The Fight Against Big Tobacco

The Movement, the State and the Public's Health

Mark Wolfson

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351482820
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Tobacco control leaders were extremely proud of the movement's achievements in the state of Minnesota. In sharing their perspectives and experiences with Mark Wolfson, they found a way of making sure that the story would get told. His training in social movements had given him an appreciation of the importance of understanding the social infrastructure on which movements are built, and Minnesota had built heavily on the infrastructure of health care and public health. What became apparent is that the struggle against the tobacco industry in Minnesota involved a close, collaborative relationship between government (or "state") actors and the leaders of the tobacco control movement.

Wolfson develops both of these themes: building on the infrastructure of health, and state-movement interpenetration, to understand the emergence, growth, and outcomes of the tobacco control movement in Minnesota. He focuses on the advantages and constraints associated with these two related themes. He goes beyond the case study method to assess the generalizability of the pattern, and whether the same sort of movement can be used by other states in North America, and even in other countries and their social movements.

How has the tobacco control movement become such a significant and successful force in shaping public policy, social norms, and the habits of millions of Americans? In this first such detailed study by a sociologist, Wolfson documents how the movement has grown over nearly three decades by building an infrastructure of health organizations and health professionals, and by fostering relationships with government. Rich in survey data, extensive interviews, and archival sources, this text is essential reading for courses in social problems, social movements, and public health. The general reader will also find it engaging, given the issues of tobacco use as an addiction and a social problem.

1

Social Movement Theory and Tobacco Control

Introduction

Tobacco use—smoking and use of smokeless tobacco—is the leading preventable cause of death in the United States. The Centers for Disease Control and Prevention estimated that cigarette smoking was responsible for over four hundred thousand deaths in 1990, including 30% of all cancer deaths and 21% of all cardiovascular disease deaths (Centers for Disease Control and Prevention, 1993a).¹ A telling statistic, often cited by tobacco control advocates, is that the number of deaths from tobacco use in the United States is greater than the number of deaths from alcohol use, motor vehicle accidents, suicides, AIDS, homicides, illegal drugs, and fires combined (Lynch and Bonnie, 1994).

Tobacco’s toll is not limited to the United States. According to estimates by the World Health Organization and the World Bank, in 1990 over three million deaths throughout the globe—six percent of all deaths—were attributable to tobacco use (Murray and Lopez, 1996). Only malnutrition accounted for more deaths.

Over the past twenty-five years, a formidable social movement has emerged in response to this vital public health problem. A number of organizations play key roles in this movement. These include nonprofit advocacy organizations, such as Action on Smoking and Health (ASH), Americans for Nonsmokers Rights (ANR), Doctors Ought to Care (DOC), Stop Teenage Access to Tobacco (STAT), the Group Against Smokers’ Pollution (GASP), and the Campaign for Tobacco-Free Kids. The “health voluntaries”—the American Cancer Society, American Heart Association, and American Lung Association—are also key actors in the movement. Associations of health professionals—such as the American Medical Association and state medical societies—have demonstrated active involvement in tobacco control advocacy. Finally, federal, state, and local government agencies have played central roles in the tobacco control movement.²

Over the course of the second half of the twentieth century, the tobacco control movement has become an important agent of social change. The movement has succeeded in educating the public about the health risks of tobacco use, changing social norms concerning tobacco use, reducing smoking rates, and encouraging the adoption of federal, state, local, and private-sector policies discouraging tobacco use. While the movement has not succeeded in a number of important areas—most notably, reducing smoking rates among adolescents and eliminating disparities in smoking by socioeconomic status—it has grown to be a major force in contemporary U.S. society, and has significantly altered how many of us lead our lives.

