The policy challenges of tobacco control: Implications for public and global health

Tobacco control in the UK has recently experienced striking successes for a coalition of health advocates, researchers, funders and policy makers, epitomised by the passage of legislation for smoke-free public places across the devolved UK. These successes have led to tobacco control being identified as a rare example of evidence-based public health policy, with close links between research, advocacy and policy communities. Internationally, the UK has played significant roles in developing tobacco control policies in the EU and the WHO (notably the WHO Framework Convention on Tobacco Control). For all these reasons, it has been suggested that other areas of public health could look to tobacco control as a source of insight and inspiration.

At the same time, this narrative of success is challenged by questions about tobacco control's contribution to broader public health and societal goals. While many regard tobacco control as necessarily central to strategies reduce health inequalities, this view has been challenged by some health inequalities researchers. The social gradient in smoking is remarkably persistent, and concerns have been raised about the stigmatization of low-income smokers; meanwhile, the long-established consensus within tobacco control is being threatened by emerging conflicts over new policy proposals. The UK's emphasis on smoking cessation has also been criticised internationally as contributing to the medicalisation of tobacco control.

Led by senior social and political scientists, and involving a variety of relevant disciplines, the proposed seminar series will explore these highly contentious issues and aim to inform the future of public health research and policy by facilitating cross-sector and cross-disciplinary conversations. The overall objective is to increase our understanding of the experience and future of UK tobacco control policy by exploring emergent tensions within the field and analysing wider implications for public and global health policy.

The series will be organised around the three spheres of challenges internal to tobacco control and their implications for public health policy and global health. These challenges will be explored via a focus on three themes that are central to tobacco control and raise broader questions across public and global health policy: the commercial sector; inequalities; and governance. The programme will be structured as a series of expanding conversations, with one theme being explored each year via three linked seminars:

Year 1: Tobacco control and the commercial sector
1. Harm reduction: the end of consensus?
2. Regulating corporations as tackling the determinants of health?
3. The UK & the global tobacco industry: culpability, liability and human rights.

Year 2: Tobacco control and inequalities
4. Tackling health inequalities by promoting stigmatisation?
5. Tobacco control, taxation and cessation: implications for policies to address inequalities.
6. Tobacco control and the development agenda beyond the Millennium Development Goals.

Year 3: Tobacco control governance
7. Towards an endgame? Challenges in developing transformational strategies.
8. Towards policy coherence in NCD strategies? Lessons across tobacco, alcohol and food policy.
9. The UK in global tobacco control: leader or problem?

Each event will be informed by relevant research, advocacy and policy communities, and there will be a strong emphasis on promoting the participation of early career researchers. Multiple formats will be used across the series to reflect the distinctive challenges of specific issues; the priority of all events will be to enable discussion and participation. Seminars will be held under the Chatham House rule, with presentations made publicly available and summaries, articles and briefings being produced based on non-attributable basis.

Who will benefit? The beneficiaries of this series will be knowledge brokers, policymakers, funders and advocates engaged in UK tobacco control, related public health issues (e.g. alcohol and obesity), health inequalities and in global health and development.

Invited participants from tobacco control within the UK will include representatives of civil society organisations (CSOs) such as ASH, ASH Scotland and ASH Wales, the British Heart Foundation, Cancer Research UK, and relevant officials from the UK Department of Health and from each of the devolved governments. While many of these organisations have a broader remit than tobacco alone, we will also invite additional participants to those seminars focusing particularly on the lessons that tobacco control might offer other areas of public health. (Such invitees will include specific public health advocacy organisations - e.g. Alcohol Focus Scotland and the Institute for Alcohol Studies - and policymakers working on alcohol and food policies.) For seminars focusing on tobacco control and health inequalities, we will invite additional participants engaged in health equity issues - e.g. policymakers responsible for health inequalities across the UK and representatives of CSOs concerned with reducing societal inequalities (e.g. the ONE Society and the Equality Trust).

Within the global health stream, participants invited to relevant sessions will include agencies and organisations for whom tobacco control and global health constitute core concerns (Framework Convention Alliance, International Union Against Tuberculosis and Lung Disease (IUATLD) and organisations for which these issues are increasingly significant to future priorities (e.g. UN Development Program). We will also invite representatives from leading philanthropic initiatives (e.g. Bloomberg and the Bill and Melinda Gates Foundation) and from the World Health Organization (WHO).

How will they benefit? The issues being discussed across each of the chosen themes are of policy salience to each of these communities, and many of the difficulties experienced by academics in discussing and addressing these controversies are shared by policymakers, civil society and funders. Each event will include at least one non-academic participant as a speaker or discussant. All sectors will be represented in the development of seminars and will be invited to participate in project outputs and dissemination processes.

Advocates, funders and officials working within tobacco control in the UK will directly benefit from the opportunity to openly explore difficult and contentious issues in a safe context. We feel there will be particular value in engaging with academic researchers on both sides of increasingly heated debates, and with officials and advocates across parts of the UK that attach different priority to particular issues (e.g. harm reduction is currently far more prominent in policy discussions in England and Wales than in Scotland). We anticipate that learning and alliances across different policy communities will be fostered by the opportunity to reflect on the tobacco control experience with others working from broader public and global health perspectives.

The development of a research agenda across the traditional silos of tobacco, alcohol and obesity policy offers particular value to policymakers and CSOs engaged in global health governance. The potential value of such intellectual engagement is highlighted by ongoing changes within the structure of WHO, in which the Tobacco Free Initiative is being combined with departments responsible for alcohol and obesity policy. Organisations with a strong emphasis on tobacco control (e.g. FCA, IUATLD) are likely to substantially contribute to and benefit from open evaluation and debate on issues such as the UK's place in the global tobacco industry; the role of tobacco control in development; and the UK's status within global tobacco control.