Abstract:

This study analyses the development of a tobacco-control agenda in Brazil following the country’s participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.

Keywords:
National Program of Tobacco Control; National Tobacco Use Control Commission; Smoke-Free Policy; Public Health Policy

Introduction

Between the early 1990s and the first years of the 21^st century, the prevalence of smoking decreased 35% on average in Brazil, dropping from 34.8% to a countrywide average of 22.4% ¹1. Monteiro CA, Cavalcante TM, Moura EC, Claro RM, Szwarcwald CL. Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003). Bull World Health Org 2007; 85:527-34.. This fall was particularly related to strong action of healthcare-related players in prevention programs and the establishment of a tobacco restrictive legislation ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300..

This process allowed that, when the World Health Organization (WHO) started the development of an international treaty on Public Health addressing global tobacco control, in 1999, Brazil became a leading country in the process of clause negotiations. The so-called Framework Convention on Tobacco Control (WHO-FCTC) was approved by a consensus of the WHO member countries in 2003, Brazil being the second signatory to adhere to the initial version of the treaty ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300.^,33. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.^,44. Scheibler JL. A emergência de fóruns reguladores globais: relações de conflitos entre atores locais no processo de regulação do tabaco [Dissertação de Mestrado]. Porto Alegre: Programa de Pós-graduação em Desenvolvimento Rural, Universidade Federal do Rio Grande do Sul; 2006.^,55. Rangel EC. Enfrentamento do controle do tabagismo no Brasil: o papel das audiências públicas no Senado Federal na ratificação da Convenção-Quadro para Controle do Tabaco (2004-2005) [Dissertação de Mestrado]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011..

Notwithstanding Brazil’s highlighted stand in the treaty development process, discussions for its ratification by National Congress, with ensuing entry in the Executive and Legislative political-decision agenda, were marked by prolonged controversies involving different players, including tobacco industry advocates, tobacco farmers, tobacco-control non-governmental organizations, public health experts and politicians. Only after two years of discussions, when the term for adhesion to the treaty was about to expire and Brazil was in risk of not participating in the first Meeting of the Parties session, WHO-FCTC would be ratified by Congress; hence, Brazil was the 100^th country to sign the Convention ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.^,44. Scheibler JL. A emergência de fóruns reguladores globais: relações de conflitos entre atores locais no processo de regulação do tabaco [Dissertação de Mestrado]. Porto Alegre: Programa de Pós-graduação em Desenvolvimento Rural, Universidade Federal do Rio Grande do Sul; 2006.^,55. Rangel EC. Enfrentamento do controle do tabagismo no Brasil: o papel das audiências públicas no Senado Federal na ratificação da Convenção-Quadro para Controle do Tabaco (2004-2005) [Dissertação de Mestrado]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011..

This paper discusses the transformation of tobacco-control actions into a State policy - characterized by the final adhesion of the country to WHO-FCTC - taking Kingdon’s Multiple Streams Approach into consideration ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003.. For this author, the formulation of public policies is made from a set of processes, including configuration of the agenda, specification of alternatives from which one option will be chosen; the choosing of one alternative by legislative voting or executive decision, and the implementation of the decision. The “planning” will depend on the way ongoing problems appear in the system, which will contribute to the design of the agenda, to the process of knowledge accumulation on the issues at stake, to the perspective of experts, and to the political process, which includes domestic mood swings, public opinion and the results of elections ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003..

Three families of processes are involved in the development of the agenda: the problems; the alternatives, and actions to face them (policies); and the set of activities related to power relationships and authority (politics). The process leading to the opening of a ‘window of political opportunity” comes from the confluence of these three agenda composition streams. In the situation under assessment, the window of opportunity was the WHO-FCTC scrutiny by the Brazilian Congress, when players and stakeholders involved with the issue operated for their demands to be included.

In accordance with Kingdon’s perspective, we claim that the process involving Brazilian participation in the WHO-FCTC - from its leading role in the preparation of the document until its approval by the Federal Senate - gave rise to a flow of problems related to tobacco control in the political agenda, which was already being tackled by the health system bureaucracy in other instances. Efforts made by the high echelon of the ministries of Foreign Relations and of Health, and by technical experts of the later, fostered WHO-FCTC ratification as policy stream and politics stream, considering the establishment of such public policies had high symbolic value for both the health system and Brazilian diplomacy, despite the change in the federal government, with a new political coalition taking the Federal Executive office in 2003. The continued support of the executive to WHO-FCTC approval, despite the hurdles during Senate procedures, made it possible for the treaty to enter the decision agenda.

