The Rise of Global Health: The Evolution of Effective Collective Action


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Gilmore A and McKee M b Moving East: How the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union-part 2: An overview of priorities and tactics used to establish a manufacturing presence. Supply Chain Management ; 15 1 : 10— A map of policy actors favouring smoking in Spain [translated from Spanish].

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Yip G Global strategy … in a world of nations? Sloan Management Review ; 31 1 : Tobacco Control ; 16 20 : — Download references. The authors are solely responsible for the contents of this paper. This work is licensed under a Creative Commons Attribution 4. Global Networks American Journal of Public Health Health Policy Article metrics. Advanced search. Skip to main content. Subjects Politics and international relations Social policy. Abstract Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control.

Introduction The marked shift in tobacco-related disease and death, from traditional to emerging markets in low and middle-income countries LMICs , began to garner major attention within the public health community during the s Stebbins, Tobacco industry globalization: a review of the public health literature We searched the peer-reviewed public health literature on tobacco industry globalization, published from —, during March—April using PubMed which includes citations and abstracts from the fields of biomedicine and health, covering portions of the life sciences, behavioural sciences, chemical sciences, and bioengineering.

Definitions and measures of globalization used While an explicit definition of globalization is not provided in most of the articles reviewed, each associates tobacco industry globalization with one or more of the following trends. Analytical timeframe of tobacco industry globalization We looked at the timeframes in which tobacco industry globalization is analysed in the public health literature.

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Agency versus structural power in tobacco industry globalization Farnsworth distinguishes between the agency and structural power of corporations. She concludes that: Despite its supposed exclusion from the FCTC process, the presence of the tobacco industry was felt throughout the negotiations. An interdisciplinary research agenda on tobacco industry globalization While tobacco industry globalization has received deserved attention within the public health community, resulting in a stronger evidence base for collective action, the above review points to opportunities for fuller understanding through an interdisciplinary research agenda.

Clarifying definitions of tobacco industry globalization As a first step, we believe a more precise definition of globalization is needed. Table 1: Units and levels of analysis to study tobacco industry globalization Full size table. Data availability Supplementary Table 1 provides the full data used for this analysis; see the Supplementary Material for the full list of references indicated. Additional information How to cite this article : Lee K et al Tobacco industry globalization and global health governance: towards an interdisciplinary research agenda.

Notes 1. Some of the papers reviewed use more than one level of analysis. Google Scholar Bero L Implications of the tobacco industry documents for public health and policy. Google Scholar Callard C , Thompson D and Collishaw N Transforming the tobacco market: Why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate.

Google Scholar Chantornvong S et al. Google Scholar Farnsworth K and Holden C The business-social policy nexus: Corporate power and corporate inputs into social policy. Google Scholar Fooks G and Gilmore A International trade law, plain packaging and tobacco industry political activity: The trans-pacific partnership. Google Scholar Fortune. Google Scholar Gilmore A Understanding the vector in order to plan effective tobacco control policies: An analysis of contemporary tobacco industry materials.

Google Scholar Hammond R Consolidation in the tobacco industry. Article Google Scholar Moodie R et al. Google Scholar Rugman A and Verbeke A A perspective on regional and global strategies of multinational enterprises. Google Scholar Scholte J Defining globalization. Google Scholar Stebbins K Tobacco or health in the third world: A political economy perspective with emphasis on Mexico. Article Google Scholar Watchman R Tobacco industry rides out recession with rising share prices. Google Scholar WHO.

During the first decade of implementation, the treaty has led to important achievements. Importantly, fuller understanding of tobacco industry activities supported these efforts, substantially enabled by the public release through whistleblowers and US litigation of internal tobacco industry documents beginning in the s Hurt et al.

