# Abstract This paper analyses the particular challenges that tobacco control poses for health governance in an era of accelerating globalisation. Traditionally, health systems have been structured at the national level, and health regulation has focused on the needs of populations within individual countries. However, the increasingly global nature of the tobacco industry, and the risks it poses to public health, require a transnational approach to regulation. This has been the rationale behind negotiations for a Framework Convention on Tobacco Control (FCTC) by the Tobacco Free Initiative of the World Health Organisation (TFI/WHO). In recognition of the need to go beyond national governments, and to create agovernance mechanism that can effectively address the transnational nature of the tobacco epidemic, WHO has sought to involve abroad range of interests in negotiations. The contributions ofcivil society groups in particular in the negotiation process have been unusual. This paper explores the nature and effectiveness of these contributions. It concludes with an assessment of whether the FCTC constitutes a significant shift towards a new form of global health governance, exploring the institutional tensions inherent in attempting to extend participation within a state-centric organisation. # Notes [[corporate determinants of health]] - At the national level, tobacco companies have largely been able to manage the policy process so as to ensure that they are able to continue trading on advantageous terms and subject to limited hindrance. This is not, of course, to deny the significant variation that exists in the extent to which to health professionals, ministers and NGOS have been able to advance tobacco control objectives, with aconcomitant variation in the domestic influence of the tobacco industry. A continuum of industry capacity to thwart effective tobacco control can be identified: - precluding serious consideration of tobacco control strategies; - defusing calls for legislation by the voluntary adoption of token selfregulation; - vetoing proposed legislation, or compromising its effectiveness by amendment; - undermining effective control measures upon implementation.