WASHINGTON--This spring, the American Cancer Society (ACS) and the Children's Defense Fund led an influential coalition of more than 150 groups in active support of the CHILD Act, sponsored by Sen. Orrin G. Hatch (R-Utah) and Sen. Edward M. Kennedy (D-Mass).
In May, the Senate rejected the measure, which would have increased the federal cigarette tax by 43 cents a pack and used the new money to expand health care for low-income children.
"If it weren't for the White House and the Republican leadership worrying about the budget deal, we would have had it," says Linda Hay Crawford, the ACS' national vice president for federal and state government relations, who works out of Washington.
Now, the ACS is planning other bold steps into the public policy arena. In this interview with Oncology News International Washington bureau chief Patrick Young, Ms. Crawford discusses the ACS' aggressive new advocacy program.
ONI: What are the Society's goals in trying to influence the federal and state governments?
MS. CRAWFORD: Our number one priority is to get more federal funds into cancer research. We still have a tremendous commitment to research. But a second goal is to get cancer prevention and control into the public policy arena. We are looking at issues beyond individual patient care and quality care and toward more preventive issues.
For example, we are campaigning to mandate Medicare coverage of different kinds of cancer screening. This can be difficult to do, since in our age of cost containment in health care, mandates are not viewed as positive.
And we are deeply involved with tobacco control. This campaign has shown us that the closer you get to the people legislating or making public policy, the more effective your advocacy will be.
ONI: What is different today from yesterday in the ACS' advocacy?
MS. CRAWFORD: The main difference is a commitment to the idea that through advocacy and public policy, we can make a real difference in cancer. That means finding new ways to get our message out through the media, through the use of communications, and through the legislative process.
ONI: How will things be different in this new era?
MS. CRAWFORD: Traditionally the American Cancer Society has worked to increase research appropriations, "getting more money." Now we are getting beyond just cancer research and looking at the bigger issues of health care--preventive health for kids, for example--and so our issues are becoming broader. We are not just looking for ways to cure cancer on all activities: research, advocacy, and education.
ONI: What other new directions do you envision for the Society?
MS. CRAWFORD: Working with elected officials, directly having contact with public interest groups, the National Governors' Association, the National Conference of State Legislatures, other legislative groups. We're going to be lobbying and advocating on health issues and getting our message out by networking, by getting involved in new kinds of organizations with political access.
The Society has been involved in tobacco-control advocacy since the signing of the National Cancer Act and the release of the first Surgeon General's report on tobacco. We added resources and a federal/state "integrated" campaign on the total tobacco-control issue when we received money from the Robert Wood Johnson Foundation.
We are today supporting--in better ways and with more resources--those issues that we know are successful in promoting antitobacco legislation, and we are also looking at overall campaigns.
ONI: What do you mean by an integrated campaign?
MS. CRAWFORD: We are working with groups with whom we have not been involved previously. With the Hatch-Kennedy bill, for example, we affiliated with the Children's Defense Fund.
The second part of this integrated campaign is to work more closely with local chapters. We are becoming one American Cancer Society, not just for advocacy but for all of our activities.
The divisions are consolidating into regions, and we are providing them, through this office, with technical systems to upgrade their advocacy efforts. Some divisions are very sophisticated; some are not. We are creating a level playing field among the regions for advocacy so they can work with state legislatures and on federal issues.
As part of all that, we are using media and communications in a much more proactive way to get our message out. If you remember, while the tobacco settlement talks were ongoing, we placed a full-page ad in the New York Times and Washington Post. It was a letter to the American people on public health principles that we feel any settlement must uphold. That is a new emphasis for the American Cancer Society.
ONI: What is the ACS position on the current proposed tobacco settlement?
MS. CRAWFORD: A settlement is not going to solve the whole smoking issue. Our concern is: If you have a settlement and legislation goes to Congress, does Congress feel that's all they need to do on the tobacco wars?
It's not the way we feel. We feel the only way that you are really going to get kids not to pick up that first cigarette is to constantly keep the issue before the legislatures, in the courts, and among the American people.
ACS Wants Changes in Proposed Tobacco Settlement
ATLANTA--Before the American Cancer Society can even consider supporting the proposed tobacco settlement, two flaws must be corrected, said ACS president Myles Cunningham, MD.
The Society wants (1) absolute assurance that the FDA will have complete and unfettered authority over the regulation of nicotine(Drug information on nicotine) and other cigarette ingredients, and (2) a significant strengthening of tobacco industry penalties for failure to reach the document's smoking rate reduction goals.
The document as it stands would require the FDA to present a "preponderance of evidence" that nicotine is harmful to health and that restricting its use would not create a black market.
Dr. Cunningham noted that the FDA's jurisdiction over tobacco products has been upheld by the Greensboro Federal Court decision. "There is no logical basis for backtracking on that victory here," he said.
As to the penalties for failing to reduce underage smoking, ACS Board of Directors Chairman George Dessart said: "It needs to be so financially painful for the industry to miss these 30% and 60% decreases in youth smoking rates at five and 10 years, respectively, that working hard to achieve them is their only option."
ONI: So, where do you go from here on tobacco-related issues?
MS. CRAWFORD: There are many areas where legislation is needed; second-hand smoke and international tobacco use are still issues. American tobacco companies are in business overseas, pushing their products, and that is an issue for ACS, for all of us in cancer control.
Excise taxes remain an issue, and many states are looking to raise cigarette taxes and use the moneys for tobacco control. Alaska's cigarette tax just went up from 71 cents to $1.00 a pack, and Hawaii is expected to follow next year.
ONI: Have you detected any public backlash to the antismoking campaigns?
MS. CRAWFORD: Absolutely none. This is where the people are on this issue. I don't know any parents who want their children to start smoking. I think just about everyone in this country feels like they have been lied to and manipulated by the tobacco companies over the last 30 years.
ONI: What about the verdicts in smoking lawsuits?
MS. CRAWFORD: As to individual claims, public sentiment isn't there at this point. People still blame those cancers you get through personal behavior on the individual and so we are not seeing plaintiffs' verdicts. That's human nature. There is a lot of work still to be done in smoking-related cancers, and I think we've only just begun.