Global frameworks, local strategies: Women's rights, health, and the tobacco control movement in Argentina

ABSTRACT

The article examines how civil society organisations in Argentina used the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to frame the country's failure to enact strong national tobacco control legislation as a violation of women's rights in the late 2000s. We analyze this case study through the politics of scale, namely the social processes that produce, reproduce, and contest the boundaries of policies and socio-economic relations. This approach understands how multiple scales overlap and connect to obstruct or enhance the right to health in Latin America. In Argentina, the global organisation of tobacco companies, the reach of international financial institutions and the national dynamics of economic austerity and export-orientation promoted the local production and use of tobacco (leaf and cigarettes) and reproduced health inequalities in the country throughout the 1990s and the early 2000s. Yet, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic.

KEYWORDS:

• Politics of scale
• women’s health
• tobacco control
• international human rights law
• Argentina
• civil society
• CEDAW

This article explores how Argentina's tobacco control movement used a global legal framework, namely international human rights law, to mobilise around local health issues in the late 2000s. Using the framework of the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which Argentina ratified in 1985, civil society organisations successfully framed the country's failure to enact strong national tobacco control legislation as a violation of women's rights. Social mobilisation on health issues in Latin America are often viewed as part of the concerns within women's, environmental justice and indigenous movements. This is particularly the case of reproductive rights and access to health services in women's movements in this region (Jelin, Zammit, & Thomson, 1990; Lebon, 2010; Molyneux, 2001). Analyses of Latin American environmental justice and indigenous movements address the ways in which the effects of environmental degradation caused by state and non-state actors affect the health of communities, which triggers mobilisation around the defense of the environment and the territories of indigenous communities (Carruthers, 2008; Dwivedi & Díez, 2008; Urkidi & Walter, 2011). Such mobilisations as well as the analyses that accompany them have been crucial to understand health as the outcome of social processes rather than as an individual condition independent of social context. It also remains important to locate social mobilisation around the social determinants of health in Latin America, such as the tobacco control movement.

The latter has been addressed in descriptive examinations of the tobacco control movement in Latin America (Champagne, Sebrié, & Schoj, 2010). Yet, an understanding of how the tobacco control movement has been able to reformulate the meanings of tobacco consumption and distribution to define locations of power and the strategic scale of action is central to address the structures of health inequalities in the region. For that reason, the article examines the use of international human rights treaties by the tobacco control movement in Argentina through the politics of scale, an approach that has been suggested as long overdue in the literature on the tobacco epidemic (Barnett, Moon, Pearce, Thompson, & Twigg, 2017). Politics of scale refer to the social processes that produce, reproduce and contest the boundaries of particular practices, policies and socio-economic relations (Keil & Mahon, 2009). Scales therefore become spatial arrangements that organise and secure interests to deal with political conflict which can be challenged and transformed (Wissen & Brand, 2011, p. 6). Because political scales are historical and social processes, a particular scale does not necessarily have priority or dominance over others. Such an approach allows an understanding of how spatial arrangements in the form of jurisdictional hierarchies are significant in reproducing health inequalities as well as in social mobilising around the right to health. Politics of scale also include the way in which actors define a social issue around a particular scale is also central to effecting change (Delaney & Leitner, 1997; Kurtz, 2003; Van Lieshout, Dewulf, Aarts, & Termeer, 2011). This process of scale framing also has concrete consequences shaping social practices (Conway, 2009, p. 284).

Approaches to social movements examine how cultural meanings and practices of domination are confronted by redefining relations of power through new identities and counterhegenomic discourses (Alvarez, Dagnino, & Escobar, 1998; Escobar & Alvarez, 1992). Also, the literature on social movements provides insights into the organisation of contestation through networks, access of resources and identification of political opportunities, which allows local contentious politics to become a transnational movement (Dufour, Masson, & Caouette, 2010; McAdam, Mccarthy, & Zald, 1996; Tarrow, 2005). Global legal frameworks then become part of the array of resources and political opportunities that create new discourses to redefine power relations. The international relations literature on global governance also acknowledge how social mobilisation in the form of transnational networks have assisted in shaping global norms and its local implementation (Kardam, 2004).

