Global public policy: does the new venue for transnational tobacco control challenge the old way of doing things?

The World Health Organization has fostered a new global public policy – the Framework Convention for Tobacco Control (FCTC). Until the 1980s, tobacco control was the sole preserve of states. Now, most countries accept the transnational nature of policy. We explain this shift by identifying mutually reinforcing changes in key policy process elements: transnational actors became a source of policy learning; an international venue ‘institutionalized’ new policies; networks began to include tobacco control groups and exclude tobacco companies; socioeconomic shifts undermined public support, and the economic case, for tobacco; and the dissemination of scientific evidence helped actors reframe the image of tobacco, from an economic good to a health crisis. These elements combined to produce an environment conducive to ‘comprehensive’ tobacco control. Yet the implementation of the FCTC has been slow and uneven, reflecting the continued importance of domestic policy environments, most of which are not conducive to major policy change.