Tobacco Use Management System: Analyzing

Tobacco Use Management System: Analyzing Tobacco Control From a Systems Perspective

In this article, the authors review the current system in place within the United States to control tobacco use. A systems thinking methodology is used to outline a framework that identifies the various subsystems of the existing tobacco use management system and to then analyze this system critically. The authors review the various subsystems, identifying systemic problems within the overall system and then provide reflections on how the system can be reformed to better meet the societal goals associated with tobacco use.

Tobacco use is a serious problem in many countries around the world. Nicotine in the form of cigarettes is the most harmful form of nicotine, yet it is also very addictive and the most desired form of nicotine. The use of cigarettes leads to a number of verified health problems, which consequently lead to enormous public health expenditures. Yet government systems have been reluctant to place restrictions on the tobacco industry that would sufficiently curtail the levels of tobacco use within the population due to the economic pressures such restrictions would create. Societal values need to be balanced in any system of control, including the tobacco management system, which results in placing health values head to head with economic values.

The authors break down the Tobacco Management System into three subsystems, operating under two suprasystems. The subsystems identified are the Tobacco Industry, the Tobacco Use Control Subsystem and the Regulatory Subsystem. These subsystems operate under the greater overarching suprasystems which are also often times found in opposition to one another: the public health system and the economic system.

The tobacco industry is a large, profitable industry that markets nicotine products to consumers. In the past this industry has often pushed for a free-market approach to regulating tobacco use, arguing that the consumer has the right to his or her own free will, and can determine their own purchasing choices. This approach would see little governmental interference in how the industry markets its products or what products the industry manufactures. Recent decades have not allowed this approach to continue, and now the tobacco industry faces restraints on how and to whom they can market their products. Overall the tobacco industry must decide whether or not to continue fighting regulatory systems, or whether they would be better served by working with the other subsystems to develop creative solutions to the situation that both satisfy the public health needs as well as their own economic needs. One area in which this can be accomplished is the manufacturing of tobacco use cessation products or of less harmful forms of nicotine products.

The Tobacco Use Control Subsystem has often been seen as being at a disadvantage due to its less centralized organization. This system consists of the various groups and organizations aimed at controlling and minimizing tobacco use. This includes companies that create cessation products as well as organizations that promote public health education. Within this subsystem there exists a debate between harm reduction goals and zero tolerance goals, and this debate weakens the subsystem's overall strength and ability to influence the other subsystems. Overtime however, this subsytem has been growing in its power and wealth, leading to its increased ability to work within the overall system of tobacco management.

The regulatory system consists of the government's role in the management system and the extent to which it interferes in the regulation of tobacco use and control. The authors point out that the issue of tobacco use is not a simple problem, it is a complex problem and as such cannot be solved with a simple solution, even though simple solutions may seem tempting. 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 or materially. 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.