Social lobbying: a call to arms for public health Alessandro Demaio, by Alessandro Demaio and Robert Marshall

The Lancet – The term lobbying derives from the public lobbies of the UK Houses of Parliament in London, where concerned citizens have gathered since at least the 16th century to speak with elected officials on the sidelines of legislative debates. In today’s parlance, lobbying has evolved to represent a more pernicious and systematic approach to influencing lawmakers, occurring much deeper within the corridors of power.

In 2018, industry representatives from food to automotive to energy sectors and beyond exercise their right to petition elected officials in the name of profits, not people. In the past decade, companies have spent more than US$3 billion annually on lobbying in the USA alone.1 Between 2002 and 2012, total expenditure on lobbying by business in the USA grew at 4% per year, twice the growth rate of US gross domestic product. Expenditure over the same period on lobbying by the sugary-drink and fast-food industries grew at 9·2% and 12·3%, respectively.2 Carefully protecting special interests, many companies and industry groups lobby to prevent new laws and regulations that threaten profits, including efforts to curb the consumption of products known to harm human health. Unsurprisingly, lobbying has been identified as one of four key channels—along with marketing, extensive supply chains, and corporate social responsibility—that contribute to the success of corporate influence.3

Contrastingly, civil society and non-profit sectors do not engage in lobbying to the same extent. A 2007 study of a cross-section of over 1700 non-profit advocacy groups found that almost two-thirds had “never” or “infrequently” engaged in lobbying.4 Further research found that just half of non-profit organisations surveyed from a range of disciplines in the USA were engaged in even the least-demanding forms of lobbying or advocacy.5

In this context, we define social lobbying as advocacy with the intention of influencing decisions made by governments, solely to protect and further the greater social good, including health. There are various reasons why public health organisations—universities and research groups, non-profit, civil society organisations, and other advocates—largely shy away from social lobbying. Many non-profit groups, particularly health and human services organisations, rely on government funding, making them less willing to engage in political or even policy-focused tactics that could jeopardise financial contributions.6 Additionally, some non-profits are financially sponsored or supported in more insidious ways by the same private interests they are ostensibly working against. The 2017 announcement by Philip Morris International to fund a $960 million non-profit Foundation for a Smoke-Free World to investigate ways to reduce the harms of smoking is a flagrant example.7 But what about the increasing presence of private industry in the boardrooms of civil society and non-profit organisations, the pervasiveness of junk-food advertising in children’s sports organisations, or the more than $100 million spent over a 5-year period by Coca-Cola on health research and partnerships?5, 8, 9 When these entangled private interests are at odds with population health, public health groups have to weigh up taking action against the risk of losing sponsorship and support. Active lobbying by the public health community can only begin after appropriate independence has been achieved from both government and the private sector.

There are further legal and financial risks that threaten public health organisations’ engagement in social lobbying. In some countries, lobbying can jeopardise a non-profit’s tax-exemption status.10These rules contrast starkly with the freedoms afforded to companies engaged in philanthropy, or so-called philanthrocapitalism. Non-profits are expected to be transparent and accountable, yet lobbying for the causes they exist to support could lead to their financial collapse. If set up as a limited liability company or an arm of a larger corporation, as some private sector-driven advocacy organisations have been, these restrictions evaporate.11 In fact, such corporate endeavours often reap substantial tax benefits and political goodwill and contribute to a societal halo effect.

Many public health organisations are ill-equipped for social lobbying. Public health advocates, doctors, and academics receive little training in advocacy or lobbying, and gaining access to politicians requires investments of time and money to build the requisite organisational and human capabilities.12 Indeed, most public organisations cite a lack of resources as the greatest barrier to further engagement in lobbying activities.5

Successful social lobbying will require a new generation of social lobbyists who are able to navigate the legislative process, communicate across the social–political divide, and influence policy makers. Such roles must be encouraged and developed within the public health community. Organisational factors also need to be strengthened: independence from government and private sector influence and funding, improved access to policy makers, and a cultural shift that sees public health professionals become comfortable with the idea of assertive advocacy to governments.

Health is inherently political and there is no public health issue that is not impacted in some way by government decision making.13 Faced with the increasingly pervasive reality of political systems gridlocked by private sector special interests, public health organisations must acknowledge their responsibility to engage with the political process. As a public health community, we have lingered too long outside the public lobby. It is time for social lobbying to protect health for all.

 Opens large imageAlex Wong/Getty Images

AD is chief executive officer of the EAT Foundation, co-founder of NCDFREE, and founder and patron of the Sandro Demaio Foundation, organisations focused on improving the health of populations through disruptive public health innovation. RM declares no competing interests.


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