ARTÍCULO DE REVISIÓN

 

The role of evidence-based media advocacy in the promotion of tobacco control policies

 

El papel de la abogacía en medios de comunicación para la promoción de políticas del control del tabaco

 

 

Ch'uyasonqo H Lane, MPH; Marina I Carter, BA

Campaign for Tobacco-Free Kids. Washington, DC, USA

Corresponding author

 

 

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ABSTRACT

This article discusses the role of evidence-based media advocacy in the promotion of tobacco control policies. Evidence is a driving force for campaigns seeking to implement a tobacco control policy. An effective campaign is based in evidence that demonstrates why a policy should be implemented, and what the potential benefits are. Media advocacy is the process of disseminating information through the communications media where the aim is to effect action, such as a change of policy, or to alter the public's view of an issue. Discussion focuses on: 1) the importance of, and methods for, collecting and communicating evidence and information to make it clear and usable for legislators, the media, and the public; and 2) the role of earned and paid media in advancing tobacco control issues. The discussion is made within the context of a specific advocacy example; in this case the 2010 campaign to increase the tobacco tax in Mexico.

Key words: media advocacy; mass media campaign; research; evidence-based policy; tobacco tax; Mexico

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RESUMEN

Este artículo presenta el papel que desempeña la abogacía en los medios de comunicación, mediante información basada en evidencia para la promoción de mejores políticas del control del tabaco. La evidencia es la fuerza impulsora de las campañas destinadas a promover una política de control de tabaco. Una campaña efectiva se basa en evidencia que demuestra por qué la política debe ser implementada, e indica los beneficios posibles. Abogar en los medios es el proceso de difusión de la información a través de medios de comunicación donde el objetivo es llevar a cabo una acción, por ejemplo un cambio de política, o alterar la visión del público sobre un tema. El manuscrito se concentra en: 1) la importancia de, y los métodos para, la recopilación y comunicación de datos e información para que sea clara y útil para los legisladores, medios de comunicación y el público; y 2) el papel de los medios y medios pagados comerciales en impulsar acciones para el control del tabaco. El manuscrito se enfoca en el contexto de un ejemplo de promoción específica, en este caso la campaña de 2010 para aumentar el impuesto al tabaco en México.

Palabras clave: abogacía en medios públicos; programas en medios masivos; investigación; políticas basadas en evidencia; impuestos al tabaco; México

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An advocacy campaign can have multiple components, players and messages, and employ a number of complementary strategies. Ideally, all key participants are working in a coordinated manner, and with consistent and evidence-based data and messages.

Evidence is a driving force for any campaign seeking to implement a tobacco control policy. An effective campaign is based in evidence that demonstrates why a policy should be implemented, and what the potential benefits are. However, ensuring that there is key evidence to draw from is only part of the picture; the ability to translate complex evidence into understandable terms is also essential. Once evidence is translated into understandable terms, the information can then be disseminated to the media.

Media advocacy is the process of disseminating information through the communications media (either earned or paid) where the aim is to effect action, a change of policy, or to alter the public's view of an issue. Earned media coverage is not paid for and has the greatest chance of success when advocates are able to interest media in a story because it is newsworthy. Paid media is when advocates pay for an advertisement or story to run in a specific outlet, at a specific time, to reach a target audience.

This article will focus discussion on: 1) the importance of, and methods for, collecting and communicating evidence and information to make it clear and usable for legislators, the media, and the public; and 2) the role of earned and paid media in advancing tobacco control issues. The discussion will be made within the context of a specific advocacy example; in this case the 2010 campaign to increase the tobacco tax in Mexico.

 

Advocacy goal: Increase the tax on cigarettes to reduce smoking

In 2010, tobacco control partners, including those from within government, the legislature, academia, civil society and international and multilateral organizations, mounted a coordinated, intensive advocacy campaign aimed at convincing the legislature to significantly increase the tax on cigarettes, with an overall goal of reducing smoking and smoking-related health consequences. An added benefit would also be increased revenue for the government.

