Leadership: Seizing Opportunities and Challenging the Status Quo
The ability to construct an “act” and to mobilize the power to implement it requires leadership that can both seize opportunities and challenge the status quo. Strong leadership means having people in place who are willing to pursue a tough and sometimes confrontational strategy. The voluntary health agencies are generally far less confrontational and much more willing to compromise than their advocacy group counterparts because the voluntary health agencies have multiple legislative issues and competing demands. Thus, historically the voluntary health agencies have rarely been effective advocates for tobacco control in the face of concerted opposition from the tobacco industry and its political allies.
The environmentalists continued their successes with Proposition 99 throughout its course. While the voluntary health agencies were having to justify their programs over child health programs, environmentalists successfully avoided having the issue framed as “mountain lions versus sick children” and kept more than their original allotment of 5 percent of the tax revenues. The fact that no one touched the environmentalists was a tribute to the environmental movement's combination of strong inside leadership and ability to use tough outsider strategies when needed.
Once Proposition 99 passed, rather than following the environmentalists' model and assuming a strong, unified, confrontational leadership posture to protect the anti-tobacco education and research programs, the health groups' lobbyists worked within the established power structure. They accepted the kind of legislative compromises that would have been expected within that system before Proposition 99 passed. They failed to capitalize on the power that they had just demonstrated by defeating the tobacco industry in the election.
During the fight over AB 75, the first implementing legislation, the reliance on the insider game by the voluntary agencies led to only modest compromises. With the election less than a year in the past, the Legislature was conscious of what the public wanted. Steve Scott, political editor of the California Journal, observed: “Their [the tobacco industry's] most important ally at the time was Speaker [Willie] Brown, but with the election still fresh in memory, even Brown's muscle couldn't pull enough votes for the industry to get its way in this battle. It was one of the first major losses suffered by the industry in the Legislature until that time.”[35]
The voluntary health agencies' decision to compromise on AB 75 and allow funding of CHDP from the Health Education Account helped the CMA, CAHHS, and the tobacco industry and put the health groups in a difficult position. They began to protest the diversions in 1994. By 1995, Steve Thompson, who had become the CMA's chief lobbyist, could use the voluntary health agencies' previous actions to counter their emerging claim that the diversions were illegal; “Overall revenue,” he said, “was diminished and what might have been, depending on one's point of view, a legal or illegal transaction initially has certainly become an illegal transaction today.”[36] Having agreed to the diversions in the past, it was difficult for the health groups to claim the moral high ground about the illegality of those same diversions as money got tighter.
Thus, in 1994, in the face of their changed position and a tough budget year, the voluntary health agencies had a hard fight before them, again being fought with no more resources than they had before Proposition 99 passed. To complicate matters further, however, they were also trying to pass AB 13 in the midst of a rancorous debate within the health community over whether AB 13 was a good idea. At the same time, the tobacco industry qualified its own initiative, Proposition 188, for the ballot, which further drained resources and energy away from the Proposition 99 battles. Not surprisingly, 1994 was the worst year yet for Proposition 99 in the Legislature, with AB 816 diverting $301 million of the Health Education and Research revenues—34 percent of the money the voters had allocated to tobacco control—into medical programs.
If the absence of leadership from public health had been a problem in the first eight years of Proposition 99, the entry of strong leaders in 1996 was key to restoring the voter-mandated funding levels. In 1996, under the leadership of AHA executive vice president Roman Bowser, AHA joined ANR and Stanton Glantz and confronted the CMA in a successful effort to separate it from the tobacco industry. The ACS leadership became more involved in the legislative process instead of merely deferring to their lobbyists. The CMA leadership, too, took a more active
In addition to changing their behavior in Sacramento, the health groups involved their grassroots membership. All these actions shifted the control over the legislation away from the lobbyists and to the organizational leaders, who were more concerned with designing an effective tobacco control program than maintaining relationships within the Legislature.