Achieving Smoke-Free San Antonio Through Community Leadership and Policy Engagement

Transcription

1 Achieving Smoke-Free San Antonio Through Community Leadership and Policy Engagement Prominent supporters of San Antonio s landmark smoke-free ordinance included Mayor Julián Castro (center), Councilmember Reed Williams (second from left) and former councilmember Justin Rodriguez (second from right). Photo courtesy of: Contributors: Chandana Nandi,Jeannette Noltenius, Juan Flores, Adrian Althoff, and Mary Jo Vázquez.

2 ff PROBLEM ADDRESSED San Antonio, which is 59% Latino and the second largest city in Texas, did not have a citywide smoke-free ordinance as of January Unfortunately, Latino engagement and advocacy around smoke-free efforts was neither visible nor organized at the local or state levels. The National Latino Tobacco Control Network (NLTCN) searched for an agency that could engage Latinos to help organize support of smoke-free policies in Texas. Juan Flores, Executive Director of La Fe Policy Research and Education Center, was interested in this topic because it directly tied into the work and mission of his organization: to improve the decision-making capacity of Mexican Americans leading to their increased involvement in system changes in health and social policies. Neighborhoods First Alliance Pro bono media and public relations firm San Antonio City Council members San Antonio Department of Health Smoke-Free San Antonio Coalition Smoke-Free Texas Texas State Department of Health La Fe s work addressed three fundamental problems: 1) lack of effective outreach, education and collaborative efforts by existing smoke-free coalitions targeting the local Latino community, 2) lack of organized Latino tobacco prevention advocacy efforts inclusive of attention to smoke-free efforts, and 3) inadequate descriptions of Latino smoking prevalence and/or policy recommendations relevant to tobacco s impact on Latinos. DESCRIPTION OF KEY STAKEHOLDERS AND PARTNERS Community health centers Community health workers Hispanic Nurses Association La Fe Policy Research and Education Center Mayor of San Antonio Mexican American Hispanic Physicians Association According to the 2010 Census, San Antonio is the second-largest city in Texas and the largest U.S. city with a Hispanic majority. DESCRIPTION OF INNOVATIVE ACTIVITY La Fe conducted baseline analysis and networking with Latino health advocates, which demonstrated that funding for tobacco control efforts in Latino communities in San Antonio had been sporadic, focused on youth and tobacco s harmfulness to individuals and families, but not focused on population-based policy efforts. This analysis helped coalesce smoke-free support efforts around a "social justice-worker rights messaging frame: workers had no choice in the matter of their exposure to secondhand smoke. National Latino Tobacco Control Network (NLTCN) National Latino Tobacco Control Network 2