While the article acknowledges the valuable insights of these approaches, spatial hierarchies are seen as one more element influencing political opportunities, resource mobilisation or the creation of international norms and counterhegemoic discourses. In other words, spatial arrangements are depicted as a container of social interactions rather than the product of materially and discoursively constituted relationships (Radcliffe, 2007). The latter is crucial for analysing mobilisation around the right to health in Latin America because spatial hierarchies shape social conditions for mobilisation, which can be contested to produce new scalar arrangements (Conway, 2009; Leitner & Sheppard, 2009).

When approaches on social mobilisations consider politics of scale, the emphasis is on ‘scale jumping,’ namely the capacity of social groups to move to higher hierarchical levels of state and global legal regulations, to fulfil their social demands (Masson, 2010). These analyses focus on how social groups undertake forum shopping, that is the selection of a human right tribunal to have a favourable decision, to produce a ‘boomerang strategy’ of pressuring on states via international organisations encourages local change (Keck & Sikkink, 1998). Here, the global scale of international human rights treaties is considered as the most effective hierarchy of action, giving ontological priority to this scale over others. Such an understanding depicts broader scales as ‘structures mechanically determining the possibilities of local scales’ (Leitner & Sheppard, 2009, p. 235). Thus, the social processes and the structures of power behind the constructions of scales producing and reproducing health inequalities, and the way these scalar arrangements are contested, are overlooked.

Thus, we argue that a politics of scale approach to the right to health, particularly in the case of the use and health effects of tobacco, is useful in understanding how multiple scales, and their constitutive social processes and structures of power and contestation, overlap and connect to obstruct or enhance the right to health in Latin America. On the one hand, the global organisation of tobacco companies and the global reach of international financial institutions connected with national dynamics of economic austerity and export-orientation, promoting the local production and use of tobacco in Argentina and reproducing the social inequalities in the country throughout the 1990s and early 2000s. On the other hand, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic in the late 2000s. As such, this approach does not emphasise the effectiveness of the global scale for mobilisation but rather focuses on the socio-spatial processes behind the production of health inequalities and their contestation.

The article also acknowledges the contribution of the study of women's and feminist movements in Latin America, particularly their analyses on their organisation through transnationalised networks (Alvarez, 2014; Dufour et al., 2010; Lopreite, 2010). While the article focuses on how a gender undertanding of tobacco use and distribution has allowed the tobacco control movement in Argentina to access CEDAW mechanisms to transform the national and local social determinants of health, this article does not focus on this movement as a women's or feminist movement. Although the tobacco control movement does consider women a group that needs mobilised and has developed political strategies around women's issues (DiMarco, 2010, p. 165; Dufour et al., 2010), the article examines the framing of tobacco use and distribution through a gendered understanding as a scalar strategy.

The article begins by briefly describing the ways in which the integration of Argentina into the global economy led to the intensification of tobacco production, manufacturing, and commercialisation in the country and its effects on women's health. This informs our understanding of the obstacles faced by the tobacco control movement in Argentina. Second, we examine the strategies civil society organisations used to establish the connections between gender and health in the CEDAW monitoring processes to advance and legitimise their struggle to establish (and enact) national tobacco control legislation. Third, the article discusses how civil society in Argentina continues to link multiple scalar frames to enact action to push for tobacco regulations and enforcement.

The global and national scales of power in the tobacco epidemic

As mentioned above, political scales are manifestations of the strategies of social groups to extend their control by creating social spatial regulations and arrangements in which scale is actively produced (Swyngedouw, 1997). Scalar arrangements have been influential in the tobacco epidemic in Argentina, particularly in its detrimental effects on the right to health in general and women's health in particular. First, higher political scales in the form of the International Monetary Fund's (IMF) structural adjustment policies of the 1980s and 1990s favoured global tobacco companies. Second, the national scale of state policy has been crucial in internalising global economic imperatives.

