Tobacco War: Inside the California Battles

by Stanton A. Glantz, Edith D. Balbach

Overview

Tobacco War charts the dramatic and complex history of tobacco politics in California over the past quarter century. Beginning with the activities of a small band of activists who, in the 1970s, put forward the radical notion that people should not have to breathe second-hand tobacco smoke, Stanton Glantz and Edith Balbach follow the movement through the 1980s, when activists created hundreds of city and county ordinances by working through their local officials, to the present--when tobacco is a highly visible issue in American politics and smoke-free restaurants and bars are a reality throughout the state. The authors show how these accomplishments rest on the groundwork laid over the past two decades by tobacco control activists who have worked across the U.S. to change how people view the tobacco industry and its behavior.

Tobacco War is accessibly written, balanced, and meticulously researched. The California experience provides a graphic demonstration of the successes and failures of both the tobacco industry and public health forces. It shows how public health advocates slowly learned to control the terms of the debate and how they discovered that simply establishing tobacco control programs was not enough, that constant vigilance was necessary to protect programs from a hostile legislature and governor. In the end, the California experience proves that it is possible to dramatically change how people think about tobacco and the tobacco industry and to rapidly reduce tobacco consumption. But California's experience also demonstrates that it is possible to run such programs successfully only as long as the public health community exerts power effectively. With legal settlements bringing big dollars to tobacco control programs in every state, this book is must reading for anyone interested in battling and beating the tobacco industry.

Product Details

ISBN-13:	9780520924680
Publisher:	University of California Press
Publication date:	05/10/2000
Sold by:	Barnes & Noble
Format:	eBook
Pages:	486
File size:	5 MB

About the Author

Stanton A. Glantz is Professor of Medicine at the University of California, San Francisco. Among his books are The Cigarette Papers (California, 1996), Tobacco: Biology and Politics (1999), and Primer of Biostatistics (1997). Edith D. Balbach is Director of the Community Health Program at Tufts University.

Read an Excerpt

Tobacco War

Inside the California Battles

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By Stanton A. Glantz, Edith D. Balbach

UNIVERSITY OF CALIFORNIA PRESS

Copyright © 2000 The Regents of the University of California
All rights reserved.
ISBN: 978-0-520-92468-0

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CHAPTER 1

Introduction

New Year's Day 1998 was crisp and clear along the coast just north of San Francisco, a fine day for a hike. Stanton Glantz, a professor at the University of California, San Francisco, and longtime tobacco control advocate, joined a group of friends to hike from high on Mt. Tamalpais down to the ocean. At the end of the trail, the hikers would meet other friends at a bar in Stinson Beach for a drink and lunch. As they approached the bar, Glantz wondered what would happen there. On January 1, 1998, after all, every bar in California was to become smoke free. Glantz had actually opposed the state law making bars smoke free because he doubted that the state legislature would stand up to the tobacco industry and pass a strong law. He also believed that such matters were best left to local communities. The tobacco industry had already mounted a major campaign to encourage people to ignore the law. By then, however, most people thought Glantz was responsible for the law. He expected to walk into another smoky bar and hear comments from his friends that he had gone too far.

But he was pleasantly surprised. A couple of people stood outside the bar smoking cigarettes, but the air inside was smoke free. Bars, the last bastion of smoking, were smoke free. California had indeed come a long way since 1978, when attorneys Peter Hanauer and Paul Loveday had recruited Glantz for an ill-fated effort to pass a state law requiring non-smoking sections in restaurants. They did not even dare think about bars.

THE CHANGING ENVIRONMENT OF TOBACCO

The landscape surrounding tobacco was not changing merely in California. By New Year's Day 1998, tobacco was a highly visible issue in American politics. President Bill Clinton allowed his Food and Drug Administration to assert jurisdiction over tobacco products as drug delivery devices. Forty-one states had sued the tobacco industry for defrauding the public out of billions of dollars that taxpayers had spent to treat sick smokers; the states would soon force the tobacco industry to pay $200 billion to reimburse them for part of those costs. Thousands of individuals sued the industry and some won. The industry was being forced to accept controls—albeit limited—on its advertising practices. Millions of pages of previously secret tobacco industry documents were made public, first in print, then on the Internet and in a depository created from the documents that Attorney General Hubert Humphrey III of Minnesota forced the tobacco industry to make public. These documents showed that the tobacco industry had known for decades that nicotine is addictive and that smoking causes a wide variety of diseases. They also demonstrated how the tobacco industry used its considerable public relations, legal, and political muscle to hide this information from the public and the courts. Later in 1998 Congress had a rancorous debate over whether to enact national tobacco control legislation that put some restrictions on the tobacco industry in exchange for giving it legal immunity. In the end, Congress strengthened public health provisions of the proposed legislation to the point that the tobacco industry and its political allies killed it.

