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This case study’s main aim is an in-depth analysis of the tactics and resistance of tobacco companies in the United States against public policy on health, focusing on the period between the 1950s and 2000. Tobacco companies executed a half century long manipulation via mass media and false scientific reports, while causing addiction and the death of millions of people. The policy process on health will be examined, mainly looking at decades, while the decision-making and political agenda of this issue was controlled by cigarette companies. For the purposes of this case study, structuralist theory will be scrutinized and applied to explain the policy process. It will refer to Steven Lukes’ work, which accounted for the structurally embedded nature of power in political processes. The theory will explain the dominance of business, while looking at latent class conflicts and the relationship between economic and political power.
The structuralist perspective of the policy process is often described as Marxist theory, as it stresses the economic determinism and the latent class conflicts. Latent class conflict exists when there would be a conflict of wants between those exercising power and those subject to it, if the subjects become aware of their interests. It refers to the fact that frequently, subjects of power are not aware of their preferences, as they are affected by power-holders in a way which is contrary to their interests. This is described as thought control and its main forum is the mass media. Mass media is proven to affect the public opinion agenda and often portrayed as a powerful agenda setter, including governmental policy agendas. Using the media’s power, influencers are able to conduct attention and create the desired ideology, which helps them to prevent or put topics on political agendas. It indicates that power is not equally spread but accumulated between a smaller numbers of powerful actors, who are able to marginalize the interests of excluded groups, such as the mass population. This social structure of capitalist society is described in the classical Marxist theory as two confronted classes: the bourgeoisie, who are the owners of the means of production and the proletariat, who work for the bourgeoisie. Hence, the theory emphasizes that business has a structurally dominant role in the policy process. This domination originates from the fact that big corporations perform economic functions for the whole society; they provide employment for numerous people and contribute highly to the country’s GDP. Therefore, business plays a prominent and powerful role in the overall scope of policy making, using their power and capital accumulation as a means to influence the policy process to their advantage. The strong relationship between economic power and political power can be observed while examining the role of government as well. The Marxist position suggests that the capitalist state is an executive committee of the bourgeoisie, or in other words, agent of powerful groups. The state’s main function is to assist the process of capital accumulation, by providing conditions in which capitalists are able to promote the production of profit. Also, the government acts to maintain order and control within society but in the first place, it serves the long-term interests of the capitalist class. It suggests that political choices are pre-ordained to provide beneficial outcomes for elites, whose preferences prevail in conflicts over political issues.
The previously mentioned points of structuralist theory will be used later on in the case study, when reviewing the policy process and explaining it, by relating elements of the structuralist perspective back to the policy process. The key arguments of the review will include the explanation of how latent class conflict was present in the case of tobacco companies and the public in the US. Also, the ways these corporations executed thought control and manipulated mass population to act against their real interests will be addressed. The understanding of the social structure of society as dominant and subordinate groups will present evidence for the unequally spread power. Importantly, the structurally dominant role of business will be presented throughout the case study, while emphasizing the marginalized interests of subordinate groups and the dominant role of vested interests. The role of government will also be analysed, looking at its non-intervention for more than half a century, which provided tobacco companies with the advantageous conditions in which they could continue the accumulation of profit. Finally, the evaluation of the policy process outcome will back up the structuralist notion’s argument; that political choices are predetermined.
