Comparison of instrumental choices to manage tobacco supply
| FCTC style “comprehensive strategy”3 | Regulated market model4 | Non-profit pro-health monopoly model | |
|---|---|---|---|
| Market instrument | Depending on country: multinational corporations; domestic tobacco companies; state monopolies (with no health mandate) | Existing tobacco manufacturers; non-profit distribution agency | Non-profit tobacco company |
| Health goal | Reduce mortality and morbidity associated with tobacco | Reduce mortality and morbidity associated with tobacco | Eliminate mortality and morbidity associated with tobacco |
| Policy goal | Reduce the demand for cigarettes; protect public from second hand smoke; maintain sustainable legal/regulated market | Reduce demand for cigarettes; reduce harm for continuing smokers | End tobacco use |
| Strategies employed | Regulated conditions on the sale of tobacco product (restrictions on advertising, mandatory health warnings); higher prices through taxation; health promotion; bans on smoking in indoor work and public places; curbs on smuggling | Continued FCTC style comprehensive strategy; publicly owned monopsony with purchaser influence over for-profit cigarette design and direct control over distribution; development of less harmful forms of tobacco products | Continued FCTC style comprehensive strategy as appropriate; public control over complete tobacco supply chain; integration of cigarette design, manufacture and supply with programmes and policies to reduce smoking |
| Assumptions (stated and unstated) | It is not feasible or practicable to end tobacco use; supply-side approaches should not be used; tobacco companies do not have a legitimate role in the development of public health strategies to reduce smoking | Better controls will not eliminate tobacco use—there will be a continuing demand for tobacco products; World Trade Organization will not allow tobacco monopolies; direct control over marketing of cigarettes will create incentives on tobacco companies to produce harm reducing products; there is worthwhile public health benefit from harm reduced products | It is possible to end tobacco use once there is no financial interest in maintaining it; tobacco companies will continue to undermine tobacco control measures and will sustain smoking; trade agreements do not prohibit establishment of monopolies if doing so achieves justifiable health objectives and if compensation is provided; acquiring tobacco supply increases capacity to innovate to achieve public health goals |
| Analogous to | Consumer protection regulations | Milk marketing boards, Scandinavian alcohol monopolies | Public water systems, post offices |
| Cigarette enterprises motivated to | Maximise profits within a regulated market | Maximise profits by developing least harmful cigarettes (according to criteria sets by monopsony distributor) | Help smokers quit as quickly as possible and prevent tobacco uptake |
| Enterprise employees directed to | Increase profits for tobacco company or retail owners | Increase profits for tobacco company or retail owners | Help smokers quit as quickly as possible and prevent tobacco uptake |
| Relationship between enterprise and health authorities | Antagonistic | Cooperative | Integrated and collaborative |
| Products sold | Branded tobacco products (other products that deliver nicotine are regulated under different authorities) | Unbranded or less branded tobacco products and less harmful tobacco products | Tobacco products progressively designed, manufactured, packaged and delivered in ways that facilitate quitting and discourage uptake |
| Direct public interest control over | Distribution, promotion, packaging, pricing | Distribution, promotion, packaging, pricing, product design, retailing | |
| Indirect public interest control over | Promotion, packaging, pricing, product design | Product design and manufacture, retailing |