 

2010 campaign context and partners

Efforts to increase the tobacco tax were ongoing in Mexico long before 2010. However, at the outset of the year, tobacco control partners rallied to employ a strategic and comprehensive tax advocacy campaign, building on lessons learned from previous attempts, and increasing the intensity of the efforts. While partners from different sectors each had a different role to play and a different manner of engaging on the issue; partners worked to coordinate messaging, and to leverage resources where possible.

Tobacco control partners in Mexico benefited from key evidence and research which supported the overall campaign goal. At the same time, partners acknowledged the need for a strong media advocacy component to disseminate the evidence as a part of the 2010 campaign. As tobacco control advocates developed the media advocacy plan, several key points were taken into consideration:

• Context: Despite popular support and intensive work by tobacco control advocates in years past, and most recently in 2009, the final budget approved by the Mexican Congress in November 2009 included only a very small specific excise tax increase on cigarettes of two pesos per pack, scheduled to be phased in incrementally from 2010 to 2013. With the defeat in large part due to intensive tobacco industry lobbying, advocates quickly saw the need for a more comprehensive advocacy campaign in 2010, including a robust media advocacy component.

• Evidence: A strong evidence base to support the implementation of an increase in the tobacco tax existed:

- International level - the existence of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was a compelling mandate for the implementation of an increased tobacco tax. Over 170 countries, including Mexico, were Parties to the treaty, within which Article 6 specifically states that Parties should adopt a tobacco tax policy to reduce consumption. ¹ The treaty incorporated such a policy based on overwhelming evidence that price and tax measures effectively reduce tobacco consumption.In addition, data from the WHO states that the most effective method to reduce the consumption of tobacco is to increase the price of tobacco products through tax increases.² To further strengthen the case, data from specific countries around the world could be utilized to illustrate the benefits of a tobacco tax increase.

- National level - data from the Instituto Nacional de Salud Pública (INSP), independent consultants, and a collaborative report titled the Economics of Tobacco and Tobacco Taxation in Mexico included economic simulations of various tax options and their effects on consumption, revenue, and lives saved, providing a compelling economic rationale to increase the tax on cigarettes.

• Environment: Advocates felt that an environment for effective media advocacy existed. Media advocacy is a long-term process, and in Mexico this process had already been initiated. Civil society groups in Mexico had been using the media to create a positive environment for tobacco control policies for several years. The success of these efforts were reflected in the fact that the amount of media coverage of tobacco control had increased over time, and the tone was increasingly more favorable towards effective tobacco control measures such as smokefree laws and increasing tobacco taxes.

• Audience - There were a number of audiences that needed to be reached through the media to successfully pass a tobacco tax increase. In Mexico, the national legislature makes final budget decisions through the passage of legislation, so the primary focus of this campaign was on legislators, regardless of party affiliation. In addition, different audiences, including public opinion leaders, the general public, government and other civil society groups, were intermittently targeted by specific tactics throughout the campaign.

• Credibility: There were many credible and varied voices supportive of the tobacco tax increase that could be convincing spokespersons on the issue, such as members of the medical and public health communities, civil society, key government officials, academia, legislators and international experts.

• Tobacco Industry Tactics: The tobacco industry had already been using a broad range of tactics to fight effective tobacco control legislation, and the tax campaign in Mexico was no exception. The industry was actively engaging the media during the 2010 tax campaign, distributing misleading and incorrect information on the economic impact of a tax increase to Mexico's economy. As such, tobacco control advocates not only had to proactively explain the health and economic benefits of a tax increase, but also strategically react to the industry's arguments.

• Funding: Paid media campaigns can be costprohibitive, as ad space must be purchased. In this circumstance, tobacco control advocates in Mexico were fortunate to have adequate funding, and were able to complement their earned media campaign with a paid media effort.

 

Evidence and key messages

Tobacco control partners must work to cite evidence showing why a policy should be implemented and what the potential benefits of that policy would be. Throughout the Mexico tax campaign, it was essential to communicate the health benefits and the potential revenue benefits of a tax increase. Partners used evidence to counter tobacco industry arguments against the proposed tobacco tax increase, and also used data from a public opinion poll to persuade legislators, as polling showed strong public support for a tax increase.