Politics stream: feasibility and solutions

During the 1990s, the Brazilian state established a broad array of tobacco-control measures based on the ongoing development of a tobacco-restraining legislation and the development of domestic expertise regarding the control of the disease ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300.^,77. Teixeira LA, Jaques TA. Legislação e controle do tabaco no Brasil entre o final do século XX e início do XXI. Rev Bras Cancerol 2011; 57:295-304..

With the regulation of the Brazilian Unified National Health System (SUS), in 1990 by Law 8,080, on August 19, the mandate for tobacco control actions was assigned to the Brazilian National Cancer Institute (INCA), which took over and revitalized the existing National Tobacco Control Program (PNTC). PNCT gathered health education and advocacy actions carried out particularly with medical societies, representatives of the Legislative and Executive, the academia and non-governmental organizations. INCA soon became the national reference for the development of actions and knowledge on tobacco control ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300..

The Brazilian Health Regulatory Agency (Anvisa) was another body with strong influence on tobacco control. Established in 1999, it organized the registration of tobacco products traded in Brazil, defined the maximum amounts of tar, nicotine and carbon monoxide for cigarettes; regulated the advertisement of these products and established the mandatory printing of warning images for smokers on cigarette packs. Having the mandate to regulate tobacco products, Anvisa played a major role in putting into effect the tobacco-control policies in that period ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300.^,77. Teixeira LA, Jaques TA. Legislação e controle do tabaco no Brasil entre o final do século XX e início do XXI. Rev Bras Cancerol 2011; 57:295-304..

Even though Brazil was the second largest tobacco producer, and the largest exporter of tobacco leaves in the world at that time, the characteristics of the PNCT, tobacco control legislation and the regulatory role of Anvisa made Brazil a world reference on tobacco control measures. One can thus infer that healthcare players had a significant role in the development of conditions for the construction of policies that led Brazil to play a main role in WHO-FCTC arrangements and its ensuing ratification by the Congress ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003..

Notwithstanding, another player was instrumental to the leading role played by Brazil in the early steps of the treaty: Brazilian diplomacy. In regards to foreign policy, since the Fernando Henrique Cardoso administration (1995-2002), Brazil had been valuing the development of South-South strategic coalitions. However, only during the Luiz Inácio Lula da Silva administration (2003-2010) would this unfold in a practical agenda of more organized actions and policies ⁸8. Vigevani T, Cepaluni G. A política externa de Lula da Silva: a estratégia da autonomia pela diversificação. Contexto Internacional 2007; 29:273-335.. Particularly under the guidance of Foreign Affairs Minister Celso Amorim (2003-2010), the idea that Brazil could occupy a more prestigious position in the international setting, being a global player, by having a discourse and policies in regards to actions of peace, and international support and cooperation on education and healthcare actions (softpower) would become more institutionally nurtured.

In this scenario, the Ministry of Foreign Affairs and the Ministry of Health took steps towards a more significant global role, enhancing initiatives with African and Mercosur countries, and with multilateral agencies such as WHO. Under the perspective of foreign affairs, the initiatives developed by the Ministry of Health were aligned to the guidelines of Brazilian foreign policy. The role played by Brazil in the discussions and resolutions dealing with protection and flexibility of proprietary rights on pharmaceutical products and its consequences in public health, in 1994, and the signing of a protocol of intentions to formalize collaboration actions between the Ministries of Health and Foreign Affairs, in 2005, are examples of this process ⁹9. Oslo Ministerial Declaration - global health: a pressing foreign policy issue of our time. Lancet 2007; 369:1373-8..

Thus, at a time when global players such as WHO, faced the challenge of tackling the tobacco problem, Brazil already had players and institutional expertise of high levels, making the country able to play a leading position in the development of a global anti-tobacco treaty. Furthermore, in a synergistic movement, Brazilian diplomacy, represented in particular by diplomat Celso Amorim, gained more strength and legitimacy in its actions, supported by alliances and international partnerships favored by Brazilian foreign policy.

The flow of problems and focal events

The development of WHO-FCTC came as a consequence of a proposition for international mobilization towards tobacco control, made in the 48^th World Health Assembly, in 1995 ⁴4. Scheibler JL. A emergência de fóruns reguladores globais: relações de conflitos entre atores locais no processo de regulação do tabaco [Dissertação de Mestrado]. Porto Alegre: Programa de Pós-graduação em Desenvolvimento Rural, Universidade Federal do Rio Grande do Sul; 2006.. Its development is also related to the acknowledgement by the international scientific community that smoking causes a number of diseases, and worsens hunger and poverty around the world. It can also be seen as a reaction against the global increase of tobacco consumption, enhanced by the tobacco industry strategy of transferring cigarette manufacturing and most of the consumption-targeted initiatives to the less regulated markets of developing countries ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300..