This burst of activity reflected the groundwork that had been laid over the previous two decades by tobacco control activists who had been working all over the United States to change how people viewed the tobacco industry and its behavior. Beginning in the 1980s, California activists, led by Hanauer and Loveday, created hundreds of city and county ordinances to protect nonsmokers from secondhand smoke and otherwise restrict the tobacco industry by working through their city and county officials. These local activists created strong public support for tobacco control policies. Even so, the tobacco industry continued to dominate the California Legislature, where tobacco control policies had scant support.

But in 1988 activists from the environmental movement and the American Lung Association and American Cancer Society reacted to this legislative impasse by creating the largest and most innovative program in the world through the initiative process, by which voters enact a law by popular vote. California voters enacted an initiative known as Proposition 99, which increased the tobacco tax by twenty-five cents a pack and devoted 20 percent of the money raised to fund a tobacco control program. Virtually overnight, California's investment in tobacco control went from almost nothing to over $100 million a year in schools, communities, and counties and at the state level. In addition, nearly $20 million a year was available to California researchers to conduct tobacco-related research. These programs dwarfed anything that any other state or the federal government had ever done on tobacco.

Far from running a traditional "smoking will kill you" campaign, the California effort viewed tobacco as a social and political problem and went after the tobacco industry directly and aggressively. The network of local tobacco control advocates that Proposition 99 created lit the afterburners on the nonsmokers' rights movement. Communities started passing clean indoor air and other tobacco control ordinances so fast that it was hard to keep track of them all. The culture around tobacco was changing. The initial results of the California campaign were nothing short of amazing: it tripled the rate of decline in tobacco use. Unfortunately for the public health, the tobacco industry appreciated that this campaign was costing it billions of dollars in lost sales and mobilized to divert the money from tobacco control and to constrain the program to ineffective strategies. Nevertheless, the California experience shows that it is possible to rapidly reduce tobacco consumption if the political will is there to do it.

The tobacco industry was not alone in its efforts to divert money from tobacco control programs. Organized medicine and other constituencies that wanted more money spent on medical services for the poor spearheaded the lobbying effort to redirect money into medical services. Politicians in both parties were happy to do the industry's bidding in exchange for campaign contributions or because of a common ideological position. In 1994, after several years of rapid reductions in tobacco use, the industry brought this progress to a halt.

For public health advocates, success in political arenas required that they set aside the conciliatory tactics they had relied on in the past and learn to be more confrontational in dealing directly with the tobacco industry. However, they were less willing to confront the industry's surrogates, especially organized medicine or powerful politicians.

While the story of tobacco control in California reflects the individuals and organizations who were involved, the story is relevant every-where. The tobacco industry's efforts to influence state and local programs are controlled nationally, and the patterns in California have reappeared wherever public health advocates try to clean the air or control the tobacco industry. As a new century begins, more and more states are implementing large-scale tobacco control programs, often through dedicated tobacco taxes or as parts of settlements of lawsuits with the tobacco industry. Massachusetts was the first state to follow California, when voters there passed Question i in 1992; Arizona was next in r994, followed by Oregon in 1996. Other states, including Wisconsin, Michigan, and Maine, created tobacco control programs through the legislative process, and Florida, Minnesota, Texas, and Mississippi, among others, did so through legal settlements with the tobacco industry.

RECURRING THEMES

The story of the battle over tobacco control in California has several recurring universal themes.

