Exploring the Political Economy Nexus of Tobacco Production and Control: A Case Study from Zambia

Introduction

The tobacco epidemic remains the most preventable health threat of our time, with nearly eight million people dying annually from tobacco use (World Health Organization 2019a). While governments continue to pursue tobacco control measures around the world, such efforts face strong opposition from tobacco interests (Bump and Reich 2013). This ubiquitous opposition manifests in familiar and novel forms in tobacco-growing countries, particularly in countries such as Zambia where the establishment of tobacco control policy is fairly recent (Labonté et al. 2018), and where the colonial roots of tobacco production date back to 1912 (Harkema 1972).

With 182 parties having signed on to the Framework Convention on Tobacco Control (FCTC), governments around the world continue to pursue important measures such as smoke-free laws, increases in excise taxes on tobacco products, graphic health warnings on tobacco packaging, education and/or mass media campaigns, youth access laws, and information exchange. One key measure from the FCTC – promoting alternative livelihoods for tobacco farmers – continues to confront challenges, as political and economic conditions and forces emphasize tobacco production as a key economic development strategy (Chung-Hall et al. 2019). Governments continue to support investment and stimulate processing and manufacturing in contravention of the provisions of the FCTC, with implications for domestic tobacco consumption (Labonté et al. 2019).

In Zambia, the country of focus of this case study, this context of policy conflict is rooted in the continued presence of tobacco farming and more recent developments to further enhance leaf processing and build manufacturing capacity. The limited progress in addressing tobacco supply partly stems from the unique features of the problem and the unfamiliarity of many tobacco control advocates and scholars with the complex political economy of agricultural production (Chingosho, Dare, and Walbeek 2020; Mazwi, Chambati, and Mudimu 2020). Amplifying this challenge is a persistent and wide-spread perception that tobacco farmers tend to earn more than other farmers even though the growing literature demonstrates otherwise (Magati et al. 2019; Donald Makoka et al. 2017).

But the problem of alternatives to tobacco production is also deeply rooted in the conception of state-market-society relationships held by governments in tobacco-producing countries, largely informed by the (neoliberal) notion that government should not interfere with production, but rather let demand for tobacco drive production levels (Lencucha and Thow 2020). Such an approach tends to focus on demand-side issues in isolation from the political and economic conditions that shape the tenuous relationship between sectors of government, driven by mandates that are often at cross-purposes (Bhatta et al. 2020; Kulik et al. 2017; Mamudu et al. 2014). Existing research on tobacco industry interference provides important insights into how opposition to tobacco control is orchestrated. Only recently, however, is research interrogating the political and economic conditions that sensitize and facilitate government acceptance of anti-tobacco control arguments advanced by tobacco interests (Schram et al. 2018; Smith and Lee 2018; Lencucha et al. 2018; Lencucha and Thow 2019). Together these factors serve as important barriers to the pursuit of alternatives to tobacco growing and hinder progress towards demand reduction.

Case Study Design and Conceptual Approach

Our interpretive case study design interrogates the political economy context of tobacco production and control in Zambia (Odell 2001). We adopt the standard definition of political economy as “a social science that studies production, trade, and their relationship with the law and the government…[and] how economic theories affect…the creation and implementation of public policy” (Corporate Finance Institute 2020). Our deductive study uses three domains of inquiry developed from the existing political economy literature on tobacco (esp. Bump & Reich, 2013), specifically: of: 1) competing interests and ideas, as well as incentive conflicts among different sectors involved in tobacco control and production, and the challenges of intersectoral collaboration (Mackay 1994; Lencucha, Drope, and Chavez 2015); 2) information problems related to imperfect (or intentionally limited and distorted) knowledge about the economic and development impacts of tobacco production (Lencucha and Pontes 2018); and 3) the roles of domestic producers and multinational corporations in lobbying against tobacco control policies and promoting local tobacco production and consumption (Glantz, Mamudu, and Hammond 2008; S. Lee, Lee, and Holden 2012)), and other implementation barriers to tobacco control policies and regulations, such as taxation (Fooks, Peeters, and Evans-Reeves 2014; Holden and Lee 2011), illicit trade controls (Rowell, Evans-Reeves, and Gilmore 2014), and/or environmental restrictions on smoking or similar regulatory measures that aim to reduce tobacco use (Collins and Procter 2011).