The process of drafting the treaty started in 1999, with the setting up of a working group and the Intergovernmental Negotiating Body (INB), which was open to the 190 WHO member states to discuss the different propositions for the writing of the document. The leading role played by Brazil in the preliminary negotiations of the treaty resulted in the appointment of the Brazilian delegate, ambassador Celso Amorim, to be appointed INB Chair ²2. Cavalcante TM. O controle do tabagismo no Brasil: avanços e desafios. Rev Psiquiatr Clín (São Paulo) 2005; 32:283-300.^,33. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.^,44. Scheibler JL. A emergência de fóruns reguladores globais: relações de conflitos entre atores locais no processo de regulação do tabaco [Dissertação de Mestrado]. Porto Alegre: Programa de Pós-graduação em Desenvolvimento Rural, Universidade Federal do Rio Grande do Sul; 2006..

The final version of the treaty was approved at the 56^th World Health Assembly, in May 2003, and included provisions for the implementation of tax policies aiming at consumption reduction; protection against tobacco smoke exposure; regulations on the dissemination of tobacco product information, packaging regulations; printing of health warnings on the packs; the development of education and awareness-raising programs on tobacco hazards; advertisement prohibition; and the implementation of nicotine addiction treatment programs. To reduce the supply of tobacco products, the treaty also addressed the control of smuggling; restrictions to tobacco production and manufacturing subsidies; gradual replacement of tobacco farming and support to economically feasible activities to tobacco farmers ¹⁰10. Instituto Nacional de Câncer. Convenção-Quadro para o Controle do Tabaco. Texto original. http://www.saude.pr.gov.br/arquivos/File/convencao_quadro_texto_oficial.pdf (acessado em 31/Mai/2016).
http://www.saude.pr.gov.br/arquivos/File... .

In this scenario, the Federal administration, sailing in an environment favorable to the Convention, established, through Decree 3,136, issued on August 13, 1999 ¹¹11. Presidência da República. Decreto nº 3.136, de 13 de agosto de 1999. Cria a Comissão Nacional para a preparação da participação do Brasil nas negociações internacionais com vistas à elaboração de convenção-quadro sobre controle do uso de tabaco, e dá outras providências. Diário Oficial da União 1999; 16 ago., a national committee with the mandate of reviewing the role of Brazil in international negotiations, supporting the Presidency of the Republic in making decisions regarding the negotiations, and accommodating the different stands of the many sectors in Brazil affected by the problem. The Committee had a multisectoral constitution, with representatives from the ministries of Health, Foreign Relations, Agriculture, Livestock and Food Supply, Economy, Justice, Labor and Employment, Education, Industry and Foreign Trade, and Agrarian Development ¹¹11. Presidência da República. Decreto nº 3.136, de 13 de agosto de 1999. Cria a Comissão Nacional para a preparação da participação do Brasil nas negociações internacionais com vistas à elaboração de convenção-quadro sobre controle do uso de tabaco, e dá outras providências. Diário Oficial da União 1999; 16 ago.. Health Minister José Serra was appointed its Chair ¹²12. Lacsko M. Sem filtro: ascensão e queda do cigarro no Brasil. São Paulo: Editora de Cultura; 2008., with the National Cancer Institute in charge of its executive secretariat ¹¹11. Presidência da República. Decreto nº 3.136, de 13 de agosto de 1999. Cria a Comissão Nacional para a preparação da participação do Brasil nas negociações internacionais com vistas à elaboração de convenção-quadro sobre controle do uso de tabaco, e dá outras providências. Diário Oficial da União 1999; 16 ago.. The Committee marks the onset of strong mobilization for the development of the treaty, under the combined influence of public policy and partisan politics. According to this line of action, the city of Rio de Janeiro would host, in 2001, under the auspices of the Ministry of Health and with the support of WHO, the Latin American Seminar on the FCTC. The main goal of the event was the gathering of Latin American countries to analyze and discuss the prepositions to be presented at the 3^rd INB Meeting ¹³13. Seminário Latino-Americano sobre a Convenção-Quadro de Controle do Uso do Tabaco. http://www.inca.gov.br/eventos/convencao_quadro/ (acessado em 31/Mai/2016).
http://www.inca.gov.br/eventos/convencao... .