First, although health promotion and medical care have a logical connection, there has always been a tension between them in the allocation of tax dollars. In the battles over the Proposition 99 revenues, the existence of an a priori agreement between those involved in health promotion and those involved in medical care did little to curtail these battles. Moreover, the financial and political interests of organized medicine often had more in common with the tobacco industry than the public health groups, who had been marginal players in California politics before Proposition 99 passed. Despite the fact that these groups successfully defeated the tobacco industry in a major electoral contest to pass Proposition 99, it was hard for them to understand their power and wield it after the election.

Second, it is easiest to make policy in areas where there is a clear consensus on how to achieve the program's goals. Before Proposition 99, no one had ever run a large-scale tobacco control program and no one knew exactly how to do it. In contrast, everyone knew how to spend money on direct medical services. This difference, combined with the lack of precedent for mounting a prevention program of the magnitude of the one created by Proposition 99, complicated the health advocates' task. The absence of a proven approach to reduce tobacco use could have been mitigated with a long time frame to develop and implement the program and a careful evaluation process. Politicians, however, who tend to rely on short schedules and temporary settlements, did not allow enough time for such a process, even though Proposition 99's tobacco control program was breaking new ground. This situation led anti-tobacco advocates to make early compromises that would come back to haunt them.

Third, programs tend to remain in place once established. Temporary agreements or one-time diversions of funds, as happened when tobacco control proponents agreed to allow some anti-tobacco education money to be used for medical services, become precedents in subsequent budget years because operating programs build their own constituencies.

Fourth, and finally, informed and activated public opinion is a powerful weapon in health policy generally and on tobacco policy specifically. When tobacco policy is left to the inside game played in back rooms, the outcome will favor the existing power structure. The tobacco industry is a tough, experienced inside player who has benefited from the existing power structure. In contrast, the public health groups' power is amplified in public arenas, where tobacco industry's power is sharply curtailed.

CONCLUSION

The California experience shows that it is possible to dramatically change how people think about tobacco and the tobacco industry and rapidly reduce tobacco consumption. Based on the initial results of the program, the state was on its way to reducing tobacco consumption by 75 percent in just ten years. The California story shows that it is possible to run such programs successfully as long as the public health community exerts power effectively. It also shows that it is possible for the tobacco industry and its political allies to weaken or destroy these programs when the public health community is timid. The tobacco industry, faced with losing billions of dollars in sales, is highly motivated and aggressive. The controlling factor in the outcome is whether the public health community is willing to directly confront this reality and devote the organizational resources—both financial and political—to beating the tobacco industry. Victory is possible but not easy, and it requires constant, determined vigilance.

While Proposition 99 passed in 1988, it had its origins over a decade earlier, in the emergence of the nonsmokers' rights movement. In contrast to the large voluntary health organizations, the grassroots advocates of nonsmokers' rights saw political and policy interventions as the key to doing something about tobacco. Rather than convincing one person at a time to stop smoking, they fought to enact laws requiring smoke-free workplaces, public places, and restaurants. Their efforts brought about systemic, environmental changes that had an impact on how citizens viewed the tobacco industry and their rights as nonsmokers. They made smoke-free bars not only possible but reasonable.

The California story begins with them.

CHAPTER 2

Beginnings: The Nonsmokers' Rights Movement

In the early 1970s a few people had the radical idea that nonsmokers should not have to breathe secondhand tobacco smoke. At that time it was considered impolite to ask people not to smoke. Smoking was not only acceptable; it was the norm. The executive director of the California division of the American Lung Association was a chain-smoker, and the American Heart Association distributed ashtrays and packs of cigarettes at its board meetings. Offering someone a cigarette was a way to open social discourse. Even the most ardent nonsmokers' rights advocates were only seeking nonsmoking sections in public places. No one dared even think of a smoke-free society.

Finding little support from the mainstream health organizations like the American Cancer Society, American Heart Association, and American Lung Association, nonsmokers' rights activists formed a loose network of grassroots organizations with various names, the most common being Group Against Smoking Pollution or GASP. The nonsmokers' rights activists viewed smoking and the tobacco industry as a social, environmental, and political problem; in contrast, the medical establishment—including most of the voluntary health organizations—viewed smoking as a medical problem in which individual patients (smokers) were to be treated (by telling them to stop smoking). The establishment's approach did not mesh easily with the tobacco control advocates' policy-oriented approach.

