Policy and politics of smoking control in Japan.

The tobacco industry took root well before the hazards of its products were proven scientifically. As elsewhere, smoking control policy has not proceeded automatically nor smoothly in Japan. Examination of the past political process discloses that the failure to enact effective smoking control is attributable to several factors, including the political environment, administrative inadequacy and an inactive medical community. Especially remarkable in this failure have been: the political leverage of the tobacco industry; a lack of clear leadership by the health ministry; the successive rejection of law suits in the courts; and the relatively weak health advocacy groups in Japan. The Diet had been effectively immobilized by pro-tobacco interests and without support from the government, administrative agencies have remained inactive. Since the late 1970s, a series of smoking control measures has been introduced by government agencies, propelled by the social movement. However limited, the introduction of smoking control measures was accomplished with, or at least facilitated by the following: the advocacy of local and international groups and organizations; the continuous visibility of the issue in the media; and changing public attitudes. Involvement of the Diet and the Ministry of Health and Welfare (MHW) was essential in translating commitments into government action. Nevertheless, the resulting measures were not comprehensively legislated. Moreover, they were not subject to continuous evaluation. Consequently, they have been mostly ineffective in decreasing the prevalence of smoking among the populace. Clearly, leadership by the health ministry coupled with political support are the key to advancing effective smoking control.