Playing the Multilevel Game: Successful Tobacco Control Advocacy Strategies in a Federal System

Tobacco control provides a good case study for public health advocacy. A wide range of conflicting interests is structured around this issue: public health interests on the one hand (second-hand smoke protection, rising health costs, and youth protection) and economic interest on the other hand (tobacco industry, restaurants, and advertisement industry). This chapter analyzes tobacco control advocacy in federal Switzerland, a country known for its particularly weak regulation on the matter. The study focuses on advocacy activities aimed at advancing the agenda on the smoking ban, advertisement restrictions, and the ban on tobacco sales to minors. We underline that structural protection is difficult to achieve because economic lobbies are well organized at the national level. However, in a federal system, the subnational government units are able to advocate for tobacco control regulations from the bottom. We found that the Swiss cantons successfully used three types of advocacy strategies. Infra-political advocacy includes nonregulatory actions aimed at setting up structural protections at the local level, on a voluntary basis and in consensual settings (i.e., playgrounds, sports areas), in the perspective of a future regulatory change. Political advocacy directly intends to change the regulation through strategical actions within the political game. Finally, para-political advocacy aims at enhancing tobacco control by improving the actual enforcement of existing regulation. This typology shows the interplay and synergy between these different advocacy types, which go beyond the classical idea of advocacy as a voicing activity limited to the political arenas.