropical Medicine. They conducted a political analysis funded by the Tobacco Free Initiative of the World Health Organization. Their political economy approach from social epidemiology concentrates on mapping the contextual, organisational, and personal features of the tobacco control situation in Thailand and Zimbabwe. These case studies were part of the second phase of their policy investigation whose purpose includes contributing to the FCTC (Framework Convention on Tobacco Control) process of the WHO and the development of guidelines to assist policy research in other low and middle income countries.
Since the purpose is a deeper understanding of the quantitative facts and figures shown in the numerous tables, figures, and appendices of this volume, qualitative interview methods were used along with position mapping to illuminate tobacco control policy efforts. “Tobacco control issues were analysed across categories of tobacco production, consumption and health promotion.”
An identified key future action is the passage of the enabling bill for the Thai Health Promotion Bill now before the National Assembly. As identified in both books, actions of non-governmental organisations (NGOs) are likely to be central. Thus, I found it interesting that the case report editors feel that academic research institutions are preferable for further research. In fact, the majority of the case findings in the Thai case report come from NGOs (Action on Smoking and Health, and the Thailand Health Promotion Institute) and their leaders. In Thailand, to exclude the research capability and/or information from NGOs would be a mistake.
In another respect, I wonder if the call to expand political economy studies and a broader international strategy for tobacco control research is being considered in light of the larger situation. The utility of the expansion of this kind of research must be balanced with the already recognised need to fund advocacy programmes to get timely policy adoption using accepted best tobacco control methods. Frankly, it is often more palatable for countries and funders to study tobacco control policy than to be responsive to strategic opportunities for policy adoption.
I found a lot of useful information in these two slim volumes. Tobacco control can be viewed both as an art and a science. Hatai Chitanondh deals with the strategic art while the case study report presents an important policy analysis that is useful in policy formulation. Both views benefit by focusing on the essential goal of policy change and including all that seek it.