This evidence has been fundamental to negotiating and implementing the FCTC. Moreover, because of growing populations, the absolute number of users and volume consumed are increasing Ng et al. In there were 1 billion smokers worldwide, consuming 5. This is projected to rise to 1. Behind these trends is a buoyant industry that has continued to enjoy growth and profitability. In , the industry experienced its best year by volume sales since , and TTCs have boasted record highs in share prices and financial returns since Wachman, ; Gara, ; Banjo, The illicit tobacco trade has also thrived during the same period, embedded within a network of criminal activity with global reach FATF, In this context, this article argues that collective action to stem the tobacco pandemic requires fuller understanding of the nature and dynamics of tobacco industry globalization.

We begin by reviewing the existing public health literature on tobacco industry globalization, identifying how globalization is defined and measured, historically located, conceptualised by unit and level of analysis, and ascribed with power. On the basis of the findings of this review, we draw on the disciplines of business studies and international political economy IPE to set out an interdisciplinary research agenda.

We argue that this expanded understanding of tobacco industry globalization is a prerequisite to strengthening GHG. We searched the peer-reviewed public health literature on tobacco industry globalization, published from —, during March—April using PubMed which includes citations and abstracts from the fields of biomedicine and health, covering portions of the life sciences, behavioural sciences, chemical sciences, and bioengineering.

Articles primarily concerned with tobacco use, or tobacco-related morbidity and mortality, were excluded. After duplicates were removed, the remaining 76 papers were coded along four dimensions see supplementary Table 1 : definitions and measures of globalization; analytical timeframe; units and levels of analysis; and nature of power amid tobacco industry globalization. While an explicit definition of globalization is not provided in most of the articles reviewed, each associates tobacco industry globalization with one or more of the following trends.

Most papers describe how TTCs undermined national-level tobacco control policies in Europe Hilamo, ; Szilagyi and Chapman, a , ; Gilmore et al. A few studies focus on policy influence at the regional and global levels through industry bodies Ong and Glantz, ; McDaniel et al. Moodie et al. This has been achieved through sophisticated marketing strategies promoting western lifestyles, and developing products for new markets Szilagyi and Chapman, ; Hafez and Ling, ; Gilmore, ; Delobelle et al.


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Internal documents reveal the specific strategies to achieve this. Stanton et al. Where necessary, TTCs adapted marketing strategies to local contexts and targeted specific populations, notably females and youth Lunze and Migliorini, In many cases, this was achieved through the above described policy influence encouraging countries to liberalize tobacco trade and investment, privatize state-owned enterprises, and pursue joint ventures. Other analyses focus on how privatization Gilmore et al.

The illicit trade is also described as part of TTC strategies, with complicity in large-scale cigarette smuggling extending into Eastern Europe Gilmore and McKee, a ; Skafida et al. Smuggling circumvented import bans and quotas in restricted markets, helped to undermine regulation, and build brand presence ahead of market opening.

It is because of the absence of clear definition, perhaps, that the existing literature does not measure tobacco industry globalization in any meaningful way. Where globalization is associated with policy influence , for instance, the indicator is whether policies favourable or unfavourable to industry interests for example, tax and tariff rates are supported by policy makers. Hurt et al. However, these papers are primarily concerned with the political power of TTCs in various policy settings, which may or may not be related to globalization per se.

Papers which define globalization as marketing cite specific marketing practices, targeted populations, and changes in tobacco consumption. For instance, Chu et al. Papers defining globalization as market access and growth largely refer to increased presence and market share in a given country. For example, Lee et al. We looked at the timeframes in which tobacco industry globalization is analysed in the public health literature.

The desire for evidence to support the FCTC process, which commenced in the late s, may have focused greater research efforts on this time period. The public release of millions of internal industry documents also explains the temporal focus of the existing literature.

The capacity to search digital copies of these documents, via the creation of on-line archives during the s, greatly enabled new scholarship Hurt et al. However, the collections currently hold few documents dating later than the early to mid s. Level of analysis concerns the location, size or scale of a research target.