The advent of WHO-FCTC was a focal event regarding tobacco-use concerns. By making visible a problem already being addressed by the federal government, the process of implementation of the WHO-FCTC enhanced the concerns with the problem. Despite the ongoing decrease of tobacco-related indicators ¹1. Monteiro CA, Cavalcante TM, Moura EC, Claro RM, Szwarcwald CL. Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003). Bull World Health Org 2007; 85:527-34. showing that the problem was under relative control, WHO-FCTC set in motion the necessary politics stream to definitively place the issue in the government’s decision-making agenda, verified by the creation of a multisectoral committee to follow up the treaty ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003..

The WHO-FCTC ratification process: political flow, agendas and alternatives

According with the multiple flow theory used in this analysis, the players involved in a process are decisive to place the issue in the governmental agenda, and in the development of alternatives for its effectiveness. Hence, health professionals were responsible for tobacco consumption to be considered a public health problem. Then, the diplomats worked on the development of an international agenda on the issue. These key players are responsible for including this issue among the concerns of the government, making new groups of players emerge, whether in favor or against the development of tobacco-control specific public policies, particularly NGOs, medical associations and associations of agricultural farmers and tobacco growers - anti- and pro-tobacco advocates - and politicians and high governmental officials ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003..

In the group of health professionals mention should be made to the National Cancer Institute experts and the PNTC staff. The former achieved international recognition among tobacco-control organizations. Vera Luíza da Costa e Silva, for instance, who worked at INCA between 1994 and 2000, in 2001 became the head to WHO’s Tobacco Free Initiative (TFI), the main tobacco-control organization in the world ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.^,44. Scheibler JL. A emergência de fóruns reguladores globais: relações de conflitos entre atores locais no processo de regulação do tabaco [Dissertação de Mestrado]. Porto Alegre: Programa de Pós-graduação em Desenvolvimento Rural, Universidade Federal do Rio Grande do Sul; 2006.. At the frontline of the disputes, the staff of the PNCT was highly important in the public hearings held during the examination of the project in the Senate. According to Rangel, a network of city and state coordinators of the Program was formed, working in accordance with the guidelines set by the Program’s city and state managers for the passing of the project ⁵5. Rangel EC. Enfrentamento do controle do tabagismo no Brasil: o papel das audiências públicas no Senado Federal na ratificação da Convenção-Quadro para Controle do Tabaco (2004-2005) [Dissertação de Mestrado]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011..

In congress there were opposing stands. On one hand, congressmen who defended the interests of tobacco farmers and the industry; on the other, those who made efforts to approve the WHO-FCTC. In general, the latter belonged to the Workers Party (Partido dos Trabalhadores - PT), and other parties that supported the government, except congressmen such as Pedro Simon (Brazilian Democratic Movement Party - Rio Grande do Sul State, PMDB-RS), Paulo Paim (PT-RS) and Sérgio Zambiasi (Brazilian Labour Party - Rio Grande do Sul State, PTB-RS), whose constituency was in tobacco-farming states ⁵5. Rangel EC. Enfrentamento do controle do tabagismo no Brasil: o papel das audiências públicas no Senado Federal na ratificação da Convenção-Quadro para Controle do Tabaco (2004-2005) [Dissertação de Mestrado]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011..

An advocacy group was formed by health-related non-governmental organizations, in favor of Brazil taking part in the WHO-FCTC. Particularly vocal in this group was the “Zero Tobacco Network” (Rede Tabaco Zero) - today known as “Tobacco Control Alliance” (Aliança de Controle do Tabagismo - ACTBr) - and medical societies, such as the Brazilian Society of Pneumology and Tisiology, who worked hard for congressmen who opposed the treaty to change their minds and accept FCTC being included in the Brazilian legislation ¹⁴14. Meirelles RHS. A ratificação da Convenção-Quadro para o Controle do Tabaco pelo Brasil: uma questão de saúde pública. J Bras Pneumol 2006; 32:ii-iii.. This advocacy group, even with no formal position within the government, worked as a political force - hidden clusters of participants, according to Kingdon - meaning that, despite being “hidden”, the group was responsible for generating ideas and paradigms and putting them in discussion ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003..

