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The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed 'tobacco exceptionalism'. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference.

British American Tobacco Cambodia (BATC) has dominated the country's tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC's in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia's increasingly controversial political and business leadership that is centred around the Cambodian People's Party with the aim of gaining access to policy makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company's ostensible contribution to Cambodia's economic and social development and, more significantly, provided BATC with opportunities to petition policy makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia's economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia's compliance with the Framework Convention on Tobacco Control.

The enforced opening of Thailand's cigarette market to imports in 1990 has become a cause celebre in debates about the social and health impacts of trade agreements. At the instigation of leading US-based cigarette manufacturers, the US Trade Representative (USTR) threatened trade sanctions against Thailand to compel the government to liberalize its domestic cigarette market. Thailand's challenge to the USTR led to referral to General Agreement on Tariffs and Trade (GATT) arbitration. While GATT ruled in favour of the USTR on market access, it also found that Thailand could subsequently enact non-discriminatory tobacco control regulation without contravening the GATT agreement. This article contributes to existing literature via its analysis of tobacco industry documents that highlight not only USTR responsiveness to lobbying from tobacco corporations, raising concerns about the drivers of globalization and the limited protection afforded to public health concerns in trade agreements. Significantly, the documents also indicate that USTR support of the tobacco industry was not unconditional, being subject to wider pressures of global trade negotiations. Such qualification notwithstanding, however, ongoing governmental willingness to advance the international interests of tobacco corporations remains a concern from a public health perspective, particularly given the failure of the US to ratify the World Health Organization's Framework Convention on Tobacco Control.

The enforced opening of Thailand's cigarette market to imports in 1990 has become a cause celebre in debates about the social and health impacts of trade agreements. At the instigation of leading US-based cigarette manufacturers, the US Trade Representative (USTR) threatened trade sanctions against Thailand to compel the government to liberalize its domestic cigarette market. Thailand's challenge to the USTR led to referral to General Agreement on Tariffs and Trade (GATT) arbitration. While GATT ruled in favour of the USTR on market access, it also found that Thailand could subsequently enact non-discriminatory tobacco control regulation without contravening the GATT agreement. This paper contributes to existing literature via its analysis of tobacco industry documents that highlight not only USTR responsiveness to lobbying from tobacco corporations, raising concerns about the drivers of globalization and the limited protection afforded to public health concerns in trade agreements. Significantly, the documents also indicate that USTR support of the tobacco industry was not unconditional, being subject to wider pressures of global trade negotiations. Such qualification notwithstanding, however,,ongoing governmental willingness to advance the international interests of tobacco corporations remains a concern from a public health perspective, particularly given the failure of the US to ratify the World Health Organization's Framework Convention on Tobacco Control.

Aim: To assess the extent to which alcohol industry actors cited evidence in submissions to the Scottish Parliament Health and Sport Committee's 2011 call for written evidence on the Alcohol (Minimum Pricing) (Scotland) Bill and to compare any citations of peer-reviewed evidence to original sources. Methods: All submissions to the consultation (n=128) were manually searched to identify those written by alcohol industry actors (n=25). The reference lists of all the alcohol industry submissions were reviewed and peer-reviewed sources were retrieved, read and assessed against their in-text citation within the alcohol industry submissions. Results: Although most industry submissions cited evidence of some sort, only 7 (28%) cited peer-reviewed evidence. Comparing the total number of citations to peer-reviewed evidence (n=17) to original sources demonstrates that 82% were questionably cited. Conclusion: Our findings demonstrate that the majority of references to peer-reviewed evidence in this sample of alcohol industry policy submissions were misleading with examples of citations being presented as supportive of arguments that the original evidence source specifically argued against. This suggests that even the depiction of peer-reviewed evidence within alcohol industry policy submissions needs to be treated with caution.