The use of key evidence was critical for the mediaadvocacy component of the campaign, and was also consistently relevant in meetings that both civil society and members of government had with legislators and key government officials to promote the passage of a tobacco tax increase by Congress.

Evidence to support the campaign

Evidence which shows that smoking is harmful is well documented, however country-specific data can sometimes be lacking. Fortunately in Mexico, research did exist that documented the burden of tobacco use in Mexico. Research published by various government entities and particularly the National Institute of Public Health, contributed valuable and relevant data. In addition, surveys such as the Global Adult Tobacco Survey and the Global Youth Tobacco Survey also tracked prevalence and trends.

Research which documents the impact of tobacco tax and taxation is not common globally. Fortunately, in Mexico, research was available that included economic simulations of various tax options and their effects on consumption, revenue, and lives saved. This economic data complemented the health impact evidence.

In addition to documented evidence, a national public opinion poll was conducted, which assessed public opinion on issues including smoking patterns, age of initiation, taxation on multiple products including tobacco, and potential uses of government revenue gained from taxation.

The available health impact, economic, and public polling evidence was translated into clear, concise messages to both inform the target audience and then move them to action. As the campaign deepened, researchers and advocates were also able to provide legislators with up to date simulations of the tax goals being presented in the Mexican Congress, to help inform the debate.

Key messages

The broad tax campaign in Mexico utilized a set of key evidence-based messages, designed to illustrate that voting in favor of the tobacco tax was not only a vote for the health of the Mexican population but also a vote to increase government savings and revenue. While there were many messages that could have been communicated, a critical aspect of an effective media advocacy campaign is to distill all of the information into a set of concise messages, usually limited to three or four key messages, that inform the audience and move them to action. In this case, the core set of messages included the following:

• Higher tobacco taxes are a win/win/win that help to save lives,^3,4 discourage youth initiation,^5-7 and bring in more revenue for the government.^8-10

• Each year, 60 000 Mexicans die from diseases related to tobacco use.¹¹ The government spends more than 45 billion pesos to manage the diseases caused by smoking, yet the revenue raised by tobacco taxes is only 24.8 billion pesos.¹²

• 7 out of 10 Mexicans support a tobacco tax increase.¹³

• Vote in favor of the health of Mexicans - vote infavor of the tobacco tax increase.

Abroad coalition of credible spokespersons, including from within government, the legislature, academia, civil society, and international and multilateral organizations, delivered these messages in multiple different contexts. This onslaught of clear evidence-based messages made the case for health and further illustrated to legislators and the public that there was a clear choice of either voting in favor of health or in favor of the tobacco industry.

Important but more segmented messages, suchas those used to counter illicit trade and impact on tobacco farmer arguments, were also incorporated into the campaign's public relations and digital components asneeded (including in one-on-one interviews and press conferences, for example). Attention was brought to thesekey messages and the more segmented messages through the media campaign in a variety of ways which will bediscussed further in the section on media advocacy.

In developing the paid media campaign, paid media campaign messages were slightly revised from the overall campaign into taglines, and focused on whether legislators were voting for health (for the tax increase) or for the interest of the tobacco industry (against the tax increase). The messaging was tested, not only for text but also for reactions to imagery. The taglines that were ultimately decided upon were directed towards legislators and getting the public to follow the issue:

Our youth smoke, and some legislators make it easier for them to do so.

Get to know your legislators, some of them don't care about your health.

My father will die of lung cancer, and some legislators are in agreement.

In addition to the references to tobacco industry interference in the legislative process, each of the paid ads included civil society logos and the following message:

Yes to the tobacco tax increase

-for the health of those we love most-

Unite (take action): www.votoporlasalud.org

 

Media advocacy (earned and paid)

To develop an effective media advocacy plan, several elements must be finalized before any proactive media work can take place. This includes understanding the current situation, choosing overall objectives and strategies, deciding what audiences need to be persuaded in order to change policy, considering evidence, drafting key messages, and honing in on tactics to achieve the objective. Civil society, working with a partner public relations firm, considered these important points as they created a concrete plan of action and timeline for 2010, designed to culminate in the months of September and October, when the tobacco tax vote was imminent. As the context, goal, audience, evidence base and key messages have already been outlined; the following discussion will focus on the media advocacy strategies and tactics.

