Institutional tensions, corporate social responsibility and district-level governance of tobacco industry interference: analysing challenges in local implementation of Article 5.3 measures in Karnataka, India

Abstract

IntroductionAccelerating progress on tobacco control will require Article 5.3 of the WHO Framework Convention on Tobacco Control to be systematically integrated into policies and practices of sectors beyond health at diverse government levels. However, no study has explored implementation challenges of Article 5.3 within multilevel systems such as India, where political decisions on tobacco control occur at diverse government levels, which may constrain action at local level.MethodsBased on 33 semi-structured interviews with diverse government and civil society stakeholders across four districts in Karnataka, India (Mysore, Mangalore, Bengaluru (rural) and Udupi), this study examines challenges to implement Article 5.3 arising from competing agendas and policies of different actors at multiple levels.ResultsOur analysis reveals generally low levels of awareness of Article 5.3 and its guideline recommendations, even among those directly involved in tobacco control at district level. Efforts to implement Article 5.3 were also challenged by competing views on the appropriate terms of engagement with industry actors. Scope to reconcile tensions across competing health, agriculture and commercial agendas was further constrained by the policies and practices of the national Tobacco Board, thereby undermining local implementation of Article 5.3. The most challenging aspect of Article 5.3 implementation was the difficulties in restricting engagement by government officials and departments with tobacco industry corporate social responsibility initiatives given national requirements for such activities among major corporations.ConclusionsPromoting effective implementation of Article 5.3 in Karnataka will require policymakers to work across policy silos and reconcile tensions across India’s national health and economic priorities.

Advancing whole-of-government approaches to tobacco control: Article 5.3 and the challenge of policy coordination in Bangladesh, Ethiopia, India and Uganda

“…This code provides for raising awareness but its measures omit preferential treatment, state-owned interests or regulation of corporate social responsibility (CSR) initiatives. This absence of CSR mirrors the majority of subnational notifications that have been adopted, including Karnataka’s state policy27 (though CSR is addressed by two districts: Udupi and Bengaluru (Rural)) 26. Conversely, in Bangladesh, measures seeking to implement Article 5.3 measures have not been adopted.…”

“…This paper builds upon linked case studies examining contextspecific challenges of tobacco control governance in Bangladesh, 23 Ethiopia, 24 Uganda, 25 the Indian state of Karnataka, 26 and the dynamics of implementation across India's states and union territories. 27 Our case selection covers diverse tobacco control experiences and trajectories via which to understand coordination challenges and opportunities associated with Article 5.3 implementation.…”

“…This absence of CSR mirrors the majority of subnational notifications that have been adopted, including Karnataka's state policy 27 (though CSR is addressed by two districts: Udupi and Bengaluru (Rural)). 26 Conversely, in Bangladesh, measures seeking to implement Article 5.3 measures have not been adopted. While the National Tobacco Control Cell has developed a draft code of conduct and guidelines, the process of approving such measures has stalled.…”

Firm foundation or neglected cornerstone? The paradox of Article 5.3 implementation and the challenge of strengthening tobacco control governance

“…One such gap is the limited attention to denormalisation of tobacco industry corporate social responsibility (CSR), reflecting tensions with national legislation that requires large companies to undertake CSR initiatives. In the state of Karnataka, Kumar et al 32 explore tensions between tobacco industry CSR and district-level approaches to Article 5.3 implementation, arguing that scope to reconcile health, agriculture and commercial agendas has been constrained by promotion of tobacco producer interests at national level.…”

“…This achievement explains the esteem in which Article 5.3 is held by those seeking to demonstrate a need to minimise policy interference by other unhealthy commodity industries, but presenting it as a model can convey an impression within commercial determinants of health debates that this problem has been solved in tobacco control 11 13. The scope of the remaining task is demonstrated by the limited development of rules and tools to define and manage interactions36; by mapping consistent gaps in coverage of guideline recommendations31; by highlighting the ‘lacuna’ under which engagement with industry CSR activities may not be seen as violating Article 5.3 guidelines32; and by demonstrating the challenge of managing close relationships arising from state interests in the tobacco industry 30 33…”