What facilitates policy audacity in tobacco control? An analysis of approaches and supportive factors for innovation in seven countries

Abstract

BackgroundTobacco control policy audacity can make radical ideas seem possible, and set in motion a ‘domino’ effect, where precedents in one jurisdiction are followed by others. This review examines tobacco control policy audacity from seven countries to identify and compare factors that facilitated it.MethodsA targeted search strategy and purposive sampling approach was used to identify information from a range of sources and analyse key supportive factors for policy audacity. Each case was summarised, then key themes identified and compared across jurisdictions to identify similarities and differences.ResultsIncluded cases were Mauritius’ ban on tobacco industry corporate social responsibility, Uruguay’s tobacco single brand presentation regulations, New Zealand’s Smokefree Aotearoa 2025 Action Plan proposals and 2010 parliamentary Māori Affairs Select Committee Inquiry into the Tobacco Industry, Australia’s plain packaging legislation, Balanga City’s (Philippines) tobacco-free generation ordinance, Beverly Hills City Council’s (USA) ordinance to ban tobacco sales and the Netherlands’ policy plan to phase out online and supermarket tobacco sales. Each case was one strategy within a well-established comprehensive tobacco control and public health approach. Intersectoral and multijurisdiction collaboration, community engagement and public support, a strong theoretical evidence base and lessons learnt from previous tobacco control policies were important supportive factors, as was public support to ensure low political risk for policy makers.ConclusionsTobacco control policy audacity is usually an extension of existing measures and typically appears as ‘the next logical step’ and therefore within the risk appetite of policy makers in settings where it occurs.

Progress, challenges and the need to set concrete goals in the global tobacco endgame

“…The past 2 years have witnessed a significant boost in endgame thinking and action. In 2020, the Netherlands announced a policy to phase tobacco sales out of supermarkets (9). After several years of internal planning, in January 2021 California, United States, announced its endgame initiative (10) to reduce smoking prevalence to below 1.9% by 2035.…”

“…In 2014, a proposal to adopt such a policy was put forward by an independent member of parliament in the Australian state of Tasmania, but it was not adopted. The City of Balanga in the Philippines subsequently implemented the policy in 2016, although it was successfully challenged by the tobacco industry (9). In September 2021, the U.S. city of Brookline, Massachusetts, implemented a TFG policy covering all tobacco products including e-cigarettes (14).…”

“…Today FCTC Article 8, requiring parties to implement measures for protection from exposure to tobacco smoke, has the highest implementation globally (18). Similarly, after Australia became the first country to adopt plain packaging for tobacco products, other countries rapidly followed (9).…”

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

“…The plan itself has six focus areas: Māori leadership; funding health promotion and community activities; tailored “wrap-around” support; only having low-level nicotine tobacco products available (to reduce demand); fewer retail outlets (to reduce supply) and enforcing the law on tobacco industry and retailers. Close engagement with Māori leadership [ 34 ] has driven the plan, which represents a marked advocacy shift towards the elimination of tobacco (rather than containment) and towards censure of the industry rather than tolerance [ 35 ]. Considerable efforts over many years led to the development of this plan, with detailed attention to a range of policies at multiple government levels.…”

Is the Public Ready for a Tobacco-Free Ireland? A National Survey of Public Knowledge and Attitudes to Tobacco Endgame in Ireland

“…Furthermore, the most recently announced legislative plan, which will provide for overdue protection of children from the sale of electronic cigarettes (e-cigarettes) (and related nicotine inhaling products) through a modern system of licencing for the tobacco and nicotine inhaling products retail sector, 15 while welcome, lacks the "policy audacity" that will characterise tobacco endgame and which is already emerging in, for example, New Zealand. 16,17 An alliance of local non-government organisations is advocating to augment these current legislative proposals to orient them more towards tobacco endgame. 18,19 However, to-date political leaders have been slow to consider the ambitious measures demanded by their own TFI policy goal.…”