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Political Barriers to Evidence-Based Tobacco Control

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Political Barriers to Evidence-Based Tobacco Control Evidence & Policy • vol 13 • no 2 • 343–64 • © Policy Press 2017 • #EVPOL Print ISSN 1744 2648 • Online ISSN 1744 2656 • https://doi.org/10.1332/174426416X14615120637063 Accepted for publication 08 March 2016 • First published online 24 April 2016 This article is distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/) which permits adaptation, alteration, reproduction and distribution for non-commercial use, without further permission provided the original work is attributed. The derivative works do not need to be licensed on the same terms. research Political barriers to evidence-based tobacco control policy: Cronyism and cognitive dissonance, a Tasmanian case study Kathryn Barnsley, [email protected] E Haydn Walters, [email protected] Richard Wood-Baker, [email protected] University of Tasmania, Australia Tasmania led in several areas of tobacco control legislation reform in the period 1997 to 2010. Despite this, Tasmania lagged in other crucial areas, particularly the allocation of resources for community education, mass media campaigns and cessation programmes. Key impediments were crony capitalism; the conservative ideology of ‘white male’ politicians; cognitive dissonance of smoking politicians; a lack of perception of priority regarding the scientific research evidence about smoking risk; and delays caused by the tobacco industry. This study analyses the political situation Delivered by Ingenta in Tasmania and argues that evidence-based progress on tobacco control resource allocation was Copyright The Policy Press not established until 2013. key words Tobacco control • crony capitalism • evidence-based policy • female politicians IP : 192.168.39.211 On: Sun, 26 Sep 2021 02:09:04 To cite this article: Barnsley, K, Walters, EH, Wood-Baker, R (2017) Political barriers to evidence- based tobacco control policy: Cronyism and cognitive dissonance, a Tasmanian case study, Evidence & Policy, vol 13 no 2, 343–64, DOI: 10.1332/174426416X14615120637063 Introduction Tasmania has a population of fewer than 500,000 people, yet it led Australia and the world in some areas of tobacco control policy and legislation reform in the period 1997 to 2010. The renaissance of reform in the late 1990s followed decades of inaction, and in a few instances thwarted action. In the 1990s and 2000s there were three important evidence-informed areas of tobacco control reform in Tasmania on the political, non–government health organisation (NGO) and community agenda; namely elimination of tobacco displays, smoke-free public areas and funding of mass media campaigns. All of these were subjected to identifiable political and bureaucratic impediments and delays (Barnsley et al, 2015). The tobacco industry 343 Kathryn Barnsley et al and its front organisations were lead instigators in these delaying tactics. Further impediments were political cronyism; the conservative ideology of some politicians, based on libertarianism, individualism and beliefs in ‘choice’; a bias towards retailers and profit rather than public health; the classic cognitive dissonance of smoking politicians, including a rejection of preventive measures and an emphasis on acute hospital funding as a priority. Additionally, there was a lack of understanding or sense of urgency regarding the scientific research evidence. The initiatives that should have been put in place on the health agenda at this time were to reduce or eliminate tobacco advertising, displays at point of sale, smoking in public places and work, and finally as a priority adequate allocation of funding for tobacco control mass media campaigns and cessation support services, such as Quit Tasmania. Effective tobacco control requires expenditure on all these. To achieve this has needed political will, albeit in the context of politicians in Australia conventionally taking much of their advice from the government bureaucracy. As Head (2013) observed there has been increased contestability in the provision of information from an array of sources. Writing about policy areas such as crime and corrections, Head (2013) also articulated that ‘policy-making in the real world is linked to public opinion’. Yet this has not held true in Australian jurisdictions in the area of tobacco control, as public opinion has, with the exception of smokers themselves, always been way ahead of reforms such as smoke-free areas in public places (Barnsley, 2011). These differences between policy domains require analysis of power politics and the influence of industry on politicians and their close advisers. There are two major political parties in Tasmania, Labor (equivalent to the Democrats in the USA, and