Methods

Building on two earlier cycles of key informant interviews and document analyses, we developed an interview guide that incorporated questions specific to our three domains of inquiry. Interviews took place November 4 – 15, 2018, were conducted with key informants from relevant ministries and organizations in Zambia (n=14), and included government actors as well as representatives from civil society and the commercial (tobacco farming or industry) sector (see Appendix 1. List of Key Informants by Sectoral Affiliation). Individuals were invited based on their involvement in tobacco at a senior policy level, initially using purposive sampling supplemented by snowball sampling. In most cases, at least two investigators were present at each interview, one or two from the Zambian research team, and one of the international investigators. All interviews took place in the workplace of the informants, or in a location of their choosing, and lasted between 30 and 120 minutes. All interviews were recorded and transcribed verbatim, and transcripts were entered into NVivo qualitative coding software and analyzed using thematic coding. The coding template was derived deductively from the interview schedule and a set of questions developed specifically to probe for the three political economy domains described earlier (see also Appendix 2. Coding Template).

Interview findings are supplemented by reference to relevant government, industry, and civil society documents (policies, reports, and media accounts) discussing tobacco production and control issues in Zambia, based on a previously published document analysis (Goma et al. 2019). Ethics approval for this study was obtained from the ethics review boards of the University of Ottawa, McGill University, Morehouse School of Medicine (American Cancer Society) and the University of Zambia.

Findings

We present our findings along the three domains of inquiry identified from a political economy perspective above, starting with competing interests and incentive conflicts, next turning to interrogating the economic, development and health impacts, before ending with the lobbying efforts of multinational companies, and other implementation barriers to tobacco control identified by our respondents.

1. Competing Interests and Incentive Conflicts

One of the central features of tobacco lies in its dual nature of being simultaneously a profitable agricultural commodity (although more so for tobacco companies than for tobacco growers as discussed below) and a significant health and environmental risk to tobacco producers and consumers. This duality leads to intra-governmental incentive conflicts in tobacco control, reflected in the positions on tobacco variously taken by political actors in Zambia:

“There is some ambiguity in policy regarding tobacco. On one hand, when it suits the politicians, they say that tobacco is a health risk. In another breath, the same politicians say that tobacco is economically viable. As a result of this double-tongued approach the Government has not yet clearly defined the tobacco policy” (Respondent from Ministry of Health).

Respondents from our interviews widely acknowledged the economic potential of tobacco production, especially in terms of contributing to the goal of the country’s National Development Plan (NDP) to achieve middle-income status by 2030 (including a representative from the Tobacco Board of Zambia and the parastatal Zambian Agriculture Research Institute, as well as one Parliamentarian). The 7^th NDP cites tobacco as an important agricultural crop – “one of the top ten products we export” (Respondent from Zambian Agriculture Research Institute) – claiming that there is an unsaturated global market capable of generating important foreign exchange revenues. To the government, the importance of tobacco production is reflected in its status as one of a handful of export-oriented agricultural commodities in Zambia.

Unlike other crops, government support stops short of direct financial subsidies to tobacco farmers, although tobacco farming benefits through general agricultural supports such as access to quality control, providing disease and pest control advice, and researching fast-growing tree varieties to replace indigenous trees cut down for tobacco curing (Respondent from Ministry of Commerce and Trade). At the same time, the political status of tobacco is visible in the incentives provided to tobacco companies to operate in Zambia, which included a tax holiday incentive program for a special economic zone (the Lusaka Multi-Facility Economic Zone) from which the Zambian government did not exclude tobacco companies, even though this decision was in direct contravention of the FCTC (Lencucha et al. 2016).

2. Information Problems and Knowledge Claims about Tobacco’s Impacts

The perceived profitability or economic benefits of tobacco production, however, require a nuanced analysis that raises the importance of evaluating competing knowledge claims about the impact of tobacco production and control. On the one hand, many of the ‘pro-tobacco’ views held by those working in the economic sector of government have some empirical support. As noted above, from a narrow macro-fiscal perspective, tobacco does contribute to the country’s foreign exchange earnings, but the extent of this benefit at the macroeconomic level, and the view that this is the only or most profitable commodity to contribute to this goal, is empirically questionable (Appau, Drope, Goma, et al. 2019). At 0.4 percent of GDP, tobacco production contributes less than maize (1.5%) and cotton (0.7%) (Goma et al. 2019). This question is further complicated by the lack of counterfactual efforts to develop the supply chains of other agricultural commodities. In addition, the value of Zambia’s tobacco leaf exports fluctuates considerably from year to year, and its foreign exchange benefits are largely offset by the value of tobacco imports (e.g., cigarettes), as occurred in 2016 and 2017 (Indaba Agricultural Policy Research Institute 2017, 72).

