Creating Public/Private Relationships in Tobacco

Control Advocacy

Alison Buckser, MPH, Campaign for a Healthy RI

Marianella Dougal, RI Department of Health

Karen Malcolm, Ocean State Action

Betty Harvey, MA, MS, RI Department of Health

Rhode Island Background Population 1,048,319 Smallest state in US-can

drive from one state border to another in 45 minutes

Personal relationships key to all business--both political and economic

No county government; only state Dept of Health

Ranks 2nd in US in tobacco excise tax at $1.71

DoH Tobacco Control Program $2.7 million (27.3% of

CDC minimum recommendation)

7 full-time staff Comprehensive tobacco

control programs

Campaign for a Healthy RI

Coalition of businesses, health organizations, community groups, physicians & grassroots advocates.

Funded by the RWJF SmokeLess States Initiative

Commitment to grassroots organizing

Policy agenda: Pass meaningful

statewide smokefree workplace legislation

Introduce two local smokefree workplace ordinances

Increase the state’s tobacco control budget to CDC recommended levels

Reduce premiums required from Medicaid recipients to maximum 2% of income

History of Private/Public Partnership: Early 1990s

ALA, AHA, ACS and DoH worked closely together Work focused on

educating and persuading legislators

Effort entirely lobbying and grasstops work—no grassroots base

Work supported by strong media advocacy campaigns

Work resulted in many successes

Then the tobacco industry adapted and sent in more lobbyists

Tobacco control lobbying became harder

History of Private/Public Partnership: Mid-1990s

Settlement money started rolling inDoH had $1 million

in year 1$2 million in year 2$3 million in year 3

DoH bureaucracy grew in response to flood of money

Distance grew between DoH and advocates Lack of time to get

together and talk Little info exchange

between advocates & DoH

Personal relationships lost

Staff turnover at advocacy organizations

History of Private/Public Partnership: Late 1990s-Early 2000s

Growing distance resulted in: Lack of unified strategic

planning Distrust Lack of info exchange Loss of synergy Increased defensiveness on

both sides Resentment of DoH control

over $ for which advocates fought

RI settlement $ was securitized – none left

Advocacy movement grew Recruitment of Ocean

State Action, savvy in politics and organizing

SmokeLess States funded dedicated staff

New focus on basebuilding and grassroots organizing

New efforts to renew bonds between DoH and advocates (now under CHRI umbrella)

Role Clarification CHRI staff: support CHRI

goals; coordinate member contributions; keep lines of communication open; mediate relationships between members; build coalition; lobby

DoH role:Protect health of RI residents Provides info, research &

education; develops policy; lets CHRI reach its funded agencies; keeps of history; funds organizations to do tobacco control

CHRI role:Effect advocacy change Voluntaries: Recruit,

educate & mobilize membership; testify; lobby; add credibility to CHRI

Consumer & Grassroots Groups: Community organizing; mobilize voting constituencies; lobby; strategic training & direction

Solutions to ‘90s Challenges

CHRI includes DoH in its evaluation and planning (and adapts to suggestions)

Increased informal meetings to build bondsActive attention to internal communicationContinued sharing of important newsNew staff introduced and given opportunities to

build relationshipsIncorporate DoH staff into CHRI committees

Results

Strong relationship between CHRI & DoH

Advocate community larger and more politically powerful

Prospects for important legislative successes strong

Weekly lobby days during legislative session

Training and ongoing TA in advocacy

DoH sits on all CHRI committees, albeit in nonvoting capacity

Results, cont.

CHRI benefits from relationship Info, TA & research Contacts with DoH

funded organizations Access to individuals

benefiting from tobacco control programs

DoH gives CHRI insight into workings of DoH and state government

Help achieving mission

DoH benefits from relationship Information delivered

informally informs action Protective allies Help achieving mission

CHRI & DoH operate differently in same arena DoH advises Gov &

legislature on policy issues while CHRI presses for policy change using grassroots base

Case Study: Potential Cut to DoH Funding

DoH alerted of potential cut to programDoH alerted CHRIAvoided misunderstanding & rumor millAllowed CHRI to get started on strategyAllowed DoH to avoid ill formed

advocate strategy

Key lessons

Contributions of DoH & advocates must be in balanceBarriers really decreased once CHRI staffed

Crucial to maintain personal relationships DoH must be accessible & understand worth of

advocatesAdvocates must see DoH as strong ally and not

opponentSeek natural alliesBe flexible and willing to accommodate to partners