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Lobbying and advocacy for the public's health: what are the limits for nonprofit organizations?

Nonprofit organizations play an important role in advocating for the public's health in the United States. This article describes the rules under US law for lobbying by nonprofit organizations. The 2 most common kinds of non-profits working to improve the public's health are "public charities" and "social welfare organizations." Although social welfare organizations may engage in relatively unlimited lobbying, public charities may not engage in "substantial" lobbying. Lobbying is divided into 2 main categories. Direct lobbying refers to communications with law-makers that take a position on specific legislation, and grassroots lobbying includes attempts to persuade members of the general public to take action regarding legislation. Even public charities may engage in some direct lobbying and a smaller amount of grassroots lobbying. Much public health advocacy, however, is not lobbying, since there are several important exceptions to the lobbying rules. These exceptions include "non-partisan analysis, study, or research" and discussions of broad social problems. Lobbying with federal or earmarked foundation funds is generally prohibited.

Attitude to Health↗

Tobacco lobby political influence on US state legislatures in the 1990s.

BACKGROUND: Throughout the 1990s the tobacco lobby was a potent political force in US state legislatures advancing its pro-tobacco agenda. OBJECTIVE: To describe the market and political motivations of the tobacco lobby and the strategies they use to achieve these goals in US state legislatures. DESIGN: This study is a content analysis and summary overview of recently released historical tobacco industry documents; tobacco related government documents; and recent state tobacco control policy reports. RESULTS: In the 1990s, the tobacco lobby engaged in a comprehensive and aggressive political effort in state legislatures to sell tobacco with the least hindrance using lobbying, the media, public relations, front groups, industry allies, and contributions to legislators. These efforts included campaigns to neutralise clean indoor air legislation, minimise tax increases, and preserve the industry's freedom to advertise and sell tobacco. The tobacco lobby succeeded in increasing the number of states that enacted state pre-emption of stricter local tobacco control laws and prevented the passage of many state tobacco control policies. Public health advocates were able to prevent pre-emption and other pro-tobacco policies from being enacted in several states. CONCLUSIONS: The tobacco lobby is a powerful presence in state legislatures. Because of the poor public image of the tobacco lobby, it seeks to wield this power quietly and behind the scenes. State and local health advocates, who often have high public credibility, can use this fact against the tobacco lobby by focusing public attention on the tobacco lobby's political influence and policy goals and expose links between the tobacco lobby and its legislative supporters.

Humans↗

Health care lobbying in the United States.

PURPOSE: To assess the relative political influence of different organizations, we examined the efforts of health care organizations to influence policy decisions by lobbying lawmakers. METHODS: We reviewed reports filed by lobbyists from 1997 to 2000, as required by the Lobbying Disclosure Act, to characterize health care lobbying at the federal level in the United States. RESULTS: Health care lobbying expenditures totaled 237 million dollars in 2000. These expenditures accounted for 15% of all federal lobbying and were larger than the lobbying expenditures of every other sector, including agriculture, communications, and defense. A total of 1192 organizations were involved in health care lobbying. Pharmaceutical and health product companies spent the most (96 million dollars), followed by physicians and other health professionals (46 million dollars). Disease advocacy and public health organizations spent 12 million dollars. From 1997 to 2000, lobbying expenditures by physicians and other health professionals grew more slowly than lobbying by other organizations (10% vs. 26%). CONCLUSION: Although policy decisions are influenced by many factors, our findings may indicate a limited political influence of disease advocacy and public health organizations and a declining political influence of physicians and other health professionals.

Drug Industry↗

How do physicians lobby their members of Congress?

BACKGROUND: Physicians are uniquely qualified to educate legislators about health care issues, but little is known about how physicians lobby members of Congress. METHODS: From the staff of 84 randomly selected members of Congress (49 senators and 35 representatives), we interviewed the legislative assistants who work on health care legislation and meet with constituents and lobbyists on behalf of their senator or representative. We asked about (1) the frequency of meetings between legislative assistants and physicians, (2) the issues discussed, and (3) the perceived effectiveness of lobbying. RESULTS: Senate and house legislative assistants met with an average of 10.0 and 4.0 physicians per month, respectively. This suggests that approximately 29,000 such meetings occur annually. The most common issues discussed were Medicare reimbursement (mentioned by 67 [81%] of 83 subjects), managed care reform (62 subjects [75%]), and funding for medical research (21 subjects [25%]). Other issues, such as access to care for the uninsured, tobacco control, abortion rights, and violence prevention, were rarely discussed. Most legislative assistants rated physicians as effective (37 [44%]) or somewhat effective (39 [46%]) as lobbyists. The most common suggestion for improving physician lobbying was to focus less on reimbursement and to address a broader range of health care issues. CONCLUSIONS: Physicians are frequent and effective lobbyists on reimbursement, managed care, and research issues. Policy makers appear receptive to increased physician input on a broader range of health care issues. Including these issues in lobbying efforts has the potential to shape health policy in a way that improves patient care and public health. Arch Intern Med. 2000;160:3248-3251.