On the other end of the line of interests, sectors connected to the tobacco- producing chain also acted as advocates, and also had their “hidden participants” playing an important role, particularly the cigarette industry. It was represented by organizations such as the Brazilian Association of Tabaco Farmes (Associação de Fumicultores do Brasil - Afubra), the Tobacco Industry Union (Sindicato da Indústria do Fumo - SINDIFUMO), and the Brazilian Association of Tobacco Industry (Associação Brasileira da Indústria do Fumo - ABIFUMO). In this group, Afubra - an entity considered by tobacco-control organizations as a front established to defend the interests of the tobacco industry ¹³13. Seminário Latino-Americano sobre a Convenção-Quadro de Controle do Uso do Tabaco. http://www.inca.gov.br/eventos/convencao_quadro/ (acessado em 31/Mai/2016).
http://www.inca.gov.br/eventos/convencao... - stood out in the fight against WHO-FCTC approval. During the negotiation process for WHO-FCTC ratification by Congress, the Tobacco Industry did not have a seat, but representatives of the different sectors of the tobacco productive chain took part in different meetings and forums to audit, with political implications for the negotiations. Among the most important ones, as we will see later in the text, are the public hearings ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

Another group included tobacco growing, and general workers organizations. The former include the Small Farmers Movement (Movimento dos Pequenos Agricultores - MPA), the Federation of Family Farm Workers of the Southern Region (Federação dos Trabalhadores na Agricultura Familiar da Região Sul - FETRAF-SUL), who had a more flexible stand regarding the ratification of the Convention, endorsing the arguments of both health professionals and tobacco growers. Other organizations joined this group, such as DESER, the Department of Rural Socioeconomic Studies, an NGO that gathers different entities of the agricultural sector, like unions and other rural workers associations, The MPA and the Workers Trade Union Confederation (Central Única dos Trabalhadores - CUT). They all supported adhesion to the treaty ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

Initially, healthcare players thought that the issue was seen under favorable eyes, and approval was sure. They expected WHO-FCTC to be rapidly ratified by Congress, considering that Brazil was internationally acknowledged in terms of tobacco control policies, had chaired the negotiations about the wording of the treaty, and was the second country to have signed it ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.^,55. Rangel EC. Enfrentamento do controle do tabagismo no Brasil: o papel das audiências públicas no Senado Federal na ratificação da Convenção-Quadro para Controle do Tabaco (2004-2005) [Dissertação de Mestrado]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011.. However, in the Southern region of the country, with 90% of the tobacco output, the ratification opened a window of opportunities for representatives of the tobacco producing chain, who were attentive to the examination of the issue by the Congress and developed their own agenda, to which part of tobacco farmers who were against the ratification adhered.

In August 2003, the WHO-FCTC was sent to the Chamber of Deputies, where a special committee was established to issue an opinion on the bill to approve the Convention. Only in May 2004 was it decided that voting should be on an urgent basis. The Chamber of Deputies approved the bill with the votes of the party leaders, and sent it to the Senate. In June 2004, the Senate sent the Convention to the Foreign Affairs and National Defense Committee, as it was an international treaty. Senator Fernando Bezerra (PTB-RN), rapporteur of the bill and government leader in Congress, sent it back to the board of the Chamber on August 26 with a favorable report ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010..

Still in August, Senator Sérgio Zambiasi (PTB-RS) requested a public hearing so that tobacco farmers could know further details about WHO-FCTC and speak their voice about ratification. A radio presenter from the State of Rio Grande do Sul, he defended the interests of small tobacco farmers of the South and said it was necessary to secure their rights and to make clear different aspects of the Convention under discussion ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

The public hearings, established by the 1988 Federal Constitution to enhance social participation in politics, lessened the tensions and disputes for WHO-FCTC ratification. They allowed new players in the discussions arena, and were the onset of a troubled period of negotiations for the approval of the bill. Six public hearings were held in 2004 and 2005. The first was in Brasília, the following four in tobacco-growing cities of the Southern region, and the last in Bahia ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

The first hearing was on September 15, 2004, with the presence of health officials and professionals, representatives of the tobacco producing chain, congressmen of the Senate and Chamber of Deputies, in addition to Health Minister Humberto Costa and a representative of the Foreign Affairs Ministry ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

The hearing started with a presentation by the Minister of Health on the importance of approving the Framework Convention, in which he provided different pieces of data on the hazards of smoking, the strategies of the tobacco industry, and the national tobacco control program. The Minister emphasized the aspects he knew tobacco producers would give him a hard time about, particularly WHO-FCTC article 17, which addressed the promotion of alternative activities to tobacco planting. Costa tried to show that the treaty did not forbid tobacco growing; on the contrary, it tried to provide government support for alternative activities to tobacco growing that were economically feasible. He also highlighted that only by ratifying the treaty could Brazil take part in the Conference of the Parties, where negotiations about the treaty protocols would take place, hence discussions about technical and financial support alternatives which directly interested the planters ¹⁶16. Senado Federal. Ata da décima sexta reunião extraordinária da Comissão de Relações Exteriores e Defesa Nacional do Senado Federal, realizada em 15/08/2004. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 31/Mai/2016).
http://www.senado.gov.br/atividade/comis... .