At the microeconomic level, the benefits to tobacco farmers are minimal, and sometimes non-existent, or even detrimental to livelihoods. For example, large-scale surveys conducted with Zambian tobacco farmers find that households earn very little from tobacco production particularly when properly accounting for extensive family labour costs and inputs (Goma et al., 2019; Appau et al 2019). What remains an ongoing challenge is operationalizing shifts away from tobacco to alternatives (Smith and Fang 2020). Findings from Zambia indicate that farmers grow tobacco largely because of the access to capital and agricultural inputs from leaf-buying companies and corresponding access to markets to sell their leaf (Appau, Drope, Goma, et al. 2019), and for the guarantee of immediate cash payments from the leaf-buying companies at the end of the season (Appau, Drope, Witoelar, et al. 2019).

Supply Chain Dynamics

These structural conditions are less about the natural economic benefits of tobacco leaf growing in the form of profit for farmers, and have more to do with supply chain dynamics that have been established by leaf-buying companies (Niño Perez 2016; Grosh 1994; Chingosho, Dare, and Walbeek 2020). Such structural arrangements are linked to the ability to sell the crop in the global market and, although similar supply chain arrangements might exist for other crops, these are often much less developed in LMICs than those developed by industry specifically for tobacco leaf. The need for crop diversification has been acknowledged by the Zambian government, and candidates include maize, soy beans, and various fruits and vegetables (Republic of Zambia 2017). However, some question whether crop diversification is possible, given Zambia’s record of having one of the lowest levels of crop diversification in Africa as measured by the Simpson’s Diversity Index (World Bank 2018), and amidst the general lack of incentives or programs aimed at crop diversification.

But even within the Ministry of Health, there were differing opinions about whether economic and social goals related to tobacco consumption are in conflict, with one respondent suggesting that economic and social goals can work hand-in-hand, since “without social development goals, you cannot drive economic development goals” (Respondent from Ministry of Health). But when discussing tobacco production and control measures specifically related to health goals, there was wide-spread acknowledgement of potential conflicts between the two, especially amongst representatives from the health and social sectors. As one respondent from the Ministry of Health described, there is a “huge discord whereby the economic development [strategy] is forgetting about our health issues”, while another acknowledged that “there is a need to increase resources discouraging the growing and investing in tobacco as it is harmful to population health”.

Finally, other interviewees also raised concerns about the role of wide-spread child labour in tobacco production (Respondent from Labour Commission), which is far greater than in other crop production, and the prevalence of green tobacco sickness amongst children, a poisoning caused by the transdermal absorption of nicotine, a known toxin (Respondent from Zambian Agriculture Research Institute). Various social determinants of health can also be undermined by tobacco production when, for example, children miss school to work on the farm (Respondent from Tobacco Board Zambia), which is a frequent occurrence (Goma et al. 2019).

Differing Sectoral Mandates and Priorities

In many ways, differences in opinion about the societal impact of tobacco are rooted in different sectoral mandates and priorities that can undermine trust between government agencies (de Leeuw 2017). The Department of Finance, which was noted as sitting “at the apex of tobacco control policy due to its economic policy coordination function” (Member of Parliament), has different interests to that of health, such as maximization of taxation revenue from economic activities related to tobacco production. The Ministry of Health, in turn, aims to minimize negative health consequences related to tobacco consumption by placing restrictions on its use and reducing overall demand (World Health Organization 2019b). Not all competing interests, however, may be capable of mitigation. The National Development Plan sets an important direction for the country’s economic development, for example, and given its reinforcement of a pro-tobacco production narrative, lends credibility to tobacco industry lobbying against tobacco control measures as one of our interviewees noted with some irony:

“Our friends in the tobacco sector have already gone to agriculture and told them this [tobacco control] law is very bad, it’s going to ruin the economy.” (Respondent from Zambia Development Agency)

In an effort to reconcile intersectoral differences, the government of Zambia has established a Ministerial Liaison Committee on Tobacco to engender better coordination of the policy responses of different ministries, specifically to avoid conflicting and contradictory policy positions. The Committee, however, lacks a clear mandate and institutional home, seldom meets, and has yet to have a common position emerge from this process (Member of Parliament). These are issues faced by many other LMICs navigating the institutional complexities inherent to the governance of tobacco production and control (Lencucha, Magati, and Drope 2016).

