Strengthening the Role of Organized Civil Society in the Struggle to Control the Tobacco Epidemic

Introduction

Brazil is unique amongst major democracies in having relatively extensive tobacco control policies that were developed and implemented almost entirely through government initiative. Unfortunately, in a political system as vast and fragmented as Brazil's, policy coherence across government is difficult to achieve.

The lack of policy coherence can be explained in part by the general absence of NGOs from the tobacco issue. Given the number of extremely active Brazilian NGOs on many other social and health issues, this absence is surprising. This project seeks to increase the participation of and strengthen the role of civil society in tobacco control in order to better ensure the effective implementation of the tobacco control policies.

Objectives

The objectives of the project are:

• To strengthen civil society capacity to participate in public debate & influence public policies related to tobacco control, particularly addressing social & economic inequity.
• To improve Brazilian capacity to undertake gender-sensitive research for advocacy and policy analysis on TC.
• To strengthen governmental support for the development and implementation of gender-sensitive tobacco control measures.

Results and Impact

Key results achieved over the life of the project to date are noted below.

Related to Outcome 1: Strengthened civil society capacity to participate in public debate and influence public policies related to tobacco control

HealthBridge has worked with ACT to strengthen its leadership role as well as to increase the role played by other civil society organizations in tobacco control. This had led to the achievement of several key results:

• RTZ - Rede Tabacco Zero - has been transformed from an informal and virtual coalition of about 100 NGOs and individuals into a legally incorporated NGO called Aliança de Controle do Tabagismo (ACT). It has established full office infrastructure in both Sao Paulo and Rio de Janeiro.
• ACT's membership has increased by approximately 300% since the beginning of the project, with more than 380 current members - making it the second largest tobacco-specific tobacco control advocacy organization in the world. At the same time, more members are more engaged in designing and participating in ongoing tobacco control activities.
• ACT member organizations have designed & implemented municipal smoke-free campaigns with local partners in a number of major cities, including Recife, São Paulo, Salvador, Rio de Janeiro, Belo Horizante, Florianópolis, and Maceió.
• Sub-networks have been established in the South and North East regions of the country.
• The media has demonstrated significant interest in tobacco control, and has published many articles about the issues of tobacco control.
• Longer-term tobacco control funding for civil society – including both core and project support - has been received from a variety of sources, including the Bloomberg Initiative, the Pfizer Foundation, Johnson and Johnson, and the World Lung Foundation.
• Collaboration has increased among academia, government, and multilateral organizations to address tobacco control issues.
• ACT has been invited to participate in most public debates addressing tobacco control – such as second-hand smoke, smoke-free legislation, crop alternatives, and litigation issues - and has become the leading civil society organization providing tobacco control information.
• Tobacco control has become a key issue in Brazilian national health seminars.
• ACT’s visibility in public debates and its recognition as a key source of information for government policy decisions – and for other civil society organizations – has contributed to its increased credibility as a leader.

Related to Outcome 2: Improving Brazilian capacity to undertake gender-sensitive research for advocacy and tobacco control policy analysis

To address the current lack of systemic and policy-relevant tobacco control research being undertaken in Brazil, largely as a result of language impediments to accessing funding, HealthBridge and ACT have worked together to identify both the key gaps in research and policy that need to be addressed and a likely source of funding specifically for Brazilian researchers. This had led to the following results:

• Key research gaps and weaknesses in Brazilian policy have been identified to guide the development of a tobacco-specific research programme.
• The Brazilian litigation landscape has been researched and mapped – leading ultimately to a change in the way that litigation against the tobacco industry is being handled and the outcomes being seen in legal cases.
• A small research grants mechanism has been established and funded (support provided by Research for International Tobacco Control) to foster and facilitate collaborative Brazilian research on tobacco and gender issues.
• Technical knowledge exchanges between Canadians and Brazilians has built civil society legislative and policy knowledge and skills, particularly around advocacy, litigation, advertising, and tax issues.
• Collaborative partnerships have been established with academia and the research community.
• ACT members have gained capacity in legislative analysis and identifying policy inconsistencies.

Related to Outcome 3: Strengthening government support for the development and implementation of gender-sensitive tobacco control measures

To increase government support to implement and enforce tobacco control measures, HealthBridge and ACT have worked together to build government-civil society relations and to bring clarity to questions about enforcement and authority. This had led to the following results:

• A Legal opinion was commissioned to clarify constitutional issues about enforcement and to identify weaknesses in existing tobacco control laws. This led to the development of model legislation which is being adapted by a number municipalities and states.
• Public opinion polls undertaken through the project have demonstrated strong public support for the enforcement of smoke-free legislation.
• Smoke-free campaigns have been launched in a number of cities with the support of and collaboration with government officials.
• ACT’s involvement in municipal & state-level committees and in the Parliamentary Front against Health has reinforced civil society-government relationships.
• There is increasing government-wide recognition that civil society can and should play a role in tobacco control.
• ACT’s shadow/monitoring report on FCTC implementation was the first substantive input received from civil society and the first Brazilian document providing summary of government-wide tobacco policies.
• Technical knowledge exchanges have built civil society skills for smoke-free law enforcement.

Lessons Learned

A number of lessons have been learned through the implementation of this project to date. One key lesson learned is that activities that depend on negotiations involving players from various governmental and non-governmental sectors are challenging and the timing does not always follow expected schedules. It is also possible to find partners in the most unexpected places; it is important to never close doors when outcomes involve political negotiations.

Another key lesson learned is that the decision-making process in Canada is significantly different from the decision-making process in Brazil. Although anticipated to some extent, this has had implications on the issue of technical cooperation and knowledge exchange (in the sense that some Canadian expertise is less relevant to the Brazilian context than originally expected).

A further lesson learned is that working at the state and municipal levels has enabled the project team to make greater progress in implementing and enforcing smoke-free areas than working at the federal level alone.

Recommendations

None to date.