Treaty advocates included Margareth Matos, Distric Attorney, DA Office of the State of Paraná; Nise Yamaguchi, President, São Paulo Association of Clinical Oncology; and Tânia Cavalcante, Head, Tobacco Division, National Cancer Institute. Overall, their speeches reinforced the arguments presented by the Health Minister, with Margareth Matos emphasizing the environmental problems the farming system caused ¹⁶16. Senado Federal. Ata da décima sexta reunião extraordinária da Comissão de Relações Exteriores e Defesa Nacional do Senado Federal, realizada em 15/08/2004. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 31/Mai/2016).
http://www.senado.gov.br/atividade/comis... .

The representatives of the tobacco productive chain who attended the hearing were the presidents of the Federation of Agricultural Workers of Rio Grande do Sul (FETAG); the Agricultural Federation of Rio Grande do Sul (FARSUL); the Federation of Agricultural Workers of Santa Catarina (FETAESC); the Federation of the Municipalities Association of Rio Grande do Sul (FAMURS); the Agricultural Federation of the State of Santa Catarina (FAESC); and the Afubra. In their speeches, they presented data about the economic relevance of tobacco, they criticized the haste to approve the Convention, and asked the government for assurances regarding the maintenance of tobacco crops, reinforcing its economic importance for the country and, in particular, for families whose livelihoods come from its farming ¹⁶16. Senado Federal. Ata da décima sexta reunião extraordinária da Comissão de Relações Exteriores e Defesa Nacional do Senado Federal, realizada em 15/08/2004. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 31/Mai/2016).
http://www.senado.gov.br/atividade/comis... .

In the subsequent hearings, the economic importance of tobacco was once again reinforced by representatives of the tobacco chain. They revisited the arguments regarding the future of tobacco farmers and the economy of the region. Therefore, the issue of alternative crops to tobacco, established in article 17 of the treaty was raised again and again ¹⁰10. Instituto Nacional de Câncer. Convenção-Quadro para o Controle do Tabaco. Texto original. http://www.saude.pr.gov.br/arquivos/File/convencao_quadro_texto_oficial.pdf (acessado em 31/Mai/2016).
http://www.saude.pr.gov.br/arquivos/File... .

Afubra, as previously mentioned, was adamantly against the ratification of the WHO-FCTC. Its president claimed it should only be approved once the guidelines for alternative crops were defined: ensuring price and markets, selection of other crops to replace tobacco, the source and the amount of resources for this conversion, etc. ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

The organizations representing tobacco growers presented an array of reasons in the hearings. The MPA had a more flexible stand regarding the ratification of the Convention, endorsing the arguments of both health professionals and tobacco growers. Its coordinator stated that the tobacco farmer was the weakest link of the tobacco productive chain, as they generated huge profits for the industry, expanding their cultivated areas, but gained less with their work. He also proposed that discussions about the WHO-FCTC also be held in producing regions, so that the farmers could be informed about the stand of the Ministry of Health and understand government intentions. This request was seconded by tobacco growers representatives ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.^,1515. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... .

Outside the hearings, in December 2004, FETRAF-SUL - an organization connected to the Workers CUT that gathered rural workers unions of cities in the states of Paraná, Rio Grande do Sul and Santa Catarina - came to support WHO-FCTC ratification ¹⁷17. Aliança para o Controle do Tabagismo. Boletim 2004; (12). http://www.tabacozero.net.br/comunicacao/boletins-antigos/boletim-act-12.htm#6 (acessado em 30/Mai/2016).
http://www.tabacozero.net.br/comunicacao... . By understanding that the treaty did not mention any prohibition or limitation to government loans or subsidies to tobacco farming, that organization voiced its support for treaty ratification shortly after the second public hearing; it was the first farmers representative organization to support ratification. From then on, FETRAF-SUL started to take part in the events on tobacco farming, with a compromising stand with the interests of the government ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010..

There was no unanimous stand among those that criticized the WHO-FCTC. Positions ranged from groups being utterly against and reactive to the treaty to segments that accepted, if not the treaty as a whole, at least parts of it.