Strategy

1. Media pressure was applied specifically to different areas of the government as the draft legislation moved from the Chamber of Deputies to the Senate, and then to the President's desk for final approval. In addition to the phased approaches, general benefits of a tax increase were continuously focused upon so that all levels of government would support a tax increase when it reached their time to vote.

2. Advocates developed a comprehensive campaign using both earned and paid media:

a) The earned media component included press releases, political and academic forums, public demonstrations, report releases, letters to public officials that were also distributed to media outlets, letters to the editors of key newspapers, and radio and television interviews.

b) The paid media component included billboards, banner ads and murals (which appeared at 16 key sites and intersections around Mexico City); blog outreach; online media via social networks such as Facebook and Twitter; and a website Voto por la Salud created to function as an online base for the campaign. Legislator opinions and arguments were tracked via Twitter and the media. Responses to arguments against the proposed tax increase were created and distributed as merited. The campaign was constantly and regularly informed by advocates who were spending a significant amount of time monitoring the "pulse" of legislators; these individuals could constantly take the temperature of legislators and communicate back to the broader team of advocates on whether messages were resonating with legislators or not. This theme was recreated on the Voto Por la Salud website, where legislators' votes on the 2009 tobacco tax vote were also posted.

Strong red and black graphic imagery and thought-provoking text were created to call attention to tobacco taxes as a priority for the Mexican public. Particularly, the color red is associated with social resistance and the creation of a social conscience, and contrasted well with the black and white to call attention to the ads.

Beyond the website and billboards, the paid media campaign included demonstrations in front of government buildings that were visible to legislators and senators. These demonstrations garnered earned media coverage that helped amplify the message.

These strategies created a common base for the tactics that are discussed in the timeline.

Tactics - examples of key interventions using evidence and media

The following examples highlight specific key points during which evidence and information were used and media action was taken to help support ongoing advocacy and lobbying efforts.

 

Earned media

• April 28, 2010 - Release of the Bloomberg Economic Report: The Economics of Tobacco and Tobacco Taxation in Mexico. The report included economic simulations of various tax options and their effects on consumption, revenue, and lives saved. The event highlighted key messages, made a specific link with the announcement of a tax proposal by a key legislative ally in Parliament a few days prior, and included speakers from the Secretaría de Salud (SSa - Mexico's Health Ministry), the Instituto Nacional de Salud Pública (INSP - the National Institute of Public Health), and the Presidents of the Health Commission in the Chamber of Deputies and in the Senate, among others. Attendance was approximately 120 people, including press from 25 different outlets. Seventy articles, the majority with a positive tone, were published within the subsequent four days. The report provided a compelling economic rationale to increase the tax on cigarettes and generated an enormous amount of press and public support.

• May 24, 2010 - In a press conference, civil society released the 5^th Annual Civil Society Report on Mexico's compliance with the FCTC. The focus of the release was to note that, while Mexico was the first country in the region to ratify the FCTC, Mexico still was far from fully compliant with the treaty; messages focused on the need to increase the tobacco tax, publish the new warning labels and to fix gaps in the prohibition of advertising, promotion and sponsorship of tobacco products. Thirty-one articles were generated in the subsequent week.

• May 31, 2010 - The Global Adult Tobacco Survey (GATS) Mexico release took place at the National Institute of Respiratory Diseases (INER) as part of World No Tobacco Day events, with the participation of high level government attendees, academic institutes, international experts, civil society and media. Key GATS release messages included a call to action to pass effective and FCTC compliant legislation to significantly reduce tobacco consumption and death from tobacco-related disease, and the sharing of specific numbers to illustrate the burden of tobacco, such as: the number of Mexicans that die each year from causes attributable to smoking (60 000); the health sector costs for care of smoking-related diseases ($75.2 billion Mexican pesos (5.7 billion USD at the time), which was equivalent to 6.2% of Mexico's GDP at the time); and how many lives a specific tobacco tax increase could save. 150 pieces were logged in the media on May 31 and June 1 alone, with much of the media coverage focused on the proposed tax increase.