3 ff San Antonio residents participating in a community workshop organized by La Fe to educate Latinos about problems associated with smoking and increase Latino engagement in smoke-free advocacy efforts. CREATE AN ISSUE BRIEF La Fe took an innovative approach to the issue of secondhand smoke, depicting it as more than just a health issue, or a medical issue, but also one that cuts across the realms of social justice and worker rights. La Fe published an issue brief that gathered data on smoking prevalence and secondhand smoke specific to Latinos in Texas and other relevant socio-economic and health data (see p.8-11). It also emphasized secondhand smoke in the workplace, and linked it to an individual s right to a healthy working environment. ORGANIZE AN AD-HOC LATINO COALITION The Smoke-Free San Antonio Coalition did not initially focus on involving representatives of the local Latino community. With the goal of increasing Latino engagement around this issue, La Fe organized a loose but effective community-based coalition to help educate Latinos about the problems associated with smoking and to keep participants abreast of the efforts of the Smoke- Free San Antonio Coalition. La Fe formed this ad-hoc coalition by contacting Latinos from a variety of backgrounds, including members of medical societies and nursing associations, community health workers and employees of community health centers, business leaders, and elected and appointed officials. Overall, La Fe's adhoc coalition has given Latinos in San Antonio a greater voice in advancing meaningful policy change relevant to their community, and may provide a stable ground upon which to address future health issues. LETTER WRITING CAMPAIGN Another effective tactic was a strong informational letter writing campaign to various policymakers and news outlets (see p. 14) Through a strong sense of advocacy and a deep understanding of the issues involved, the letter writing campaign played an important role in the distribution of information to the public. EARNED MEDIA COVERAGE In addition to strong print media coverage like the attached op-ed (see p. 13), Juan Flores, the Executive Director of La Fe Policy Research and Education Center, also participated in televised interviews, including conversations on Univision and Telemundo. La Fe coordinated similar interviews for Dr. Rodolfo Urby, a physician and leader with the Mexican American Hispanic Physician Association. MEETINGS WITH LEGISLATORS AND TESTIMONY Alongside media efforts, the local coalition made its case directly to the San Antonio City Council. Giving a Latino voice to the debate was essential to swaying Council members that this was an issue critically important to the bienestar (well-being) and health of the Latino community. Testimony before Council committee meetings and the full Council provided unique smokefree perspectives (see p ). ADDRESSING THE OPPOSITION Some opposition to the Clean Indoor Air ordinance during City Council hearings came from traditional civil rights organizations such as the League of United Latin American Citizens (LULAC) and the National Association for the Advancement of Colored People (NAACP), which had not engaged on this issue previously. This occurred in part because the state and local smoke-free coalitions had not done outreach to minority communities. They opposed the measure out of concern that it would affect minority businesses already suffering economic hard times. La Fe and NLTCN were asked by the local and state smoke-free coalitions to help minimize and defuse their opposition. This was achieved in part through relationships built over the years by both agencies with local and national Latino leaders. National Latino Tobacco Control Network 3

4 ff KEY COMPONENTS Community organizing Building an ad-hoc Latino coalition Collaborative brokering with organizations for mutual support on other Latino issues Strong leadership Informational letter writing campaign Media involvement Understanding of workers right to a healthy working environment Distribution of information to the public Community representation at City Council meetings Engagement with local, state and national mainstream coalitions Funding and technical assistance from the National Latino Tobacco Control Network (NLTCN) PLANNING, DEVELOPMENT AND IMPLEMENTATION SKILLS USED A respected Latino organization was identified by NLTCN to establish a network of local grassroots community organizations and leaders. La Fe, based in San Antonio, was contracted by NLTCN to lead this Latino effort. La Fe demonstrated to the Smoke-Free San Antonio Coalition their leadership and capacity through their organizing efforts and ability to connect and gain support from community organizations, Latino healthcare professionals, and grass-root leaders. La Fe also utilized its media network and knowledge of the local policy context, including relationships with City Council members and the Mayor, to help inform and drive the broader coalition efforts. With assistance from La Fe, members of the Latino workforce spoke before the City Council and presented their concerns. In collaboration with the pro bono media firm, La Fe was able to reach out to the public by developing a media campaign using the Gracias Por No Fumar testimony and op-ed materials. La Fe organized Latinos to attend City Council hearings to voice their support for the passage of a new, tougher smoke-free ordinance. Other skills included the ability to: Write and publish op-eds Write and publish letters to the editor Conduct research and write and publish policy briefs Publish materials in both English and Spanish Cultivate longstanding relationships with mainstream and Latino media contacts, in print, radio, TV and online publications Prepare, submit and deliver testimony before the City Council Cultivate long-term relationships with public appointed and elected officials Understand the difference between advocacy and lobbying Counteract the messages of the tobacco industry Work with national, state and local Latino organizations Work with local and state mainstream tobacco control efforts Work with local and state health department personnel Diffuse opposition National Latino Tobacco Control Network 4