The global integration of Argentina's economy in the 1980s and 1990s favoured the production and commercialisation of tobacco products, as well as the concentration of the industry in two global companies. Hit by a debt crisis in 1982, Argentina underwent a series of structural reforms in order to obtain loans from the IMF and the World Bank (WB) to repay its international debt throughout the 1980s and 1990s. Through the imposition of structural adjustment programs (SAPs), the WB and the IMF encouraged the Argentine state to support large farms growing crops for export, including tobacco (Felder & Patroni, 2016). For instance, the liberalisation of trade included in SAPs promoted agricultural exports, including tobacco among large producers (Cao, 2007). Export promotion, also part of SAPs, was also encouraged through tax exemptions to acquire large areas of land and invest in agricultural enterprises, particularly in poor regions such as the northern region of Argentina, characterised by tobacco production (Aráoz, 2007, p. 285). This practice reinforced earlier government support to tobacco growers through the Special Tobacco Fund (STF) started in 1972. The STF is financed by a tax on tobacco use and the funds are redistributed to the tobacco-growing provinces to promote cheap tobacco production and keep the price of cigarettes low (Mejia & Perez-Stable, 2006, p. 53). During the 1990s, there was a large investment flow into the tobacco sector and trade liberalisation and de-regulation also increased market access opportunities for global tobacco companies. Between 1993 and 2000, for example, direct foreign investment in food and tobacco production increased 40%, representing 29% of the Argentinean total GDP in manufacturing, compared to a 28% and 19% of chemical and auto industries respectively (Ernst, 2005, p. 18). This trend was also reflected in the increase of tobacco leaf production and leaf exports by 27% between 1980 and 1995 and 133% between 1980 and 1990 respectively. Cigarette production rose 10.63% between 1980 and 1995 while the volume of cigarette exports in million sticks grew from 11 to 724 between 1980s and 1990 and to 2452 in 1995 (WHO, 2002).

The reliance of the state's export-oriented strategy on tobacco production and commercialisation was further intensified by the financial crisis of 2001. The Argentine government further promoted an economic model based on the export of agricultural commodities, including tobacco, to increase the flow of foreign exchange into the country. The opening of markets and the financial crisis also triggered a process of acquisitions of Argentine tobacco companies by global corporations. In the 2000s, the two major tobacco companies in Argentina, Massaline Particulares S.A., and Nobleza Piccardo, were fully acquired by the global corporations Philip Morris (PM) and British American Tobacco (BAT), which control 70% and 30% of the Argentine tobacco market respectively (Alderete, 2014). Accordingly, the subsidiaries of PM and BAT became the main destination for the tobacco produced in the northern provinces of Argentina (Bercovich, 2004). These provinces produced 80% of tobacco leaf production during the 1990s and early 2000s (Corradini et al., 2005).

The concentration of the tobacco industry as well as Argentina's reliance on producing and exporting agricultural commodities such as tobacco increased the political influence of global tobacco corporations as well as tobacco growers and tobacco leaf buyers in domestic policy who have lobbied the government to avoid the imposition of regulations on the tobacco industry (Sebrie, Barnoya, Perez-Stable, & Glantz, 2005, pp. 53–5). An example of this is the Argentine Senate's lack of ratification of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC), despite its signing by Argentina's Executive branch in 2003, as the FCTC identifies mechanisms to reduce the health, social, and economic damage caused by tobacco production, consumption and distribution. These mechanisms include bans on tobacco advertising and marketing, place warnings on packages, implement measures to protect exposure to second-hand smoking, and promote higher taxes on tobacco products as well as government support for alternatives to tobacco-related economic activities (WHO FCTC, 2009). Overall, the tobacco control movement in Argentina confronted several economic actors at different political scales which had connections to each other. While the WB and the IMF indirectly set the conditions for the growth of the tobacco industry in Argentina throughout the 1980s and 1990s, it was the national state that internalised the structural adjustment policies with the support of sectors of the Ministry of Agriculture, Congress representatives and local legislatures of tobacco growing regions, global tobacco companies (BAT and PM), the Argentinean Tobacco Growers Association (Mejia, Schoj, Barnoya, Flores, & Pérez-Stable, 2008; Ministerio de Agricultura, Ganadería y Pesca de la Nación, 2011). The latter, global companies and the growers’ association, are also connected through the International Tobacco Growers Association. The links between the national state and domestic tobacco growers is also evident in cases such as that of Ramon Puerta, Senator and who owned a tobacco-producing farm in northern Argentina the ratification of the FCTC was obstructed in the mid-2000s (Mejia et al., 2008).

