Tuesday, August 16, 2005

The Co-optation of the Anti-Smoking Movement - CHALLENGING DOGMA (Post #5): Tobacco Control as a Grassroots Social Movement

When I started my career in tobacco control, it was truly a grassroots social movement. The individuals involved in the movement were largely unpaid volunteers and they were involved because of a deep personal conviction in the cause, motivated by nothing other than a sincere desire to reduce tobacco-related morbidity and mortality. Similarly, the organizations involved seemed to be motivated solely by a desire to reduce tobacco-related disease.

But there was one thing which we didn’t have in the movement: money. Both individuals and organizations worked either as volunteers or on a shoestring budget. Even many of the researchers in the field did their tobacco research on no budget or on a very low budget. There were no multi-million dollar grants for anti-smoking research or interventions.

Nevertheless, the movement was highly successful. The grassroots nature of the movement gave it great credibility. It also provided great political power, as policy makers and the public viewed proposed tobacco control programs and policies as having originated from the community itself. And most importantly, the local, grassroots nature of the movement resulted in profound changes in social norms at the community level.

At the time, many of us (myself included) felt that if only we had money, if only we could establish a huge infrastructure for tobacco control, then we could really have an impact. If only there were a number of well-funded, national organizations devoted to tobacco control. If only there were well-funded national grant-making organizations that could fund research and intervention at the local level. And if only these national organizations would have the money necessary to be able to access the media: that would give us tremendous political power.

Money, we believed, could extend and enhance the grassroots social movement of tobacco control, bringing it to all communities throughout the country.

The Rest of the Story

Unfortunately, there were a number of consequences of the influx of money into the tobacco control movement that I had not foreseen.

First, money has created an additional influence on both individuals’ and organizations’ actions, beyond simply the desire to reduce tobacco-related disease. That influence is the need to maintain the influx of money to support the individuals’ funding or the organizations’ infrastructure.

One consequence of this is that individuals and groups that are funded by an organization no longer feel at liberty to criticize that organization. But because there are only two groups that supply the bulk of available funding for tobacco control programs (the Campaign for Tobacco-Free Kids and the American Legacy Foundation), those groups end up being essentially immune from public criticism. They can thus take any action they desire, no matter how unethical or inappropriate, without much fear of retribution or even attention to their wrongdoing.

A second consequence of this, in my view, is that it has created a “regulation for regulation’s sake” mentality, whereby the major group – in this case, the Campaign for Tobacco-Free Kids – seems to be intent on pursuing comprehensive federal regulation of tobacco, regardless of the potential effects of such legislation on the overall tobacco control movement and the public’s health. The desire to achieve something at the federal level is apparently so strong that it has led the Campaign and the groups following it to go so far as joining with Philip Morris in helping that company to promote its chief legislative priority for this Congressional session.

This mentality is also in evidence at the state level, where tobacco control practitioners often now seem to be working under the assumption that passing some legislation is better than passing nothing, even if the bill is not appropriate from a public health perspective. The assumption seems to be that we must accomplish something by passing some sort of legislation, so that we can say we accomplished something. But the fact that what we accomplished may actually be harmful to the overall cause of protecting the public’s health seems less important than the fact of “accomplishing” something.

A perfect example of this is the passage of Georgia’s Workplace Smoking Law, which I believe represents a public health policy without any public health justification. It actually creates a more hazardous workplace for many restaurant workers without guaranteeing protection from the alleged health hazards of secondhand smoke for any restaurant worker.

Second, money has resulted in the appearance of one prominent anti-smoking organization – the Campaign for Tobacco-Free Kids – that in my opinion has essentially taken over the entire movement. There simply is no other organization with the level of resources available and thus there is no competition or opposition to anything the Campaign decides to do or to support.

While there could be no single, dominant organization when no one had money, the fact that one group has huge amounts of money and others have little has created a harmful monopoly in the tobacco control infrastructure.

But what makes the situation even worse is that the Campaign has co-opted the grassroots social movement of tobacco control by taking it upon itself to play the role of “official” representative of the tobacco control movement in all major federal policy matters. It was the Campaign that was at the negotiating table during the global tobacco settlement talks, which ultimately resulted in the Master Settlement Agreement. And it was the Campaign that was at the negotiating table during the talks that ultimately resulted in the federal FDA tobacco legislation that is currently before Congress.

And in my opinion, the Master Settlement Agreement is the worst public health blunder of my lifetime. It would be surpassed as the worst blunder if the FDA tobacco legislation were enacted.

Unfortunately, policy makers in Washington seem to have the impression that somehow the Campaign for Tobacco-Free Kids is the representative of the anti-smoking movement. So anything the Campaign approves seems to be viewed – inaccurately -- as representing the endorsement of the public health establishment. It is the Campaign’s self-annointment as the representative for the movement that has enabled two of the worst federal tobacco control policies ever to gain acceptance or serious consideration.

The creation of the Campaign for Tobacco-Free Kids played a substantial role in the ultimate development of what I think are the two worst existing or proposed national tobacco control policies that have ever been considered: the national tobacco settlement and the proposed FDA tobacco legislation.

Third, I think money has led to the end of the grassroots nature of the tobacco control movement, and to its institutionalization as a money-driven bureaucracy that has little interest in what the grassroots actually think. I simply do not see groups like the Campaign for Tobacco-Free Kids or even the voluntary health agencies really taking the time to listen to their constituencies. They tell their constituencies what to think and what to support. There is no room for dissension or opposition and no interest in engaging the grassroots in the decision-making process.

So rather than being a movement that is driven by the community, through its individual grassroots advocates, the tobacco control movement has become one that is driven by one or two national organizations, without grassroots participation in the decision-making process.

Fourth, and perhaps most importantly, I think that the “monopolization” of the tobacco control movement has pushed aside or perhaps even undermined the work of true grassroots organizations as well as individuals, working at the community level, leaving them essentially powerless. How can a local advocate or advocacy group play any kind of leadership role when the leadership has been usurped away by one or two national organizations?

So I have to say that I was wrong. The availability of money at the national level has not helped the tobacco control movement. It has hurt it.

While the national money has certainly resulted in some “accomplishments,” in the long run, I think it has resulted in, and will continue to result in greater harm to the tobacco control movement. What I see is the degradation of the movement due to its co-optation by one or two well-funded national organizations, with the loss of integrity and character of the movement and its major organizations, the emergence of a regulation for regulation’s sake mentality, and most importantly, the destruction of the grassroots social movement that achieved tremendous success in the effort to reduce the toll that tobacco takes on the health and lives of Americans.

No comments: