Article Text

Achieving policy impact on tobacco economics research: experiences and lessons learnt
Free
  1. Erika Siu,
  2. Frank J Chaloupka,
  3. Jeffrey Drope,
  4. Margaret Dorokhina
  1. Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
  1. Correspondence to Erika Siu, School of Public Health, University of Illinois, Chicago, IL 60608, USA; erikas{at}uic.edu

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Introduction

If the goal is to inform more effective tax policies, building the local evidence base is critical. However, it is not the end. To take the next step toward the adoption and effective implementation of evidence-based policies, the ‘knowledge-to-policy’ channels between researchers and policymakers must be developed and cultivated through a consistent and accessible flow of information within durable stakeholder networks.

This overview article discusses the policy-focused research model of the project ‘Accelerating Progress on Tobacco Taxes in Low- and Middle-Income Countries (LMICs)’ (grant number KC 085918), which is funded at approximately US$4 million per year by Bloomberg Philanthropies as part of the Bloomberg Initiative to Reduce Tobacco Use (the views expressed in this document cannot be attributed to, nor do they represent, the views of the University of Illinois Chicago (UIC), the Institute for Health Research and Policy, or Bloomberg Philanthropies). Through this project, 30 think tanks have gained essential skills in analysis of tobacco economics and have disseminated their findings to stakeholders in their respective countries. Collectively, over the past 5 years, the UIC team has supported think tank production of local evidence in 18 LMICs, resulting in over 120 policy reports and briefs. The research has already informed the adoption of more effective fiscal policies to reduce tobacco use in 11 LMICs.

Policymakers often request local evidence to support policymaking, and proponents find that using research produced by in-country institutions is more credible and convincing in their work. The challenge often lies in the production of research that advocates can use to push for change and that policymakers can use to develop new laws. Researchers are not only required to produce quality research, but in addition to being objective and credible, the research must be accessible, timely and relevant to policy. Moreover, researchers need to be connected to proponents and policymakers. These connections help generate research questions and frame the results so that the findings speak directly to policy needs.

This overview article explores this challenge by presenting the work of partner think tanks in not only producing, but also effectively disseminating tobacco tax policy-focused research in LMICs. This overview article is not an independent evaluation of the project. Rather, since the authors have been directly involved in the implementation of this project, the article’s purpose is to provide an overview of the research contained within the supplement and to reflect on how to achieve policy impact through the production, translation and dissemination of high-quality research. The partners in this project are called ‘think tanks’; however, they range from research teams within a university to government-sponsored research institutions, to actual self-identified think tanks, all of which produce policy-oriented research. As explained in more detail below, the project partners were selected based on a variety of criteria with an emphasis on independent research acumen over the form of organisational classification.

The next section provides a review of the literature on the use of evidence to inform policy. The final section concludes with an overview of the selected partners and the research contained in this supplement.

Literature review

Think tanks work to inform policy by producing evidence relevant to their topics of interest. Ideally, this leads to the development of effective and beneficial policies, though the reality is less simple. Not all think tanks and not all evidence are equally effective in reaching this goal. Only intentional and high-quality efforts stand out in the crowded field of policy research. This literature review discusses the characteristics that best position think tank research to be influential in policymaking.

Frameworks and characteristics for success

Different frameworks model the characteristics adopted by effective think tanks, including organisational features, and the evidence produced. Although each framework presents a unique viewpoint, there are overlaps in these assessments.

Koon et al consider ‘embeddedness’, or the think tank’s position and influence relative to other actors in the policymaking arena and argue that four think tank attributes facilitate the uptake of evidence in policymaking in LMICs: reputation, capacity, and quality and quantity of connections to decision-makers.1 Koon et al’s model focuses on organisational qualities and interactions with decision-makers, while acknowledging the role of the policy environment.1 By improving their reputation, increasing capacity and fostering existing relationships with policymakers while developing new relationships, the evidence that think tanks produce becomes more embedded in the policymaking process.