The politics of scale of tobacco production and commercialisation have become part of the social determinants of health of non-communicable diseases associated to tobacco use in Argentina. The country has had one of the highest smoking rates in Latin America since the 1990s. By 2014, one in four adults in Argentina smoke (Alderete, 2014). Tobacco production and consumption in the country affected women's health in particular. In the 1990s women accounted for a higher relative proportion of smoking related diseases and mortality than men (Corrao, Guindon, Sharma, & Shookohi, 2000, p. 27). As of 2006, 47% of women and 20% of children were exposed to second-hand smoke (Wipfli et al., 2008, p. 674). In a 2008 study in Buenos Aires, 10% of women continued smoking during pregnancy while an estimated 50% of women were exposed to second-hand smoking during pregnancy (Althabe, Colomar, Gibbons, Belizan, & Buekens, 2008).

The decline in the provision of public health services, which was another product of structural adjustment of the 1980s and 1990s policies and austerity measures implemented in the aftermath of the 2001 crisis, also impacted women as public health care users and unpaid caregivers (Cavagnero, 2008; Lloyd-Sherlock, 2005). Argentine women who smoke or suffer from tobacco-related non-communicable diseases remained vulnerable during the 1990s and 2000s (Batthyanny & Correa, 2010, p. 138; Durand, 2000), particularly as women's access to health care declined. In 2001, for example, only 59% of women were covered by some form of health care insurance (Hernandez Bello, 2004, p. 12). The direct of costs for health care in Argentina related to diseases attributable to tobacco use reached 14% of the GDP in 2006 (Carbajal, 2006). This placed heavier demands on women as unpaid caregivers for children, seniors, and the sick or disabled (Budlender, 2008, p. 9; Durand, 2000). This domestic context prompted the tobacco control movement to contest the existing politics of scale of tobacco production and use in Argentina through the connection of multiple scales, namely international human rights treaties, women's bodies and their health and the household in order to push for an agenda similar to that of the FCTC.

The multiple scales of human rights

This section explores the ways in the tobacco control movement connected multiple scales to frame the right to health around tobacco-related non-communicable diseases through the lens of women's rights. This, however, is not new in Argentina. During the military dictatorship of the 1970s and early 1980s, mothers of the disappeared, namely the Mothers of the Plaza de Mayo, mobilised around human rights issues in Argentina by linking the personal, that is the scale of the household, to national politics, and later on to international human rights treaties. The movement politicised the scale of the family household by stressing how the individual suffering of mothers was connected to larger structures of power at the national level to make demands to the state (DiMarco, 2010, p. 161). The legacy of this movement is the internalisation of the international human rights treaties into the national constitution.

Constitutional reforms in 1994 (article 75.22) incorporated nine international human rights treaties into the constitution, including the UN CEDAW (Shelton, 2011). CEDAW requires states to guarantee women's rights, support education that contributes to their health, and eliminate all forms of discrimination of women in health care. Conventions such as CEDAW also includes monitoring mechanisms and request regular updates from state parties to track progress against priorities. In addition, the Supreme Court of Argentina has recognised other human rights treaties ratified by Argentina such as the International Covenant on Economic, Social and Cultural Rights (CESR) as having constitutional hierarchy (Council of Europe, 2014, pp. 11–12) and reports to human rights committees are considered relevant to the interpretation of domestic law. This legal context set the stage for the tobacco control movement to connect the scale of women's bodies to national politics and the global scale of international human rights treaties to contest the existing politics of tobacco production and consumption in Argentina.

