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Article Excerpt
"Smoking represents the most extensively documented cause of disease ever investigated in the history of biomedical research." U.S. Surgeon General's Report, 1990.
"I'll tell you why I like the cigarette business. It costs a penny to make. Sell it for a dollar. It's addictive and there's fantastic brand loyalty." Warren Buffett, U.S. investor.
"Parents exposing their children to second-hand smoke is the most common form of child abuse in America." John Banzhaf III, antitobacco activist, Time, October 25, 1993.
Introduction
Explaining tobacco control policy is not easy. In a brief comparative study, Wilensky (2002) argues that decentralized "moral populist" countries such as the United States, United Kingdom, Canada, Australia, and New Zealand not only have developed some of the most restrictive policies on tobacco consumption but also have managed to enforce these policies to a greater degree than other countries. More generally, these same five countries are more likely to have morality policy issues on the political agenda (Studlar, 2001). In contrast, Marmor and Lieberman's (2004) study of comparative tobacco control policy finds that greater restrictiveness in Anglo-American countries occurs because of decentralist features of the political structure, which allow antitobacco social movements and interest groups to find some venues to push their agenda. These contrasting arguments raise the issue of whether tobacco control policy is closely tied to morality concerns.
Through a systematic historical analysis, this paper examines whether tobacco control policy in the United States can be considered morality policy. The nature of morality policy as a distinct policy arena is examined, and tobacco control in the United States is evaluated for its fit with those characteristics. Moral concerns have been a part of tobacco control policy at certain times, first at the turn of the twentieth century, and, more recently, since the mid-1980s, and accelerating in the mid-1990s with the rise of "denormalization" of the tobacco industry as a goal of some U.S. states and antitobacco organizations. Despite the prominence of some moral concerns, especially from passionate antitobacco campaigners, the economics and associated political influence of a highly profitable industry and concerns over public health are also involved in the debate over the issue. For some actors it is mainly a "political economy" policy, for others one of public health regulation (Cairney, 2007).
This paper investigates the question of whether tobacco control in the United States can be considered morality policy. Following other recent studies of issues sometimes considered to be morality policy, it argues that tobacco control is a "blended" issue, one that can take on economic and public health, as well as morality dimensions, depending on successful agenda setting and framing by interest groups. The priorities of different dimensions of an issue can change over time because of an emphasis on different dimensions. This can occur through new information, as well as the search for easily understood themes by those challenging established power relationships, such as those between the government and the tobacco industry network (manufacturers, growers, vendors, advertisers, and the hospitality sector).
In policy debates in the United States, scientific information is rarely enough by itself to be persuasive; it often has to be supplemented by a social movement persistently willing to advocate different policies through changing the framing of the issue in the media, the public, and the minds of political figures. This has been the case with antitobacco advocacy in the United States, which emerged slowly but was well established by the 1980s, leading to increased challenges to the political dominance of protobacco interests and some policy changes (Baumgartner & Jones, 1993; Nathanson, 1999, 2005). In challenging a vested interest, moral concerns may become especially important as readily understood public appeals for group mobilization. Baumgartner and Jones (1993) indicate that a change in attention to policy, as well as the framing of policy (what they call "tone"), can lead eventually to changes in outcomes on major policy issues. This suggests that as the scope of participants on an issue expands or shrinks, the nature of the policy type may become less distinct.
Policy Typologies, Morality Policy, and Tobacco Control
The problem of "what kind of policy is this?" is a key question to answer because it can help observers understand how tobacco control policy is processed, the nature of the contending forces and their arguments, and what outcomes are likely to occur. The most famous policy classification beyond nominal ones is Lowi's (1964) trichotomous formulation of distribution/regulation/redistribution. Distribution is the politics of logrolling among cooperative interests, largely out of the public eye. Regulation involves more contending interests and has greater public visibility but is focused on practices in particular economic sectors. Redistribution is concerned with major changes in social and economic power, highly visible and contentious. Ideally, antitobacco groups would like to make tobacco control into a redistributive issue to enhance government regulation to the point where the tobacco manufacturing industry would its have profitability greatly reduced or even abolished. Thus far, they have managed to achieve a redefinition of the issue into a regulatory one with both public health and political economy dimensions as well as possibly morality ones.
This schema has often been discussed and reformulated by Lowi himself (Lowi, 1998) as well as by others (Smith, 1975; Tatalovich & Daynes, 1988, 1998). Nevertheless, tobacco control, or indeed any other public health issue, has never figured prominently in these studies. Although tobacco control policy has been examined in U.S.-based agenda-setting studies (Baumgartner & Jones, 1993; Givel, 2006b; Worsham, 2006), these have not systematically attempted to place tobacco control in policy categories other than political economy and public health. Baumgartner and Jones (1993) suggest that before the 1960s, tobacco policy in the United States was largely noncontroversial and distributive. There was little public attention to the issue, and tobacco politics largely involved policies of agricultural subsidies. As the participants and arguments in this policy arena have broadened, the issue has become more publicly contentious and regulatory. This confirms Lowi's (1964) suggestion that the nature of policies can change over time. Studlar (2002, p. 264) finds that the placement of this issue in a policy typology is "mixed and problematic" because of policy legacies and lack of coordination among government institutions, some of which continue to subsidize tobacco at the same time others are restricting it. For instance, promotional activities for tobacco manufacturers, especially in opening markets in developing countries such as China, have continued through the U.S. Special Trade Representative, even as more restrictions have been placed on tobacco domestically in the United States.
Independently, one of the major developments of Lowi's original formulation has been the category of "morality policy" (also called "emotive symbolic politics" and "social regulatory policy") as a distinct policy type because of its content and characteristic policy processes. As developed by Smith (1975), Tatalovich and Daynes (1988, 1998), Mooney (2001), and Smith and Tatalovich (2003), morality policy involves issues not amenable to a purely materialistic conception of interests. The most characteristic features of morality policy are (1) a basic conflict of moral values on at least one side of the issue, (2) high saliency, (3) technical simplicity, (4) high public participation, and (5) lack of compromise (Meier & McFarlane, 1993; Mooney & Schuldt, 2008; Roh & Berry, 2008; Wald, Button, & Rienzo, 2001).
In an investigation using the Lowi-derived framework, Smith and Tatalovich (2003) find morality policy outcomes problematic rather than deterministic. Although a developing postmaterial culture may generate a few outcomes according to majoritarian sentiments, in most cases, despite the popular interest in these issues, political elites in executive, legislature, and/or judiciary impose their own values over the majority's wishes in morality policy. They argue that overall morality policy is a combination of redistribution (divisive issues that are elite decided) and regulation. Such issues are likely to be highly visible in the United States because of its federal and pluralistic institutional structure.
Among the issues which have been cited as examples of morality policies in the United States are abortion, alcohol, illicit drugs, capital punishment, gambling, sexual behavior, fluoridation, gun control, treatment of ethnic, racial, and sexual minorities, the role of religion in education, euthanasia, and various questions of censorship, ranging from pornography to sex education. In short, although there are some variations among jurisdictions, these are issues of life, death, sexual practices, religion, addictive substances and practices, and intergroup relations (Studlar, 2001). Alcohol, sex education and behavior, illicit drugs, fluoridation, and even gun control might be considered public health issues, but this is not the only basis for discussion. In fact, some politically active groups contend that individual choice or religious codes should prevail over public health concerns on these issues.
Tobacco control is often combined with alcohol and gambling into a category of "sin" policies that have moved from legal prohibition to activities that are heavily taxed...
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