Yesterday, I attended a session of the World Bank Institute’s Flagship Course on Health , attended by health specialists from various countries. An expert panel shared experiences of using communication and persuasion toward bringing about pro health outcomes. Several success stories were shared on applying behavior change communication in areas such as hygiene and sanitation, nutrition and education, and immunization in Africa and Asia. Complementary to this focus on individual and social change was a presentation by Patricia Sosa, Esq. on experiences of the Campaign for Tobacco-Free Kids . The organization advocates for policy change in various countries and the core of their strategy is changing the rules of the game to reduce tobacco use.
In Turkey, for example, they were able to decrease the prevalence of smoking by advocating for a ban in workplaces and public spaces. Public opinion research, conducted early on to inform the strategy, found that 85% of the population and even a majority of smokers, 63%, would support such a policy. Armed with this information, the campaign was able to convince policymakers that should they enact such a policy, they could count on public support.
In Ukraine, a series of tax increases (3 hikes in 8 months) have been enacted due to a successful lobbying strategy. Through research, they linked smoking and its very high prevalence in thge country to other public policy problems, such as negative population growth (more people were dying than being born) and that previous tax increases on tobacco were actually below the rate of inflation (linked to some strange facts like cigarettes being cheaper than bread). Using this information, they put together a public interest lobbying strategy and educated policymakers on the issue. Targets included the ministries of health, finance, and the economy, and the presidential administration.
Examples such as these have provided evidence for the effectiveness of the Campaign for Tobacco-Free Kids  policy change framework. Although country contexts differ in many ways, Patricia Sosa said that these policy changes have been found to achieve decreases in smoking behavior universally. Summing up their experience is an advocacy for policy change framework, with the following components:
• Using Science/Research: Gathering information through research to build solid arguments and drive advocacy and communication efforts. Includes scientific analysis and public opinion research.
• Communications: Earned and paid media efforts to support policy change and keep the issue in the public eye (we “earn” media coverage by educating journalists on the issue).
• Direct Policy Advocacy: Efforts to educate and influence policy makers on policy options.
• Coalitions and Partnerships: Develop networks and allies to advocate for change.
Each of these components makes sense and, taken together, they can serve as a menu of options for a powerful policy change campaign. But we know that when it comes to policy analysis and policy change, the devil is in the details. It’s important to find out, for instance, how much of a tax increase is likely dissuade smokers from buying a pack of cigarettes (e.g., we know that to a certain extent, cigarette consumption is inelastic). The framework shows that it is critical to give those who make decisions on behalf of their constituents the best available information on policy alternatives. However, we can’t stop there. As also reflected in the framework above, we must find ways of helping these constituents hold their leaders accountable by encouraging public scrutiny and building strong coalitions and partnerships.
Photo credit: Flickr user Grantuking