In March 2005, the Senate’s Foreign Relations and National Defense Committee sent the matter for analysis by the Agriculture and Agrarian Reform Committee. On May 31^st, World No-Tobacco Day, the issue was discussed in a meeting between the President of the Senate, Renan Calheiros, the Minister of Health and representatives of different entities and NGOs, who asked for a speedy approval ¹⁸18. Renan promete acelerar votação da convenção anti-tabagismo. Agência Senado 2005; 31 mai. http://www12.senado.leg.br/noticias/materias/2005/05/31/renan-promete-acelerar-votacao-da-convencao-anti-tabagismo (acessado em 04/Jun/2016).
http://www12.senado.leg.br/noticias/mate... . At that time, a petition signed by 24,000 people supporting ratification of the treaty was presented to the President of the Senate. Senators Tião Viana (PT-AC) and Aloizio Mercadante (PT-SP) were also present in the meeting and showed sympathy to the cause. The concern with those in favor of the WHO-FCTC was that the ratified treaty should be delivered to WHO until November 2005, so that Brazil could take part in the first WHO-FCTC Meeting of the Parties. In the following month, tobacco farmer representatives were also received by the President of the Senate, and presented a petition signed by more than 195,000 people against ratification. Senators Pedro Simon (PMDB-RS), Paulo Paim (PT-RS) and Sérgio Zambiasi (PTB-RS) escorted the group. Senate President Renan Calheiros said that decision on the matter would be make only when discussions made all parties clear on what was at stake ¹⁸18. Renan promete acelerar votação da convenção anti-tabagismo. Agência Senado 2005; 31 mai. http://www12.senado.leg.br/noticias/materias/2005/05/31/renan-promete-acelerar-votacao-da-convencao-anti-tabagismo (acessado em 04/Jun/2016).
http://www12.senado.leg.br/noticias/mate... .

Between August and October 2005, the Agriculture and Agrarian Reform Committee held four other public hearings in cities of tobacco farming areas ¹⁵15. Senado Federal. Portal das atividades legislativas. Comissões. http://www.senado.gov.br/atividade/comissoes/comissao.asp?origem=&com=54 (acessado em 30/Jun/2016).
http://www.senado.gov.br/atividade/comis... . Discussions remained polarized between groups in favor and against WHO-FCTC ratification. Those in favor of ratification in addition to health-related arguments, emphasized that nowhere in the Convention was it established that tobacco planting should be eradicated. On the contrary, the Convention proposed the development of institutional tools that ensured subsidies to alternative crops to tobacco. Those against the treaty claimed that first the alternative crops should be in place, and only after the ratification process should be initiated.

The significant presence of tobacco farmers in the hearings mobilized politicians from the farming areas, whether in Congress, or in producing city and state governments. They were all against the treaty. In the opposing front, the Ministry of Health gained support from the governments of the states of Paraná and Santa Catarina, who were in favor of the ratification in the hearings held in Irati and Florianópolis. However, government representatives of the state of Rio Grande do Sul were adamant against treaty ratification.

More than 4,000 tobacco farmers attended the hearing held on September 23, 2005, in the city of Camaquã, Rio Grande do Sul ¹⁹19. Comissão debate convenção sobre uso do tabaco com produtores de fumo e autoridades de saúde. Agência Senado 2005; 26 nov. http://www.senado.gov.br/AGENCIA/verNoticia.aspx?codNoticia=50406&codAplicativo=2&parametros=camaquã (acessado em 04/Mai/2010).
http://www.senado.gov.br/AGENCIA/verNoti... , and discussions were fierce. The representative of the governor, Erico Feltrin, highlighted the importance for tobacco farmers of treaty approval considering that it proposed planting new crops as an alternative to tobacco, and the lack of indication that tobacco should be eradicated. Representatives of the Ministry of Health, Ministry of Agriculture and Ministry of Agrarian Development also spoke, and reinforced those arguments. Representatives of the NGO Zero Tobacco Network, FETRAF-SUL and the INCA also spoke in favor of the treaty.