Together, the unit and level of analyses help define the population of a research enterprise. This literature offers analysis of how the industry is changing, often in specific groups of countries or regions, and TTC adaptation accordingly. For the most part, this research treats TTCs as part of an increasingly homogeneous industry in pursuit of globalization.

With the accumulation of detailed knowledge about TTC activities over time, scope for comparative analysis of TTC activities is now possible. Most of this work sets out broad trends in the industry, in terms of, its structural consolidation and expansion into LMICs. For the most part, this research is descriptive in nature, and offers limited explanation in relation to globalization of the world economy. For example, Chantornvong et al. Lunze and Migliorini conduct a state-focused analysis of TTC influence of tobacco control policy in Russia since the s. Baker et al. Eckhardt et al. Farnsworth distinguishes between the agency and structural power of corporations.

Agency power is the capacity of corporations to act independently in ways that achieve desired ends. Firms may exert agency power through various forms of political engagement and institutional participation. Structural power operates in situations where governments are compelled to favour industry interests without the need for firms to take explicit action. Farnsworth and Holden write that globalization tends to increase corporate structural power by increasing the mobility of capital. Since investment is a fundamental source of production, employment, consumption and, by extension, tax revenues, the opportunity for corporations to move operations out of a national economy may compel the government to act in ways amenable to corporate interests.

This is consistent with the prevailing definition of tobacco industry globalization as policy influence and TTCs as the primary unit of analysis. Many papers document the use of agency power in specific national settings to influence science and policy for example, Hilamo, ; Szilagyi and Chapman, b ; Gilmore et al. Others analyse agency power exerted at regional Holden and Lee, ; Peeters et al. Lee et al. Gilmore et al. The agency power of the tobacco industry, to influence the FCTC process, is also well recognized Morley et al. During negotiations, the industry secured membership on national delegations Assunta and Chapman, ; Jin, , sought to undermine WHO WHO, , and lobbied delegates Otanez et al.

Gridlock, Innovation and Resilience in Global Health Governance

Wipfli describes industry lobbying of delegates, presence on national delegations, hiring of private consultants and third party organizations to support industry positions, and diversion of attention to youth prevention and voluntary codes. She concludes that:. Despite its supposed exclusion from the FCTC process, the presence of the tobacco industry was felt throughout the negotiations.

Their arguments formed the backbone of many of the most contentious debates among countries, and their impact is obvious in the final text of many key provisions in the treaty. Wipfli, : While tobacco industry globalization has received deserved attention within the public health community, resulting in a stronger evidence base for collective action, the above review points to opportunities for fuller understanding through an interdisciplinary research agenda.

This can be achieved by drawing on two disciplines in which globalization has been a core concern: IPE and business studies. As a first step, we believe a more precise definition of globalization is needed. The definitions of globalization used in the public health literature focussing predominantly on policy influence, marketing, and market access and growth imply an expanded capacity by the tobacco industry to assert influence, operate, and secure economic gains, over a wider geographical territory.

However, it is difficult to delineate what is changing in the tobacco industry, whether this is new or distinct, and whether existing or new collective action is needed to govern its trajectory and impacts. The work of Scholte is useful for distinguishing globalization from the terms liberalization, universalization, westernization and internationalization. The trans-territorial connections of globality are different from the inter-territorial connections of internationality.

The transborder transactions of globality are different from the open-border transactions of liberality. The transplanetary simultaneity and instantaneity of supraterritoriality is different from the worldwideness of universality. The geographical focus of globality is different from the cultural focus of western modernity.

The multiple meanings of global health governance: a call for conceptual clarity

Although globalisation … has some overlap with, and connections to, internationalisation, liberalisation, universalization and westernization, it is not equivalent to any of these older concepts and trends Scholte, : To what extent have industry actors, or aspects of their operations, progressed beyond replication and expansion into new national markets, to the restructuring of their operations supraterritorially.