Government↗

Mass media, 'monsters' and mental health clients: the need for increased lobbying.

A review of the limited empirical and theoretical literature indicates that current mass media representations of mental health service users appear to emphasize violence, dangerousness and criminality. This is despite the empirical evidence that indicates a decline over the last 40 years in the number of homicides carried out by people identified as suffering from mental health problems. Such inappropriate representations do much to increase stigma, ostracism, harassment and victimization of these individuals by the public. Furthermore, it can be argued that there is another repercussion of these representations and that is the subsequent government position/policy and the resulting legislation concerning care of people with mental health problems. Consequently, this paper argues that there is a clear need for psychiatric/mental health (P/MH) nurses to become more mindful of the wider, socio-political environment in which their practice occurs, particularly if psycho-social approaches to practice are adopted in their fullest sense, and as a result increase their political lobby. Such increased lobbying should occur on behalf of, and in collaboration with, service users, and accordingly the authors describe a range of activities under the broad headings of pro-active and reactive lobbying. Furthermore, it is incumbent upon P/MH nurse educationalists to prepare aspirant P/MH nurses for this lobbying role and equip them with the skills necessary to do so.

Humans↗

Tobacco Institute lobbying at the state and local levels of government in the 1990s.

OBJECTIVE: To describe variation in Tobacco Institute (TI) lobbying expenditures across states and test whether these expenditures vary in relationship to measures of tobacco control activity at the state level. INDEPENDENT VARIABLE: Data for this study came from the TI's State Activities Division (SAD) annual budgets for the years 1991-97, excluding 1993. These data include budgetary information pertaining to state and local lobbying activity and special projects reported by state. DEPENDENT VARIABLES: The following measures of state tobacco control activity during the period 1991 to 1997 were considered: (1) American Stop Smoking Intervention Study (ASSIST) funding; (2) voter initiatives to raise cigarette taxes; (3) cigarette excise tax level; (4) workplace smoking restrictions; (5) the intensification of smoke-free air laws covering private worksites, government worksites, and restaurants; (6) the intensification of strength of sales to minors laws; (7) the intensification of strength of laws that punish minors for possessing, purchasing, and/or using cigarettes; (8) state status as a major grower of tobacco; (9) partisan control of state government, 1996; and (10) an overall composite index reflecting a state's strength of tobacco control, combining cigarette prices with workplace and home smoking bans. RESULTS: The overall annual budget for the TI declined steadily during the 1990s, from $47.7 million in 1991 to $28.1 million by 1996. The proportion of the TI's budget allocated to the SAD remained relatively stable at about 30%. TI expenditures for lobbyists were highest in California where tobacco control activity has been strong for the past decade. We found significant associations between TI SAD expenditures and cigarette excise tax levels, the status of a state as a recipient of federal ASSIST funds, and changes in the strength of statewide laws that penalise minors for possessing, purchasing, and/or using cigarettes. We found little or no association between state and local lobbying budgets of the TI and changes in statewide smoke-free air laws, although we did find evidence of TI special project expenditures earmarked to specific states and localities to resist clean indoor air legislation/regulations (that is, Maryland and New York City). We found no significant correlation between TI lobbying expenditures and sales to minors' laws, status as a major producer of tobacco, or partisan control of state government. CONCLUSIONS: The findings from this study support the hypothesis that in the 1990s tobacco control activities such as raising cigarette excise taxes and participation in ASSIST attracted TI resources to undermine these efforts.

Adolescent↗

A shift in the historical trajectory of medical dominance: the case of Medibank and the Australian doctors' lobby.

During the twentieth century, episodes of major health policy reform were relatively rare. These rare episodes were pivotal 'critical junctures' in determining the paths taken by modern health systems and in creating a unique health policy arena. A pivotal 'turning point' in Australia came in the form of national health insurance. Introduced in the early 1970s, Medibank (universal, compulsory national health insurance) was the first significant structural health policy change in Australia during the twentieth century. When Medibank health insurance proposals were presented in Australia, political struggles erupted. Government leaders in Australia faced fierce opposition from key players within the health policy arena. Prior to this turning point, one of the key health policy players-the Australian Medical Association (AMA)-had developed a corporate partnership with the non-Labor government. When the Medibank proposal emerged, power structures in the health policy arena were re-aligned. The political role of the AMA shifted from a corporate partner to a pressure group.Examining the political processes surrounding this unique episode of major health policy change helps to illuminate the dual and dynamic nature of the doctors' lobby. Our study aims to demonstrate empirically Day and Klein's proposition that the doctors' lobby operates as a pressure group, rather than as a corporate-style partner, during periods of structural reform in health care [Political Studies, 40 (1992) 462]. This case study of the doctors' lobby during Medibank negotiations represents a rare break in the tradition of ultimate medical professional veto power in health policy decision-making and provides empirical evidence that challenges a widely held perception about an inevitable historical path of medical dominance.

