Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
Department of Public Health, School of Psychology and Public Health, La Trobe University VIC 3068, Australia.
Health Promot Int. 2022 Feb 17;37(1). doi: 10.1093/heapro/daab033.
The Turkish government first announced its intention to proceed with tobacco plain packaging legislation in 2011; however, it was 7 years before the legislation passed in December 2018. This study (conducted in 2018 before the legislation was passed) explored the policy context in Turkey between the first announcement that plain packaging legislation would be introduced and the passage of the legislation in 2018, and identified barriers and facilitators influencing its introduction. Publicly available documents relevant to plain packaging in Turkey were analysed. Interviews were conducted in 2018 with ten key informants including academics, bureaucrats in government ministries and leaders of non-government organizations (NGOs). Thematic analysis was undertaken, using a framework for systematically analysing how issues reach the policy agenda. The introduction of plain packaging legislation proved to be problematic, with many false starts and delays. Findings suggest these were mainly due to political barriers including changes in government, tobacco industry opposition and the national economic crisis. However, plain packaging legislation in Turkey managed to advance on the policy agenda, primarily through the collaborative advocacy efforts of NGOs, academics, and leadership from particular tobacco control advocates and politicians. Turkey's experience provides lessons for the wider uptake of tobacco plain packaging legislation, illustrating the critical importance of building effective coalitions between a range of stakeholders and political support within government while raising public awareness. Lay summary This research provides insights into the barriers and facilitators of decision making and action that shaped the process of introducing tobacco plain packaging legislation in Turkey. Major barriers that slowed Turkey's progress in enacting plain packaging included the financial and national economic crisis in 2018, changes in health ministers and opposition by the tobacco industry. A major facilitator of the policy process was the collaborative advocacy efforts of non-government organizations, academics, politicians and the leadership of certain tobacco control advocates. The insights from this case study may help other low- and middle-income countries to anticipate and successfully navigate the challenges involved in introducing tobacco plain packaging, an important policy measure for reducing the burden of tobacco-related disease in their populations, and its social and economic impacts. Building effective coalitions and fostering and supporting leadership are important strategies for the successful introduction of plain packaging legislation.
土耳其政府于 2011 年首次宣布有意推行烟草平装立法；然而，直到 2018 年 12 月该立法才通过。本研究（在 2018 年立法通过之前进行）探讨了土耳其在宣布将引入平装包装立法和 2018 年通过立法之间的政策背景，并确定了影响其引入的障碍和促进因素。分析了与土耳其平装包装相关的公开文件。2018 年，与包括学者、政府部委官僚和非政府组织（NGO）领导人在内的 10 名主要知情人进行了访谈。使用系统分析问题如何进入政策议程的框架进行了主题分析。平装包装立法的引入被证明存在问题，出现了许多错误的开始和延误。调查结果表明，这些主要是由于政治障碍造成的，包括政府更迭、烟草业反对和国家经济危机。然而，平装包装立法在土耳其的政策议程上得以推进，主要是通过非政府组织、学者以及特定烟草控制倡导者和政治家的领导的协作倡导努力。土耳其的经验为更广泛地采用烟草平装包装立法提供了教训，说明了在提高公众意识的同时，在政府内部建立一系列利益相关者之间的有效联盟和政治支持的至关重要性。
研究结果提供了有关决策和行动的障碍和促进因素的见解，这些决策和行动塑造了在土耳其引入烟草平装包装立法的过程。减缓土耳其实施平装包装的主要障碍包括 2018 年的财政和国家经济危机、卫生部长的变动以及烟草业的反对。政策进程的一个主要促进因素是非政府组织、学者、政治家和某些烟草控制倡导者的领导层的协作倡导努力。本案例研究的见解可能有助于其他低收入和中等收入国家预测和成功应对在引入烟草平装包装方面所涉及的挑战，这是减少其人口中与烟草相关疾病负担及其社会和经济影响的重要政策措施。建立有效的联盟以及培养和支持领导层是成功引入平装包装立法的重要策略。