5 ff RESOURCES Staff and program support from La Fe La Fe's relationships with local stakeholders Pro bono media and public relations firm Univision and Telemundo media relationships Media relations with print and on-line journalists La Fe secured locations for coalition meetings The Smoke-Free San Antonio Coalition provided strategy support and engagement. Technical and financial support from the National Latino Tobacco Control Network (NLTCN) via training programs, resource materials, information and policy brief reviews, technical tobacco prevention translations, and phone consultations. The local and state health departments provided funds and engaged in the Smoke-Free San Antonio Coalition. SUSTAINING THIS INNOVATION The city of San Antonio needs to reinforce and implement these smoke free policies. Since many Latino, African American and Asian/Pacific Islander and other minority business owners and community members were not fully engaged in passing this clean indoor air ordinance, the implementation of smoke-free laws in local establishments is not assured. The city and state health departments need to fund Latino and minority communities to engage on this issue, fund media campaigns, fund cessation services, fund programs to educate parents and children, support efforts to raise taxes and fund enforcement efforts so that there is a change in social norms. Also, the city of San Antonio and the City Council need to ensure that amendments are not introduced to weaken the smoke-free laws and, if such amendments are introduced, to fund and mobilize Latino and other minority communities to publicly share their perspectives and defend worker rights. Mainstream national organizations, statewide coalitions, the Texas Department of State Health Services and local health departments in San Antonio, and National Networks for Tobacco Control and Prevention need to continue ensuring that tobacco control efforts at the local and state levels in Texas include Latinos and other minority communities, as well as priority populations such as low SES and LGBT communities. Representative Mike Villarreal (D-San Antonio) and La Fe s Juan Flores discuss benefits of smoke-free policies for workers and families in Texas. DISSEMINATION La Fe and NLTCN jointly prepared and disseminated information in print and online through their respective websites. Advocates conducted Spanish and English print and TV media interviews. The Smoke-Free Coalition managed its own website, through which it disseminated information to other constituencies. Juan Flores presented on La Fe and the Smoke- Free San Antonio Coalition at LULAC's national conference in Cincinnati in June Meetings were held with the National Executive Director of LULAC on several occasions by La Fe and NLTCN in order to bring different Latino perspectives to their attention. EVALUATION MEASURES The health impact of this intervention in the workplace was not evaluated. The success was measured by the fact that Latino voices were heard as part of the Smoke Free San Antonio Coalition due to the intervention, and that the smoke-free ordinance in San Antonio passed. However, no scientific process evaluation was conducted. RESULTS With the support of the Smoke-Free San Antonio Coalition, on August 19 th, 2010 the City Council voted for the smoking ban in all work places, including restaurants and bars, signifying a success not only for health advocates, but also for social justice and rights in the workplace (summary of new ordinance attached on p. 12). National Latino Tobacco Control Network 5

