Tobacco industry interference in low- and middle-income countries

Numerous studies have documented, for decades, the tobacco industry's strategies to delay, weaken, or block tobacco control measures.[1]The data collected helped to design a model of tobacco industry political activity known as "The Dystopian Politics Model."[2]This model is widely used in tobacco control research and advocacy. A new study attempted to determine whether the model was relevant to low- and middle-income countries (LMICs).

Tobacco industry interference in public policy has been identified as the major obstacle to implementing proven measures to reduce tobacco use.[3]. It is therefore essential to understand and address this tobacco industry interference in public health policymaking. A dynamic model of political influence was conceptualized with five discursive (argumentation-based) and five instrumental (action-based) strategies. The tobacco industry's political activity was studied based on this model in two areas: taxation[4] and marketing of tobacco products[5].

When the model was created in 2016, the vast majority of evidence on tobacco industry strategies came from high-income countries. A new study[6] sought to verify whether the model was relevant for low- and middle-income countries (LMICs). This study is all the more appropriate since the tobacco industry, due to the decline in its sales in many countries, has particularly targeted LMICs in recent years. The stakes are high with 80% of all smokers living in LMICs. Furthermore, the researchers note that the adoption and implementation of the measures of the Framework Convention on Tobacco Control (FCTA) tend to be slower and weaker in these countries, which specifically report the obstacle of tobacco industry interference.

A model broadly suited to low- and middle-income countries

For this study, the researchers interviewed 22 tobacco control stakeholders and researchers from eight LMICs (Bangladesh, Colombia, Ethiopia, India, Uganda, Sri Lanka, Ukraine, and Zambia) that had recently adopted a key tobacco control policy. It was found that the industry in LMICs uses a set of arguments and techniques broadly similar to those identified in the model. The results suggest that this model provides a suitable tool for studying and predicting the tobacco industry's political activities across countries, regardless of income level.

In the case of discursive strategies, the researchers observed a remarkable consistency between the lessons learned from the basic model's taxonomy and the findings in LMICs. The health actors interviewed mentioned that the tobacco industry's overall approach consists of designing and disseminating a narrative according to which tobacco control policies are undesirable by exaggerating the costs of their adoption and ignoring the beneficial results they could have. The most frequently cited argument is the growth of illicit trade. The industry used this argument to oppose almost all proposed measures, whether tax increases, health warnings, or plain packaging. Regarding actions deployed in connection with the model's instrumental strategies, all the modalities identified in the taxonomy were used in LMICs, particularly legal actions by the industry to challenge or undermine legislation/regulation. The industry's main argument at this level was that the proposed policies were unconstitutional or that the relevant public body was abusing its power and exceeding its jurisdiction.

Additional industry strategies identified in LMICs

The results of this research showed that the industry adjusts its approach depending on the context in which it operates. Several criteria play an important role, including levels of corruption and the progress already made in denormalizing tobacco products. For example, in many high-income countries, the industry's objective is to rehabilitate its tarnished image through public relations campaigns. In contrast, in the countries included in the study, the industry enjoys a favorable reputation that it seeks to maintain. In these countries, tobacco companies highlight their economic contribution to the country, for example in terms of jobs. They also position themselves as credible partners with governments through corporate social responsibility (CSR) activities to address crises in certain countries (natural disasters, civil conflicts, or more recently the Covid-19 crisis).[7]).

The industry claims that additional regulations would have negative consequences for the national economy and development. These claims have often been repeated by front groups working for its interests, such as retailer associations or tobacco farmer and producer organizations. In countries where tobacco is grown, it has highlighted the supposed impact on tobacco farmers and farming communities, claiming that farmers would find it difficult to switch to other crops or alternative activities.

Two additional modalities of action were also identified in the study. First, in the low- and middle-income countries studied, several tobacco control actors reported having been victims of intimidation by the tobacco industry, including threats, anonymous calls, and cyberattacks. Second, the industry has made considerable efforts to establish and maintain lasting relationships with the media, in order to facilitate the dissemination of information favorable to its interests. The industry offers financial and in-kind incentives to the media, and organizes training and study trips for local journalists. However, even in high-income countries, recent data[8] suggest that there is also a need to continue the denormalization of tobacco industry activities among journalists and editors.

Keywords: Interference, Tobacco industry, Low- and middle-income countries, LMICs, Taxonomy, Development, Taxonomy Photo credit: World Bank ©Generation Without Tobacco

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[1] The Lancet Global Health. Stop industry interference, save lives. Lancet Global Health 2019, doi.org/10.1016/S2214-109X(19)30469-3 [2] Selda Ulucanlar, Gary J. Fooks, Anna B. Gilmore, The Policy Dystopia Model: An Interpretive Analysis of Tobacco Industry Political Activity, Plos Medecine, September 20, 2016 doi.org/10.1371/journal.pmed.1002125 [3] Bialous SA Impact of implementation of the WHO FCTC on the tobacco industry's behavior Tobacco Control 2019;28:s94-s96. [4] Smith KE, Savell E, Gilmore AB What is known about tobacco industry efforts to influence tobacco tax? A systematic review of empirical studies Tobacco Control 2013;22:e1. [5] Savell E, Gilmore AB, Fooks G. How does the tobacco industry attempt to influence marketing regulations? A systematic review. PLoS One 2014;9:e87389. [6] Matthes BK, Lauber K, Zatoński M, et al. Developing more detailed taxonomies of tobacco industry political activity in low-income and middle-income countries: qualitative evidence from eight countries. BMJ Global Health 2021;6:e004096. doi:10.1136/bmjgh-2020-004096 [7] Zatonski M, Gilmore AB, Hird T. The two faces of the tobacco industry during the COVID-19 pandemic, 2020 [8] Ioannidis JPA. Lethal news: the dexterous infiltration of news media by the tobacco industry agenda. Eur J Clin Invest 2019;49:e13125. National Committee Against Smoking |