1. 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

2. 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 2 nd 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

3. 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

4. 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

5. History of Private/Public Partnership: Mid-1990s Settlement money started rolling in DoH 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

6. 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)

7. 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

8. Solutions to ‘90s Challenges CHRI includes DoH in its evaluation and planning (and adapts to suggestions) Increased informal meetings to build bonds Active attention to internal communication Continued sharing of important news New staff introduced and given opportunities to build relationships Incorporate DoH staff into CHRI committees

9. 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

10. 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

11. Case Study: Potential Cut to DoH Funding DoH alerted of potential cut to program DoH alerted CHRI Avoided misunderstanding & rumor mill Allowed CHRI to get started on strategy Allowed DoH to avoid ill formed advocate strategy

12. Key lessons Contributions of DoH & advocates must be in balance Barriers really decreased once CHRI staffed Crucial to maintain personal relationships DoH must be accessible & understand worth of advocates Advocates must see DoH as strong ally and not opponent Seek natural allies Be flexible and willing to accommodate to partners