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Abstract
This volume presents the work initiated and executed under the African Tobacco Situational Analyses (ATSA), a recent major public health initiative sponsored by the Canadian government’s International Development Research Centre (IDRC). Conceived to illuminate the factors that will facilitate the reform of Africa’s major public health policies, this program focused particularly (but not exclusively) on policies concerning tobacco. The results, presented in this book, are an important contribution to the literature on global public health and international development, and comprise the most comprehensive evidence-based analysis of tobacco policy in the African region.
The country-level analyses of this study examine topics such as smoking prevalence, the status of relevant smoking-related policies, and the politics of public health policy reform – as well as the role played by the tobacco industry in each of these key areas. Sitting above these case studies is an overarching conceptual framework, operating with the expressed goal of creating generalizable lessons for the continent as a whole. Thus, ultimately this book permits the reader not only to grasp the depth and complexity of the tobacco situation in each country, but also to draw meaningful conclusions regarding what sort of public health policy reforms have been broadly successful across Africa – and how these successes might be replicated in the future.
Jeffrey Drope is Assistant Professor of Political Science, Marquette University, Milwaukee, Wisconsin, USA.
This volume utilizes the work initiated and executed under a recent major public health initiative, the African Tobacco Situational Analyses (ATSA), which was sponsored by the Canadian government's International Development Research Centre (IDRC) with funds from the Bill and Melinda Gates Foundation. The program was conceived to illuminate the factors that will facilitate the reform of major public health policies, particularly, but not limited to, tobacco. The results, presented in this volume, are an important contribution to the literature on global public health and international development, and comprise the most comprehensive evidence-based analysis of tobacco policy in the African region.
‘Tobacco use in Sub-Saharan Africa is growing rapidly as a result of strong economic growth and the aggressive marketing tactics of tobacco multinationals. Although the policy interventions are well understood, the political economy of tobacco control in Sub-Saharan Africa is not, and this volume is a timely addition to the literature, offering the most comprehensive review of the political economy of tobacco control in Sub-Saharan Africa yet. The attention to detail in the 12 country case studies – representing diverse linguistic, geographic, political, legal and developmental environments – sets new standards for tobacco control research on the continent.’ —Dr Evan Blecher, International Tobacco Control Research Program, American Cancer Society
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Matter | i | ||
Half Title | i | ||
Title | iii | ||
Copyright\r | iv | ||
Contents | v | ||
LIST OF FIGURES AND TABLES | vii | ||
FOREWORD | ix | ||
PREFACE | xi | ||
ACKNOWLEDGMENTS | xv | ||
LIST OF ABBREVIATIONS AND ACRONYMS | xix | ||
Main Matter\r | 1 | ||
Chapter 1 INTRODUCTION | 1 | ||
Knowing and Articulating Your Context | 3 | ||
The ATSA Narratives | 4 | ||
Overview of the Book | 6 | ||
Notes | 12 | ||
Chapter 2 THE POLITICAL MAPPING PROCESS | 13 | ||
Domestic Institutions | 14 | ||
Domestic Interests | 22 | ||
The International – Institutions and Interests | 24 | ||
Conclusion – A Dynamic Interaction | 26 | ||
Notes | 27 | ||
Chapter 3 PROGRESS ON SMOKE-FREE POLICIES | 29 | ||
The Path of National Comprehensive Tobacco Control Policy | 32 | ||
Working with Existing Policies | 33 | ||
Creative Alternative – Or Complementary – Solutions | 36 | ||
Post-legislative Challenges: Implementation and Enforcement | 38 | ||
A Final Key Component: Public Awareness | 39 | ||
Conclusion | 40 | ||
Notes | 41 | ||
Chapter 4 TAXATION AS A TOBACCO CONTROL STRATEGY | 43 | ||
Review of Key Tax-Related Terms | 44 | ||
Cigarette Affordability | 46 | ||
Strategies for Tobacco Taxation | 47 | ||
State of Tobacco Taxation in the ATSA Countries | 48 | ||
The Political Challenges of Tobacco Taxation | 54 | ||
A New International Dimension | 58 | ||
Conclusion | 60 | ||
Notes | 61 | ||
Chapter 5 THE CHALLENGES OF IMPLEMENTING BANS ON ADVERTISING, PROMOTION AND SPONSORSHIP | 63 | ||
