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Power: Turning Ideas into Action

To get their “act” through the political process, tobacco control activists needed political power, and the primary source of their power was public sentiment. To activate public sentiment, they had to keep the process as public as possible. Between 1989 and 1996, however, the health lobbyists did not exploit this resource. Until 1996, tobacco control advocates supported having the Proposition 99 programs designed by a conference committee, not by the policy committees of the Senate and Assembly. By sending the bill to a conference committee, tobacco control advocates lost the advantage of public debate and review. A conference committee is very much an insider forum in which the public is generally excluded from knowing what is going on or being given a chance to influence the process.[29] The public health groups have not been as successful at the inside game as the tobacco industry or the medical groups. Unlike the tobacco industry and medical groups, which are major sources of campaign contributions, public health groups do not make campaign contributions.[6][30-32] After the voluntary health agencies agreed to major cuts in AB 99 in 1991 in exchange for three years of program stability, the more powerful insider players simply ignored the deal. Even so, the voluntary health agencies continued to play the insider game, while not increasing resources for their lobbying efforts.

The agencies do, however, enjoy high name recognition and credibility with the public.[33] By contrast, the tobacco industry has very low public credibility. This difference in public standing means that outside strategies are likely to be the public health community's best means to achieve good tobacco policy, because the skills and resources of the voluntary health agencies tend to be amplified in public arenas while those of the tobacco industry are muted. But outsider strategies require a commitment of resources to a continuous public information effort. Equally important, they require a willingness to anger powerful politicians and interest groups by publicizing their misdeeds.

With nearly exclusive reliance on the insider strategy between 1989 and 1996, another problem for the public health groups was that the media and thus the public were kept uninformed and disengaged. To raise an issue in the insider circle is not the same as raising it with the media, which is an outsider strategy. The first major move outside the Capitol—when ALA filed a lawsuit in 1992 over the media funding—generated some publicity and protection for the media account budget. But when


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the later lawsuits over AB 816 successfully challenged the diversion of funds from Health Education and Research into health care, the voluntary health agencies did not use publicity about their victory to bring public pressure to bear on the governor or the Legislature. The legal victories, although clearly a successful use of outsider strategies, were not further amplified in the outsider forum. The court victory was instead viewed as a new piece of ammunition to bring into the insider game, not as a way to involve the public and get the media to frame the issue as “following the will of the voter.”

In 1996 the tobacco control groups made a decision to engage the public and shift the focus away from Sacramento. Although AHA and ANR, on one hand, and ALA and ACS, on the other, engaged in different campaigns to restore the voter-approved funding levels to Proposition 99, there were some common themes in their approaches. Leaders in both coalitions sought to expand the scope of the conflict in 1996 to involve more than just the Legislature and the Sacramento insiders.[34] In particular, they worked to involve the media and the public more and to involve local level activists and agencies in the fight to restore the anti-tobacco programs. They committed time and money to the effort. Shifting the venue out of the Legislature into a more public arena meant that the debate over the future of Proposition 99 would occur in a venue in which the public health groups were more powerful and the tobacco industry and its medical allies were weaker. This more favorable venue contributed to the health groups' victory.

In the years following 1996, the Legislature continued to vote for full funding of the Proposition 99 Health Education and Research Accounts, even without a massive campaign to protect them. These votes were achieved even though the Court of Appeal had overturned the Superior Court's decision that SB 493 violated Proposition 99, leaving open the issue of whether or not the diversions were legal. Tobacco control activists had demonstrated that they could create the kind of public pressure it takes to leverage legislative behavior and, over time, impaired the ability of the tobacco industry to control the Legislature.

In 1998, after the smoke-free bar law went into effect, the Legislature withstood several attempts to overturn the ban, in spite of the tobacco industry's all-out attack on it. Tobacco control activists had, over the course of two decades, convinced the Legislature that people cared about tobacco control issues and had learned how to make it painful to ignore the public will on tobacco issues.


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