Tobacco control, global health policy and development: towards policy coherence in global governance
Tobacco control, global health policy and development: towards policy coherence in global governance
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DOI：
10.1136/tobaccocontrol-2011-050418
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发表时间：
2012-03-01
期刊：
影响因子：
5.2
通讯作者：
Collin, Jeff
中科院分区：
文献类型：
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作者：
Collin, Jeff
世卫组织《烟草控制框架公约》（FCTC）表明了国际社会在打击烟草流行方面的政治意愿，以及烟草控制在全球卫生议程中的新的突出地位。然而，在管理与外交和贸易政策优先事项的冲突方面存在重大困难，在努力与发展政策产生协同作用和避免与其他卫生优先事项产生紧张关系方面也面临重大障碍。本文使用政策一致性的概念来探讨烟草控制与贸易、发展和全球卫生优先事项之间在目标、政策和实践方面的一致性和不一致性。由于《烟草控制框架公约》谈判未能令人满意地解决贸易与健康之间的关系，一些争议突出表明多边和双边协定对烟草控制政策构成的挑战。虽然世界银行的工作表明了烟草控制对发展的潜在贡献，但由于千年发展目标中没有非传染性疾病，因此向发展中国家提供《烟草控制框架公约》执行支助的范围有限。即使在国际卫生领域，烟草控制的优先事项也可能难以与其他议程相协调。本文最后讨论了在何种程度上，烟草控制一直追求通过一种治理模式，非常故意不同于其他健康问题中使用的，在什么可以被称为“烟草例外主义”。本文所作的分析表明，重新审视这一差异假设将对非传染性疾病政策、全球卫生、发展和烟草控制大有裨益。
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.