Khayatzadeh-Mahani Akram, Breton Eric, Ruckert Arne, Labonté Ronald
School of Public Policy, University of Calgary, Calgary, AB, Canada.
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Policy Plan. 2017 Jul 1;32(6):835-846. doi: 10.1093/heapol/czx015.
Shisha smoking is a widespread custom in Iran with a rapidly growing prevalence especially among the youth. In this article, we analyze the policy process of enforcing a federal/state ban on shisha smoking in all public places in Kerman Province, Iran. Guided by the Advocacy Coalition Framework (ACF), we investigate how a shisha smoking ban reached the political agenda in 2011, how it was framed by different policy actors, and why no significant breakthrough took place despite its inclusion on the agenda.
We conducted a qualitative study using a case study approach. Two main sources of data were employed: face-to-face in-depth interviews and document analysis of key policy texts. We interviewed 24 policy actors from diverse sectors. A qualitative thematic framework, incorporating both inductive and deductive analyses, was employed to analyze our data.
We found that the health sector was the main actor pushing the issue of shisha smoking onto the political agenda by framing it as a public health risk. The health sector and its allies advocated enforcement of a federal law to ban shisha smoking in all public places including teahouses and traditional restaurants whereas another group of actors opposed the ban. The pro-ban group was unable to neutralize the strategies of the anti-ban group and to steer the debate towards the health harms of shisha smoking. Our analysis uncovers three main reasons behind the policy stasis: lack of policy learning due to lack of agreement over evidence and related analytical conflicts between the two groups linked to differences in core and policy beliefs; the inability of the pro-ban group to exploit opportunities in the external policy subsystem through generating stronger public support for enforcement of the shisha smoking ban; and the nature of the institutional setting, in particular the autocratic governance of CHFS which contributed to a lack of policy learning within the policy subsystem.
Our research demonstrated the utility of ACF as a theoretical framework for analyzing the policy process and policy change to promote tobacco control. It shows the importance of accounting for policy actors' belief systems and issue-framing in understanding how some issues get more prominence in the policy-making process than others. Our findings further indicate a need for significant resources employed by the state through public awareness campaigns to change public perceptions of shisha smoking in Iran which is a deeply anchored cultural practice.
水烟吸食在伊朗是一种普遍的习俗，其流行率迅速上升，尤其是在年轻人中。在本文中，我们分析了伊朗克尔曼省在所有公共场所实施联邦/州水烟吸食禁令的政策过程。在倡导联盟框架（ACF）的指导下，我们调查了水烟吸食禁令在2011年是如何进入政治议程的，不同政策行为体是如何对其进行框架构建的，以及尽管该禁令已被列入议程但为何没有取得重大突破。
我们采用案例研究方法进行了一项定性研究。使用了两个主要数据来源：面对面深入访谈和关键政策文本的文件分析。我们采访了来自不同部门的24名政策行为体。采用了一个结合归纳和演绎分析的定性主题框架来分析我们的数据。
我们发现，卫生部门是将水烟吸食问题纳入政治议程的主要行为体，将其框架构建为一种公共卫生风险。卫生部门及其盟友主张执行一项联邦法律，在包括茶馆和传统餐馆在内的所有公共场所禁止水烟吸食，而另一组行为体则反对该禁令。支持禁令的群体无法抵消反对禁令群体的策略，也无法将辩论引向水烟吸食对健康的危害。我们的分析揭示了政策停滞背后的三个主要原因：由于两组之间在证据方面缺乏共识以及相关分析冲突导致缺乏政策学习，这与核心信念和政策信念的差异有关；支持禁令的群体无法通过为执行水烟吸食禁令争取更强大的公众支持来利用外部政策子系统中的机会；以及制度环境的性质，特别是CHFS的专制治理，这导致了政策子系统内缺乏政策学习。
我们的研究证明了ACF作为分析政策过程和政策变化以促进烟草控制的理论框架的效用。它表明了在理解某些问题在决策过程中如何比其他问题更突出时，考虑政策行为体的信念系统和问题框架构建的重要性。我们的研究结果进一步表明，国家需要通过公众宣传活动投入大量资源，以改变伊朗公众对水烟吸食的看法，因为水烟吸食是一种根深蒂固的文化习俗。
