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

Lead Research Organisation: University of Edinburgh
Department Name: Sch of Social and Political Science


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.

Planned Impact

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.


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Description This seminar series has been strikingly successful in securing high levels of participation from academics, policymakers and civil society. Its exploration of synergies and differences across tobacco control and alcohol policy provided a very distinctive space in which to develop discussions that were of clear value to participants from across these sectors, discussions which are now being taken forward in multiple fora.

In addition to 3 directly attributable publications to date, two further papers are in progress that emerge from discussions held regarding terms of engagement with commercial sector actors and managing career development in the context of divided research and policy communities. Wider collaborations across the project team, with invited speakers and with seminar participants are now informing substantial project proposals (with submissions to Wellcome Trust, and ESRC and MRC via Global Challenges calls in late 2016). The seminar series has further increased engagement of the research collaborators in policy debates within Scotland, UK and internationally, strengthening knowledge exchange with civil society and international organisations.
Exploitation Route One of our events led to the development of an international survey on attitudes among public health researchers, policymakers and advocates to engagement with commercial sector actors. This is shaping ongoing discussions within health organisations (both internationally and within the UK) about how to identify and manage conflict of interest, and the survey itself has been made publicly available via a leading health journal
Sectors Healthcare,Government, Democracy and Justice,Other

Description A key strength of this series has been the extent to which civil society organisations and policymakers have engaged fully in it. The ideas and approaches discussed are actively shaping discussions around future policy priorities, including via approaches to identifying and managing conflict of interest and possibilities for an increased focus on supply-side approaches to reducing harm attributable to alcohol and tobacco. The reach of the work has expanded as it progressed with substantial engagement with international organisations (including the World Health Organisation and its Pan-American Health Organisation) and by increasing engagement with related spheres (notably alcohol and nutrition research and policy). Seminars held: 1. Identifying key challenges in tobacco and alcohol policy, 17 December 2013. Speaker: Jeff Collin (U of Edinburgh) 2. Understanding and addressing alcohol industry tactics, 17 June 2014. Speakers: Prof Sally Casswell, Massey University (New Zealand); Michael Thorn (Foundation for Alcohol Research & Education, Australia) 3. Industry funding - challenges for health research, policy and advocacy, 25 September 2014. Speakers: Alison Cox (Cancer Research UK), Ben Hawkins (London School of Hygiene & Tropical Medicine), David Jernigan (Johns Hopkins Bloomberg School of Public Health, USA), Mike Daube (Curtin University, Australia) 4. Workshop: Alcohol, tobacco and neighbourhoods: understanding and regulating availability, 16 December 2015. Speakers: Katherine Frohlich (Université de Montréal), Niamh Shortt (CRESH, University of Edinburgh), David Fone (Cardiff University School of Medicine), Alison Douglas & Laura Mahon (Alcohol Focus Scotland), Sheila Duffy (ASH Scotland), 5. Perceptions of unhealthy commodity industries and conflict of interest in health governance and research, 4 May 2016. Speakers: Mor Eltanani (University of Edinburgh), Alison Douglas (Alcohol Focus Scotland), Katherine Brown (Institute of Alcohol Studies) 6. Symposium: Tobacco, Alcohol & the SDGs: Challenges for global health governance, 29 June 2016. Speakers: Judith McKay (Senior Policy Advisor, WHO), Mike Daube (Curtin University), Paula Johns (Alliance for the Control of Tobacco Use, Brazil), Shoba John (HealthBridge, India), Andrew Black (Head of Global Tobacco Control Projects, Department of Health, England), Ben Hawkins (LSHTM), Chris Holden (University of York), Fabio Gomes (Advisor on Nutrition and Physical Activity, Pan American Health Organization), Gerard Hastings (Emeritus Professor of Social Marketing, University of Stirling), and Sharon Friel (Professor of Health Equity, Australia National University) 7. Early career researcher workshop: Career development in public health: balancing the demands of public health research and advocacy (with e-cigarettes as a case study), 1 July 2016. 8. Inequalities and tobacco: challenges and priorities for future research and policy, 4 October 2016. Speakers: Hilary Graham (University of York), Amanda Amos (U. of Edinburgh). 9. Meeting: Towards a tobacco end-game for Scotland: a review of progress so far and discussion on next steps, 24 October 2016. Speakers: Shiela Duffy (ASH Scotland), Alison Cox (CRUK), Prof. Brigit Toebes, Groningen University
First Year Of Impact 2014
Sector Education,Healthcare,Government, Democracy and Justice
Impact Types Societal

Description Cancer research UK, Tobacco Advisory Group
Amount £90,000 (GBP)
Organisation Cancer Research UK 
Sector Charity/Non Profit
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 10/2016 
End 03/2018
Description Taking Lessons from Brazil: seminar on nutrition policy co-hosted by Obesity Action Scotland and Global Public Health Unit, University of Edinburgh 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact This seminar explored the ground-breaking dietary guidelines introduced in Brazil with two key participants in that process, Dr Fabio Gomes de Silva, Advisor on Nutrition and Physical Activity, Pan American Health Organization, and Dr Ines Rugani, Nutrition Institute at the State University of Rio de Janeiro.In 2014, the Brazilian government introduced world-leading new dietary guidelines that extend beyond the traditional confines of nutritional policy to engage with environmental sustainability and the social and cultural dimensions of food. The guidelines take a new approach to categorising foods based on the extent of processing involved rather than with reference to nutrients. The aim is to encourage fresh, minimally processed foods and actively discourage consumption of ultra-processed foods and drink products.
The seminar provided an opportunity to discuss the 'Brazilian Experience' and its lessons for approaches to public health in Scotland.
Year(s) Of Engagement Activity 2016
Description Towards a Tobacco Endgame for Scotland 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact A dialogue with health officials, policymakers, advocates, research funders and academics to discuss challenges and opportunities associated with a focus on endgame strategies for tobacco control in the context of ongoing discussions about revising Scotland's strategy
Year(s) Of Engagement Activity 2016
Description World Health Organization Global Coordination Mechanism for NCDs 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact On 19-21 October 2016, representatives from Member States, United Nations organizations, other intergovernmental organizations and non-state actors such as non-governmental organizations (NGOs), philanthropic foundations, business associations, and academic institutions convened at a Global Dialogue Meeting in Balaclava, Mauritius to discuss a critical dimension of accelerating noncommunicable disease (NCD) prevention and control: how non-State actors can support governments in meeting their NCD-related commitments to implement the NCD Global Action Plan and the global targets on NCDs as part of realizing the 2030 Agenda for Sustainable Development.
Year(s) Of Engagement Activity 2016