Misinformation

An area central to tobacco control has long been the struggle over generating and interpreting evidence of the impacts of tobacco production and consumption on society. While the dangers of tobacco consumption are now widely known (although less so amongst tobacco users in LMICs such as Zambia), it is less clear what the health and economic impacts of tobacco production are on small scale farmers. Proponents of tobacco production present it as a viable economic development strategy and claim that it can contribute to social development and poverty reduction goals in Zambia:

“Tobacco is really important in terms of poverty reduction, as it were, in that tobacco is a lucrative or profitable crop. I mean, compared to other crops, tobacco is very profitable and usually it is being grown for household income” (Respondent from Tobacco Board of Zambia).

However, one of our respondents noted that small scale farmers are generally not aware of how much labour (in terms of hours) actually goes into producing tobacco leaf, especially since small scale farmers often rely on the labour of family members as cost-free inputs (insofar as direct payment, not opportunity cost) into the production process (Respondent from Zambian Agriculture Research Institute). This makes it difficult to question the dominant (and usually empirically unsupported) view of tobacco’s profitability. The importance of doing so rests partly on tobacco being one of the world’s most labour-intensive crops to grow (Makoka et al. 2016), increasing the demands on household labour contributions in poorer, small-scale farming communities. Efforts to capture and monetize this ‘free household labour’ component of tobacco production generally conclude that it is difficult for small scale farmers to generate any consistent profits from tobacco production (Appau, Drope, Witoelar, et al. 2019; Magati et al. 2019; Donald Makoka et al. 2017; World Bank 2017). Moreover, the provision of inputs on credit at the start of the season for farmers on contract with the leaf-buying companies may cause many of them to fall into a cycle of debt-dependence to these companies (Respondent from Ministry of Health), with the return that farmers can produce often below the cost of the credit they receive (Respondent from Ministry of Agriculture). This is partly because the monopsony or oligopsony power of the leaf buying companies that provide the input credits largely determines the price paid to farmers at the end of the season, closing the loop on farmers’ subordinate and dependent relationship, reproducing a market structure that disempowers farmers while ultimately enriching the multinational tobacco companies that control the overall global production chain (Member of Parliament).

3. Tobacco Lobbying and other Implementation Barriers

This section describes the impact of lobbying efforts on tobacco control policies from the perspective of our respondents. In light of farmers’ difficulties to make ends meet through planting tobacco, one respondent noted favourably a recent effort in Zambia to “push for alternative livelihoods and crop diversification for tobacco farmers” (Respondent from Ministry of Health). However, as another Ministry of Health employee disclosed, the “tobacco industry is currently accusing the Ministry of Health of pushing legislation that will stop tobacco growing and production”. Although the Ministry of Health was not actually doing so, the potential repercussions of such legislation on farmers’ livelihoods led to policy approaches incentivizing crop diversification away from tobacco leaf rather than pursuing a coercive, legislative path towards alternative livelihoods:

“The industry and farmers are questioning their future in the absence of tobacco. So to avoid these accusations, we [the Ministry of Health] want the issue of alternative livelihood to come as a policy and not legislation” (Respondent from Ministry of Health).

Respondents further noted that the draft 2018 Tobacco and Nicotine Products Control Bill does not include any reference to providing alternative livelihoods, since “we were advised by our legal team that alternative livelihood cannot be inserted in the legislation draft bill” (Respondent from Ministry of Health).

These policy decisions reflect the influence of tobacco interests relating to the third domain of inquiry, with one respondent describing how stakeholder consultations on new tobacco legislation have been dragged out: “These are big boys, so they can always lobby, they can always arm twist, they can delay things” (Member of Parliament). In this context, it is important to note that tobacco companies have been successfully fighting the legislative domestication of the FCTC in Zambia (Member of Parliament), originally to be implemented through the 2010 Tobacco Control Bill. However, this bill was repeatedly stalled over the course of almost a decade until it was finally redrafted in 2018 and reintroduced for legislative consideration. As of October 2020, however, the relevant ministries continue to debate the proposed legislation, with no parliamentary approval in sight.

The tobacco industry was allowed to attend the first two days of the Regulatory Impact Assessment (RIA) consultative meeting and demanded as a condition to participate that during the first two days of the meetings the Zambia Tobacco Control Consortium – the main Zambian tobacco control coalition – would not be present, a flagrant violation of FCTC Article. 5.3. While tobacco control actors were kept from participating in the meeting, the Zambia Chamber of Commerce and Industry (ZACCI) publicly declared that it would “…have the opportunity to comment on government’s plans in a very early stage” and on behalf of the major tobacco companies operating in the region, “influence plans in their favour” (Tobacco Tactics 2020, 1).