Introduction: Coalitions of supporters of comprehensive tobacco control policy have been crucial in achieving policy success nationally and internationally, but the dynamics of such alliances are not well understood. Methods: Qualitative semi-structured, narrative interviews with 35 stakeholders involved in developing the European Council Recommendation on smoke-free environments. These were thematically analyzed to examine the dynamics of coalition-building, collaboration and leadership in the alliance of organizations which successfully called for the development of comprehensive European Union (EU) smoke-free policy. Results: An alliance of tobacco control and public health advocacy organizations, scientific institutions, professional bodies, pharmaceutical companies, and other actors shared the goal of fighting the harms caused by second-hand smoke. Alliance members jointly called for comprehensive EU smoke-free policy and the protection of the political debates from tobacco industry interference. The alliance's success was enabled by a core group of national and European actors with long-standing experience in tobacco control, who facilitated consensus-building, mobilized allies and synchronized the actions of policy supporters. Representatives of Brussels-based organizations emerged as crucial strategic leaders. Conclusions: The insights gained and identification of key enablers of successful tobacco control advocacy highlight the strategic importance of investing into tobacco control at European level. Those interested in effective health policy can apply lessons learned from EU smoke-free policy to build effective alliances in tobacco control and other areas of public health.

Objective: Tobacco companies have made extensive efforts to build alliances against comprehensive smoke-free legislation. This article analyses the interaction between actors who opposed the development of the European Council Recommendation on smoke-free environments. Methods: Drawing on data from 200 policy documents and 32 semistructured interviews and using qualitative textual analysis and organisational network analysis, opponents' positions on, and responses to, the policy initiative, strategies to oppose the policy, and efforts to build alliances were investigated. Results: The non-binding nature of the policy, scientific evidence and clear political will to adopt EU-wide measures combined to limit the intensity of commercial sector opposition to the comprehensive EU smoke-free policy. Most tobacco companies, led by the Confederation of European Community Cigarette Manufacturers (CECCM), voiced reservations against the proposal, criticised the policy process and fought flanking measures on product regulation. However, some companies focused on instigating harm reduction debates. These divergent approaches and the reluctance of other commercial actors to demonstrate solidarity with the tobacco sector prevented the establishment of a cohesive commercial sector alliance. Conclusions: The comparatively limited opposition to EU smoke-free policy contrasts with previous accounts of tobacco industry resistance to tobacco control. While context-specific factors can partially explain these differences, the paper indicates that the sector's diminished credibility and lack of unity hampered political engagement and alliance building. Industry efforts to emphasise the benefits of smokeless tobacco during smoke-free policy debates highlight the potential of harm reduction as a gateway for tobacco companies to re-enter the political arena.

Social network analysis (SNA), a method which can be used to explore networks in various contexts, has received increasing attention. Drawing on the development of European smoke-free policy, this paper explores how a mixed method approach to SNA can be utilised to investigate a complex policy network. Textual data from public documents, consultation submissions and websites were extracted, converted and analysed using plagiarism detection software and quantitative network analysis, and qualitative data from public documents and 35 interviews were thematically analysed. While the quantitative analysis enabled understanding of the network's structure and components, the qualitative analysis provided in-depth information about specific actors' positions, relationships and interactions. The paper establishes that SNA is suited to empirically testing and analysing networks in EU policymaking. It contributes to methodological debates about the antagonism between qualitative and quantitative approaches and demonstrates that qualitative and quantitative network analysis can offer a powerful tool for policy analysis.

Uzbekistan shows how countries that privatise state owned tobacco industry can be manipulated by global companies

Successive UK governments have actively supported the expansion of alcohol exports. Jeff Collin, Emma Johnson, and Sarah Hill explore the implicit tensions between national economic interests and global health goals

International audience ; Background Germany has been identified as one of a few high income countries that opposed a strong Framework Convention on Tobacco Control (FCTC), the World Health Organization's first global public health treaty. We examined whether the tobacco industry had influenced the German position on the FCTC. Methods Analysis of previously confidential tobacco industry documents Results The tobacco industry identified Germany as a key target within its global strategy against the FCTC. Building on an already supportive base, the industry appears to have successfully lobbied the German government, influencing Germany's position and argumentation on key aspects of the FCTC. It then used Germany in its efforts to weaken the FCTC. The evidence suggests that the industry enjoyed success in undermining the Federal Health Ministry's position and using Germany to limit the European Union negotiating mandate. Tactics included the creation of controversy between the financial, trade and other ministries on one side and the health ministry on the other, the use of business associations and other front groups to lobby on the industry's behalf and securing industry access to the FCTC negotiations via the International Standardization Organization. Conclusion The evidence suggests that Germany played a major role in the tobacco industry's efforts to undermine the FCTC. Germany's position consistently served to protect industry interests and was used to influence and constrain other countries. Germany thus contributed significantly to attempts to weaken an international treaty and, in doing so, failed in its responsibility to advance global health.