The UK has one of the most comprehensive set of tobacco controls in the world. For public health advocates, its experience is an ‘evidence-based’ model for tobacco control across the globe, and for alcohol and obesity policies in the UK. In Scotland, policy-makers often described the ‘smoking ban’ as legislation so innovative that it helped justify devolution. These broad and specific experiences allow us to identify and explain different types of success. The UK’s success relates to smoking ‘denormalization’ and reduction, and the explanation comes partly from the ways in which policy-makers framed tobacco as a public health epidemic and produced a policy environment conducive to policy change. The ‘smoking ban’ success relates to the implementation and behavioural change that is lacking in most other countries. The explanation comes from the ‘window of opportunity’ for specific policy change, and the design of the policy instrument backed by the prioritization of its delivery by key public bodies. The overall lesson, particularly for advocates of evidence-informed policymaking, is that evidence only ‘wins the day’ when it helps reframe debate, produce a conducive policy environment, and actors exploit ‘windows of opportunity’ for specific reforms. In most countries, this did not happen.
The global tobacco control ‘endgame’: Change the policy environment to implement the FCTC