Not a Grassroots Campaign
By Patrick Reilly
The defeat of Sen. John McCain's $516 billion tobacco control bill in June reduces the chances of another large bill passing Congress anytime soon. But comprehensive anti-tobacco legislation will be back because the backers of this year's campaign are just beginning.
Tobacco control supporters have the backing of deep-pocketed benefactors. That is how the American political system works, and the anti-tobacco lobbies almost held their own against the immensely wealthy and politically savvy tobacco industry.
What is surprising is where the anti-tobacco forces get their money. Of course, many donors contribute to the tobacco control budget, but most of these contributions come from just two sources that work closely together: the Clinton Administration and the Robert Wood Johnson Foundation.
Federal programs begun by the Clinton Administration are funding the state and local networks that tobacco control advocates used in this year's push for even more new laws. That effort failed, but ongoing federal programs continue to help state and local coalitions increase cigarette taxes that in turn will fund more tobacco control efforts. Government-supported activists are the core of the next federal-level anti-tobacco campaign.
The Robert Wood Johnson Foundation works hand in glove with the Administration. It has contributed millions to anti-tobacco efforts for the past several years. Although the private grantmaker is the largest health care philanthropy in the United States, it operates in relative obscurity. But its support for tobacco control has propelled the recent national debate: the foundation is the largest funder of the Center for Tobacco-Free Kids, the leading nonprofit advocate for the McCain bill.
Private Gifts, Public Impact
With $6.7 billion in assets, the Robert Wood Johnson Foundation (RWJF) funds health-related research and advocacy. It has focused on expanding access to medical care and insurance, improving end-of-life care and preventing substance abuse.
But like many modern philanthropies, RWJF shows little respect for individual choice and the free-market system. The foundation was endowed by General Robert Wood Johnson, an entrepreneur and industrialist who built the medical care products company Johnson & Johnson into an international giant. But RWJF's board funds liberal nonprofits that support taxes and government controls, and anti-tobacco efforts have become one of its top priorities since 1991.
The Foundation's decision to emphasize youth smoking explains why public health groups and legislators have rushed to embrace the issue. Writing in the Foundation's 1997 annual report, RWJF president Dr. Steven A. Schroeder endorsed taxes on tobacco as "one of the most effective ways to reduce youth tobacco use" and a "way to generate revenue for such programs as expanding health insurance coverage for children."
"[I]t appears that the Foundation was one of a number of actors that elevated the prominence of tobacco as a national policy issue," writes Schroeder. "...[I]t is clear that the political atmosphere surrounding tobacco use among children has been irrevocably changed. We are proud of our role in making that happen." From 1991 until last year, RWJF made 159 grants to anti-tobacco organizations and activities. Its first grant was to Stop Teenage Addiction to Tobacco (STAT). Founded in 1985, STAT seeks to involve youth in efforts to "take action against the tobacco industry in their hometown." In 1993 RWJF initiated its "Smokeless States" program, at the time the nation's largest private tobacco control program. Managed by the American Medical Association, it supports nonprofit coalitions in 32 states that implement statewide tobacco control initiatives. In 1993 RWJF authorized $10 million in initial funding for 11 states. In 1996 another 21 states and $20 million were added to the program.
Although recipients may not use grant funds to lobby for specific legislation, the funded groups' activities often have clear implications for public policy. RWJF coalitions helped hike cigarette taxes by $.71 per pack in Alaska and $.68 per pack in Oregon. Kentucky's ACTION coalition brandishes RWJF funding and the Americans With Disabilities Act to bully public establishments to ban smoking.
Many Smokeless States grants have been awarded to divisions of the American Cancer Society (ACS). Last year grants to ACS divisions totaled $7.2 million. The American Lung Association, American Medical Association and American Nonsmokers' Rights Foundation also have received grants.
RWJF also funds groups like the Advocacy Institute, a Washington, D.C.-based training ground that teaches liberal nonprofits how to lobby. Last year RWJF gave the Advocacy Institute $157,000 to provide "technical assistance" to the Smokeless States program. This year it gave the Institute $460,000 to produce a series of policy papers on tobacco control policies targeted at youth.
The Institute is led by liberal activist Michael Pertschuk, Jimmy Carter's Federal Trade Commission chairman. At the FTC, Pertschuk led an unsuccessful crusade to ban advertisements for high-sugar cereals aimed at young children. This compelled even the Washington Post to chide Pertschuk for turning the FTC into "a great national nanny."
The Advocacy Institute's political savvy helped coordinate liberal activists who brought down Robert Bork's 1987 nomination for the Supreme Court. More recently Pertschuk and his staff helped mastermind the campaign for federal and state tobacco control measures.
