Organizations (NGOs) have a policy dominance in tobacco control, NGO communities are well developed and have tight links to government while the industry is largely economically absent. In addition, the health ministry plays a central role in the policymaking process, FCTC Article 5.3. is strictly interpreted and the framing of tobacco focuses on the health aspects of smoking. In contrast, in countries where the tobacco industry and associated businesses have a policy dominance, the industry is more strongly embedded in the domestic economy while NGO communities are weak or absent in the field of tobacco control. In these countries, the health ministry plays a subordinate role in the policymaking process, FCTC’s article 5.3. is only interpreted in terms of transparency and tobacco is framed as a private problem. They concluded that the way tobacco is framed in a country and the way institutions are arranged correspond to the policy monopoly in place, with strong similarities across countries with the same policy monopoly. Despite an active community of health NGOs in the Netherlands, the political agenda of the current ruling party often objects to the introduction of strict tobacco control regulations. Since tobacco control has not been a priority, the response to policymaking has been stagnant and uncoordinated. Amersfoort relevant recommendations: Put in place an endgame goal, building on the (moderate) gains achieved to date. SILNE-R data show that governments that have embraced endgame goals have committed themselves to ending smoking altogether and that a set endgame goal likely facilitates the adoption of measures in order to achieve this goal. The most progressive SILNE-R countries (Finland and Ireland) both have governments that have translated endgame goals to policy. A strict interpretation of FCTC article 5.3 among all ministries is required. Provide better support for the NGO community in the Netherlands to create strong networks at national and international levels so that they can actively try to influence policymakers and politicians to ensure them to use article 5.3 as much as possible. Costs and cost effectiveness of various TC policies As regards the current landscape of tobacco control policies and their costs in 7
Policy development processes ~ a case study of The Netherlands WP4 reported on findings, summarised here, from 13 in-depth interviews with staff in 4 schools in the Netherlands, and explored why secondary schools choose not to make school hours a smoke-free time for all students. Adolescents smoking outside the school premises is a commonly reported side-effect of STPs and schools in some countries do not allow adolescents to leave the school premises during school hours. This practice is associated with less smoking. To understand why schools in the Netherlands do not adopt such a policy when they have the authority to do so, WP4 applied the Advocacy Coalition Framework to their analyses of data from teacher interviews. None of the schools prohibited all adolescents from leaving the school premises. The Advocacy Coalition Framework (ACF) is a theory used to explain policymaking processes and is discussed in some detail in WP3's Report D3.1. In brief, ACF posits that the likelihood of stakeholders using their power to adopt new and adapt existing policies depends largely on their belief systems. Belief systems operate at three levels. Deep core beliefs are based on fundamental values in society. Policy core beliefs are based on perceptions of the problem, solution (e.g., expected impact) and the capacity, power and credibility of those responsible for advocating for the change. Secondary beliefs are based on the (context-specific) feasibility of actually implementing the policy in question. Analyses of teacher interview data identified 2 Deep core beliefs, 3 Policy core beliefs, and 1 Secondary belief expressed by staff members. The first Deep core belief expressed by staff members was that they believed that schools should guide older adolescents to make responsible use of their autonomy. Implicit in this belief was that "younger" adolescents need protection and that "older" adolescents need to learn to make independent choices. This included preparing for the "real world" in which smoking is a choice. Nevertheless, staff believed that schools should "demotivate" students regarding smoking. The second Deep core belief expressed was that staff members believe that schools should intervene when adolescents bother others. Implicit in this belief is that