6 ff UNIQUE CHALLENGES WEAK COMMUNITY-BASED CAPACITY First, in the beginning, the Smoke-Free San Antonio Coalition did not adequately reach out to the Latino community as a strategy to bring unique voices and political power to bear in the fight for a smoke-free ordinance, even though 59% of the population of the city is Latino. The Coalition s reliance on Latino staff in mainstream coalitions serving as the primary representatives of Latino voices proved insufficient. However, the community-based efforts of NLTCN, including its support of Juan Flores s La Fe in the form of technical assistance, training and funds for education and advocacy activities, resulted in increased Latino involvement in a relatively short period of time. With the support of La Fe, the campaign started to reach the Latino community more effectively and bring more Latino voices to the table. For example, Latino community members and representatives from community-based organizations expressed their concerns about health issues regarding smoking in bars, restaurants and other places at the three San Antonio City Council hearings on the indoor smokefree ordinance. Once engaged, Latino voices were effective and powerful. LACK OF LOCAL TOBACCO CONTROL FUNDS TARGETING LATINOS: Second, the experience of the Smoke-Free San Antonio Coalition suggests that the lack of previous systematic and/or sustained tobacco control efforts in Texas to build local Latino capacity in San Antonio was a significant obstacle for the campaign. Largely because local minority communities had not been fully engaged previously on this issue, the Coalition struggled to secure broad-based support from groups representing Latinos and other minorities, including the local branches of the League of United Latin American Citizens (LULAC) and the National Association for the Advancement of Colored People (NAACP). While NLTCN s involvement eventually helped bridge the gap, it is conceivable that Latino community support would have been even more forthcoming, and at an earlier stage in the campaign, if local community-based service providers had been recipients of sustained state and/or federal funding for tobacco control work with Latinos and other minority groups during years prior. LOCAL POLITICS: Third, mainstream tobacco control advocates also did not adequately lay the groundwork politically for the Smoke- Free San Antonio Coalition s minority outreach efforts. Crucially, they were caught off guard when the local chapters of several minority-led groups with a track record of engagement on national health policy reform efforts, including LULAC and the NAACP, decided to pursue their own agendas such as job creation and economic development at the expense of the Smoke- Free San Antonio Coalition. These advocates also did not focus on incorporating issues or perspectives into their campaign relating to the historical struggles of Latinos and other minorities for political power (i.e. social justice, worker rights and discrimination issues, lack of health insurance, zoning variances), which may have contributed to the sense among some minorities that the campaign was not prioritizing their communities needs. ADAPTATION BY OTHER ORGANIZATIONS It is possible to adapt this experience for other organizations, state and local health departments, local and state coalitions and national groups. What is vital is to have a reputable and well-known Latino and/or minority organization that can provide leadership, has capacity and credibility in educating and organizing at the local community level, and understands the value of building and maintaining a network of community members who can who can partner with local/state smoke free coalitions. This organization must also take a lead role in developing resolutions, testimonials, editorials, fact sheets, issue briefs and other public education materials in English and Spanish, and know how to make these efforts relevant, culturally appropriate and community competent. Reaching out to the public through media is crucial. Providing personal stories from the people who are most affected is essential in order for the City Council, the mayor and/or state legislators to understand that their respective constituencies are behind the smoke-free efforts. National Latino Tobacco Control Network 6

7 ff Lessons Learned In order to secure vibrant Latino support for policy changes, local Latino and minority groups should be educated on tobacco control, and engaged consistently, in a sustained and systematic way. Community-based direct service providers often have local relationships with policy makers and political capital that are critical to the success of tobacco control efforts. Local organizations serving Latinos and other minority groups should receive tobacco control funding for a period of at least five (5) years prior to the start of a major campaign/initiative covering their communities /constituencies. Local health departments and smoke-free coalitions need to reach out to these community-based groups, provide training, and support them before asking them to attend their meetings and back their policy priorities. The tobacco industry has been funding community-based events and/or conferences including cultural and arts activities, scholarships, and they have consistently provided local and national Latino and/or minority organizations with funding to gain their loyalty. Publicly attacking national Latino and/or minority organizations for speaking against smoke-free efforts is counterproductive, since policy efforts require broad-based coalitions not just in local efforts, but in statewide and national efforts. When policies are proposed and/or debated, Latino and other minority voices have to be at the table from the beginning, including setting the agenda, discussing strategies and participating in decision making. Several community based organizations must receive funding for education and advocacy, since one group cannot represent the myriad concerns of Latino and other minority residents. Local racial/ethnic tobacco use data collection should cover minority worker issues and reflect the problems and concerns of Latino and other minority and priority populations. All policy briefs, talking points and educational materials need to be presented from a culturally appropriate point of view in both English and Spanish, and should include the Gracias Por No Fumar logo on all materials. La Fe's efforts supported by NLTCN provided a model for local and state governments that can be replicated in any state or community. Wherever there is Latino and minority leadership and a willingness in the community to take action, local communities can step up and provide the information and political support necessary to enact meaningful policy change. Attachments 1) Gracias Por No Fumar: Exposure to Second Hand Smoke and Texans (La Fe issue brief) (p. 8-11) 2) Summary of Revised City of San Antonio Smoking Ordinance (p. 12) 3) Smoke-free ordinance needed to protect workers (Op-ed, San Antonio Express-News) (p. 13) 4) La Fe letter to City Council member (p. 14) 5) La Fe City Council testimony in favor of a stronger smoke-free ordinance for San Antonio (p ) National Latino Tobacco Control Network 7

