Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Hosmer House, 3630 Promenade Sir William Osler, Montreal, QC H3G 1Y5, Canada.
Globalization and Health Equity, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Health Policy Plan. 2018 Apr 1;33(3):420-428. doi: 10.1093/heapol/czy005.
Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos.
烟草控制规范在过去十年中得到了加强。迄今为止，47 个撒哈拉以南非洲国家中有 43 个是《烟草控制框架公约》（FCTC）的缔约方。《烟草控制框架公约》的近乎普遍通过表明这些规范的力量日益增强，尽管各国对执行这些规定的承诺程度差异很大。然而，烟草控制是一个国际规范网络的一部分，这些规范对各国政府如何实施和加强烟草控制措施有影响。鉴于支持烟草生产的经济论点仍然是烟草控制工作的一个突出障碍，因此仍需研究经济部门如何构建和调动其对烟草生产的政策承诺。本研究探讨了这样一种观点，即国际规范的分歧促进了各国政府内部政策的分歧。本研究在三个非洲国家进行：肯尼亚、马拉维和赞比亚。这些国家代表了烟草控制政策的一个连续体，肯尼亚在这方面是非洲最先进的国家之一，而马拉维是少数几个不是《烟草控制框架公约》缔约方、几乎没有采取措施的国家之一。我们进行了 55 次重点知情者访谈（赞比亚=23；肯尼亚=17；马拉维=15）。数据分析包括对访谈记录和笔记的演绎编码，以识别对国际规范（即承诺、协议、机构）的提及，同时进行归纳分析，以解释参与者对这些规范的理解。我们的分析表明，烟草控制承诺尚未渗透到非卫生部门，这些部门认为烟草控制与国际经济规范在很大程度上是冲突的。这种冲突的原因似乎包括：（1）对经济发展规范的根深蒂固和狭隘的概念化，（2）经济利益塑造政策话语的力量，以及（3）以官僚主义孤岛形式存在的部门之间的结构性鸿沟。