Williams evaluates the role of the organisation and its research based on the legitimacy of the evidence produced.2 The argument centres on the need for coherence in a think tank’s identity, process and outcome. Coherence in identity requires that the organisation adheres to its chosen position.2 Other research, however, adds that strong ideological views have the opposite effect and decreases the think tank’s credibility.3 Recognising the nuance between these concepts is necessary for think tanks to reap the benefits from remaining consistent and transparent in their chosen positions. Coherence in process is achieved by a think tank when it commits to independence, integrity and transparency in its research processes.2 Financial transparency, both in terms of funders and clients, varies largely between think tanks and translates to varying levels of independence and integrity in the research being produced.4 Finally, coherence in outcome refers to a think tank’s ability to produce research that is significant and useful to the audience.2 When think tanks combine these three competencies, they gain more legitimacy in the crowded field of policy research.

Role of the other research actors and the policy environment

Think tanks are not the only actors that produce research and attempt to inform policy, so the role of other relevant groups and the relationships among them must be considered. Different policy environments can create opportunities or barriers for think tank research.

Doberstein conducted a randomised controlled experiment in 2016 and a direct replication of it in 2017 to compare the perception of credibility of policy research from three different sources: think tanks, academics and advocacy groups.3 5 Both studies conclude that policy analysts perceive think tank research as less credible compared with academic sources, yet more credible than the findings produced by advocacy groups.3 5 Collaboration among think tanks, other actors and decision-makers can address this perceived gap in credibility. Hansen et al argue that including policymakers in the entire knowledge production process assists in the production of evidence that is both relevant and timely in policy development.6 Wiltsey Stirman et al’s systematic review finds that the support of stakeholders increases the likelihood of long-term impact.7 In Thailand, the focus on co-production of knowledge, which includes actors such as policymakers, civil society and think tanks working collectively, results in a range of successful policy changes.8 As Redman et al summarise, co-production requires trust between the stakeholders, increased research capacity, the development of long-term relationships and an approach tailored to each environment.9

Kessler and Glasgow highlight the need for research that examines complex problems in a timely manner.10 They argue that evidence produced should be timely and applicable to the intricacies of the real world to have an impact.10 Systematic planning and the development of organisational capacity to produce credible and timely evidence can ensure that think tanks play a significant role in informing policy.

Limitations of research

Although the phrase ‘evidence-based policy’ is commonly used, Drèze criticises the term, citing the inherent disconnect between research findings and political decisions.11 Unlike research, policy also requires understanding, values and deliberation.12 Evidence can facilitate understanding, and, therefore, contribute to policymaking. However, it cannot substitute for the factors that motivate decision-makers.12 A more comprehensive approach that does not exclusively rely on the production of research is essential for organisations to reach their goals.

Project overview

Against this backdrop, the UIC team engages in mentored research with teams involving data collection, analysis, and the development and dissemination of fiscal policies to reduce tobacco use. Along with original data collection, researchers use national-level surveys, such as household expenditure surveys and other pre-existing secondary data to provide analysis of the economic impacts of fiscal policies. As explained in more detail below, the research teams are also mentored through the dissemination process and integrated into policy networks and coalitions to increase the policy impact of their research.

In the first Tobacconomics Supplement (2020), we discussed the criteria by which the think tank partners were chosen at the start of the project in 2017. We first began with desk scoping of highly rated economic policy think tanks in four regions: East Asia, South Asia, Latin America and Southeastern Europe. For this, we consulted a global think tank index as well as international partners from international finance institutions, tobacco control communities, think tank capacity building consortia and donor foundations with initiatives based in LMICs.13 After short-listing several think tanks in each region, we contacted the prospective partners to solicit their interest in learning more about our project and conducted teleconference interviews based on this interest. Similar to Koon et al’s model above, think tanks were evaluated based on the criteria of capacity, impact, motivation and independence.1

  • First, capacity was evaluated according to organisational, research and dissemination ability. Sufficient organisational capacity and accountability mechanisms were necessary. A strong indicator of this competence was previous funding from international organisations with demonstrable outputs. Economic research competence was important even if potential partners had not previously worked specifically on the economics of tobacco control. In the end, none of the selected partners had ever worked on tobacco taxation before, though many had previously researched areas of economics and public finance. Previous publications in scientific journals by researchers in the organisation also indicated capacity. Finally, communications capacity, such as previous experience publishing policy briefs, opinion pieces and social media messages within the organisation, was preferred to ensure that research reached the intended audiences. However, in many cases, the project team built the capacity of project partners in this area as well.

