The Perfect Storm: Applying the Multiple Streams Framework to Understand the Adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico

Abstract

Background: The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law.

Methods: We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings.

Results: Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed.

Conclusions: The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.

Keywords: Mexico; health advocacy; health policy; tobacco control; tobacco industry.

Figure 1

Community support and triggering conversations on social networks (May 2021–December 2021). Left side caption: Every year 9 thousand people die in Mexico from cigarette smoke and they have never tried it: Yes to having 100% smoke-free environments throughout Mexico. It’s For Everyone: Yes to the reform of the tobacco control law. Right side caption: Flavored cigarettes attract children and young people. Without the law, with the law. Yes to removing flavorings and additives. It’s For All: Yes to the reform of the tobacco control law.

Figure 2

The campaign produced powerful images, rich infographics, and captivating messages focused on youth that were employed in various media platforms including newspapers, radio, television, billboards, subway stations, buses, and social media.

Figure 3

Tagging policymakers on Twitter and posting social media graphics with their faces asking them what side they were on (public health or with industry), and distributing personalized boxes with pictures of their faces. Caption: Yes to having 100% smoke-free environments. Yes to having zero cigarette advertising. Manuel Añorve Baños, Senator for the Institutional Revolutionary Party. Which side are you on? It’s For Everyone: Yes to the reform of the law for tobacco control.