The harms associated with tobacco use are well documented in the scientific literature and articles published in national newspapers. However, less information is available on the politics inherent in tobacco control policy-making and the factors that explain tobacco control policy outcomes. This article will concentrate on this information gap, focusing on the key stakeholders, ideologies, power and politics inherent in tobacco control policy-making in Sri Lanka. I am applying a policy science approach that encourages diversity of perspectives to understand tobacco control policies situated in the history as opposed to content analysis of the prevailing national tobacco control policy. Therefore, I will endeavour to answer questions such as; who are the tobacco control policy actors?, who has been influential (or not)?, what are some of the beliefs and ideologies of tobacco control policy actors?, have there been any consensus and contradictions inherent in tobacco control policy-making?
Paying close attention to the external environment and how external factors influence the national stance taken on tobacco control is an important area often ignored in tobacco control policy analysis. Two main external influences on tobacco control include transnational tobacco companies (TTC) and external health experts, often led by the World Health Organisation (WHO). While the former is more concerned about increasing profits, the latter focuses on tobacco control strategies, primarily aiming to reduce the harm caused by tobacco use.
Sri Lanka signed and ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2003. Countries signatory to the FCTC are expected to give priority towards protecting public health and address the demand and supply of tobacco through a multitude of strategies. The six key components of the WHO tobacco control framework, which is popularly known as the MPOWER package include; monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco use, warning about the dangers of tobacco use, enforcing bans on tobacco advertising, promotion and sponsorship, and raising taxes on tobacco.
Although a signatory to the FCTC, Sri Lankan action to implement the FCTC convention generally has been slow in some areas and swifter in others. Legislative changes to give effect to the WHO FCTC have been realised faster when national legislation was passed in 2006. This includes measures relating to restrictions on smoking in public places; packaging and labelling requirements; tobacco advertising, promotion and sponsorship; establishment of the National Authority on Tobacco and Alcohol (NATA); and offences and penalties. Although national dissent against tobacco use had existed prior to signing the FCTC and is described further in this article, it was the WHO which influenced the passing of national legislation against tobacco and the establishment of (NATA).
Despite this, implementation of the legislation concerning tobacco control was slow to begin with e.g. introduction of pictorial health warnings (PHW) on the packaging of tobacco products and increase in tobacco taxes as per WHO standards. According to research conducted in low and middle income countries, tobacco control policy implementation lag is attributed to the influence of powerful transnational tobacco companies (TTCs) lobbying politicians and misguiding them with information and presenting or funding research that is tainted with the economic benefits of the tobacco industry and the contribution it makes to the economy through taxes and the livelihoods created. These take place in the context of other external economic development agencies such as the World Bank arguing for spatial restrictions to reduce opportunities to smoke and advocating on raising taxes on tobacco as a means to reduce the consumption. Such strategies are particularly aimed at young smokers who are especially price sensitive. Across all smokers in low and middle income countries, the World Bank estimates that a 10% rise in price will cause an 8% decrease in demand. Additionally, the IMF also recommends increasing taxation of tobacco as part of their economic stabilisation programmes. These are external drivers and it is noteworthy that Sri Lankan policy-makers do not act in isolation- they are influenced by a number of external pressures.