Argentine Smoke-Free Alliance (ALIAR) and the Inter American Heart Foundation, based in the United States, which has an affiliate in FIC-A (Fundación Interamericana del Corazón Argentina), have led the tobacco control movement in Argentina. ALIAR was established in 2007 and represents an alliance of more than 100 civil society organisations committed to tobacco control which include human rights advocates, health workers and researchers, professional medical associations and environmental organisations (Champagne et al., 2010). FIC-A serves as the secretariat for ALIAR (Champagne et al., 2010). The mandate of the FIC-A is to address the contributors to cardiovascular disease, for which tobacco use is a prominent risk factor. In partnership with the O’Neill Institute for National and Global Health Law, ALIAR and FIC-A mobilised to counter the influence of global tobacco corporations and domestic tobacco growers in Argentina's health policy through shadow reports to the CEDAW Committee. Shadow reports are formal mechanisms that UN bodies use which permit civil society to participate in monitoring the implementation of UN international human rights treaties. These shadow reports provide an alternative account to formal national reports on of the implementation of treaties (Cabrera & Gostin, 2013). The partnership with the O’Neil Institute also shows how challenges to political economic structures behind health inequalities struggles do not have to cover larger political scales but rather about connecting local spaces (Gibson-Graham, 2002, p. 32).

In a 2010 shadow report presented to the CEDAW Committee, ALIAR and FIC-A demonstrated that Argentina was not complying with Articles 3, 10, and 12, which respectively address the state party's obligation to guarantee women's rights, facilitate access to information to guarantee women's and their families’ well-being, and eliminate discrimination against women in health care (ALIAR et al., 2010, p. 6). The report argued that the lack of compliance arose from the absence of a national policy regulating tobacco advertising (which heavily targeted women) and a failure to promote smoke-free spaces, thereby increasing women's and children's exposure to secondhand smoke. The shadow report also indicated that state policies promote the tobacco industry such as the STF, which undermine efforts to protect women's health from targeting tobacco industry marketing. The submission highlighted the need to approach tobacco control through a gender lens (ALIAR et al., 2010, p. 15). In the same way, the report cites CEDAW's Committee's commentaries and reports that call for a gender perspective in understanding the social determinants of health and the gendered effects of tobacco smoking. Finally, the report called for the adoption of national tobacco control legislation and the ratification of FCTC to uphold country's international commitments (Cabrera & Carballo, 2014, p. 238). ALIAR and FIC-A also argued that women's vulnerability to secondhand smoke exposure increases with more extreme poverty.

The shadow reports show the framing of the right to health through the connections of multiple scales in order transform the social and political determinants of the tobacco epidemic in Argentina. The national and the global scale of international human rights treaties are implicated through Argentina's constitution, which allows for the use of international human rights treaties as a tool to enforce the human right to health domestically. The consequences of tobacco use and exposure among women encouraged ALIAR and FIC-A to view this epidemic through the scale of women's bodies, the household and the locality. The multiscale framing of the right to health offered the tobacco control movement a route to engage with the CEDAW monitoring mechanisms. These organisations focused on consumption rates and exposure to secondhand smoke in the household, workplace, and public spaces, highlighting the marginalisation of women's health in everyday interactions and settings at multiple political scales. The coalition also highlighted the role of national structures of political power in the form of STF, economic austerity and declining health services in undermining women's health.

The CEDAW Shadow report, in addition to the coalition's mobilisation at the national level, influenced the approval of a national tobacco control law in Argentina's Congress in 2011. The Law 26.687 on Advertising and Promotion and Tobacco Product Consumption bans tobacco advertising and sponsorship, forces manufacturers to put public health warnings on cigarette packets and prohibits smoking in enclosed spaces such as bars, restaurants, covered stadiums, schools, hospitals, and workplaces. It also makes it illegal to sell cigarettes to under-aged youth and ends the practice of selling single cigarettes. The law imposes fines of those who fail to comply. Yet, there are several loopholes and exceptions within this law. For instance, advertising can take place at the point of sale and smoking is permitted in parks, public squares, and open-air stadiums, and clubs of smokers (Presidencia de la Nacion Argentina, 2011).