This pro-tobacco industry bias raises wider questions about the role of civil society in tobacco control. On the one hand, organized business interests within civil society were widely perceived as instrumental to, and effective in, undermining regulatory and legislative initiatives surrounding tobacco control, through the lobbying efforts described above. On the other hand, health-oriented civil society organizations (CSOs) were perceived by some respondents to represent a counter-balance to corporate interests in tobacco, spear-heading various media campaigns to raise awareness about the potential harm associated with tobacco production and consumption. As one representative from the Ministry of Health noted:

“Since we cannot attack the Government, we are now banking on civil society advocates that are against the tobacco industry to speak on our behalf. The more civil society protests, Government will be compelled to listen to their concerns” (Respondent from Ministry of Health).

As such, civil society is seen to play the role of a vibrant watchdog, increasing the pressure on the Zambian government to pay greater heed to health concerns in the context of both tobacco production and consumption (Respondent from Ministry of Health). A recent example of the former is the director of Zambia’s Tobacco-Free Association publicly rebuking Japan Tobacco International for paying Zambian tobacco farmers a fraction of what it pays tobacco farmers in Japan, exploiting and maintaining many tobacco farmers in health-compromising poverty (Quimz 2019). Despite such media efforts, Zambia lags behind in implementing new tobacco control measures and enforcing existing laws, including in the area of banning tobacco promotion, advertisement and sponsorship (Respondent from Ministry of Health).

Discussion

Political economy offers an entry point into analysing the complex relationship between the political and economic actors involved in tobacco production and control and can shed light on the underlying structures that determine the distribution of wealth and power and their contestation (Harris 2013; Reich 2019a). As such, it can support policy processes by assessing the political landscape, including through assessments of the power and position of key actors, as well as the feasibility of policy reform given existing actors and social-economic structures (Reich 2019b). In our discussion, we bring our main findings in conversation with the existing literature on the political economy aspects of tobacco production and control. This discussion aims to draw out key features of the political economy of tobacco that translate across contexts, while addressing the country-specific features of our findings in Zambia. Our results echo much of what has been found in published work, our key findings being that the narrative of tobacco’s benefit to the micro- and macro-economy is perpetuated by entrenched interests and taken up by government sectors working with misinformation and under a narrow framing. We also find a context with limited alternatives. This context is structured by a longstanding history of tobacco growing and an institutionalization of tobacco in government, as well as the broader structural conditions of the global economy, namely the push for export-oriented cash crops, the dwindling of government support for and privatization of supply chains, and the concentration of power among transnational corporations.

The presence of MNCs as important economic actors in LMICs has influenced the way in which the political processes and power relations in domestic policy environments operate, with particular repercussion for the role of corporate (MNC) lobbying against tobacco control measures (Smith and Lee 2018). Understanding tobacco control dynamics through studying lobbying efforts of big tobacco is, of course, not a new area of study in the tobacco control literature. Tobacco companies are some of the most politically active companies in the world and have poured billions of dollars globally into lobbying governments to counter and undermine regulatory processes, increasingly by globally coordinating their opposition to any novel tobacco regulation (Hawkins, Holden, and Mackinder 2019). Such lobbying by big tobacco has been well-documented in the global health literature (Lee, Ling, and Glantz 2012; Willemsen and Fooks 2019; Gilmore et al. 2015) but remains understudied in the context of LMICs.

In the case of Zambia, incentive conflicts between different government branches are widespread when it comes to tobacco control policy. Political economy analysis can help explain competing interests and associated conflicts among different government agencies, by highlighting the changing distribution of power and resources across government. Since the rise of neoliberalism in the 1980s, economic and finance ministries have strengthened their positions as the dominant location of power and policy development (Bieler and Morton 2004), and economic development goals often take on a narrow character to the exclusion of direct health and social considerations (Lencucha and Thow 2019; Meurs, Seidelmann, and Koutsoumpa 2019). This is based on the notion that growth leads to enhanced social welfare through greater employment opportunities and the diffuse trickle-down effect of rising personal income and increased social protection spending (Labonté and Ruckert 2019). As our findings confirmed, ministries with a mandate that mainly focuses on economic development and revenue generation are more likely to support the tobacco industry and see tobacco production as a viable development option for Zambia. Other social ministries are more likely to oppose tobacco for the detrimental health effects associated with its production and consumption, but persistently lack the political leverage within government to impose their views.