How has this movement become such a large and pervasive force? This book develops two central arguments to answer this question. First, the tobacco control movement was able to grow rapidly by building on a rich “infrastructure” of health organizations and health professionals. Ironically, the movement’s base in these institutions has in some ways constrained the issues it has pursued and the strategies and tactics it has used to pursue them. Second, the movement has an integral relationship with government, a relationship that I characterize as state-movement “inter-penetration.” This relationship has also contributed to the movement’s rapid growth and its widespread influence. And again, the relationship has imposed important constraints on the tactics and strategies employed in the movement. As explained in the following section, this relationship also presents a challenge to our theoretical understandings of state-movement relations.³

Theory and Research on Social Movements

It is reasonable to ask whether tobacco control efforts fall within the domain of social movement theory. Efforts to control the use of tobacco—especially those that use political means to achieve policy changes—are widely considered to be a social movement. For example, proponents of tobacco control often refer to these efforts as a “movement” (e.g., Pertschuk and Erickson, 1987). Moreover, tobacco control advocates seek social changes that go beyond individual changes in behavior. In the past twenty years—especially in the past ten—a key distinction has been made between persuading people to change their behavior (e.g., smoking) and changing the social and legal environment that enables and supports tobacco use. In the words of longtime nonsmokers’ rights activist and scientist, Stanton Glantz, “the health community [historically] viewed the problem of smoking in a medical rather than a social and environmental context, in which the focus should be on the smoker (the patient) rather than on the environment, which moves into politics” (Glantz, 1987:746). This approach is embodied in enactment of laws that prohibit smoking in restaurants and other public places; restrictions on the availability of tobacco to youth through commercial sources such as convenience stores, grocery stores, and vending machines; and increases in state and federal taxes on cigarettes and smokeless tobacco products.⁴

Finally, advocacy organizations have played a central role in efforts to achieve these changes. In both the area of clean indoor air and youth access to tobacco, local, grassroots activism has played a key role, especially in the earlier years in the development of these two areas, before government agencies became heavily involved in advocacy efforts [see Glantz 1987 on clean indoor air and Sylvester 1989 on youth access to tobacco].⁵ Thus, common usage, a focus on structural change, and involvement in advocacy support the application of the term “social movement” to tobacco control efforts, and the use of social movement theory to understand them, and to further develop this body of theory.

The analysis presented in this book is informed by theory and research on social movements over the past twenty-five years. Work on social movements during this period has been guided by several theoretical perspectives. Resource mobilization theory (McCarthy and Zald, 1977) developed in response to earlier perspectives on social movements, which emphasized the irrational or expressive aspects of social movements (e.g., Turner and Killian, 1972; Kornhauser, 1959; Gurr, 1970; Davies, 1962). Resource mobilization theory, as developed and articulated by Zald and Ash (1966), Oberschall (1973), McCarthy and Zald (1973, 1977), Gamson (1990), and Jenkins (1983), emphasizes the central role that resources—including money, volunteer labor, legitimacy, and expertise—play in social movements. Analysts drawing on this perspective have assessed the ways in which the amount and types of resources available to groups affect the emergence, form, and impact of collective action (McCarthy and Zald, 1973; Staggenborg, 1986; Gamson, 1990; Wolfson, 1995a; Jenkins and Eckert, 1986).

A second set of analysts, whose perspective has sometimes been characterized as “political process” theory, emphasize the role that “political opportunity” plays in explaining the emergence and trajectory of social movements (Jenkins and Perrow, 1977; McAdam, 1982; Tarrow, 1994; Tilly, 1978).⁶ According to McAdam, these writers “saw the timing and fate of movements as largely dependent upon the opportunities afforded insurgents by the shifting institutional structure and ideological disposition of those in power” (1996:23). Based on the work of Tarrow (1994) and other analysts, McAdam (1996:27) and colleagues (1996:10) have developed a list of the dimensions of political opportunity:

1. The relative openness or closure of the institutionalized political system.
2. The stability or instability of that broad set of elite alignments that typically undergird a polity.
3. The presence or absence of elite allies.
4. The state’s capacity and propensity for repression.

