From global agenda-setting to domestic implementation: successes and challenges of the global health network on tobacco control
Health Policy and Planning
Global policy attention to tobacco control has increased significantly since the 1990s and culminated in the first international treaty negotiated under the auspices of the World Health Organization-the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC's progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member
... tries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990s, in translating countries' commitment to the FCTC into domestic policy change. By comparing the network's influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network's effectiveness around the FCTC's implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buyin, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network's success than the evidence base for the effectiveness of tobacco control interventions. The network's variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment. A global health network of tobacco control scientists and advocates, which formed around the creation of the Framework Convention on Tobacco Control (FCTC), successfully extended its life cycle into promoting the domestic implementation of the FCTC. The network's effectiveness in promoting the implementation of the FCTC has varied across policy issues highlighting the role of domestic political factors in shaping tobacco control policy-making. The case of global tobacco control highlights the trade-off faced by global health networks between maintaining internal cohesion and forming alliances with actors in their social environment.