• July 21, 2010 - Presidents of the Health Commissions in the Senate and Chamber of Deputies hosted a political forum on tobacco tax in the Mexican Congress, with the participation of key legislators, high-level members of government, national and international experts and key civil society spokespersons. At the request of a key legislative ally, partners developed fact sheets that highlighted the current tobacco tax structure in Mexico, including simulations of the tax goals being presented in the Mexican Congress, international examples of tobacco taxes, and counter-arguments to industry tactics and attempts to block the passage of a tobacco tax increase. Fact sheets were distributed to all forum participants and included in media press packets. Media coverage included 15 one-on-one interviews, 87 news articles, and two televised panel discussions in the following week.

• August 31, 2010 -A key legislative ally hosted a press conference to officially release the results of a public opinion poll on tax. More than 45 journalists attended, and 65 publications carried stories about the event over the next two days alone. Polling results showed that 7 out of 10 Mexicans supported a tobacco tax increase.

• September 24, 2010 - The tobacco industry issuedstatements claiming that an increase in taxes would increase illicit trade, using the inaccurate example ofCanada. In response to a request from the SSa, partners delivered to the leadership of the SSa, Secretaríade Hacienda y Crédito Público (SHCP - Mexico'sMinistry of Finance) and multiple media outlets a letter from international public health organizations, including key Canadian organizations, which directly countered inaccurate arguments appearing in the Mexican media. Civil society partners in Mexico drafted a similar letter, and both were disseminated to media outlets. The letters resulted in articles in key newspapers that reached the government ministries, the target audience.

• October 7, 2010 - In a press conference, advocates launched the paid media campaign and the new"Voto Por La Salud" website. The press conference repeated the campaign's key message and created a call to action for legislators to raise tobacco taxes. The campaign launch garnered more than 62 articles.

• October 18, 2010 -Tobacco growers' associations issued statements claiming that the increase in tobacco taxes would have a negative effect on family farmers. In response, advocates provided evidence to legislators, and as background information to reporters, showing that the economic costs of treating tobacco-related health issues are exponentially higher than the economic detriment to tobacco producers resulting from reduced consumption. Advocates also highlighted programs that help tobacco farmers transition to alternative crops. The tobacco industry intensely lobbied individual legislators, many of whom had previously voted in the interests of the tobacco industry, in an attempt to block the passage of the tax. Advocates worked both to denounce these connections between legislators and the tobacco industry, and also to develop a proposal that would have the broadest support in Congress.

• October 19, 2010 -The tobacco industry threatened to close their operations in Mexico, predicting thousands of job losses. In response, advocates provided evidence to legislators, and as background information to reporters, showing that the tobacco industry´s investment in Mexico was insignificant for the Mexican economy and affected a very small part of the population (less than one percent of agriculture and manufacturing jobs in Mexico are tobacco-related). This strategy backfired for the tobacco industry, as legislators realized that the industry was trying to intimidate them and, as a result, became more hostile to industry interests. The headline in one of the leading Mexico newspapers the next day stated: Tabacaleras deben someterse: Congreso (Legislators to Tobacco Industry: Submit).¹⁴

• October 26, 2010 - As the Congress was poised to make its final vote on the proposed legislation, Centro de Investigación y Docencia Económicas, A.C. (CIDE) released a report on tobacco industry interference in Mexico. The report, titled Identificación de las estrategias de la industria tabacalera en México (The Identification of Tobacco Industry Strategies in Mexico),¹⁵ showed the many ways in which tobacco companies attempt to influence the passage and implementation of tobacco control legislation. El Universal, a key newspaper in Mexico, published an extensive article covering the report titled Tabacaleras compran politicos (Tobacco Companies Buy Legislators), and which drew attention from legislators.¹⁶

 

