A public policy analysis with key stakeholders’ insights to understand India’s compliance with the WHO framework convention on tobacco control

BACKGROUND: Tobacco-related morbidity and mortality is a global public health challenge. India is the second largest consumer of tobacco in the world. The present paper synthesises the data from qualitative interviews of experts working in the field of tobacco control alongside a critical analysis of the national tobacco control policy of India. METHODS: The research methods adopted for the present work included the following: 1) qualitative in-depth interview of experts and analysis of the qualitative data using thematic analysis; 2) searching existing literature and secondary data on the national tobacco policy and analysing the same using the methodological orientation of qualitative content analysis; and 3) health policy analysis of the national tobacco policy. Themes and sub-themes obtained from the two approaches were compared to generate meaning. RESULTS: Nine experts (three women and six men) participated in the in-depth qualitative interviews from a variety of professional backgrounds (preventive oncology researcher, tobacco cessation specialist, public health expert, clinicians and human rights activists). The systematic and comprehensive literature search resulted in finding 14 research papers, reviews, policy documents and commentaries on the tobacco epidemic in India. The various themes that emerged from the qualitative interviews that found support from secondary data as well were: ‘Conflicting policies of Government: Promoting tobacco production and at the same time restricting its use’, ‘Failure to shield from influence of tobacco industry’, ‘Demand reduction proposals through taxation and pricing’, ‘Legislation to protect from and reduce the harm of second-hand smoking’, ‘Health warning on packaging and labelling of tobacco products’, ‘Promotion and advertisement of tobacco products’, ‘Prohibiting production by and sale to minors’. DISCUSSION: The control of a tobacco epidemic has multiple structural and functional challenges embedded in the complexity of the public–private interfaces, socio-economic forces, conflicting interests of the stakeholders and diverse nature of the problem. Any intervention planned to reduce the tobacco usage at a population level needs to take these factors into consideration.