Holden et al. There is evidence that the global consolidation of tobacco leaf growing and processing, centred around three Hammond, and then two dominant firms, is being accompanied by supraterritorial restructuring Goger et al. Overall, appreciation of these definitional distinctions offers greater precision about the nature of the changes occurring in specific parts of the tobacco industry, and as a whole, and thus the extent to which true globalization is occurring.

More precise indicators are needed to measure tobacco industry globalization. Rather than describing globalization as binary in occurrence, uniform across the industry, or linear in its trajectory, globalization can be studied as a process that is happening to varying degrees in different parts of the industry, at different geographical locations, with diverse features and varying impacts on production and consumption.

We suggest measuring globalization by focusing on two types of indicators. First, firm-level indicators measure changes in individual companies that suggest progression from national, to international, to global concerns. A key firm-level indicator is business type such as sole proprietorship, partnerships, corporations and cooperatives.

Each type and subtype has different forms of ownership, governance, liability, regulatory burden and taxation. All have been found in the tobacco industry but, over time, corporations have dominated Callard et al. Moreover, most TTCs are publicly-traded rather than private companies, with shareholders distributed worldwide. This form of ownership may facilitate globalization by enabling access to sufficiently large capital investment. Analysis of the relationship between type of business and form of ownership, and global business strategy pursued, remains needed.

Type of organizational structure can also serve as firm-level indicators of globalization. A firm initially seeking to expand foreign markets will traditionally establish separate domestic and foreign divisions. As foreign markets grow even further, the firm may adopt a more decentralized organizational structure divided by function, production or service, customer or location that is, transnational enterprise. There are many variations to the latter, to support a global business strategy, in terms of the distribution of assets, operations and human resources Chee and Harris, A more globalized firm will, not only have substantial foreign operations, but hold a larger proportion of assets offshore, perhaps to reduce tax liability Stulz, A higher proportion of sales and earnings will not only be achieved through exports, but through overseas production by joint ventures, licensed manufacturers or factories abroad.

This type of data can be gleaned from company reports, as well as business and financial news sources. This measure has been comparatively applied to tobacco Holden and Lee, and alcohol companies Hawkins et al. These data exclude smaller, but highly transnationalized, firms.

Depending on the availability of standardized and longitudinal data, indicators such as the above could be used to develop a composite index of tobacco industry globalization. A second way to measure tobacco industry globalization is industry-level indicators. These concern changes to the structure and activities of the industry as a whole. One potential indicator is the concentration ratio. Further research is needed to calculate and analyze HHI scores for the tobacco industry by region and globally over time, to understand trends in concentration of the industry as a feature of globalization.

This, in turn, can inform more detailed analysis of the factors behind these trends for example, barriers to entry, business strategies , and the implications for global governance. The work of Philip Shepherd, on the concentration of cigarette manufacturing into an oligopoly in Latin America from the s, is a useful starting point.

He writes that stagnation of traditional markets prompted fierce competition for new markets, notably between US companies and BAT.

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There is a need to extend this analysis, beyond the s, when tobacco industry globalization accelerated worldwide Denniston, Another set of useful industry-level indicators are offered through global value chain GVC analysis. This framework captures the interconnectedness of certain sectors in the world economy, including shifting patterns of tobacco trade and production. Such data help identify points in the tobacco GVC which are more or less globalized, and how this chain is distributed across different geographies.

Accurate data on volumes, sources and geographical flows are not possible, given the nefarious nature of the trade, and its passage through several jurisdictions before final sale. Nevertheless, using a GVC framework to integrate existing studies of selected national and regional jurisdictions will provide a clearer understanding of the increased interconnectedness of the illicit trade over time and space. Analysis of tobacco industry globalization would benefit from greater attention to temporal dimensions of change, their location within particular historical timeframes, and the articulation of these with geographical factors.

