Week 7.2/ 7.3 Case Study in Policy Change: Tobacco Policy

1
Week 7.2/ 7.3 Case Study in Policy Change
Tobacco Policy

2
Context of Stability and Change

• Policy appears to have changed dramatically in a
  short period of time
• 2002 Legislation on Advertising
• 2006 Legislation on Public Places
• Comes after 50 years of frustration among public
  health about the lack of legislation

3
Questions and Implications

• Has policy changed dramatically?
• If so, then what model of change best describes
  these events?
• Or what does each model tell us about the case
  study?
• Or what to look for? Which factors to consider?
• Central to wider discussions of power who has
  the power to change or influence policy? What
  factors/ influences are most relevant?

4
3 points to case study

• As with agenda-setting discussion - the number of
  factors to identify and models to explore is
  huge. Any study of change entails a choice.
• Difference between apparent change and actual
  change
• Our narrative of change determines the value of
  each model

5
Basis of post-war stability 1

• Socio-economic basis of tobacco company power,
  particularly in the UK
• 40k-300k jobs in 1979
• Equivalent of 9.3 billion taxes
• Successful export
• Smoking prevalence high - in 1974, 51 of men and
  41 of women smoked
• Tobacco control seen as a vote-loser

6
2. Tobacco Policy Community

• Producer-dominated, based on resources of
  industry
• Its position was cemented during WW2 when the TAC
  was set up to ensure the supply of cigarettes to
  soldiers and civilians
• Close relationships with senior and junior
  ministers/ civil servants in Treasury and DTI, MPs

7
3. Surrounded by Issue Network

• TAC joined by FOREST, TWU, Trade Associations
• Role of Advertising Authority and sympathetic
  newspapers
• Public health groups either relatively
  disorganised (BMA) or underfunded (ASH)
• So, tobacco companies controlled the image of
  tobacco
• Framing tobacco as an economic issue jobs, tax
  revenue, and exports was the basis for support
  from the Treasury, the DTI, and the Department of
  Employment.

8
Next Question Did Policy Change Dramatically?

• We have the 2 examples of legislative change
• A focus on these policy instruments alone may
  exaggerate change
• How do these fit in with wider policy instruments?

9
8 possible types of policy instrument to examine

• Regulation on advertising, smoking in public
  places, sales of cigarettes, and levels of tar.
• Economic incentives (subsidies to farmers, tax
  expenditure on arts sponsorship) and penalties
  (taxation, litigation).
• Public education including the ratio of health
  education to tobacco advertising.
• Smoking cessation services and nicotine
  replacement therapy.
• Funding external organizations (such as ASH).
• Funding scientific research (for example, through
  the Medical Research Council).
• Tackling tobacco smuggling.
• Levels of enforcement and the scale of punishment
  (particularly relevant to the history of
  voluntary agreements).

10
Interview Research

• Suggests fundamental disagreement on what recent
  events mark
• For some, it represents a watershed/ sea change
  in policy. A conclusive sign of a challenge to
  industry dominance.
• For others, it reflects incremental change.
• Both narratives point to different aspects of
  change drawing on these instruments

11
(No Transcript)
12
Incremental Narrative 1

• 1900-1970s
• bans on selling to children 1908/33 withdrawal
  clinic 1958
• TV ban 1965
• Voluntary agreement on health warnings on packs
  1971
• Smoking phased out public transport/ cinemas

13
Incremental Narrative 2

• 1980s hardening of the stance
• More restrictive controls on voluntary
  advertising
• Stronger government health warnings
• Taxation to discourage smoking in the 1984 and
  1986 budgets.
• Voluntary agreements as a signal to tobacco
  companies (if they fail, we will legislate)

14
Incremental Narrative 3

• Agenda accelerated from 1997
• Promise to implement EU directive on advertising
• More health education funding
• More smoking cessation funding
• Higher taxes plus better customs controls
• More limited public places ban would still lift
  UK to top of tobacco control league

15
Government Position

• Tax has peaked
• Policy not ahead of evidence (SCOTH 1998)
• Deliberately incremental and voluntary approach
  tried first
• This approach was working in restaurants and
  workplaces
• Until recently, public health groups agreed with
  this approach

16
Incremental Narrative suggests

• Policy community was never closed
• Lack of progress based on lack of scientific
  evidence or public support for change
• Groups like Ash were not excluded (they were
  funded by government)

