Tobacco industry interference in low- and middle-income countries: Adapting the Policy Dystopia Model

Numerous case studies illustrate that tobacco industry actors use the same, or a very similar, set of arguments and techniques when working against public policies. This evidence was used to develop a framework of tobacco industry interference known as the Policy Dystopia Model (PDM) [1]. The model has gained prominence among public health researchers and advocates and has also been used to explore other unhealthy commodity industries. However, only around ten percent of the articles included in the PDM document industry interference in low- and middle-income countries (LMICs). It is critical that the tobacco epidemic is addressed in LMICs: around 80% of smokers live in LMICs [2] and the adoption and implementation of the World Health Organization Framework Convention on Tobacco Control tends to be slower and weaker than in high-income settings [3]. With this project, we aimed to assess whether the PDM captures contemporary tobacco industry interference in LMICs.
Semi-structured interviews were conducted with 22 advocates from eight LMICs which had recently adopted or consulted on a key tobacco control policy. The PDM’s taxonomies of discursive and instrumental strategies were used as the starting point for the coding framework but we allowed for the identification of additional strategies. By this, we sought to ensure that all strategies from the PDM and the data were captured.
We found that the set of discursive and instrumental strategies used by the tobacco industry was largely consistent among the LMICs included in the study, and with the PDM. Several minor strategies and arguments were identified which were not reflected in the PDM. These included the argument that the tobacco control policy punishes ‘reputable’ tobacco industry actors which would provide employment, and pay taxes. Newly identified instrumental strategies focused on building and maintaining a positive image. The original PDM had stressed industry efforts of rehabilitating its tarnished image; here, tobacco industry actors were, for example, reported to offer support to the government or public actors in moments of crisis.
This work shows that the PDM is fit for purpose and also allows for a more nuanced understanding of industry interference. It is important to not treat the PDM as a ‘tick box’ exercise but as a tool that can facilitate in-depth research and capture context-specificities. The refined model could be used to help develop case studies on tobacco...


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