Paid media

From October 7 until the vote -The paid mass media campaign had many components such as banners in high-visibility spots throughout the city and public demonstrations several times throughout the month in which advocates dressed in campaign t-shirts and gas masks distributed information and white chrysanthemums to symbolize the deaths of tobacco victims. Additional components included a social media campaign that echoed the messages of the paid media campaign and a website which provided information and tracked the voted of legislators. Mexico's media took note of the high-visibility advocacy campaign, particularly as it demanded accountability from legislators. Over the course of the paid media campaign, more than 50 media interviews with campaign spokespeople were conducted, and more than 180 media stories were published, including three front-page articles in the primary national newspaper. This media coverage was estimated to have an ad equivalence of $1.5 million USD; a number far higher than the actual costs of the paid campaign. The paid and earned media campaigns were influential in gaining the support of a variety of key political parties, including Partido Acción Nacional (National Action Party, PAN), Partido Revolucionario Institucional (Institutional Revolutionary Party, PRI), Partido de la Revolución Democrática (Party of the Democratic Revolution, PRD), Partido Verde Ecologista de México (Ecologist Green Party of Mexico, PVEM), Partido del Trabajo, (Labor Party, PT) and the former Partido Convergencia (Convergence Party).

 

Outcome of the campaign

In late October 2010, after a year of intensive efforts by partners, legislators in the Mexican Federal Congress voted overwhelmingly to support a tobacco tax increase. The final vote tallies were 430 in favor, 11 against and 13 abstentions in the Chamber of Deputies (October 19) and 70 in favor, 10 against, and 3 abstentions in the Senate (October 26). To give a sense of the drastic change from the previous year, in 2009, votes were 135 in favor, 280 against and 13 abstentions in the Chamber of Deputies and 56 in favor; 42 against and 5 abstentions in the Senate. In one year, votes went from 191 in favor to 500 in favor.

 

 

In the largest tobacco tax increase since 1985, the specific tax on cigarette packs was raised by seven pesos, bringing the tax to 69.2% of the total retail price of cigarettes. The 2010 tax increase was a major victory for tobacco control, particularly when viewed in light of the previous year's resounding defeat. In 2009, the average price of a pack of cigarettes was $26.52 pesos; the approved tax increase in 2010 brought this average price to $35.74 pesos, an increase of 34.8%. According to economic simulation models, the tax increase is projected to reduce tobacco consumption by 17.3%, an overwhelming country-wide health impact.

The overall campaign, which, in addition to the evidence-based media advocacy component, incorporated multiple strategies and efforts by a variety of actors - including government, civil society, academia, and international and multilateral organizations - was deemed a success.

 

Conclusions

Effective media advocacy is a long-term process. In the case of the 2010 tobacco tax increase campaign in Mexico, tobacco control partners were able to leverage the fact that key evidence and research which supported the overall campaign goal existed. In addition, groups in Mexico had been working with and educating the media to create a positive environment for tobacco control policies for several years; the foundation that these media efforts built provided a favorable environment for a targeted earned and paid media advocacy campaign.

Throughout the Mexico tax campaign, it was essential to communicate the health benefits and the potential revenue benefits of a tax increase. Tobacco control advocates were able to move quickly to use evidence to counter tobacco industry arguments against theproposed tobacco tax increase, and also use data from apublic opinion poll to persuade legislators that the public was also in favor of the tax increase, as polling showed strong support for the tax. In addition, the campaign was constantly and regularly informed by advocates who were spending a significant amount of time monitoring the situation in the legislature and communicating backto the broader team of advocates on whether messages were resonating with legislators or not.

Clear, concise, evidence-based messages, inclusion of a wide variety of spokespeople, message testing and polling, and collaboration between many sectors of society provided a wide range of perspectives, expertise, skills, and resources, and ultimately gave the campaign the power to help propel tobacco control partners to a successful outcome.

 

Acknowledgements

The authors would like to thank members of the Campaign for Tobacco-Free Kids team and partners in Mexico for their support in the development of this article. A special thank you also to Bloomberg Philanthropies for its investment in the promotion of tobacco control policies in Mexico and globally. Funded with support mom Bloomberg Philanthropies.

 

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Corresponding author:
MPH Ch'uyasonqo H Lane
Campaign for Tobacco-Free Kids
1400 Eye Street, NW
Washington, DC, USA
E-mail: clane@tobaccofreekids.org

Received on: March 6, 2012
Accepted on: March 12, 2012
Declaration of conflict of interests: The authors declare that they have no conflict of interests.