Also, lack of regulations to limit the various exceptions in the law has allowed tobacco companies avenues to continue to circumvent the law. For instance, tobacco companies could turn any space such as a nightclub or a bar into a point of sale in order to advertise. In lieu of sponsorships, tobacco companies implemented corporate social responsibility (CSR) programmes as a way of promote their cigarettes. For instance, tobacco companies have financed anti-poverty campaigns in the form of road pavement in poor neighbourhoods in order to include the logo and name of the company in these CSR programmes (Lipcovich, 2012). In the same way, any enclosed space could be turned into a smokers’ club (FIC-A et al., 2012; Hecha la Ley, 2013).

For these reasons, FIC-A, along its international partners, employed other international human rights treaties in a similar manner to the way they had engaged with CEDAW. For example, they presented the shadow report presented by the same coalition to the CESR committee in 2011. In their report, the coalition placed emphasis on article 7 and 12 of the CESR, which refers to the right to safe and healthy working conditions and improvements in environmental and industrial hygiene (FIC-A et al., 2011, p. 9). In this way, the report connected the threat of second-hand smoking to economic rights, as in the right to a healthy environment in the workplace. By doing so, it pointed out the weaknesses and legal gaps in Argentine's tobacco control legislation and indicated how these gaps reflect the lack of implementation of the FCTC as the legislation does not comply with the maximum international standard set by the WHO convention (2011, p. 11, 18). In its account to the CESR committee, FIC-A introduced taxation and pricing as new issues, which is particularly important in Argentina as cigarettes in the country are the cheapest in the region (Pan American Health Organization [PAHO], 2013, p. 20). The report refers to article 2 of the CESR which indicates the state parties’ obligation to allocate the maximum available resources to realise and protect economic, social and cultural rights to justify the need of state intervention to increase taxes and prices on cigarettes in Argentina to reduce tobacco consumption (2011, p. 16). Thus, this shadow report framed the right to health through the scale of the workplace with the enforcement of this economic right in national and international law.

Subsequently, the continued mobilisation of ALIAR and FIC-A prompted the enactment of specific regulatory legislation in 2013, prohibiting direct and indirect promotion and advertising, including the use of non-traditional advertising such as television screens and movable and luminous signs. The only form of advertising allowed is the use of banners at the point of sale (Ministerio de Salud Argentina, 2013). The regulations specify the characteristics of open and enclosed spaces as well as the characteristics required to turn a site into a retail location or a smokers’ club. For instance, the regulations indicate that a smokers’ club cannot have employees and must not have a commercial activity (Hecha la Ley, 2013). This latter measure aims to prevent tobacco companies from changing any location into commercial site or a smokers’ club.

In the aftermath of challenging the scalar arrangements of the tobacco industry, the tobacco control movement constructed new scales of national regulation, including the integration of some stipulations of the FCTC into national legislation such as the banning of advertising and the promotion of smoke-free environments. This has been influential in setting a context where smoking rates among adult women in Argentina decreased from 34% in 2000 to 18.4% in 2015 (World Bank, 2017). In 2005, 52% of people in Argentina were exposed to second-hand smoking. This percentage decreased to 40.2% in 2009 and 36.3% in 2013 (Secretaría de Programación para la Prevención de la Drogadicción y Lucha contra el Narcotráfico [SPPDLN], 2016, p. 30).

It is worth noting that such changes in legislation took place during the presidential administration of Cristina Fernandez de Kirchner (2007–2015), who is considered part of the Latin American Pink Tide movement. The Pink Tide refers to the rise of left-wing governments in South America opposing the market liberalisation and austerity measures promoted by IMF and WB from 2000 to 2014 (Spronk, 2014). While a change in policy direction could have provided the tobacco control movement in Argentina political opportunities to push for its agenda, this was not necessarily central to the coalition as the administration of Fernandez de Kirchner was reliant on taxes on agricultural exports for revenues to fund social programmes. This included the continued reliance on agricultural exports of tobacco (Gruss, 2014).