The mobilization of those in favor of the Convention was essential in the final stage of the process. The manifestations promoted by these groups attracted the attention of the media, giving the necessary weight to the issue, which decisively influenced the approval of the bill ³3. Jaques TA. Impasses e estratégias: Convenção-Quadro e controle do Tabagismo no Brasil (1986-2005) [Dissertação de Mestrado]. Rio de Janeiro: Casa de Oswaldo Cruz, Fundação Oswaldo Cruz; 2010.. In September 2005, a mobilization was organized in Brasília by organizations such as the NGO Tobacco Zero Network and the São Paulo Society of Clinical Oncology. They disclosed the names of Senators who were against ratification, in order to pressure them ²⁰20. Leite F. No Senado, minoria apóia tratado antifumo. Folha S. Paulo 2005; 28 set. http://www1.folha.uol.com.br/fsp/cotidian/ff2909200525.htm (acessado em 05/Jun/2016).
http://www1.folha.uol.com.br/fsp/cotidia... . In October, treaty advocates visited the offices of Senators and, once again, pressured the Senate President for a swift approval of the bill ²¹21. Renan recebe defensores da convenção para controle do tabaco. Agência Senado 2005; 26 out. http://www.senado.gov.br/AGENCIA/verNoticia.aspx?codNoticia=51322&codAplicativo=2&parametros=convenção+tabaco (acessado em 04/Jun/2016).
http://www.senado.gov.br/AGENCIA/verNoti... .

On October 27, 2005, following a request for urgent voting presented by Senator Tião Viana, the bill was brought to the floor, and the favorable reports made by the Committees of Agriculture and Agrarian Reform, Foreign Affairs and National Defense, and Social Issues were read.

During the discussion of the bill in the Senate, rapporteur Heráclito Fortes informed he had received an official note from the Chief of Staff, Dilma Roussef, informing the stand of the Federal Government on the issue. That document was signed by six Ministers, and presented the reasons for treaty ratification and proposals, in order to appease tobacco farmers and encourage the decision for ratification. The first proposal was that, at the time of ratification, a statement with the interpretation of specific clauses of the treaty be issued, a sort of safeguard to avoid commitments that could somehow be detrimental to Brazil. The second proposition was the launching of the Program to Support Diversification of Tobacco Farming Areas, with four strategic pillars: funding, technology access, value added to local output, and trading assurance. The Program was detailed in the statement ²²22. Aviso da Ministra da Casa Civil ao Senador Heráclito Fortes. Aviso nº 1.151/2005. http://www.al.sp.gov.br/repositorio/legislacao/coletanea/15_5_28.htm (acessado em 30/Mai/2016).
http://www.al.sp.gov.br/repositorio/legi... .

The statement prompted a favorable opinion of the rapporteur. After his report was presented, discussion ensued and ratification was consensual, thirteen days prior to the deadline for the Brazil to take part in the first WHO-FCTC Conference of the Parties. Treaty ratification was through Legislative Decree 1,012, of October 28, 2005. Brazil was the 100^th country to ratify the FCTC ³.

Conclusion

According to Kingdon’s theory, a window of opportunity can only be opened when the flow of problems, policies and politics are aligned ⁶6. Kingdon JW. Agendas, alternatives, and public policies. New York: Longman; 2003.. In this case, the flow of problems consisted in classifying tobacco output, trade and use as a public health issue. In regards to flow of policies, there is intense and successful work by health-related players to develop tobacco-control public policies and actions. From movements abroad this flow won an important ally - the Ministry of Foreign Affairs - which enhances and reinforces the negotiations, leading Brazil to a position of prominence within the WHO-FCTC scope. Subsequently, political events take place, particularly in partisan politics or political flow, that finally allow WHO-FCTC to be included in the national legislation. Worthy of note is that there were complex and synergistic policies and political relations in both domestic and international settings.

In regards to the international setting, we saw that early in the 21^st century different global players, such as the United Nations, WHO, and part of the health-related international scientific community joined efforts towards the establishment of a tobacco-control treaty. In the domestic setting, the leadership of Brazilian diplomacy in the development of the WHO-FCTC gave rise to a tobacco-related political agenda and flow of problems which were, to some extent, being considered by healthcare players in Brazil but, since then, with international legitimacy, positively reflected on future actions of these players. In other words, the role of the Ministry of Foreign Affairs combined with that of healthcare players made possible the development and also the ratification of the WHO-FCTC as a public policy in the domestic setting.

WHO-FCTC entry in the Brazilian legislation also indicates a complex, non-linear course in the development of anti-tobacco policies in Brazil and its discussions in Congress. It included players with different, but at times converging interests - such as those of the healthcare area and diplomacy -, the discussions followed a political flow typical of democracies. Contrary to swift decisions that are often connected to technical-based processes, the discussions about the WHO-FCTC were extensive, even in terms of territoriality, and included marginal decision-making players, which made this process more complex, as it encompassed a broader and more representative political base of the political forces associated with the issue at stake.

References

Publication Dates

History