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12 ff SUMMARY OF REVISED CITY OF SAN ANTONIO SMOKING ORDINANCE City Code, Part II, Chapter 36 / Ordinance No Effective Date: August 19, 2011 The San Antonio City Council voted to make changes to the smoking ordinance that will prohibit smoking in additional places within the city limits of San Antonio. The summarized changes may be viewed in full detail in Chapter 36 of the City Code. ( Where is smoking newly prohibited? Indoor/Enclosed Spaces: - Bars - Billiards halls - Bingo facilities - Comedy clubs - Gaming facilities - Restaurants, except outdoor seating areas designated as smoking sections - Places of employment Outdoor Spaces: - San Antonio Zoo facilities and grounds - All outdoor sports arenas, stadiums, and amphitheaters - All pavilions and playgrounds in city-owned parks - Within 20 feet of all outdoor public transportation stations, platforms, and shelters under city authority What signs or changes are required? Post signs at every entrance with the words No Smoking or with the international symbol. All ashtrays and other smoking-related items must be removed. Where is smoking unregulated/allowed? - Outdoor restaurant seating areas properly designated as smoking areas - Private clubs as defined in the ordinance - Hotel/motel rooms designated as smoking rooms - Private residences, except when used as a child care, adult day care, or health care facilities - Retail tobacco stores - Tobacco product manufacturing facilities What signs or changes are required? Post signs at every entrance to indicate smoking is permitted and include the required warning message about risks of secondhand smoke exposure: Tobacco smoke causes cancer, heart and lung disease, and can harm your baby. Need help? Call the San Antonio Metropolitan Health District at (210) Visit National Latino Tobacco Control Network 12

13 ff Smoke-free ordinance needed to protect workers By Juan H. Flores San Antonio Express-News June 10, 2010 CT We are at a crossroads in which comprehensive smoke-free policies can have positive health and economic benefits to individuals, families and communities, especially the Latino population. This ethnic group is the largest segment of the population in the hospitality industry workforce. Sadly, it s also the occupational sector that has the lowest level of smoke protection. Food service workers have a 50 percent greater risk of dying from lung cancer than the general population, in part, because of exposure to secondhand smoke in the workplace. These workers deserve protection from this workplace health hazard as much as bankers, lawyers or office workers. The facts show not only that the Latino community is in particular need of protection from secondhand smoke, but also that it is very supportive of smoke-free workplace policies. A recent poll by Baselice & Associates, showed 71 percent of Latinos in San Antonio believe secondhand smoke is a serious health hazard. Poor health and reduced quality of life caused by both smoking and secondhand smoke on individuals and families is preventable. Twenty-nine cities across Texas and 29 states across the United States have passed strong smoke-free policies with little or no costs to local/state governments, or businesses. San Antonio is the only large metro city in Texas without a comprehensive smoke-free ordinance to protect its workforce from secondhand smoke across all public facilities, worksites and hospitality businesses. Exposure to secondhand smoke is not a matter of personal choice. In fact, choice is more often limited or reduced when we have few options to work and enjoy leisure activities in facilities in which smoking is not allowed. The lack of choice is also unequal across population groups. Additionally, most San Antonio citizens also know smoking and secondhand smoke are a major cause of premature deaths chronic health problems, and high health care costs. According to the U.S. Surgeon General, each year 53,000 nonsmokers die from secondhand smoke. In Texas, an estimated 24,000 people die from smoking attributable illnesses. It s important to know that: Comprehensive clean-air policies do not affect restaurant revenue or the sale of alcoholic beverages in bars, according to numerous studies of sales tax data in Texas and other states. There is no risk-free level of exposure to secondhand smoke, according to the U.S. Surgeon General. Smoke-free workplace laws immediately and notably improved heart health (including fewer heart attack hospitalizations), particularly in nonsmokers, according to studies in numerous states and countries. Public officials often talk about the importance of prevention; however, they must act now. The results of passing a strong smoke-free ordinance will be improvements in Latino and communitywide health and financial security for generations to come. People who want clean air to breathe should not have to be exposed to secondhand smoke and this ordinance change is necessary to protect San Antonio s entire workforce. Juan H. Flores is executive director of La Fe Policy Research and Education Center. National Latino Tobacco Control Network 13

