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Barriers to evidence-based tobacco control in Tasmania : a case study
thesisposted on 2023-05-27, 10:01 authored by Barnsley, KI
Tobacco-smoking is by far the biggest single killer of Tasmanians, exceeding all motor vehicle accidents, illicit drugs, alcohol, suicide, homicide, fires and assaults combined. The tobacco industry is the vector of multiple chronic and deadly diseases caused by smoking, which can affect every organ of the body. Tasmania has higher smoking rates than all other states in Australia, and for a decade in the 2000s, the smoking rate in Tasmania did not fall at the same speed as other states. Tobacco control in Tasmania has been characterised by a strong legislative reform agenda, but weak commitment to allocation of resources for mass-media campaigns and cessation-support services. This thesis was triggered by professional concerns about these issues, and examines barriers to the funding of evidence-based tobacco control in Tasmania. The hypothesis is that there are specific barriers to implementing evidence-based tobacco-control measures in Tasmania. The initial proposal and research questions related to: evidence transfer to politicians and bureaucrats, and how such evidence is used and influenced; the role of policy entrepreneurs; factors influencing resource allocation; and does it matter if a politician is a smoker? The theoretical framework used was that of Kingdon, and agenda setting. The work began with a literature search focusing on evidence and knowledge transfer, and then progressed to requests for documents from the Department of Health and Human Services (DHHS) and other relevant agencies. In the early stages there was considerable cooperation from the DHHS, including access to files. In the later stages, with follow-up as the documents were read and analysed and more questions arose, DHHS and other departments insisted on formal requests in conformity with the relevant right to information legislation. A 1970s case of corruption and cronyism involving the tobacco industry was discovered at an early stage, and recently released archived files were examined to give a historic context to recent issues. Initially it had been intended to conduct interviews with bureaucrats, politicians and non-government leaders. However, as the researcher and all supervisors were embedded in the Tasmanian health community, it became clear that the small-scale nature of Tasmania meant that the answers given would almost certainly be confounded by familiarity. Further, a vast amount of information was available in documents. Therefore, it was decided to examine what people said and did as documented contemporaneously. The first major finding was that crony capitalism involving the tobacco industry was deeply embedded in the Tasmanian political system, and had been for decades. In the 1970s a tobacco company had managed, through corrupt processes, to eject an unsupportive Tasmanian government from office. No noteworthy ideological differences between the major political parties on tobacco control were found, as their actions appeared to be personality-driven. Conservative white males‚ÄövÑvp dominated governments, and it was not until 2013 that a bloc of progressive female political leaders finally broke the impasse, and allocated adequate funding to tobacco control. Senior politicians were poorly informed about the importance of tobacco control, and the evidence on how to reduce smoking rates. Many of the significant politicians who rejected the evidence were smokers. Politicians and bureaucrats refused to allocate earmarked funding to tobacco control in the years when states controlled taxation revenue streams, which perpetuated disadvantage in Tasmania. The myriad bureaucratic barriers to effective tobacco control were substantial, and included primacy of the rescue culture‚ÄövÑvp that prioritized acute care and illicit drugs use. There were silo effects in resource allocation; confused accountability, with complex internal committee systems; failure of key public servants to believe the evidence; failure to transfer evidence to Parliament and ministers; and importantly, a lack of resources for support, monitoring and evaluating anti-smoking services. It was found that although there were a number of anti-smoking non-government organisations (NGOs) active in Tasmania, these were small, under-resourced, and lacking research and advocacy expertise. There were individuals who lobbied hard, but no policy entrepreneurs of the stature of leaders in some other Australian states. Small jurisdictions are vulnerable to crony capitalism and tobacco industry interference, and national governments, the World Health Organisation (WHO), philanthropists and national NGOs have a responsibility to provide assistance to achieve and implement evidence-based tobacco-control measures. To be effective bureaucrats need to streamline their operations and consultations. Accountability mechanisms need to be Barriers to evidence-based tobacco control in Tasmania unambiguous. Decision-making structures, which incorporate illicit drug and alcohol policy-making, overwhelm tobacco control as a priority. Tobacco control requires persistence and planning. Governments that do not adopt a priority approach for tobacco control across all agencies and ministries will find that internecine spats strangle reform. The apparent success of progressive women in breaking through these barriers needs to be tested in other contexts. Evidence is vital to underpin policy, but opportunities to develop new charismatic tobacco-control endgame ideas should not be dismissed, simply because the evidence is minimal at the start of a new initiative. There are times when executing rational ideas can gain traction, while evidence can only be ultimately gained through implementation.
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