Tobacco Control in Bolivia: Transnational Civil Society Efforts in Securing a Comprehensive Law.

Introduction: To document the adoption of a comprehensive tobacco control law in Bolivia, a low-income country in South America.
Aims and Methods: Analysis of the Bolivian case study by reviewing news sources, tobacco control legislation, industry websites, and advocacy reports. Application of the Policy Dystopia Model to analyze tobacco industry and health advocacy arguments and action-based strategies.
Results: For decades tobacco control progress in Bolivia remained relatively stagnant due to industry interference. In the 2000s and 2010s, Bolivia ratified the WHO Framework Convention on Tobacco Control (FCTC) and implemented a couple of laws that began restricting smoking in public places and tobacco advertising. In 2015, tobacco control civil society emerged with the creation of Fundación InterAmericana del Corazón (FIC) Bolivia, which began coordinating efforts to counter industry interference. Between 2016 and 2020, FIC Bolivia with financial and technical support from international health groups proactively coordinated interministerial meetings, identified and met with key policymakers, and held public educational socialization events to introduce and support a FCTC-based tobacco control bill. Tobacco companies argued to policymakers and the media the bill would result in lost sales/jobs, increase illicit trade and help smugglers profit but only secured minimal changes. In February 2020, Bolivia passed Law 1280, which established 100% smoke-free environments, banned tobacco advertising (except at the point-of-sale), required 60% pictorial health warnings, among others.
Conclusions: International financial and technical support combined with proactive advocacy strategies, including identifying and engaging key policymakers, coordinating interministerial meetings, and educating the public can help pass strong tobacco control laws, especially in low-income countries.
Implications: Low- and middle-income countries struggle to adopt comprehensive tobacco control legislation due to weak state capacity, limited resources, and aggressive tobacco industry interference. This is one of a handful of studies to examine the adoption of a comprehensive tobacco control law in a low-income country, Bolivia. Proactive health advocacy strategies, including identifying and engaging key political allies, helping coordinate interministerial meetings, and aggressively educating and engaging the public can help pass strong tobacco control laws, especially in low-income countries.
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