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15 ff June 10, 2010 La Fe Policy Research and Education Center Promoviendo Bienestar para Familias y Comunidad con Conocimiento, Confianza y Poder Promoting Family and Community Well-being through Knowledge, Trust and Empowerment Testimony in favor of a stronger smoke free ordinance for San Antonio: I m Juan Flores, executive director of La Fe Policy Research and Education Center. The Center works to continually improve the Bienestar of Mexican Americans through policy analysis, education, leadership development, civic involvement and advocacy. Bienestar affirms our culture, community experience, and values to achieve equality of opportunity through responsive social and health policies. San Antonio must have comprehensive smoke free policies which can have positive health and economic benefits to individuals, families and communities, especially the Latino population. They are one of the largest segments of the population in the hospitality industry workforce. It s also the occupational sector that has the lowest level of smoke free protection. Food service workers have a 50 percent greater risk of dying from lung cancer than the general population, in part, because of exposure to secondhand smoke in the workplace. These workers deserve protection from this workplace health hazard as much as bankers, lawyers or office workers. No one should have to choose between their life and their livelihood. The facts show not only that the Latino community is in particular need of protection from secondhand smoke, but also that they are very supportive of smoke free workplace policies.. Twenty nine cities across Texas and 29 states across the United States have all passed strong smoke free policies with little or no costs to local/state governments, or businesses. National Latino Tobacco Control Network 15

16 ff Exposure to secondhand smoke is not a matter of personal choice as some would argue. In fact, choice is more often limited or reduced when we have few options to work and enjoy leisure activities in facilities in which smoking is not allowed. The lack of choice is also unequal across population groups. Finally, a. Comprehensive clean air policies do not affect restaurant revenue or the sale of alcoholic beverages in bars, according to numerous studies of sales tax data in Texas and other states. b. There is no risk free level of exposure to secondhand smoke, according to the U.S. Surgeon General. c. Smoke free workplace laws immediately and notably improved heart health (including fewer heart attack hospitalizations), particularly in nonsmokers. d. The results of passing a strong smoke free ordinance will be improvements in Latino and community wide health and financial security for generations to come. The workforce with the least smoke free protection is also the most uninsured. We are a city that is aggressively developing and promoting its health industry and which recently received over 15 millions dollar to create a healthier environment. Therefore, I urge the City Council to do what s right and pass a strong smoke free ordinance to ensure ALL workers have access to a healthy work environment. Juan H. Flores, M.U.P. Executive Director The National Latino Tobacco Control Network (NLTCN) is an open information and support system for tobacco control and health disparities advocates and experts who want to become more effective in changing policies and social norms around tobacco control through exchange of information and personal and institutional linkages. NLTCN is a member of the National Tobacco Prevention Networks This publication was supported by CDC Cooperative Agreement Number U58/DP Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Contact: Juan H. Flores, M.U.P. Executive Director La Fe Policy Research and Education Center 1313 Guadalupe Street, Suite 102 San Antonio, Texas , (Fax) National Latino Tobacco Control Network 16