Australia↗

Learning to lobby for probreastfeeding legislation: the story of a Texas bill to create a breastfeeding-friendly physician designation.

Legislation can reduce institutional barriers to breastfeeding. Lobbying is the process by which legislation is influenced by a special interest group. While generally thought of as an activity available only to the rich and powerful, lobbying by lactation activists can be an effective way to change public policy. A breastfeeding coalition in central Texas has been involved with lobbying efforts since 1995. Tactical lessons learned are shared to inspire and assist others seeking to pass probreastfeeding legislation.

Breast Feeding↗

Tobacco industry allegations of "illegal lobbying" and state tobacco control.

OBJECTIVES: This study assessed the perceived effect of tobacco industry allegations of "illegal lobbying" by public health professionals on policy interventions for tobacco control. METHODS: Structured interviews were conducted with state health department project managers in all 17 National Cancer Institute-funded American Stop Smoking Intervention Study (ASSIST) states. Documentation and media records related to ASSIST from the National Cancer Institute, health advocates, and the tobacco industry were analyzed. RESULTS: The tobacco industry filed formal complaints of illegal lobbying activities against 4 ASSIST states. These complaints had a temporary chilling effect on tobacco control policy interventions in those states. ASSIST states not targeted by the tobacco industry developed an increased awareness of the industry's tactics and worked to prepare for such allegations to minimize disruption of their activities. Some self-reported self-censorship in policy activity occurred in 11 of the 17 states (65%). CONCLUSIONS: Public health professionals need to educate themselves and the public about the laws that regulate lobbying activities and develop their strategies, including their policy activities, accordingly.

Community Participation↗

Is this legal? A non-profit primer on lobbying and political activities.

Lobbying by tax-exempt entities is permissible, but regulated by the Internal Revenue Code. Tax-exempt entities that lobby should not be confused with political activity by tax-exempt entities. Although a public charity may not involve itself in political campaign activities in any way, a public charity may engage in a certain level of lobbying activities. Consider three hypothetical situations involving CEOs of health care providers.

Charities↗

Managed health care companies' lobbying frenzy.

The top dozen national managed health care companies and two industry trade groups spent at least $2,023,041 on lobbying expenses and campaign contributions to key lawmakers during last year's health care debate, according to an analysis of Federal Election Commission data and federal lobbying disclosure forms. Five of the top six spenders are large insurance companies that are rapidly transferring their business from traditional indemnity insurance to HMOs. Over half--52 percent--of campaign donations from the top managed care companies' and trade associations' PACs and employees went to members sitting on the five Congressional committees with jurisdiction over health care reform.

Financial Support↗

Healthcare lobbying efforts turn to states.

With federal policy action frozen by a budget and re-election frenzy, more healthcare legislative battles are turning up in the state capitals. Three states in particular are experiencing stepped-up lobbying activity from hospitals. And three lobbying giants, the American Assn. of Retired Persons, the American Hospital Assn. and the American Medical Assn., are struggling to overcome their own challenges.

Certificate of Need↗

Political lobbying for child and adolescent psychiatry.

Lobbying for child and adolescent psychiatry works best when association members team with staff to communicate with members of Congress. Communication comes in many forms, some more effective than others, but without it, no opportunities for policy changes are generated. Legislators want to know what their constituents are interested in, and child and adolescent psychiatrists serve themselves and their profession by knowing the legislative agenda, using the tools available for reaching out to legislators, and using every opportunity available to move the agenda.

Adolescent↗

Europa DONNA, the European Breast Cancer Coalition: lobbying at European and local levels.

Breast cancer is a serious medical and social problem, and the ultimate goal should be to promote accessible and financially sustainable high standard healthcare interventions and develop patient-oriented strategies for prevention, diagnosis, and treatment. EUROPA DONNA, a nonprofit organization, is a European women's movement against breast cancer. It provides a focus for the exchange of information and experience between members and serves as a moving force for combined actions. EUROPA DONNA represents the concerns and interests of European women to local and national authorities and governments, drawing attention to the need for improvement in or introduction of essential programs and services in the fight against breast cancer. It is a coalition of individual women and associations involved in the fight against breast cancer, active in 32 European countries, each organized as a national independent forum. Lobbying is one of the most important activities of EUROPA DONNA. In fact, only by involving institutions both on a local and a national level is it possible to achieve results that can benefit a large number of women.

Breast Neoplasms↗