The literature does acknowledge differences in geographical focus over time. It remains unclear, however, how the pace of globalization has progressed or varied over time across different geographies. The work of Shepherd is again useful, in this respect, by documenting what might be considered as a first phase of tobacco industry globalization in Latin America in the s. Building on this work, Lee et al. Future research may examine a fourth phase, comprising the emergence of new TTCs, most likely from Asian companies adapting to foreign competition and seeking to globalize.

Importantly, not all firms will pursue a global strategy at the same time or pace, or even at all. Some may not be capable, or choose deliberately not, to globalize. First, there can be non-globalization whereby a firm focuses attention solely on the domestic market. We suggest classifying such firms, with a purely national orientation, as domestic tobacco companies. Second, where a firm is active in regional markets, in addition to the domestic market, there is a strategy of semi-globalization.

For example, firms may initially focus on expanding activities regionally and, if successful and desirable, later expand operations Rugman, Regional strategies should be viewed, in this sense, as a complement, rather than alternative, to domestic operations. Tobacco firms with this orientation can be classified as regional tobacco companies. Third, where a firm is active domestically, regionally, and beyond, these firms might be classified as TTCs engaging in globalization. Together, this suggests a more sophisticated conceptualization whereby domestic, regional and global business strategies can co-exist and impact upon each other.

Firms may pursue different strategies over time depending on diverse internal and external factors at play Ghobadian et al. An expanded historical timeframe of tobacco industry globalization would also benefit from several excellent histories of tobacco production and consumption, which offer important contextualization of contemporary trends Kluger, ; Cox, ; Gately, ; Brandt, ; Proctor, Analysis of tobacco industry globalization can build on these important works by, for example, relating existing patterns of leaf production to colonization Benson, , trends in the illicit trade to the history of marginalized populations, and emergence of TTCs to the spread of neo-liberalism from the late twentieth century.

As described above, TTCs are the unit of analysis in most of the literature to date given the prominence of their activities and access to internal documents. Moreover, TTCs have largely been studied as unitary, separate and homogeneous actors operating at the national level. The business studies literature, sometimes written by industry insiders, is valuable for understanding the distinct way in which TTCs, given varied operating environments and organizational structures, have engaged with globalization.

Ghoshal and Nohria evaluate 41 large companies including RJ Reynolds, BAT and Swedish Match to identify combinations of environment and structure that work better than others. Beyond TTCs, there are opportunities for new insights by expanding attention to other units and levels of analyses see Table 1. Looking at other industry actors along the GVC—including national firms and state-owned enterprises, leaf growers and processers, and other sectors directly supporting TTC operations for example, financiers, logistics, accountants, management consultants, advertising firms, legal representatives, wholesalers and retailers —would provide fuller understanding of the diversity of globalization experiences.

A further set of actors support the political and economic interests of the industry worldwide including industry associations, chambers of commerce, third parties, manufacturers of tobacco-related products for example, matches, lighters, cigarette paper , media and industry funded groups. In order to manage the growing number of health actors in GHD then, health institutions or international health departments have to be strengthened to uphold accountability and transparency when it comes to health and foreign policy. As a final point, one of the current quandaries the globalizing world is facing in health is the spread of Ebola.

GHD must be put to use in order to accelerate the effective response based on concrete actions of states in order to contain the outbreak. Spreading doom-laden statements about the contagion only serves to undermine and detach states from cooperating with each other. The challenge therefore lies on the international community in stepping-up its efforts to educate the public about health including other preventive measures. As mentioned earlier, the world is indeed rapidly globalizing and with such increased interconnectedness comes more complex health problems.

This serves as a wake-up call for the increasing need of effective and efficient global health policies—policies which can hopefully be formulated and implemented through Global Health Diplomacy. Related content Money Politics Part I : Money always comes with strings attached What does the 'pork barrel' scam suggest about the Philippine government? Fracking Europe: The Solution? International Organization of la Francophonie IOF : humanist values against globalization diplomacy , foreign policy , global health diplomacy , health This website uses cookies to improve your experience.

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