Intragovernmental conflicts also reflect legacies of institutionalized mandates that give preference to particular knowledge claims and can be based on (mis)information provided by the tobacco industry, the second area where political economy can make a substantial contribution (Bump and Reich 2013). Just as tobacco companies in the past attempted to hide the negative health impacts of smoking by funding studies that questioned the link between smoking and lung cancer (Petticrew and Lee 2011), they are today promoting inaccurate information about the role of tobacco production in economic development in LMICs, and the costs/benefits of tobacco production to small scale farmers. In the case of Zambia, farmers are rarely aware of the true input costs – typically excluding ‘free’ household labour from their calculations – and, as such, have imperfect information when making choices regarding what crops to farm. The political economy approach illustrates that the political and economic (interest-based) motivations behind knowledge claims surrounding tobacco’s impact and regulation are key to shaping government orientation to the crop.

The structural transformation of production relations is another area of political economy interest (Lee, Hawkins, and Wiist 2016). But macro-structural transformations are rarely studied in tobacco control. Our research unveiled deep structural transformations of production relations in Zambia, through the emergence of contract farming (Goma et al. 2019). Contractual relationships between tobacco farmers and leaf-buying companies provide inputs into tobacco production without upfront payment by growers which are deducted from the eventual sale of tobacco leaf. While nominally ensuring such sales at the end of the growing season, such contractual agreements are often broken by tobacco companies which may purchase less tobacco leaf than initially agreed upon. Such contractual relationships are rapidly becoming the norm in tobacco production and other cash crops in sub-Saharan Africa (SSA) (Mandhiza 2016), and are also growing in other LMICs (Niño Perez 2016), with contractual production of tobacco reported by 76% of Zambian tobacco farmers (Goma et al. 2019).

A political economy perspective illustrates how the changing power dynamics inherent to tobacco production, in general, and the introduction of contract farming, in particular affect power dynamics. The power imbalance is supported by the fact that government, by deferring to private companies to manage the supply chain for tobacco, facilitates the centralization of market power in the hands of a small number of tobacco leaf buyers (the monopsony or oligopsony referenced earlier in this article) that offer access to credit and farming inputs, especially fertilizers, while also having final authority over, or undue influence in, determining the quantity, quality, and total sale value of the product delivered by the farmer at the end of the season (Otañez, Mamudu, and Glantz 2007).

Finally, our findings further suggest political economy analysis can be insightful by highlighting how the neoliberal values that are deeply embedded within our global order “have suffused the discourse and institutions in tobacco-growing countries creating recurrent patterns of argumentation against tobacco control that transcend local contexts” (Lencucha and Thow 2019, 517). This normative embeddedness creates a policy environment that tends to prioritize commercial interests over public health goals and structures the institutional landscapes of governments around the world (Buse, Tanaka, and Hawkes 2017). The main counter-balance to this business discourse can be found within civil society. In the case of Zambia, non-governmental organizations were invoked by one Ministry of Health official as allies to raise policy issues that the Ministry of Health itself was not comfortable raising inside government.

Conclusion

This article presented a political economy analysis of empirical findings from a qualitative study of tobacco production and control in Zambia, focusing on the political and economic conditions that affect tobacco control and the development of agricultural alternatives to tobacco. Our analysis identified MNCs as active participants in the political economy of tobacco control in Zambia, through their effort to embed their own knowledge claims, ideas and interests through lobbying within the Zambian tobacco landscape. The existence of competing knowledge claims about the development and health impacts of tobacco are further mirrored in the incentive conflicts between competing government sectors, leading to the need for better intersectoral collaboration amongst tobacco control actors. On the structural side, we noted the importance of the emergence of contractual farming, and the attendant transformation of power relationships inherent to it. This structural transformation makes it much harder to promote alternative crops as it increases the dependence by tobacco farmers on MNCs and the inputs they provide into agricultural production.

To date political economy perspectives have mostly implicitly informed the governance for health literature and subsequently received limited attention from researchers and practitioners as a theoretical backdrop to tobacco control analysis (Participants at the Bellagio Workshop on Political Economy of Global Health 2015). However, a sensitivity to political economy deepens our understanding of policy contexts and explicitly highlights the role of political power and economic interests in tobacco control. In many LMICs, the slow progress toward control in some areas and the complete failure in others testifies to the power of these forces (Bump and Reich 2013). What is more, political economy analysis also has practical implications in that it can help devise effective strategies to promote policy adoption and implementation. In particular, implementing the FCTC at the national level will likely require political economy analysis to identify implementation barriers and facilitators.