17
Dominance Narrative

• Series of minimal changes from post-war
• Health education spend miniscule compared to
  tobacco advertising
• TV ban only possible because no legislation
  needed
• More significant legislation never passed in 20th
  century
• Active health ministers drummed out
• Voluntary agreements never enforced a victory
  for the industry

18
Examples

• introducing filter tips, which helped marketing
  to women and persuaded some that they were
  smoking safely
• stopping advertising on high tar cigarettes,
  which had a low and declining market share
• Limiting advertising expenditure, which suited
  the companies with the highest market shares.
• Other measures, such as health warnings on
  cigarette packs, were traded for the ability to
  use brand names in advertising
• Coupon schemes and sponsorship violated
  agreements

19
Dominance Narrative summary

• Incremental steps never by partisan mutual
  adjustment
• Voluntary agreements lasted until 2007
• Legislation the first significant means to
  challenge dominance

20
The point of narratives

• Crucial to the explanatory power of our models
• If policy change is dramatic, we can use models
  of change stressing punctuated equilibrium or
  change from above and below
• If it is incremental and would have happened
  anyway, then

21
Above and Below Explanations

• Venue shift, in which binding decisions made in
  venue B affect policy in venue A (Baumgartner and
  Jones, 1993, 32).
• Multi-level governance (MLG), which describes the
  dispersal of power from central government to
  other levels of government and non-governmental
  actors
• Policy transfer and learning.

22
Remember types of transfer

• Direct coercive transfer, which can involve a
  supra-national body (such as the EU) taking over
  responsibility for policy development and
  obliging individual countries to follow.
• Indirect coercive transfer, which describes a
  perception within region A that it should follow
  the policy of region B.
• Voluntary transfer, which describes the relative
  freedom to interpret and learn from decisions
  made elsewhere.

23
Elements of all 3 in Advertising legislation

• Coercive EU and Europe Against Cancer tar,
  tax, then TAD 1 and 2
• Evidence of coercion on recalcitrant government?
• 1990s opposition based on importance of BAT to
  economy
• Changed with Labour 1997
• But Labour voted against TAD2 wording or
  Ecclestone?
• No rush to pass UK Bill

24
Transfer from Scotland Voluntary or Indirect
Coercive?

• Pressure from Scotland on advertising bill
• Member bill plus lobbying
• Venue shift in smoking in public places
• A shift of group attention from the Scottish
  Executive to the Scottish Parliament as a means
  of shifting the policy venue relating to smoking
  bans from the UK to the Scottish arena
• Involved reframing issue as public health, not
  Health Safety (as in Ireland)
• Commitment from rest of UK to ban smoking
  influenced UK?

25
Upshot of influence from above and below?

• EU influence and Scottish/ UK embarrassment
• But UK bill went further, suggesting elements of
  voluntary transfer?
• Scotland did not register in Westminster on
  advertising
• Department of Health (John Reid) resisted
  Ireland/ Scotland Approach on smoking ban
• Instead, chose to continue with incremental
  change
• So what explains comprehensive ban?

26
Policy Networks and External Factors

• Remember that the policy communities and
  monopolies literature is there to explain long
  periods of stability
• So explanations of change require attention to
  factors external to these networks?

27
Possible External Factors 1

• Ideological change following the election of a
  new government.
• Change from above and below.
• Changing information
• Medical evidence (although remember experience of
  SCOTH)
• Policy learning from the experience of
  international policy change (although remember
  Department of Health attitude to Ireland).

28
External Factors 2 changing economic benefits

• The number of jobs in the UK directly related to
  tobacco fell from 40,000 in 1979 to 11,000 in
  2003.
• Tobacco tax in 1996 was one-quarter of the value
  in 1950 as a proportion of total revenue .
• Rising imported and illegally imported market
  shares. Before the 1980s almost all tobacco
  consumed in the UK was from a domestic source,
  with UK tobacco consumption supporting UK
  employment

29
External Factors 3 Social Change

• The drop in smoking prevalence from 51 per cent
  of men and 41 per cent of women in 1974 to 28 per
  cent of men and 24 per cent of women in 2005
• Changing public attitudes e.g. those in favour
  of smoking restrictions in pubs rose from 48 per
  cent in 1996 to 65 per cent in 2004.