Tobacco is a major health hazard and an important economic commodity. Its latter feature led to the ignorance of harm caused by cigarettes for decades by the manufacturers and in fact, the US government as well. This part of the case study will analyze the process of the policy on health in the US from the 1950s until 2000. The central actors of the policy process are tobacco manufacturers, the US government, scientists, the mass media and the most numerous but most oppressed group, the public. Tobacco companies and the public had extremely opposed interests, as even though tobacco has been proven to be harmful for health since the early days of manufacturing, citizens were not aware of it due to the diversified manipulation, and the consumption over time led to addiction. In the early 1950s cigarette sales dropped owing to health concerns but the tobacco industry made reassuring steps; it paid to publish the “Frank Statement to Cigarette Smokers” in hundreds of newspapers in the US. This statement was the first step in a half-century-long campaign to mislead the American public about the damaging effects of smoking. Even though, the harmful effects of tobacco on health was understood by the industry from the early days of manufacturing, the industry engaged in a vigorous effort to silence critics, distort science, influence public opinion and coordinate their strategy to avoid public policy that might damage sales. Interestingly, the US government did not conduct its own scientific research on the issue, when it first became a concern in the early 1950s, just accepted the declarations of manufacturers. It isquestionablewhether the government’s interest was the health of its citizens or the generated capital from selling cigarettes. The ‘Frank Statement’ declared that the public’s health was the industry’s concern above all others and promised a variety of good-faith changes. These changes were used to open up new markets and affect more people. The industry introduced new cigarettes, that were presented as safer, giving health-conscious smokers an alternative to quitting. These new cigarettes were filtered and flavoured and were advertised with the explicit message that filters removed dangerous substances, while preserving flavor It was marketed aggressively, however, the advertisements were false. Tobacco industry chemists were aware that filters did not removed tar or nicotine, yet added another dangerous substance: the asbestos in the filter, but thisinformation was prohibited by the industry. It was not only direct advertisements that modified the interests of people, the tobacco industry’s multimillion dollar advertising budget allowed commercial collaboration with major motion picture studios in Hollywood. Smoking in movies was associated with adolescent and young adults’ smoking initiation and sales increased. Therefore, between 1970 and the mid-1990s, public health experts called for the film industry to eliminate smoking from future movies accessible to youth, however the industry resisted, arguing that tobacco imagery was integral to the artistry of American film. Public health experts could achieve minimal success; tobacco remained a prominent part of the movies.
The media was not the only instrument to influence public opinion and avoid public policy. Economic power is an important source of political power, as it allows the purchase of expertise to generate information instrumental in the policy process and liaison agents to transmit this information to the relevant policy makers. The tobacco companies acted accordingly; after the 1954 ‘Frank Statement’ manufacturers declared their determination to cooperate closely with those who were working to protect public health. In fact, manufacturers turned this to their advantage and adopted voluntary codes and pre-emptive legislation. The industry assertedself-regulation rather than government legislation and the government approved. The industry purchased scientific records that stated a less harmful nature of smoking than it actually was and the self-regulation was ineffective in terms of providing true information to consumers. However, the industry lobbied for pre-emptive legislation and acquiesced in the introduction of warning labels on cigarette packets in the 1970s. It was a consent decision from the industry, as the labels warned of the risks involved in smoking, thus smokers could be said to consent to damaging their own health if any harm occurs; it was a protection against lawsuits. Opening international markets through trade sanctions with governmental intervention could also be observed. Tobacco companies in the US pressured Japan and other countries in the Western Pacific Region to remove trade barriers to foreign cigarette imports and the state intervention occurred in 1986. The US government made successful measures with international trade in order to remove the tariffs and other restrictions on foreign cigarettes. This represents the cooperation between government and business, emphasising the vested interest of the government. Governmental cooperation was dominant, as agents of the industry occupied several positions amongst state decision-makers. The government gave veto power to the tobacco industry over the membership of the advisory committee that eventually produced the general reports on smoking and health, including the first surgeon general’s report in 1964, which found to be a manipulated consensus. Tobacco manufacturers employed support from some of the most prestigious law firms as well and commanded the allegiance of a significant section of the Congress. In terms of policy making, there were not meaningful policies produced by the government, presenting the cooperation of industry and state and the domination of vested interests. In 1999 the WHO proceeded with the Framework Convention on Tobacco Control (FCTC), that had an impact on tobacco use in the US as well. The FCTC considered challenging the industry’s freedom to continue doing business and promoted anti-smoking measurements. In the US, tobacco control policies were presented after 1995, that included increased cigarette excise tax, that led to increased cigarette prices and discouraged those who were sensitive to this. Restrictions on smoking in public places and private worksites were introduced and by 2000, it was clearly set for people that cigarette consumption was harmful for their health. The industry did not take responsibility due to the consistently developed playbook that directed the behaviourof industry executives, lawyers, scientists and government officials friendly to the industry. It presented itself as a source of revenue, supplier of jobs, patron of the arts and sport, defender of freedom and provider of pleasure. Even though cigarette sales had decreased since the introduction of public policies, the company could develop a multibillion dollar business during the unregulated decades. Many consumers became addicted and smoking still affects millions of people.
