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The Keys to Success: Ideas, Power, and Leadership

Health policy entrepreneurs are most likely to be successful when they are solving a problem that the legislative leadership recognizes as important.[19] Unfortunately for tobacco control advocates in California in 1988, tobacco was not on the Legislature's agenda prior to Proposition 99. In fact, it was being kept off the agenda by powerful tobacco interests.

In contrast, health care for children was actively on the agenda, in particular the need for additional funding for the popular Child Health and Disability Prevention Program (CHDP). By funding CHDP with Proposition 99 Health Education Account money, the legislative leadership


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got money for CHDP, the CMA got money for doctors, and the tobacco industry kept money away from programs that reduced tobacco use.

To be successful in overcoming these legislative roadblocks and in securing implementing legislation that reflects public health priorities, tobacco control advocates had to exploit three factors: ideas (ways of framing the problem and creative approaches to solving it), power (generation of resources to translate ideas into action), and leadership (recognition of opportunity and commitment to challenge the status quo).[19] The public health advocates were weak in all three areas from 1989 until 1996, when advocates made a concerted effort to return to tobacco control's key power base—public awareness and involvement. The result in 1996 was funding for tobacco control programs in the way the voters had mandated.

After the funds were restored, however, the field of conflict simply shifted to the administration, where tobacco control advocates had to face the same problems all over again.


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