A third theoretical perspective that has informed recent social movement research is concerned with “framing” processes (Snow et al., 1986; Snow and Benford, 1992; Gamson and Meyer, 1996; Benford and Snow, 2000). Work on framing represents a deliberate attempt to bring a concern with culture and meaning back into the study of social movements (Benford and Snow, 2000). Specifically, this work is concerned with the ways in which activists and other participants in movements actively create common understandings underlying collective action. “Framing work” seeks to define a particular state of affairs as being in need of redress. For example, tobacco control advocates have worked to define children’s access to cigarettes through vending machines and stores as an unacceptable threat to children’s health (see Chapter 2). Similarly, activists have argued that exposure of nonsmokers to secondhand smoke at work, in public transportation, restaurants, and stores is an unacceptable infringement on the rights of nonsmokers (see Chapters 2, 3, and 4). Activists also work to create “frames” for responding to an unacceptable shared grievance. For example, the idea that people should band together to lobby their city council or state legislature to enact laws restricting youth access to tobacco, or to enact laws prohibiting smoking in certain work and public settings, is— usually—not a matter of a lightbulb going off in someone’s head. Rather, activists work hard to define these or other concrete activities as appropriate responses to a state of affairs defined as in need of action. Framing is contentious work, since government agencies and other authorities, scientists, industries whose products or behavior are the target of regulatory efforts, countermovements, and factions within a social movement may actively promote alternative definitions of (1) whether a particular state of affairs constitutes a problem, and (2) appropriate responses to the problem (Meyer and Staggenborg, 1996; Benford and Snow, 2000).

Finally, new social movement (NSM) theory is concerned with explaining the emergence and dynamics of contemporary social movements (Me-lucci, 1980; Touraine, 1981; Laraña et al., 1994; Kriesi et al., 1995; Pichardo, 1997). It distinguishes these “new” social movements—such as environmental movements, peace movements and movements opposing the deployment of nuclear weapons, and gay rights movements, from past movements—in particular, from working-class movements of the past (Pichardo, 1997). It is argued that the emergence of these movements is tied to the shift in Western countries from an industrialized to a postindustrial economy. These movements tend to be concerned with quality of life issues associated with the new economy, rather than issues of resource allocation. These movements, it is argued, are largely rooted in the middle class, and issues of self-identity are said to play a central role in explaining movement participation (Pichardo, 1997; Buechler, 1995).

In a recent review and synthesis of work on social movements, McAdam and colleagues (1996) argued that work by analysts from each of these perspectives on or theories of social movements has converged on a core set of factors used to explain the emergence and development of social movements. One of these factors is “mobilizing structures,” which are defined as “those collective vehicles, informal as well as formal, through which people mobilize and engage in collective action” (McAdam et al., 1996:3). This concept of mobilizing structures includes informal and formal social groups that movements may build on, including friendship networks, neighborhoods, work networks, churches, unions, and professional associations (McCarthy, 1996:145). It also includes formal and informal groups that are “dedicated” to (i.e., are singularly meant to be used to) advance the goals of the movement. Examples include informal activist networks as well as formally organized social movement organizations (SMOs), among others (McCarthy, 1996:145).

A second category of factors is political opportunities. As explained above, the concept of political opportunity is meant to describe the political environment in which a movement operates and with which it interacts. It includes the degree of openness of the formal political structure to advocacy efforts, the nature of alignments between powerful “elites,” actual alliances between movements and these elites, and the state’s ability and inclination to repress a movement (McAdam, 1996:27; McAdam et al., 1996:10).

The third set of factors identified in the review and synthesis by McAdam and colleagues (1996) falls under the rubric of “framing processes.” As discussed above, this term is meant to capture the efforts of movement participants to create and promote interpretations or “meanings” of events and situations in such as way as to catalyze collective action.

This book will draw on previous theoretical and empirical work on social movements—especially the emerging synthesis, described above—to help understand the tobacco control movement. In particular, two streams of the literature that are part of this synthesis are especially germane to this study. The first stream follows from the concern with “mobilizing structures.” Specifically, I will draw from theory and research concerned with the ways in which movements are built on preexisting patterns of social relations (or social “infrastructure”), and the consequences of this for the ways in which a movement is structured and its goals are framed, the tactics and strategies it employs, its growth trajectory, and its impact.

The second stream of social movement theory and research deals with the relationships between “the state” and movements. Clearly, this work falls squarely within the focus on political opportunity. Although I will draw from the insights of past work on this topic, I will argue that existing theory and research on states and social movements is inadequate to the task of understanding the tobacco control movement. In fact, the pattern in the tobacco control movement does not seem to “fit” any of the existing conceptualizations of state-movement relations. Thus, one aim of this book is to develop a new model of this relationship, one that I term state-movement “interpénétration.”

