UC Santa Cruz

This dissertation investigates the rising authority of non-state actors vis-à-vis the state by examining how tobacco companies are using trade agreements to constrain governments from implementing progressive public health policies that require placing pictorial health warning labels (HWLs) on cigarette packages. In particular, the dissertation seeks to address two different but related puzzles. First, despite being developed countries and global health leaders, it is unclear why Australia has implemented strong HWLs on cigarette packages while New Zealand has delayed its HWL proposal. Second, it is unknown why Uruguay, a developing country, has implemented strong HWLs while New Zealand, a developed country, has delayed its proposal. Informed by archival research of previously secret tobacco industry documents, interviews conducted with policymakers and health advocates closely involved in the policymaking process, and applying a most-similar and most-different systems design, this research demonstrates that tobacco industry trade threats are causing a chilling effect by delaying strong HWLs in New Zealand, but not in Australia and Uruguay and that the key factor in determining the implementation of strong HWLs lies in the governments’ reception to these trade threats. The findings suggest that leftist governments, continued bureaucratic leadership and capacity in the Health Ministry, and independent and confident tobacco control and trade advocacy are necessary conditions in explaining how governments can shape the reception of tobacco industry trade threats and properly implement progressive HWL policies without being weakened or delayed.

Given the limitations of using existing trade agreements to globally preempt strong HWLs in Australia and Uruguay, this analysis also examines the evolving nature of global trade and health governance to demonstrate how tobacco companies are aggressively attempting to shape the pending Trans-Pacific Partnership Agreement (TPP) to further distance decision-making authority away from governments. These efforts have succeeded in securing trade mechanisms, including trade promotion authority, aimed at eliminating the policy space for health advocates to lobby for public health exemptions in trade agreements, but have failed to secure the investor-state dispute settlement (ISDS) mechanism in the TPP to directly challenge tobacco control policies in TPP member states. The results of this research will assist governments to properly implement strong HWLs without being weakened or delayed, which will dramatically help reduce smoking initiation and cessation rates, lower government health expenditures and tobacco industry profits, and help accelerate the global diffusion of strong HWLs. These results also have important implications for future regulations of alcohol, food, and medicine, which are increasingly being targeted through trade agreements.