The World Health Organization reports that more than 5.4 million people die each year from tobacco-related diseases. Moreover, evolving markets have generated a dramatic shift in consumption from developed to developing countries, and within a decade, more than 70% of the disease burden from tobacco will fall on developing countries. To facilitate this shift, opponents to tobacco control - led by the tobacco industry - have recently begun a widespread assault against tobacco control using international economic agreements, particularly trade and investment rules. This complex nexus of economic and public health policymaking may prove to be home to the largest threat facing tobacco control. The emerging battleground is particularly in countries with weaker capacity, more politically vulnerable governments and a greater economic reliance on tobacco, which includes particularly Sub-Saharan Africa. While there is a small literature documenting some of these recent efforts and another literature that clearly presents the competing legal arguments and some legal solutions, little is known about the political processes that frame these interactions. Understanding these processes is a crucial component to addressing this challenge: helping policymakers to develop strategies to integrate health and economic policies positively. This project aims to fill this gap by identifying rigorously how key actors are accessing the political processes domestically and internationally in order to utilize and/or change economic policies in an effort to influence tobacco control. To reach this aim, we will first collect and analyze existig data and scholarship relevant to the intersection of tobacco control and economic policies in Africa. Using expert consultation with our African partners, we will extensively interview key actors in the region, including relevant ministry officials, civil society advocates and industry representatives. We will complement these interviews with dynamic focus group sessions across the region involving key stakeholders in the processes around the public health-economic policy nexus. One of the project's principal aims is to improve capacity in these vital substantive areas in the region. Accordingly, there will be close coordination among the HIC and African co-investigators, not only for research collaboration, but also to train a select cohort of advanced graduate students in African and North American universities who focus specifically on the political economy of tobacco control in developing countries. As the final component of our capacity-building strategy, the multi-disciplinary team will present the key findings to major stakeholders - policymakers, advocates and scholars - in a series of workshops across the region that will offer specific recommendations for how to develop and implement effective public health and economic policies that co-exist positively. The workshops will be accompanied by a corresponding set of country-specific policy briefs that will also be distributed to key stakeholders unable to attend a workshop.

Public Health Relevance

Identifying how the rules and laws in economic agreements, including particularly those pertaining to trade and investment, are being used by different actors to influence tobacco control will help to ensure more effective implementation of tobacco control policies generally and the provisions of the World Health Organization's Framework Convention on Tobacco Control specifically. These provisions form the foundation of a coordinated global attempt to protect people around the world from the dangers of the number one risk factor for non- communicable disease, tobacco use. Government officials and civil society organizations in Africa and other developing regions will use this research to inform their strategies to protect existing public health legislation from aggressive and erroneous invocation of trade and investment laws, and to develop new legislation that will be less vulnerable to these types of attacks.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZCA1-SRLB-Y (M1))
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Hartsock, Peter
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American Cancer Society, Inc.
United States
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Lencucha, Raphael; Reddy, Srikanth K; Labonte, Ronald et al. (2018) Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia. Health Policy Plan 33:420-428
Magati, Peter; Drope, Jeffrey; Mureithi, Leopold et al. (2018) Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014. Pan Afr Med J 30:166
Labonté, Ronald; Lencucha, Raphael; Drope, Jeffrey et al. (2018) The institutional context of tobacco production in Zambia. Global Health 14:5
Appau, Adriana; Drope, Jeffrey; Labonté, Ronald et al. (2017) Disentangling regional trade agreements, trade flows and tobacco affordability in sub-Saharan Africa. Global Health 13:81
Makoka, Donald; Drope, Jeffrey; Appau, Adriana et al. (2017) Costs, revenues and profits: an economic analysis of smallholder tobacco farmer livelihoods in Malawi. Tob Control 26:634-640
Lencucha, Raphael; Drope, Jeffrey; Labonte, Ronald (2016) Rhetoric and the law, or the law of rhetoric: How countries oppose novel tobacco control measures at the World Trade Organization. Soc Sci Med 164:100-107
Lencucha, Raphael; Magati, Peter; Drope, Jeffrey (2016) Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya. Health Policy Plan 31:1402-1410
Lencucha, Raphael; Drope, Jeffrey; Labonte, Ronald et al. (2016) Investment incentives and the implementation of the Framework Convention on Tobacco Control: evidence from Zambia. Tob Control 25:483-7
Lencucha, Raphael; Drope, Jeffrey (2015) Plain packaging: an opportunity for improved international policy coherence? Health Promot Int 30:281-90
Gilmore, Anna B; Fooks, Gary; Drope, Jeffrey et al. (2015) Exposing and addressing tobacco industry conduct in low-income and middle-income countries. Lancet 385:1029-43

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