This section of the case study will contemplate whether the previously discussed structuralist theory can explain the events of the tobacco case. It is worth recalling that the most dominant sections of the concept were the latent class conflict, which originates from the classical Marxist theory, and economic determinism. The latent class conflict was explained as two classes, which, in the present case are the tobacco manufacturers and the American public, who are conflicting due to their differing interests. The word ‘latent’ refers to the phenomena, that even though there is no confrontation between classes, it does not account for their similar interest but simply for the fact that those who are subjects to power are not aware of their interest. In the case of tobacco manufacturing, this perception is relevant, as the cigarette industry was manipulating their consumers by developing media campaigns and heavily marketing their message overdecades.This was based on a false or manipulated consensus and the direction of public attention towards ideological values of smoking, while suppressing their fear of health issues. The huge marketing campaign after the introduction of new cigarette products with filters is a significant example of it. The filtered cigarettes were described as safe and were marketed aggressively attention paid to gender division; producing advertisements intended for men and women separately, acquiring consumption from both sexes. Smoking was associated with admired features, such as athletic prowess, sexual attractiveness, professional success, self-fulfillment or adult sophistication; all of them were a feature that people wanted to achieve, increasing their desire to smoke and suppressing their fear of health damage. The theory explains that the result of this way of advertising was to make consumers unaware of their real interest.
The structuralist perception stresses the dominant role of business, which is comparable to the examined policy process on health, notably the businessinfluence to prevent tobacco emerging as a political issue and to avoid public policies that were damaging for their main aim; to maximize sales. Business not only had a structurally dominant role in agenda setting, it could have been detected when tobacco companies were exercising their power over half a century to prevent public policies, but they were dominant through the whole public policy process. The analysis of the policy process included that agents of manufacturers held offices in governmental decision-making bodies, even possessed veto power over the membership of the advisory committee, which was beneficial for them to shape public opinion and influence future public policies. Examining the role of business, the statement of structuralist theory, that power is very unequally spread can be proved, as business subordinated nearly all of the main actors of the policy process. Using their economic resources, they could manipulate scientists to produce documents in their interest. However, the weakness of the structuralist model is the difficulty to measure the actors’ real interests. In terms of scientists, rational thinking suggests that their main aim is to produce scientific records and conduct scientific research, which provide accurate and true information. In this case, where researchers contributed to providinga manipulated consensus, it might propose an ego-centric view, that they as well put vested interests in first place. Therefore, the theory adopts a condescending view of humans, that everyone can be bought and capitalist interests are privileged over morality as well. At the same time, the interest of business can be easily detected; it is to maximalise sales and make the biggest profit possible; contrary to the mass population, who without thought control, would have avoided health degradation. That position of the sate in the structuralist theory stresses that the state is an agent of powerful groups and its main function was described as the assistance in providing the conditions of wealth accumulation. Looking at the tobacco case, the theory arguably explains the process. The government itself contained the agents of manufacturers, who represented their interests’ in agenda setting and at decision-making as well. Also, the performance of the state throughout many decades, while there were several rumors about the hazardous nature of cigarettes the state did not take strict measurements to detect the case but allowed self-regulation within thecompanies, which presented one-sided information. Therefore, the statement that the state’s main focus is to provide beneficial conditions to elites meets precisely the described lack of state regulation towards tobacco companies. The state provided them the chance to develop amulti billion dollar business, from which the government also got its share, not only financially but several corporations provided employment and contributed to the GDP growth. The last noted description of the concept is the statement that the outcome of the policy process is pre-ordained. The outcome of the policy benefits those whose preferences prevailed during the policy process, and it is noteworthy that business benefited the most from the process. Although, there were several minor policies, overall the tobacco manufacturers achieved their aim to accumulate an enormous amount of wealth, that was beneficial for the government’s finance as well, while the health of the American public paid a high price for the dominating vested interests. Overall, structuralist theory competently explained the events during the whole process. The main points of the theory were connected to actual events and allowed better understanding of the policy process.
To conclude, the case study’s main aim was to examine the public policy on health in the US, which was produced as an answer for the health issues caused by cigarette consumption. The case study introduced the main points of the structuralist theory and then, examined the policy process from the non-decision making until the implementation of policies with the aim to reduce the consumption. By analysing the events through the lense of the structuralist theory, it gave better understanding of the motivations of different actors throughout the process. The strengths of explaining events using political theory were numerous and provided better understanding and in-depth analysis of the process. Using the theory, the interests of the actors were highlighted, however, the real interests of every actor could not be precisely described. Other weakness of the framework was the difficulty to declare the generating forces of actions, as using only an elitist view to explain events can provide a condescending view of humans. However, the detailed analysis is very dominant, as compared to quantitative studies, the focus can be narrow, hence it does not generate general description but provides more accurate information of the chosen topic. Another strength of comparing theory and policy process is the advantage that the issue can be addressed both theoretically and practically; hence it providesmore detailed information and keeps all of the elements of the process examined through focusing on them from two different perspectives.
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