Other recent grants reveal the scope of tobacco control efforts: The National Education Association got $500,000 for a "teacher, youth and parent tobacco control advocacy program." Prospect Associates, a major recipient of federal grants for tobacco control efforts, received $53,000 to host a national conference of state-level "tobacco prevention professionals," as did a National Medical Association project to mobilize tobacco control "support systems" in the African-American community. The Arizona chapter of the American Cancer Society received $3.2 million in 1995 for a Tucson program to engage youth in tobacco control. The majority of RWJF's tobacco-related grants support research, analysis and training. But often these activities contribute greatly to government tobacco control. For example, in 1995 RWJ funded and released a study showing 73 percent of Americans favored regulations to restrict youth access to tobacco products. The study was a major impetus for current federal and state efforts. Other RWJF studies have examined attitudes of legislators toward tobacco control policies, the effectiveness of lawsuits against tobacco companies and the implementation of tobacco control laws. But the Johnson Foundation's most important contribution to the tobacco control movement is the $20 million it committed over five years to establish the Center for Tobacco-Free Kids (TFK) in 1996. TFK has rounded up $32 million in initial funding commitments, including support from the American Cancer Society ($10 million), American Heart Association ($1 million), Annie E. Casey Foundation ($400,000) and smaller donors, including several foundations. (See box listing donors to TFK.)
That makes TFK the leading tobacco control organization in the U.S. Last year its vice president, Matthew L. Myers, helped forge the $368.5 billion court settlement between tobacco companies and 40 state attorneys general. This year TFK pushed for Sen. McCain's bill. (See this month's issue of Organization Trends.)
Initial Funders of Center for Tobacco-Free Kids
Private foundation grants are a trickle compared to the flood of taxpayer dollars streaming into anti-tobacco coffers.
Consider federal funding for the National Organization for Women (NOW). Since 1994 NOW has received more than $600,000 from the federal Centers for Disease Control (CDC) for "initiatives by organizations to strengthen tobacco control."
The stated purpose of NOW's program, called the "Redefining Liberation Campaign," is to challenge a perceived connection between "women's liberation" and tobacco, typified by once-popular advertising slogans like "You've come a long way, baby." But NOW's anti-tobacco program looks suspiciously like just another way to spend taxpayer money on its feminist agenda.
NOW's application for a 1994-95 grant of $187,000, described its "efforts and relevant experience." The activities it considered relevant to tobacco control were a 1992 reproductive freedom march, a march and rally opposing the Persian Gulf War, protests encouraging the Senate to hold hearings on Anita Hill's allegations against Clarence Thomas and a boycott of Florida citrus to oppose the industry's use of Rush Limbaugh as a spokesman. NOW promised to model its tobacco control efforts after its training and action program to "defend" abortion clinics from protesters.
NOW also uses its CDC grants to assist other nonprofits, including the Asian Women's Health Conference, Women and Girls Against Tobacco, Stop Teenage Addiction to Tobacco and National Lesbian Health Organization. Its partners include Americans for Non-Smokers' Rights and the American Lung Association.
The most recent CDC grant supports NOW's "Love Your Body" campaign. According to NOW's California chapter, the campaign will include information booths at 56 Lilith Fair concerts and a national "Love Your Body Day."
CDC grants to NOW are made through the agency's "national organizations" program. According to spokesman Ellwin Grant, the goal of the CDC's Office on Smoking and Health is to target anti-tobacco messages at "populations who traditionally have not been involved in tobacco control efforts," i.e. racial minorities, youth and women.
CDC has allocated $1.2 million for nonprofit activities between 1997 and 2000. Other recipients include six nonprofits that help "initiate and improve tobacco control policies and programs." They are:
* American Medical Women's Association (AMWA): Also targeted at women and girls, the AMWA program seeks to increase media coverage of tobacco and women's health issues and challenge the influence of tobacco industry advertising on females. AMWA is an association of female medical workers who seek to raise awareness about women's health and fight sexual harassment.
* Laborers Possessive Health and Safety Fund of North America: The Laborers Possessive International Union of North America represents 750,000 construction laborers. The CDC grant enables the union to address members' smoking habits, reduce medical claims and involve union leaders in tobacco control efforts.
* National Association of African-Americans for Positive Imagery (NAAAPI): This coalition of community-based groups was formed in 1991 to urge a boycott of R.J. Reynolds' ill-fated "Uptown" cigarette brand, which was marketed to blacks. It receives CDC funds to reduce the influence of tobacco and alcohol marketing aimed at blacks and to increase participation by African-American organizations in tobacco control efforts.
* National Association of Children's Hospitals and Related Institutions: This association is using CDC funds to study secondhand tobacco smoke at five hospitals in California, Maryland, New York, Ohio and Texas.
* Northwest Portland Area Indian Health Board: Through its "Western Tobacco Control Project," this group uses CDC funds to mobilize American Indian tribal communities to control tobacco use. Partners in the project include the Alaska Natives Health Board and the Montana-Wyoming Indian Health Board.
