Background
Methods
Project background
Stakeholder selection
Country | Stakeholder function(s) |
---|---|
Belgium | 1. Civil servant |
2. Member of parliament (opposition) | |
3. Cancer fund employee | |
4. Academic expert | |
5. Academic expert | |
6. Civil society organization employee | |
Finland | 1. Civil servant |
2. Member of parliament (opposition) | |
3. Cancer fund employee | |
4. Academic expert | |
5. Tobacco Control Alliance network employee | |
6. Enforcement agency employee | |
Germany | 1. Civil servant |
2. Member of parliament (coalition) | |
3. Assistant of member of parliament | |
4. Cancer fund employee | |
5. Academic expert | |
6. Civil society organization employee | |
7. Civil society organization employee | |
Ireland | 1. Civil servant |
2. Member of parliament (senate) | |
3. Cancer fund employee | |
4. Academic expert | |
5. Alliance network employee | |
Italy | 1. Civil servant |
2. Civil servant assistant | |
3. Cancer fund employee | |
4. Academic expert | |
5. Academic expert | |
6. Civil society organization employee | |
7. Civil society organization assistant | |
The Netherlands | 1. Member of parliament (opposition) |
2. Cancer fund employee | |
3. Academic expert | |
4. Tobacco Control Alliance network employee | |
5. Tobacco Control Alliance network employee |
Confidentiality
Interview topics
Analysis
Main codes | Code | Sub code |
---|---|---|
Dominant frame | Public health | - Tobacco as an addictive substance |
- Need to protect children’s health | ||
- Economic burden to society | ||
Liberal-conservative | - Smoking as individual choice | |
- Tobacco is a legal product | ||
- Nanny state/patronizing government | ||
No frames/discussion | ||
Civil and business institutions | Health advocacy institutions | – |
Retailers | – | |
Tobacco industry | - Industry advocacy | |
- Industry image | ||
- Economic presence (Manufacture and production) | ||
Government institutions | Public health policy frameworks | – |
Interpretation FCTC article 5.3 | – | |
Health ministry centrality | – |
Results
Country | Policy monopoly | Display ban imple-mented | Frame | Health advocacy institutions | Retailers | Tobacco industry economic presence | Public health policy frameworks | Inter-pretation FCTC 5.3 | Health ministry role | Smoking pre-valencea |
---|---|---|---|---|---|---|---|---|---|---|
Finland | Health | Yes | Health | Developed | Opposition | Largely gone | Endgame strategy | Strict | Central | 20% |
Ireland | Health | Yes | Health | Developed | Opposition | Largely gone | Endgame strategy | Strict | Central | 19% |
The Netherlands | Unclear | No | Individual choice/ paternalistic government | Developed | Opposition | Largely gone | No | Strict | – | 19% |
Belgium | Unclear | No | Individual choice/ paternalistic government | Developed | Opposition | Largely gone | No | Transparency | – | 19% |
Germany | Tobacco industry and business | No | Private problem/ no discussion | Weak | – | Manufacture and production | No | Transparency | Subordinate | 25% |
Italy | Tobacco industry and business | No | Private problem/ no discussion | Absent | – | Manufacture and production | No | Transparency | Subordinate | 24% |
Dominant frame
‘There was an absolutely unanimous agreement that this is a harmful product. That we are dealing with an industry that has been not just deceitful but has told lies in the past about their knowledge about the damage their product did. And that our government has a duty to protect our children.’Ireland, Member of Parliament.‘It’s something that is only very reluctantly done in Germany - to have a policy that really influences personal freedom of decision making. So Germany has been very reluctant to do something like that. Not only in health but also in other policies.’Germany, civil society advocate.‘Germany in particular is very similar to Italy, I think. They are very interested in environmental problems, but the behaviors linked to health are something more personal.’Italy, civil society advocate.‘The VVD [liberal-conservative ruling party] is an anti-paternalistic party, and tobacco control policies are seen as paternalistic’The Netherlands, civil society advocate.‘The VLD is liberal-conservative and the mentality there is that everyone has to know for themselves what they do when it comes to protecting their health.’Belgium, Member of Parliament
No frames
‘Smoking is not very high on the agenda generally - it’s not really perceived as a big problem.’Germany, civil society advocate‘The parliament addresses tobacco problems only if there is some law in discussion. For example the transposition of the directive, or when the taxes change, or when the smoking ban was proposed, or ten years ago the adoption of the Framework Convention on Tobacco Control. But in other periods they don’t have an interest in tobacco control.’Italy, civil servant
Civil and business institutions
Health advocacy institutions
‘In Finland there is a really large NGO community. Huge, powerful NGOs - but you also have to realize that most of the NGOs receive public money.’Finland, civil society advocate‘We don’t have such a strong NGO structure as in many other countries. It’s mostly health organizations and research institutions that deal with diseases like cancer and others. Therefore they see tobacco as a big problem and engage in tobacco control. There are only very few NGOs, very small … not very powerful... With a few exceptions that only focus on tobacco control.’Germany, civil society advocate‘There is the need of creating a sort of infrastructure where non-governmental organizations, scientists, cancer patient associations, associations of people with heart attacks, go together in order to push for a new law. This does not exist in Italy at the national level, it is not developed.’Italy, civil society advocate
‘We are heading towards a new modus operandi; we’re starting to delineate that now. But implicitly I’m saying that we are not strong enough right now.’Belgium, civil society advocate‘The idea behind our alliance is that if you work together, you are much more powerful, and it is better to speak with one voice instead of many different voices who all want something else. Concerning lobby, this works quite well, and if we send a letter, we always do that in name of the three big funds.’The Netherlands, civil society advocate
Retailers
‘You will not hear the tobacco industry in the media here in Belgium; it is especially the tradespeople who are very active. And why? Because they receive a lot of money from the tobacco industry because of the sponsorship contracts. He who pays the piper calls the tune.’Belgium, civil servant
Tobacco industry
‘Politicians are very not very keen to face tobacco control. We had Renzi before, a prime minister that was promoting new things with tobacco. Italy is the nation where Philip Morris is testing IQOS. [ …] He [Renzi] was really proud of this and the tobacco industry did several investments for plants in several locations near Bologna. There was another 500 million euros promised by 2020 for the purchase of Italian tobacco.’Italy, academic expert.
