For example, one approach to regulation would be to outlaw tobacco use entirely, but this action would have serious consequences that the government may not be able to accept. Thus the government must walk a precarious line within its role in the system, cautious of setting precedents that could be harmful in other areas of governing, yet still acting in the interest of the public.
The authors identified five systemic problems that exist within the current tobacco management system:
1) Tobacco is marketed with the goal of making a profit, by for-profit tobacco industry companies, and this is at odds with the goals of the public health sector related to reducing the use of tobacco products.
2) the Tobacco Use Control subsystem is limited in its abilities to create and provide cessation products and prevention services, and lacks a dynamic capacity in addressing these issues
3) This same subsystem is split between harm reduction and use reduction
4) the regulatory system is rudimentary and not dynamic
5) the suprasystems control the subsystems, but have little interest in the actual issue (public health vs. economic systems -- they have other concerns).
The authors conclude that the current tobacco use management system is in need of reform and suggest that the regulatory subsystem be strengthened by exercising greater control over tobacco products and constraints, thereby creating change in how the tobacco industry is operated. Furthermore, the control subsystem needs to be more centralized in its organization so that it can be strengthened and focused in its efforts. Specific reform is suggested in areas of marketing and manufacturing practices that make harmful nicotine products more appealing, either psychologically...
For example, the authors suggest that flavored tobacco products be placed under greater restrictions by the regulatory subsystem. The overall analysis by the authors suggests that the place for change is within the industry itself as well as the control subsystem, as the government appears to be, and will likely remain, reluctant in becoming too involved. While they do not see this as ideal, if it cannot be changed, change can be sought elsewhere.
The authors' approach is thorough and well organized, providing a succinct framework in which to investigate the important issues that are currently creating stalemates within the tobacco management system. By analyzing the overall system with respect to its separate parts, detailing the important elements of each subsystem, and discussing the challenges and overall systemic problems involved in each subsystem, the authors have highlighted areas in which the system can be reformed. Although the authors have made useful suggestions, and presented a cohesive framework from which this problem can be investigated, their presentation of the material could be improved. The initial introductory section is poorly conceived and does not provide a clear or concise thesis statement. The most useful and well written section of the paper comes at the end when the authors discuss reforms, but part of this section would have been useful if repeated or placed at the beginning of the article in order to give the reader a greater understanding of what the paper was tackling and where it was headed with its analysis.
References
Borland, R., Young, D., Coghill, K., & Ying Zhang, J. (2010). The tobacco use management system: Analyzing tobacco control from a systems perspective. American Journal of Public Health, 100, 1229-1236.