  • In terms of motivation, it was essential that the partners displayed an interest not only in the research, but also in integration with the stakeholder community and the knowledge-to-policy process of tobacco tax reform. Policy engagement would require coordination with the tobacco control community to meet the need for policy relevant research and translation of research findings into accessible briefings for advocates, policymakers and the media. Assessing this level of motivation by the prospective partner was not a straightforward undertaking in our scoping efforts, but clearly communicating the scope of the research and dissemination activities to prospective partners at the outset was helpful.

  • Next, the think tank’s policy impact was evaluated. This was measured indirectly through media coverage, policy changes following their research, participation of researchers on economic advisory panels, awards received, other formal recognition of research, etc. The types of policy changes, regardless of any ideological orientation, were irrelevant in the evaluation process, so long as there were no conflicts of interest with the tobacco industry or the government.

  • Finally, potential partners were vetted for independence from both the government and importantly, the tobacco industry.

The online supplemental file 1 shows a list of the think tank partners involved in this project from 2017 to 2021.

In addition to creating a framework of ‘core competencies’ of economic analysis on fiscal policies as detailed in the first article, we also developed a set of ‘core competencies for policy impact’. Since the overall goal of this 6-year project is to develop an in-country team into a trusted resource of economic research on tobacco taxation, our capacity building focuses on the core competencies in box 1. The first step is to translate the research findings into clear and accessible briefs and reports with concrete policy recommendations flowing from the findings. These research products should be disseminated strategically through the right channels and to influential people and organisations within the stakeholder network. These channels to policymakers may be based on formal or informal and direct or indirect means of dissemination. Establishing the channels requires a distinct skill set.

Box 1

Core competencies of policy impact

Research translation

Demonstrated ability to produce clear and accessible policy reports, briefs, key messages and concrete policy recommendations.

Strategic dissemination

Demonstrated ability to disseminate the research strategically with an appreciation for budgetary cycle and/or political timing, effective outreach and adaptability to remote (that is, not in-person) outreach.

Coalition building

Demonstrated ability to develop supportive relationships with key stakeholders from civil society.

Relationships with policymakers

Demonstrated ability to develop supportive relationships with key policymakers.

Trusted resource status

Demonstrated ability to produce rapid response technical assistance upon request from policymakers.

Sustainability

Demonstrated interest and motivation to inform policy in the long term.

As part of this dissemination, supportive relationships with civil society and policymakers are essential in pursuit of the end goal: each think tank and their research becoming an ‘embedded’ or trusted resource. And, because taxation generally requires a significant amount of evidence for the careful design and adoption of effective tax policies, the think tank involvement must be sustainable in the long term, even after the conclusion of this 6-year project. In this respect, the project aims to connect and situate partner researchers into durable tobacco control networks as well as establish their roles as respected, credible providers of technical assistance to policymakers on tobacco taxation.

Toward this goal, each team devised dissemination strategies to strengthen the policy impact of their research. First, the UIC project team held training for each of the think tanks in developing and implementing a strategy for policy impact, and several months later, each think tank submitted a draft strategy to identify and strengthen informal and formal links to policymakers, such as tax administration and Ministry of Finance officials, and parliamentarians. The UIC team reviewed the strategy and provided written comments and questions, which served as the basis for a teleconference to learn more and refine the team’s policy impact strategy.

Partner experiences

Partner spotlight 1

UIC’s partner in Brazil is the Catholic University of Brasilia, Faculty of Economics (UCB). In 2020, UCB advised tobacco control partners and government officials by modelling the impacts of the various proposals for tobacco tax reform under debate in the national Congress as part of a broad tax simplification reform. In addition to direct communication with the Ministry of Finance, UCB has conducted simulations and translated these results into accessible policy reports and briefs, which tobacco control partners have disseminated further. This research complements previous research on consumer responses to tax increases, illicit trade, and the medium-term and long-term impacts of tax increases, such as lower medical expenses and higher productivity from a decrease in tobacco-related morbidity and mortality.

