Journal of Health Politics, Policy and Law 27.3 (2002) 525-527
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Inside the California Battles
Stanton A. Glantz and Edith D. Balbach. Tobacco Wars: Inside the California Battles. Berkeley: University of California Press, 2000. 469 pp. $50.00 cloth; $19.95 paper.
Attempts to limit the use of tobacco products through public policies have been made in the United States since the 1960s, whereas the many editions of James Hoefler and Lee Fritschler's Smoking and Politics (1996) have portrayed policy making at the federal level, Stanton A. Glantz and Edith D. Balbach's descriptive analysis adds to the growing literature that focuses on state and local policies. Tobacco Wars: Inside the California Battles chronologically discusses the political conflicts surrounding local ordinances, state and local ballot initiatives, state legislation, and court decisions related to tobacco control in California from the early 1970s to the late 1990s. It is not structured by frameworks or concepts derived from the social science literature, as are such recent volumes as Martha Derthick's Up in Smoke (2002) and Mark Wolfson's The Fight against Big Tobacco (2001). Instead, it is a highly detailed, straightforward description followed by the drawing of a set of general political lessons to guide future tobacco control advocates.
Four themes can be derived from the chronology of events described in Tobacco Wars: the socialization of conflict is necessary to achieve tobacco control, interest groups are central to these conflicts, careful attention needs to be paid to the framing of the issues, and the implementation phase is crucial for a successful public policy.
The American Lung Association, the American Cancer Society, the American Heart Association, the California Medical Association (CMA), and the tobacco industry are the major interest groups. The three voluntary health organizations, in alliance with grassroots antitobacco groups, are seen as the primary advocates for tobacco control. Glantz and Balbach contend that these advocates are most effective when socializing conflict and doggedly checkmating the tobacco industry and that their tendency to shy away from raw political battles is a significant obstacle to assertive policies. The CMA is portrayed as driven by self-interest to emphasize enhancing the financing of the delivery of medical services at the expense of tough policies to constrain the tobacco industry. The tobacco industry, often through front groups (e.g., Californians for Common Sense, Californians against Regulatory Excess) at the state and [End Page 525] local levels, is depicted as a very shrewd political force which sees policy making as an open-ended battle.
The authors portray interest groups as engaging one another in a series of policy-making episodes which are structured by strategies aimed at displacing conflict in a manner that advantages them. Although the authors make no effort to utilize the social science literature, their description resembles the themes in E. E. Schattschneider's classic on understanding political conflict, The Semisovereign People (1960). Throughout they explicate the groups' tactics for shaping the ongoing conflicts: the tobacco industry uses antitaxation, if not antigovernment, sentiment; appeals for the protection of individual rights to thwart regulation; claims that tobacco control programs will be too costly; and avoids debates that focus on health issues (e.g., secondhand smoke) because public opinion is decidedly negative about the industry's veracity in rebutting evidence of ill health effects. The public health groups counter with appeals for promoting the health of the individual and the public in the noble pursuit of the public good. The CMA, although nominally committed to tobacco control as health promotion, shies away from direct and sustained confrontations with the tobacco industry and focuses on funding for the delivery of medical services. In turn, this position is welcomed by the tobacco industry because it highlights treating the individualized effects of smoking and not the curtailing of overall tobacco consumption.
Glantz and Balbach conclude that the CMA and the tobacco industry are generally at a disadvantage when jousting with tobacco control advocates in highly publicized campaigns; however, the advocates fare much better in the "inside game" played to determine...