While the medical and health establishments did not take the non-smokers' rights movement seriously, the tobacco industry did. The industry recognized the issue of secondhand smoke as a major threat to the social support network that it had spent decades building around tobacco use. As early as 1973, the tobacco industry clearly identified the emerging nonsmokers' rights movement as a problem: "More and more, smoking is being pictured as socially unacceptable. The goal seems [to be] the involvement of others—non-smokers, children, etc.—in addition to health and government organizations. The main thrust of these zealots seems to be that 'smoking is not a personal right because it hurts others; that smoking harms non-smoking adults, children, and even the yet unborn.'"

By r978, the industry recognized the full dimensions of the threat represented by the nonsmokers' rights movement. A research report prepared by the Roper Organization for the Tobacco Institute (the tobacco industry's political arm) concluded:

The original Surgeon General's report, followed by this first "hazard" warning on cigarette packages, the subsequent "danger" warning on cigarette packages, the removal of cigarette advertising from television and the inclusion of the "danger" warning in cigarette advertising, were all "blows" of sorts for the tobacco industry. They were, however, blows that the cigarette industry could successfully weather because they were all directed against the smoker himself.

The anti-smoking forces' latest tack, however—on the passive smoking issue—is another matter. What the smoker does to himself may be his business, but what the smoker does to the non-smoker is quite a different matter. ... Nearly six out of ten believe that smoking is hazardous to the non-smokers' health, up sharply over the last four years. More than two-thirds of nonsmokers believe it; nearly half of all smokers believe it.

This we see as the most dangerous development to the viability of the tobacco industry that has yet occurred. [emphasis added]

The nonsmokers' rights movement was growing and having some significant legislative successes. In 1973 the Arizona Legislature ended smoking in elevators, libraries, theaters, museums, concert halls, and buses. In 1975 Minnesota mandated separate smoking areas in restaurants, meeting rooms, and workplaces, in addition to the types of restrictions put in place in Arizona. The Minnesota law was the last time that clean indoor air legislation would pass without vigorous opposition from the tobacco industry.

THE BERKELEY ORDINANCE

In the spring of 1973, lawyer and legal editor Peter Hanauer went to a meeting of Berkeley GASP after his wife saw a meeting notice on a community bulletin board. Hanauer recalled, "It was a fairly ineffective group at the time. I mean, we were busy grinding out leaflets and trying to get a few new members here and there." While there were thoughts about some greater level of activism—two of the founders, Irene and Dave Peterson, had created a foundation to provide legal representation to people who were affected by secondhand smoke in the workplace—not much happened until they were joined by Paul Loveday, a former professional basketball player turned lawyer. Loveday brought a clear vision and strong leadership to the group and soon became president of GASP. The aggressive Loveday and studious Hanauer, who was elected treasurer, were the "odd couple" that became the backbone of the non-smokers' rights movement in California.

(Continues...)

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Excerpted from Tobacco War by Stanton A. Glantz, Edith D. Balbach. Copyright © 2000 The Regents of the University of California. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