The Social Infrastructure Of Movements

A spate of recent scholarship on social movements has explored the ways in which movements emerge from and are shaped by existing associ-ational “infrastructures,” such as churches, block clubs and other networks based in neighborhoods, friendship networks, fraternal organizations, and unions (Morris, 1984; McAdam, 1982; Oberschall, 1973; Snow et al., 1980; Rosenthal et al., 1985; McCarthy, 1987; Gould, 1993). Although he drops the term in later work, and subsumes infrastructure into the concept of “mobilizing structures,” McCarthyprovides this definition and examples:

[T]he range of everyday life micromobilization structural social locations that are not aimed primarily at movement mobilization, but where mobilization may be generated: these include family units, friendship networks, voluntary associations, work units, and elements of the state structure itself. ... I mean to include all of the institutions commonly included within the boundaries of the concept “civil society” as well as institutional structures of the state and the economy that serve as relational contexts for insurgent mobilization. (1996:141, 364)

A classic example of this is the way that the 1960s civil rights movement built on existing structures in the South, including historically black colleges and universities, black churches, and local chapters of the NAACP (Morris, 1984). The extent to which a movement can build on existing sets of organizations and relationships depends on a number of factors. The first such factor is the degree to which the problem that a movement addresses, and the strategies and tactics it uses to address them, can be articulated—or, in the language of recent analyses of social movements, “framed”—in a way that is consistent with the belief systems, aspirations, life experiences, and interests of these organizations and associations and the people in them (Benford and Snow, 2000; Jenkins and Wallace, 1996; McCarthy and Wolfson, 1992) In addition, the amount and quality of resources in organizations and networks will affect the ability of a movement to build organizations, recruit members and other adherents, and engage in collective action.⁷

The analysis presented in this book represents, in part, an attempt to identify the kinds of infrastructures from which the tobacco control movement emerged and gained support—including money, labor, space, equipment, expertise, and goodwill. It also represents an attempt to understand how these bases of support have shaped the movement’s development. For example, many individuals trained in various medical specialties, nursing, and public health have played important leadership and activist roles in the movement. In addition, many of the key organizational actors in the movement are health organizations. While building on the “infrastructure” of health organizations and professions has facilitated the rapid growth and development of the movement, it has also constrained it in important ways—for example, in selection of issues, strategies, and tactics, and in the characteristics of the adherents it attracts, as we shall see in subsequent chapters.

States And Social Movements

The state plays a prominent role in many recent accounts of social movements. Analysts operating from a variety of theoretical perspectives— resource mobilization, political process, new social movements, framing— have emphasized the important role of the state in shaping the emergence, growth, and decline of movements (McCarthy and Zald, 1977; McAdam, 1982; Jenkins and Klandermans, 1995).

How has the relationship between the state and movements been theorized? I argue that writing on this subject has been dominated by three images of the state’s role in these relationships: (1) as a target, (2) as a provider of constraints and opportunities, and (3) as a facilitator or sponsor. Throughout the book, and especially in Chapters 7 and 10, 1 use case materials from the tobacco control movement to see how well the case conforms to existing conceptualizations. I argue that existing approaches do not do a good job of characterizing or explaining the empirical pattern found in the tobacco control movement. A new model of the state/movement relationship is suggested by my analysis of this movement. This model describes the “interpénétration” of state and movements.

Conceptualizations of State-Movement Relations

The most pervasive image of the relationship of states and movements is the state as target of the movement. For example, social movement organizations often seek formal recognition of their claims to a voice on policy issues within a particular issue arena (Tilly, 1978; Gamson, 1990). Tilly has termed the achievement of forma...

Table of contents

• Cover Page
• Half title
• Title Page
• Copyright Page
• dedication
• Preface
• 1 Social Movement Theory and Tobacco Control
• 2 Tobacco Use and Tobacco Control in the United States
• 3 The Single-Issue Groups—1
• Index