Labour in the UK) and the Liberals (similar to the Republicans in the USA, and the Conservatives in the UK). There are two Houses of Parliament, and the government is elected by the lower House of Assembly (Parliament, 2015). Delivered by Ingenta The upper-house Legislative Council reviews legislation, and can amend bills. The Copyright The Policy Press Tasmanian multi-member electorate system also allows minor parties to be elected, and the third political party, the Greens, has played a pivotal role in Tasmanian politics (Crowley, 2003). IP : 192.168.39.211 On: Sun, 26 Sep 2021 02:09:04 This study reports on the political circumstances that existed at various times, and how these influenced tobacco control in Tasmania. It argues that because of cronyism and cognitive dissonance, a critical conjunction was slow to emerge to enable the firm establishment of evidence–based progress on these measures. Method To clarify the barriers to evidence-based tobacco policy in Tasmania, a forensic document analysis was undertaken. There is considerable evidence on record about words and actions of political actors and their advisers. A qualitative data analysis was conducted, using documentation obtained from various sources for 1997 to 2010. Documents relating to tobacco control were sought via Right to Information and Freedom of Information legislation from: Health and Human Services, Primary Industry Parks and Water, Treasury and Finance, and Premier and Cabinet. Some documents, such as minutes of meetings, and details of funding, were provided by NGOs. Internal government working documents provided included minutes of meetings, copies of emails and correspondence, some limited ministerial briefing material, internal reviews of programmes, reports, notes and memoranda. These 344 Political barriers to evidence-based tobacco control policy documents were read and examined for relevance to the processes of developing tobacco control policy, and scrutinised and compared over the time period to enable the trail of policy making to be captured. Digital documents and Hansards, which are transcripts of parliamentary proceedings, for the period 1997 to 2010 were copied into Microsoft Word, searched for ‘tobacco’ terms, examined, sorted, recorded and analysed using QSR International NVivo. The key words ‘smoke’ and ‘smoking’ were not used as there were many thousands of irrelevant references to smoke and fires, as Tasmania is a forestry state. Iterative coding was used, firstly by individual or organisation, then themes which included: funding, children, smoke free areas, legislation, addiction, advertising, asthma, committees, corruption, dirty ashtray awards, FCTC, fire deaths, smuggling, kids in cars, licensing, litigation, passive smoking, pregnant women, prisons, pro-smoking arguments, mentions of research evidence, smoking cessation, social unacceptability, state budget, tobacco action plan, vending machines. A further set of coding included the role of cabinet, child smoking, civil liberties arguments, costs of smoking, political party funding by the tobacco industry, sport, taxation, teachers’ pay, tobacco companies’ behaviour and Treasury. Other documents were sorted and analysed manually. Grey literature searches included published government reports, newspaper reports, government websites and tobacco industry document websites (Legacy Library). The Legacy documents were searched using the keyword ‘Tasmania’. Documents made available from earlier published studies included a file and records from the State Archives office, and newspaper reports from the 1960s to the 1980s extracted from microfiche at the Tasmanian State Library, then copied. Larger scale studies of tobacco policy processes, using similar documentation, have been conducted in Poland (Balwicki, 2015) and India (Rao, 2015). The theoretical framework used for this research is that of Kingdon (1995) with particular emphasis on agenda-setting and knowledge-transfer. In public health the Delivered by Ingenta agenda-setting processes outlined by Kingdon rely on three policy windows of Copyright The Policy Press opportunity to be open simultaneously: • recognition that a problem exists IP : 192.168.39.211 On: Sun, 26 Sep 2021 02:09:04 • agreement on the way forward • a lack of boundaries between the politicians, civil servants and advocates; appear to be precursors to progress (Mannheimer, 2007). The role of policy entrepreneurs, another key factor outlined by Kingdon, was considered, but no evidence was found of significant policy entrepreneurs (Ballard, 2004) of the stature of those identified by Ballard in Victoria and NSW. Results The tobacco industry, cronyism and political donations Throughout the 1990s and into the 2000s the tobacco industry denied evidence of the detrimental health
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