* Stop Teenage Addiction to Tobacco (STAT): The CDC grant enables STAT to develop "youth advocacy training materials" and to mobilize youth organizations nationwide for tobacco control.
Besides its national organizations grants, CDC manages a grant program called IMPACT, which provides $250,000 to $600,000 annually to each of 32 states for their anti-tobacco efforts. There is no projected ending date for the program.
CDC provides $9.9 million annually for school-based "coordinated health programs" targeting tobacco use in 15 states. More than 30 tobacco control organizations collaborate with CDC and receive funding. CDC also works with the Association of State and Territorial Health Officials, National Association of County and City Health Officials, National Association of Local Board of Health, National Council of State Legislators and World Health Organization.
When citizens ask about "smoking and health," CDC refers them to groups like Action on Smoking and Health (ASH), the Advocacy Institute, American Cancer Society, Americans for Nonsmokers' Rights, Group Against Smokers' Pollution (GASP) and TFK. CDC also sponsors a "Media Campaign Resource Center" to help states and nonprofits share anti-tobacco advertisements.
ASSISTing Tobacco Control
The federally funded National Cancer Institute (NCI) also supports anti-tobacco groups through its Project ASSIST (American Stop Smoking Intervention Study). Established in 1991, ASSIST provides about $25 million annually to 17 state health departments to support state coalitions of tobacco control advocates. It aims to duplicate a successful 1988 initiative in California to raise cigarette taxes and fund anti-smoking efforts.
ASSIST was scheduled to end this year, but NCI extended it through September 1999, when it probably will be merged into the CDC's IMPACT program.
ASSIST is a unique joint project with the American Cancer Society (ACS). ACS has contributed an estimated $25 to $30 million to the program and may not receive ASSIST grants. But it has equal status with state health officials when it comes to managing ASSIST funds. This gives ACS effective control over the use of $25 million annually in federal funds.
ASSIST has been criticized for supporting lobbying and political activities, although using federal funds for such activities is illegal. The program's guidelines encourage "policy advocacy," defined as "the presentation of information to public or private decisionmakers to encourage and persuade them to support and/or adopt smoking control policies and/or procedural changes."
NCI officials claim to distinguish advocacy from lobbying on specific bills before state legislatures. But in practical terms, the goals are the same: increased cigarette taxes, expanded regulation of tobacco products and advertising, and state funding for the activities of anti-tobacco advocates.
For example, Project ASSIST in Niagara County, New York recently sent hundreds of postcards to the county board of health in June seeking a ban on smoking in public places. And in February a North Carolina ASSIST leader recommended laws restricting tobacco advertising and increasing cigarette taxes to local activists.
According to the Washington Post, "Cancer institute officials deny spending U.S. funds on political activities, but acknowledge enlisting a private partner, the American Cancer Society, to lobby lawmakers. The Society's files aren't subject to open-records laws because it receives no ASSIST funds."
NCI also contracts with the Advocacy Institute to train ASSIST recipients in lobbying and public relations techniques. The Institute communicates with anti-tobacco groups through its Electronic Communications System and SCARCNet (Smoking Control Advocacy Resource Center Network), which is funded by ASSIST. The Advocacy Institute uses SCARCNet for training and action alerts. SCARCNet notices have called on advocates to contact legislators to lobby for general policies and specific legislation.
SCARCNet was first developed in 1987 with a grant from the Kaiser Family Foundation. Other funders included the American Cancer Society, California Department of Health, CDC, Robert Wood Johnson Foundation and Rockefeller Family Fund.
As for the Advocacy Institute, its funders include the California Wellness Foundation, Nathan Cummings Foundation, Ford Foundation, Gerbode Foundation, Haas Foundation, John D. & Catherine T. MacArthur Foundation and many others.
The Next Wave
Should government tobacco control programs continue indefinitely? Many conservative legislators would like to cut their funds, and a new administration might do so after the elections in 2000. Tobacco advocates know this, and they are taking precautions. The federal government for its part is trying to help nonprofits prepare for the future.
Recipients of ASSIST, IMPACT and other government grants are encouraged to lobby for increased state-level taxes on cigarettes and other tobacco products. Federal agencies want to ensure that more state tax revenues are used by state health departments and nonprofit coalitions for tobacco control.
Meanwhile the Robert Wood Johnson Foundation can be expected to continue its private support for tobacco control. And following this year's high-profile battle on Capitol Hill, other foundations are likely to contribute more to future efforts.
Clearly the tobacco control movement is not grassroots-initiated. It is funded by veteran liberal activists in the foundation, government and nonprofit worlds. Given time tobacco control advocates can wage an increasingly effective public relations assault and recruit more supporters.
If and when they return to Capitol Hill, it will be with a vengeance.
Substantial research assistance was provided by Koch Foundation fellow Karen Jones, a junior Classics major at the University of Dallas, and Brendan Scanlon, a junior History major at Boston College.