30
But

• While socio-economic shifts affect the resources
  of tobacco policy participants, they do not
  determine outcomes
• They key emphasis in networks literature is on
  mediation interpretation the attention given to
  and weight placed on these factors by
  decision-makers

31
The Advocacy Coalition Framework

• Starting point is division of policy into
  subsystems with competing advocacy coalitions and
  a policy broker.
• Remember, unlike policy communities, ACs contain
  more actors from wider process e.g. researchers
  and journalists
• Also includes actors from multiple levels of
  government.

32
Emphasis on belief systems as glue that binds
participants

• Range from
• core beliefs which are impervious to change
  (e.g. freedom v security)
• policy core (e.g. proper scope of government)
• secondary aspects most subject to change (e.g.
  best way to deliver)

33
ACF model of stability and change

• Stability
• Parameters of policy constitution, social
  structures/ values
• Core values of actors
• Dominance of one AC?

34
Change inspired by external events

• New resources to challenge AC dominance and/ or
• Assimilation of new evidence
• But note treatment of evidence
• Core beliefs unaltered
• Evidence subject to interpretation/ ranking
  using those values

35
Application to tobacco

• The ACF replaces the idea of a producer network
  within an issue network
• Rather, we have pro- and anti-tobacco coalitions.
• Pro-tobacco dominates but still engages with
  anti-tobacco coalition
• But still no sign of Lindbloms partisan mutual
  adjustment
• Rather, adjustment (or policy learning) is made
  by a dominant coalition in the face of changing
  information (interpreted through belief systems)
  and external environments.

36
Significant Policy Change

• Comes from external shocks to the system a new
  government with different ideas, increasing EU
  influence, shifting public opinion,
• But mediated by the dominant coalition which
  learns/ adapts to maintain its positions
• Examples - introducing filters for cigarettes,
  funding medical research, voluntarily restricting
  advertising, and providing ventilation in public
  places.

37
Significance of ACF to tobacco

• Anti-tobacco coalition may now dominate the
  subsystem, but
• the value of the ACF is in explaining why such a
  shift took so long.
• Much of the delay was achieved through the
  constant re-appraisal of new evidence
• Includes the post-war rejection of the scientific
  evidence on illness,
• More recent scepticism about the level of risk
  from passive smoking and what constitutes a
  proportionate response.

38
Problems with ACF?

• Explains stability but not change? Change
  through external factors means ACF black box
  not required?
• How do we explain temporary alliances?
• E.g. feminists/ Christians and pornography
• E.g. civil liberties groups and tobacco companies
• BBPA and shifting alliances
• ACFs too broad to track venue shift
• Constitution a source of stability or change?

39
Punctuated Equilibrium

• Explore long periods of policy stability
  punctuated by short bursts of intense attention
  and policy change
• Baumgartner and Jones (1993)
• The forces that create stability during some
  periods are the same that combine during critical
  periods to force dramatic and long-lasting
  changes during other periods.

40
Common Factors

• Problem definition - policy issues are
  inherently multi-dimensional.
• Competition to Define Problems
• Public Policy Consequences
• So, a successful reframing/ redefinition of a
  problem leads to attention shift

41
Attention Shift and Venue Shift

• Attention can shift dramatically as new
  dimensions gain prominence and others are
  ignored
• An issue shifts from communities of
  professionals who know all the arguments to
  higher levels of public, media, and governmental
  awareness
• This may involve pursuing issues in other
  venues if one is relatively closed e.g. an EU
  or devolved strategy to counter UK dominance

42
Long-term attention shift in tobacco

• Gradual shift in attitudes in post-war period in
  developed countries
• BJ study of US contrasts
• Start of 20th century minimal media attention,
  government attention favourable (agricultural
  export issue)
• Pre-1950s still a non-issue, glamour, high
  consumption
• Since 1960s raised and negative media coverage,
  reappraisal of economic benefits (e.g. rising
  health insurance, lower productivity)

43
(No Transcript)
44
General shift in problem definition

• Causality link between smoking (then passive
  smoking) and cancer
• Categorisation as a health ( safety) issue
  rather than employment, economic, civil liberties
• Comparisons with other countries
• Similar shift in UK, with medical and public
  health messages progressively more prominent