Partner spotlight 2

One of UIC’s partners in Mexico is Centro de Investigación Económica y Presupuestaria México (CIEP). In addition to analysing consumer responses to price increases and modelling the revenue and health impacts of tax increases, CIEP developed and launched an online Tobacco Tax Simulator in 2020 and regularly presents research to the National Congress of Deputies on how increasing the excise tax on tobacco products impacts health and national budget revenues. CIEP provided estimations of the impacts from the recent changes in the excise tax on tobacco to inform an annual adjustment for inflation. The group is closely coordinated with the local tobacco control community as well as Congress and the Ministry of Finance in Mexico. Through its research, CIEP has analysed the legal mechanisms necessary for investment of tax revenues toward health spending, and estimated the crowding out effect of tobacco spending on households, as well as the medium-term and long-term outcomes of tax increases, such as lower medical expenses and higher productivity from a decrease in tobacco-attributable morbidity and mortality.

Partner spotlight 3

The Institute for Socioeconomic Analysis (ISEA) has been instrumental in achieving an increase of the tobacco excise in Montenegro by providing technical assistance to ministries of health and finance. Over the past several years, the team has produced high-quality evidence on the negative impacts of tobacco use and behavioural responses to tobacco tax increases among different income groups. In 2022, the specific component of the tobacco excise increased by ten percent with another increase of nearly ten percent planned in January of 2023. The researchers continue to model the impacts of the new tax increases and are now conducting an extended cost–benefit analysis of tobacco taxation.

Partner spotlight 4

A notable illustration of the knowledge-to-policymaking process comes from Pakistan, where we work with two think tanks—the Pakistan Institute for Development Economics (PIDE) and Social Policy Development Centre (SPDC). In 2018, the first year of the capacity building partnership, PIDE and SPDC produced high-quality research disseminated through reports, briefs and two conferences. The research recommended elimination of the third tax tier and increased tax rates based on economic analysis of behavioural responses to tax increases, prevalence analysis and examination of the broader economic impacts of tax increases. The research outcomes were disseminated widely and used by government officials to inform the government’s new budget with removal of the third tax tier and increased rates in both remaining tax tiers. Since the tax reform in 2019, SPDC and PIDE have continued to produce and disseminate research on the economic costs of tobacco use in Pakistan, the under-reporting of tobacco production by the tobacco industry, the developmental impacts of parental smoking, the crowding out effect of tobacco spending on poor households and the macroeconomic impacts of tobacco taxation.

Partner spotlight 5

UIC’s partner in Vietnam is Development and Policies Research Center (DEPOCEN). DEPOCEN has conducted several research studies on tobacco control, including an illicit trade survey, a discrete choice experiment to provide a better understanding of smokers’ consumption responses to the introduction of a specific tax on tobacco, and a crowding out analysis of tobacco spending and how tobacco use drives smoking households further into poverty. In addition to modelling the impacts of tobacco tax increases on revenue and public health, DEPOCEN has supported the Ministry of Finance in its analysis of more effective tax structures for tobacco. In addition, DEPOCEN also disseminates its research to the National Assembly of Vietnam and is connected to the tobacco control community in the country.

Research in this supplement

The papers included in this supplement span the regions of Asia, Latin America, and Southeastern Europe. The research focuses on consumer responses to cigarette price increases (Divino et al,14 Nguyen et al,15 Vladisavljevic et al16) as well as their distributional impacts (Cruces et al,17 Gligorić et al,18 Divino et al,19 Cizmovic et al,20 Nguyen et al15). Two papers analyse tax leakages along the tobacco supply chain: Vladisavljevic et al16 use data from a primary survey in the Southeastern European region to analyse determinants of tobacco tax evasion and Drope et al examine the regional implications of the tobacco value chain in Paraguay. In addition, Meilissa et al21 provide new estimates for the economic costs of tobacco use in Indonesia. Finally, Huesca et al22 estimate the broader macroeconomic impacts of tobacco taxation in Mexico.

Conclusion

The articles contained within this supplement have been produced in the second phase of this project on tobacco economics. It is hoped that the articles will not only stimulate further research and build local evidence, but also have a policy impact with the aim of more effective tobacco tax policies. For more information about Tobacconomics or the project, visit Tobacconomics.org.

Ethics statements

Patient consent for publication

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Twitter @erikadayle

  • Contributors All authors (ES, FJC, JD and MD) actively participated in the drafting and revision of this article as well as the project which is the basis for the research articles contained in this supplement.

  • Funding This study was funded by Bloomberg Philanthropies (KC085918).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.