How Nepal defended and implemented its strong tobacco control legislation

Dharma Bhatta, Eric Crosbie, Stella Bialous and I just published “Defending comprehensive tobacco control policy implementation in Nepal from tobacco industry interference (2011-2018)” in Nicotine and Tobacco Research.  This paper describes how health advocates in Nepal, with assistance from international organizations, successfully defended its comprehensive tobacco control law from continuing industry attacks after it was passed.

There has been a lot of research on how laws get passed, but less on what happens during the implementation period.  This case shows that even in a low and middle income country it is possible to defend and enforce strong legislation.

This paper is the third and final paper in our series on tobacco control in Nepal.  The first described the early history of tobacco control in Nepal, including the entry of the multinational tobacco companies and the political connections they built and how health advocates used litigation to move tobacco control legislation forward.  The second describes how health advocates built on this foundation to pass strong legislation that exceeded FCTC standards.  This new third paper describes how they defended the law after it passed and secured effective implementation, including implementation of very large pictorial warnings on cigarette packs.

Here is the abstract for the new paper:

Background Nepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry interference to force implementation of law.

Methods  Policy documents, news stories and key informant interviews were triangulated and interpreted using the Policy Dystopia Model.

Results  The tobacco industry tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the tobacco industry used litigation to block implementation. The tobacco industry argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits and monitored tobacco industry activities to successfully counter tobacco industry opposition.

Conclusions  Both tobacco control advocates and the industry used the discursive and instrumental strategies described in the Policy Dystopia Model. The model was helpful for understanding tobacco industry activities in Nepal and could be applied to other low-and middle-income countries. Civil society, with the help of international health groups, should continue to track tobacco industry interference and learn the lessons from other countries to proactively to counter it.

The full citation is:  Dharma N Bhatta, Eric Crosbie, Stella A Bialous, Stanton Glantz, Defending comprehensive tobacco control policy implementation in Nepal from tobacco industry interference (2011-2018), Nicotine & Tobacco Research, , ntaa067, https://doi.org/10.1093/ntr/ntaa067.  It is available here for free.