‘In every state they want to have a little location, not very big, but then they have the right to go to the politicians and say, “You must do something for the jobs. Otherwise we will lose the jobs!”’Germany, civil society advocate‘There are many actors who can approach individual members of parliament in the constituencies. The influence of the industry via the constituencies and individual members of parliament is stronger than via ministries of the federal government itself.’Germany, civil servant
‘Tobacco is not so difficult, because we have already been successful in demonizing -and rightly so - I mean, demonizing the tobacco industry. So that is much more straightforward than alcohol lobbying, which is much more difficult.’Finland, civil society advocate‘I think the NGOs have generated sufficient levels of distrust among the general public around the tobacco industry. There’s no great love for them, they don’t have presence so they don’t provide loads of jobs and factories that you can identify.’Ireland, civil servant
Government institutions
Public health policy frameworks
‘The Healthy Ireland Framework is an initiative that is a cross-sectoral initiative that was launched by the prime minister of the country. It has to do with actions across all these different sectors, but also working with community- and voluntary organizations.’Ireland, academic expert
Interpretation of FCTC’s article 5.3
‘I think in principle if members of the [health] committee say: “I want to listen to the representative of Philip Morris”, then that person will be invited. In the FCTC, there is this famous article 5.3 which says that tobacco companies and tobacco industry must not be involved in tobacco policymaking, and that is very well followed in most of the Western countries, like in Finland. So when the ministry and the government propose legislation, they don’t negotiate with the tobacco industry anymore. The tobacco industry can send a letter to them if they want, but there’s no negotiating anymore.’Finland, Member of Parliament‘Not that they won’t listen. They listen, assess, and make a decision, in fairness. The WHO though, made it very clear that we shouldn’t be meeting with tobacco companies when we are talking about tobacco policy. It is alright to meet in regard to other matters in relation to commerce and smuggling and all that stuff. That’s fine.’Ireland, Member of Parliament
‘At this moment, the guideline for civil servants is that one should limit oneself to technical implementation issues.’Netherlands, academic expert
‘There is a sort of light interpretation because they intend article 5.3 only on the side of transparency. If the relations are transparent, you can do everything.’Italy, civil servant‘The ministry of food and agriculture says: “We show what meetings we have on our internet site”. But all you see is for example the date and it says the ministry and there were for example [representatives from the] “Deutschen Zigarettenverband” [an organization representing five tobacco manufacturers] and they talked about taxes or something like that, and you don’t get any more information. They say this fulfils 5.3. This is transparent. “Look here: we have showed that we have met with them”. And the names of the people of the government are blacked out. If we do get information, then many things are blacked out.’Germany, civil society advocate
Health ministry centrality
‘He [health ministry civil servant] often was looking for the NGOs support for what he was doing, than the other way around. I think on many of the issues around some of these things he was very far-reaching and looking hard. So the NGOs were behind him, supportive … He was the author of a lot of the legislation at the time.’Ireland, civil servant‘Well in Finland we had the working group for what should be done for tobacco policy. It was quite a large-scale working group, led by the ministry of health. [ …] They published their report in 2009 and there were many suggestions to improve the Tobacco Act [ …]. This [a display ban] was one of those suggestions which was ultimately implemented.’Finland, civil servant
‘This minister relies very heavily on her small entourage and involves the ministry only little. She sometimes even makes decisions without the ministry knowing.’Belgium, civil society advocate
‘For tobacco and alcohol policy, responsibility in terms of product regulation mainly resides in the food and agriculture ministry. Responsibility for prevention resides in the ministry of health. The health ministry cannot simply say, “We will propose a bill and let’s get it done”. It would be nice, but unfortunately this is not the case.’Germany, civil servant