List of Figures and Tables
Preface

I. Introduction
The Changing Environment of Tobacco
Recurring Themes
Conclusion
2. Beginnings: The Nonsmokers' Rights Movement
The Berkeley Ordinance
Proposition 5
The Tobacco Industry Joins the Battle
The $43 Million Claim
The Postmortem
Proposition 10
Going Local
The San Francisco Ordinance
The Tobacco Industry's Counterattack
Tobacco Control Advocates Mobilize
The Proposition P Campaign
Lessons from the Proposition P Campaign
Conclusion
3· Proposition 99 Emerges
The Idea
The Coalition for a Healthy California
The Legislative Effort
The CMA and the Tobacco Industry
The Napkin Deal
Conclusion
4· Beating the Tobacco Industry at the Polls
Locking in Money for Prevention
Organizing the Campaign
The Industry Campaign
Getting the Medical Providers to Buy In
Collecting the Signatures
Launching the Election Campaign
Putting the Issue before the Voters
The CMA's Quiet Withdrawal
The Fake Cop Fiasco
Reflections on the Industry's Defeat
Conclusion
5· Moving to the Legislature
The Tobacco Industry's Pricing Strategy
Conflicting Views of Health Education
A Hostile Legislative Environment
California's Fiscal Problems
Down the Legislative Path
The Coalition's Disintegration
The Governor's Budget
The Tobacco Industry's Legislative Strategies
Conclusion
6. Proposition 99's First Implementing Legislation
The Voluntary Health Agencies' Legislation
Other Significant Tobacco Education Legislation
The Child Health and Disability Prevention Program
Negotiations and Agreements
Project 90
The Battle over the Media Campaign
The Research Account
The Outcome
Conclusion
7· Implementing the Tobacco Control Program
Two Different Models
Leadership at DHS
The Media Campaign
The Local Lead Agencies
Encouraging Diversity
The Schools: A Different Approach
Early Leadership Problems
Monitoring and Accountability
Formalizing Noncooperation between DHS and the
Schools
Conclusion
8. The Tobacco Industry's Response
The Industry and the Media Campaign
"It's the Law"
The Industry and the Schools
Conclusion
9· The Battle over Local Tobacco Control Ordinances
Beverly Hills
Lodi
Sacramento
The Escalating Fight over Local Ordinances
Long Beach
Placer County
The Sacramento Battle over Measure
The Tobacco Industry's Plan: "California's Negative
Environment"
The Tobacco Industry and the California
Public Records Act
Conclusion
10. Continued Erosion of the Health Education
Account: 1990-1994
Early Postures
The CMA Position
Governor Wilson's Budget Cuts
The Tobacco Industry's Strategy
The Final Negotiations
AB 99 Emerges
The Governor Tries to Kill the Media Campaign
The First Litigation: ALA's Lawsuit
The I992-I993 Budget Fight
Positioning for 1994
The Governor Kills the Research Account
Conclusion
II. Battles over Preemption
SB 376: The First Threat of Preemption
The Voluntary Health Agencies Accept Preemption
The Birth of AB I3
The Tobacco Industry's Response: AB 996
The View from outside Sacramento
AB I3 and AB 996 on the Assembly Floor
On to the Senate
The Philip Morris Plan
The Philip Morris Initiative
The Continuing Fight over AB I3
The Philip Morris Signature Drive
The Legislature Passes AB I3
AB I3 and Proposition I88
The Stealth Campaign
The "No" Campaign
The Wellness Foundation
The Federal Communications Commission
Conclusion
I2. The End of Acquiescence
The Governor's I994-I995 Budget
The Creation of AB 816
Objections to CHDP
The Hit List
The ANR-SAYNO Lawsuit
The Conference Committee Hearing
The CMA
Last-Minute Efforts to Stop AB 8I6
The Floor Fight
The Final Bill
Conclusion
I3. The Lawsuits
Child Health and Disability Prevention
Comprehensive Perinatal Outreach
The Health Groups' Victory
The Lawsuit's Aftermath: SB 493 in 19995
The SB 493 Lawsuits
Conclusion
I4. Doing It Differently
The Need for a Change
The December Meeting
The CMA
The Governor's Budget
Changes in the Legislature
The Coalitions Form
The "Hall of Shame" Advertisement
The Wellness Grant
The CMA House of Delegates Meeting
The Philip Morris Memo
The Governor's May Revision
Reaction to the Governor's New Budget
Attempted Restrictions on the Media Campaign
The Research Account
The Final Budget Negotiation
Engaging the Media
The End of the Diversions
Conclusion
15. Political Interference in Program Management
Squashing the Media Campaign
"Nicotine Soundbites"
Implementing Pringle's Pro-Tobacco Policies
Shutting Out the Public Health Community
The TEROC Purge
The Strengthened Advertisements
The 1998 Hearings
Trying to Control TEROC
Delayed Implementation of the Smoke-free
Workplace Law
Pulling the Advertisements for Smoke-free Bars
The California Tobacco Survey: TCS "Fires"
John Pierce
Conclusion
I6. Lessons Learned
The Players
The Keys to Success: Ideas, Power, and Leadership
Ideas: Knowing What You Want
Power: Turning Ideas into Action
Leadership: Seizing Opportunities and Challenging
the Status Quo
Conclusion

Appendix A. Organizations, Programs, and People
Involved in Tobacco Control in California
Appendix B. Important California Tobacco Control
Events
References
About the Authors
Index