45
But .

• Differences in ability to shift venues
• Before the 1990s, most policy progress in the US
  was achieved through the courts or states
• Far fewer influential venues in the UK
• Remember tutorial discussion no demonstration
  that public and media attention determines the
  nature or intensity of governmental response (or
  precedes it)
• A discussion of narratives reinforces this point

46
Dominance Narrative 1. Post-War Period

• Series of minimal changes from post-war
• Voluntary agreements never enforced a victory
  for the industry
• Voluntary agreements lasted until 2007
• Legislation the first significant means to
  challenge dominance
• Post-war history of unsuccessful public health
  attempts to shift the policy image of tobacco
  within government, with little recourse to
  alternative venues.
• Appears not to support idea of punctuation

47
Incremental Narrative 1. Post-War Period

• More evidence of changing policy image within
  government from 1960s
• Health ministers increasingly saw smoking as a
  health/ illness issue
• BUT not because of venue shift (indeed
  Westminster critical of shift)
• BUT not because of changing public opinion
  (measures taken despite PO)
• Again, not supportive of idea of punctuation?

48
Dominance Narrative 2. Smoking Ban

• More supportive of punctuation
• Venue shopping after devolution focussed English
  attention
• Contributed to increased levels of attention to
  passive smoking
• Shifting image of tobacco (including balance
  between freedom and public health)
• Reduced ability to appeal to individual choice (a
  feature of post-war debates)
• But ..

49
Incremental Narrative 2. Smoking Ban

• Qualifies the force behind this change.
• Remember Department of Health rejected
  comprehensive ban
• Department of Health suggestion that a complete
  ban would go ahead of public opinion
• Scotland used results of a consultation to
  legitimise decision. England presented the
  survey evidence

50
(Cm 6374, 2004 98)

• Surveys show 86 of people in favour of
  workplace restrictions, and a similarly
  substantial majority of people supporting
  restrictions in restaurants. But when people are
  asked whether smoking should be restricted in
  pubs the figures fall substantially to around
  56 and when people are asked which sort of
  restrictions they would prefer in pubs only 20
  of people choose no smoking allowed anywhere
  and the majority tend to be opposed to a complete
  ban

51
Suggests

• A degree of mediation and choice in the evidence
  to select
• Government position still did not change after
  similar consultation results
• Full explanation of ban requires analysis of
  venue shift to Westminster
• Since its influence is unusual (rebellions
  notwithstanding), this requires extra
  explanation a focus on idiosyncratic reasons for
  policy change

52
Policy Windows

• Separate streams come together at critical times.
  A problem is recognised, a solution is developed,
  a political change makes it the right time for
  policy change, and potential constraints are not
  severe ..these policy windows, the opportunities
  for action present themselves and stay open for
  only short

53
So how did the window open for smoking ban?

• John Reid established the Department of Health as
  the department in charge
• This raised the prominence of the CMO who was
  active and stated publicly that he considered
  resigning when cabinet did not support full ban
• It also accelerated the shifting resources of
  groups. Tobacco already on the wane with few
  links to Health. Licensed trade access was with
  DTI. BMA and ASH joined by others (CRUK, CIEH,
  TUC).

54
2. Changing Treasury Attitudes

• Falling significance of tobacco to revenue and
  exports
• New focus on a health inequalities agenda
• It identified smoking as the single most
  significant causal factor for the socio-economic
  differences in the incidence of cancer and heart
  disease

55
3. Westminster

• Background of embarrassing Labour rebellions
• Prospect of a further revolt and Cabinet split
• Fostered by Chair of Health Select Committee who
  undermined Reids line on the manifesto secured
  a HC report on smoking and promised to deliver
  many MPs
• Barron and Taylor persuaded Blair to grant a free
  vote
• Huge public health campaign to MPs in their
  constituencies
• Labour vote crucial since Conservatives voted
  against full ban

56
Are these results generalizable?

• Across countries very similar policy
  developments in industrialised countries. Fairly
  similar processes (or factors for explanation
  see Studlar).
• Across policy areas, a bit less certain
• Unusual parliamentary influence
• Unusual intensity and open strategy
• Unusual direction of indirect coercive transfer

57
Summary of points to explore in tutorials

• Was policy change incremental or dramatic?
• Is there evidence of a punctuation?
• What factors explain change public opinion,
  changing attitudes, changing socio-economic
  conditions ?
• Which actors were most influential ministers,
  civil servants, groups, media ?
• Which models explain change best?
• What does each model suggest we study?