The ALIAR and FIC-A coalition has focused most of its reporting and advocacy on tobacco consumption and second-hand exposure. Other social processes behind tobacco consumption and distribution and women's right to health continue to be overlooked. For instance, limited attention has been placed on women as tobacco producers. This is particularly significant in Argentina because it is the sixth largest worldwide producer of tobacco leaf (Tovar, 2012). The Argentine tobacco industry employs nearly half a million people, including significant numbers of women and children (Tovar, 2012). Tobacco cultivation introduces specific health risks as a result of transdermal nicotine absorption (Schmitt, Schmitt, Kouimintzis, & Kirch, 2007). These health hazards affect women and children mostly who work in this industry under precarious conditions (Soto Baquero & Klein, 2012). A focus on women as tobacco producers might allow ALIAR and FIC-A to build support for the ratification of the FCTC among female workers in the producing tobacco provinces of the north of Argentina, especially since the FCTC also includes economic support to alternative livelihoods for tobacco farmers and farm workers in Article 17. Nevertheless, the strategy used by ALIAR and FIC-A based on human rights treaties paved the way to address this issue through their work in the shadow report in the CESR Committee.

Conclusions

This article employed a scalar analysis to explore recent tobacco control movement activities in Argentina. Such an approach recognises that changes in scale offer different possibilities for how an issue is framed, what actions can be envisioned to address it, and who are the stakeholders involved thereby changing the conditions, opportunities and structures for action. The tobacco control movement in Argentina is fundamentally engaged in a struggle of relations of power that range from the intimate, embodied level of the individual to the supranational level of the FCTC. By examining scales, we are able to illustrate how the tobacco control movement in Argentina employed policy discourses and frames at varying scales to argue that the women's right to health was being violated.

The Argentine case illustrates how international human rights frameworks do not automatically or mechanically protect the right to health at the local level. Rather, the contestation of existing political scales that obstruct the right to health and the framing of tobacco-related diseases through different scales are central to bringing about more concrete legislation that materialises international treaties domestically and addresses the particular needs of citizens, especially women. Such a strategy has been effective in changing national and local socio-political determinants of health related to the tobacco epidemic to the extent that the same coalition has created a guide for the elaboration of shadow reports to be presented at UN bodies in relation to the implementation of tobacco controls for other civil society organisations (FIC-A and O’Neil Institute, 2012). In this case study, the tobacco control movement in Argentina connected the effects on global and national scales of tobacco production and commercialisation on women's bodies and their position in the household, related them to the obligation of the Argentine state to protect, respect and fulfil the right to health contained in the national constitution and international human rights treaties through the lens of women's rights, and later one through an approach to economic rights. In this sense, the framing through women's rights has been key to make these scalar connections. For instance, indigenous women in Chiapas, Mexico, have addressed their subordinate position in their households and local villages as well as the political autonomy of their indigenous community through the language of women's rights in international human rights law (Speed, 2008). Still, mobilisation around women's rights also depends on the historical legacies of concrete forms of contestation by feminist and women's movements at the national level, as reflected in the case of Argentina.

A scalar approach to the right to health in Latin America shows how a solution to the global tobacco epidemic needs to go beyond a focus on individual tobacco use and health in order to consider sources of inequality, and the structures at the global and national level that create them, which impair women's health and promote the profits of tobacco companies. This in turn opens spaces for institutions and civil society organisations that are pushing not only for tobacco control policies but also for gender-specific health and social agendas at different political scales.

Acknowledgements

We would like to thank Dr. Lorraine Greaves and the Canadian Institutes of Health Research (Project GGH-84622) for their support in 2008 of our initial work on gender, globalization and tobacco control in Argentina. We thank the reviewers for their thoughtful feedback throughout the manuscript development process.

Disclosure statement

No potential conflict of interest was reported by the author(s).