FCTC Defi nitions and Article 13 | 63 | ||
ATSA Country Overview and Model Laws | 64 | ||
The Central Challenge of Enforcement | 72 | ||
Youths and Advertising: Empirical Findings | 73 | ||
The Continued Cunning Ways of the Tobacco Industry | 75 | ||
Conclusion | 77 | ||
Notes | 78 | ||
Chapter 6 THE PURSUIT OF PACKAGING AND LABELING REQUIREMENTS | 79 | ||
The Ultimate Goal – Graphic Pictorial Warnings | 82 | ||
Size and Placement are Essential | 83 | ||
Font and Color Requirements of Warnings | 85 | ||
Language of the Warning | 87 | ||
Content and Rotation of Warnings | 88 | ||
Inclusion of Constituents and Emissions | 89 | ||
Opportunities for Enforcement | 90 | ||
Conclusions | 91 | ||
Notes | 93 | ||
Appendix A – South Africa Health Warnings | 95 | ||
Chapter 7 BURKINA FASO | 97 | ||
Executive Summary | 97 | ||
Brief Description of Political System | 98 | ||
Scope of Tobacco Problem | 99 | ||
Politics | 101 | ||
Tobacco Industry | 104 | ||
ATSA Review | 105 | ||
Notes | 105 | ||
Chapter 8 CAMEROON | 107 | ||
Executive Summary | 107 | ||
Brief Description of Political System | 108 | ||
Scope of Tobacco Problem | 109 | ||
Politics of Tobacco | 110 | ||
Tobacco Industry | 115 | ||
ATSA Review | 120 | ||
Notes | 120 | ||
Chapter 9 ERITREA | 123 | ||
Executive Summary | 123 | ||
Brief Description of Political System | 124 | ||
Scope of Tobacco Problem | 125 | ||
Politics of Tobacco | 126 | ||
Tobacco Industry Monitoring | 130 | ||
ATSA Review | 133 | ||
Notes | 133 | ||
Chapter 10 GHANA | 135 | ||
Executive Summary | 135 | ||
Brief Description of Political System | 137 | ||
Scope of Tobacco Problem | 137 | ||
Politics of Tobacco | 139 | ||
Tobacco Industry | 144 | ||
ATSA Review | 146 | ||
Notes | 146 | ||
Chapter 11 KENYA | 149 | ||
Executive Summary | 149 | ||
Brief Description of Political System | 150 | ||
Scope of Tobacco Problem | 151 | ||
The Politics of Tobacco Control | 153 | ||
Tobacco Industry | 162 | ||
ATSA Review | 165 | ||
Notes | 166 | ||
Chapter 12 MALAWI | 167 | ||
Executive Summary | 167 | ||
Brief Description of Political System | 169 | ||
Scope of Tobacco Problem | 169 | ||
Politics of Tobacco Control | 170 | ||
Tobacco Industry Monitoring | 180 | ||
ATSA Review | 182 | ||
Notes | 182 | ||
Chapter 13 MAURITIUS | 185 | ||
Executive Summary | 185 | ||
Brief Description of Political System | 186 | ||
Scope of Tobacco Problem | 187 | ||
Politics of Tobacco | 190 | ||
Tobacco Industry | 199 | ||
ATSA Review | 200 | ||
Notes | 200 | ||
Chapter 14 NIGERIA | 201 | ||
Executive Summary | 201 | ||
Brief Description of Political System | 203 | ||
Scope of the Tobacco Problem | 203 | ||
Politics of Tobacco | 204 | ||
Tobacco Industry Monitoring | 216 | ||
ATSA Review | 217 | ||
Notes | 218 | ||
Chapter 15 SENEGAL | 219 | ||
Executive Summary | 219 | ||
Brief Description of Political System | 220 | ||
Scope of Tobacco Problem | 221 | ||
Politics | 222 | ||
Tobacco Industry | 225 | ||
ATSA Review | 225 | ||
Notes | 226 | ||
Chapter 16 SOUTH AFRICA | 227 | ||
Executive Summary | 227 | ||
Description of Political System | 228 | ||
Scope of Tobacco Problem | 229 | ||
Tobacco Control Policies | 231 | ||
Tobacco Industry | 240 | ||
ATSA Review | 243 | ||
Notes | 244 | ||
Chapter 17 TANZANIA | 247 | ||
Executive Summary | 247 | ||
Brief Description of Political System | 248 | ||
Scope of Tobacco Problem | 249 | ||
Politics of Tobacco | 251 | ||
Tobacco Industry | 256 | ||
ATSA Review | 258 | ||
Notes | 258 | ||
Chapter 18 ZAMBIA | 261 | ||
Executive Summary | 261 | ||
Brief Description of Political System | 263 | ||
Scope of Tobacco Problem | 263 | ||
Politics of Tobacco Control | 266 | ||
ATSA Action – Enforcement of a Smoke-free Lusaka (Capital City) | 272 | ||
ATSA Action – Tobacco Cessation | 276 | ||
Tobacco Industry Monitoring | 277 | ||
ATSA Review | 280 | ||
Notes | 281 | ||
Chapter 19 CONCLUSION: TOBACCO CONTROL IN AFRICA – PEOPLE, POLITICS AND POLICIES | 283 | ||
Thinking Systemically: Policy Change | 284 | ||
The Underestimated Role of the Bureaucracy | 284 | ||
Thinking Smartly: Exploiting Opportunities | 285 | ||
The Next Frontier: Implementation and Enforcement | 286 | ||
The Legacy of Bad Rules | 288 | ||
The Central Role for Civil Society | 288 | ||
Promoting Government Will | 289 | ||
Early Interventions | 291 | ||
Tobacco Cultivation | 291 | ||
The Continuing International Component | 292 | ||
Emphasizing the “Whole” | 293 | ||
Notes | 293 | ||
End Matter | 295 | ||
NOTES ON CONTRIBUTORS | 295 | ||
Country Chapter Authors | 296 | ||
INDEX | 299 |