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Ideas: Knowing What You Want

The way an issue gets framed often determines the solutions that will be pursued and who will be included in discussions of the issue.[20] So people make an effort to frame the issue so that their preferred solution becomes the chosen course of action.[21] Good tobacco legislation, from a public health standpoint, results when the tobacco use is framed as a public health issue and bad legislation results when it is instead framed as an issue of personal freedom.[22]

In the various California electoral campaigns, the tobacco industry tried to frame tobacco control as excessive government regulation, unfair taxation, or a violation of personal choice, while the public health groups tried to frame it as a health issue in which the tobacco industry was interfering with local decision making. In 1979, in analyzing the failure of Proposition 5, both proponent Paul Loveday and his opponents in the tobacco industry noted that the tobacco control side did not do a good job of staying on its issues.[23-25] By 1988, when they passed Proposition 99, public health groups had learned how to stick with their own messages and avoid discussing the industry's messages. By the time of Proposition 188 in 1994, tobacco control activists had done their polling and knew that calling Proposition 188 “the Philip Morris initiative” could kill it. They stayed on that message and won big.


While they had learned how to frame issues in electoral campaigns by 1988, the public health groups still had to learn the same lesson in legislative battles. They got off to a good start on framing the issue in the initial budget skirmishes in 1989. In January 1989, when Governor George Deukmejian proposed the first Proposition 99 budget, he did not touch the money in the Health Education and Research Accounts but used money from the medical service accounts in a way that violated the intent of the initiative. The voluntary health agencies joined the CMA in protesting this violation of the will of the voters. The voluntary health agencies also used this argument to force the CMA and tobacco industry to back down on the Project 90 effort to divert funds out of anti-tobacco education into medical services in the summer of 1989.

The health groups then made a key error at the end of June 1989 when they agreed to use Health Education Account money to fund CHDP. By doing so, they compromised their ability to frame the issue as “following the will of the voters.” Giving up some money for CHDP in exchange for a decent bill, viewed from an insider perspective, was a reasonable and appropriate action. As strategy, from an outsider's standpoint, it was not. The health groups could no longer mobilize public support behind the integrity of the initiative since they themselves had violated it. They cleared the way for medical groups and others to frame the fight over Proposition 99 revenues as sick children versus a silly anti-smoking campaign or as just another budget fight. In 1998, looking back on that first year, Carolyn Martin recognized, “I think inexperience led to the first CHDP diversions and we did abandon the moral high ground. We did not understand or know how to use our newfound power.”[13]

Even with the lawsuits in 1994 and 1995, when the courts ruled that the diversions were illegal, the voluntary health agencies did not reframe the issue as following the will of the voters. By not putting effort and resources into publicizing the victory, the health groups allowed Governor Pete Wilson to frame the issue as one in which the courts encroached on the Legislature's prerogative and disrupted medical care for the poor. By resisting the compromises of 1994 and 1995, both in the Legislature and in court, however, the health groups started to reclaim the issue of “following the will of the voter,” which paved the way for the fight in 1996 to restore the Health Education and Research Accounts.

But getting the issue framed in a way that helps public health is only part of the battle. Tobacco control advocates also need to know what they want the money for. In 1989, when Proposition 99 passed, they were not ready. Although the dangers of tobacco use were well defined, with

over 60,000 studies documenting the toll of tobacco use, in 1989 the methods for preventing tobacco use and for encouraging cessation were not as well defined.[26] The problem for the public health advocates was that, in the words of Cliff Allenby, Deukmejian's secretary of health and welfare, “They had no act.”[27] Without an “act” in the form of a firm idea of what should be done with the money, the voluntaries were in a weak bargaining position.[28]

From the beginning, the CMA, Assembly Speaker Willie Brown (assisted by Steve Thompson), and the other health providers did “have an act.” CHDP was in place and could readily be expanded. All it lacked was money. If part of the object was to prevent youth from starting to smoke, then all the health providers needed to do was to present a plausible argument that advice from a doctor was one route to achieving this goal. Looked at carefully, it was not really plausible that advising infants and toddlers not to smoke would be very effective. But no one challenged the plausibility of the program. The health groups deferred to the medical groups because they thought they had no choice.

Even in 1991, as it was becoming clear that the California Tobacco Control Program was working and tobacco use was dropping, the voluntary health agencies' lobbyists in Sacramento did not protect what the tobacco industry realized was a major strength of the tobacco control program: the local lead agencies. The lobbyists were willing to let the industry curb the local programs, apparently not realizing the degree to which cutting the local programs was an industry priority. Between reducing local funding outright, implementing Section 43 reductions, and diverting local money into Comprehensive Perinatal Outreach, Assembly Bill 99 served the tobacco industry's interests. The local programs were not fully restored until the fight of 1996 restored all funding to the California Tobacco Control Program.

From the start, the public health groups understood the value of the media campaign. While the lobbying effort was able to protect funding for the media campaign, including through such measures as the ALA lawsuit filed to protect the media campaign funds in 1992, the media campaign needed protection in addition to funding. The industry, if it could not kill the media campaign, wanted to limit its messages. By 1996-1997, the health groups were forced to learn how to pressure the administration for a high-quality media campaign.

By 1996, the tobacco control activists had an “act.” They knew what they wanted; the issue was how to get it from the political process.

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