InterAmerican Heart Foundation H EALTHY C ARIBBEAN 2OO8 Civil Society as the agent for Change: What Works Healthy Caribbean 2008 Barbados, October 16,

InterAmericanHeartFoundation

HEALTHY CARIBBEAN 2OO8

Civil Society as the agent for Change: What Works

Healthy Caribbean 2008Healthy Caribbean 2008Barbados, October 16, 2009Barbados, October 16, 2009

Beatriz Marcet Champagne, PhDBeatriz Marcet Champagne, PhD



Objectives of presentation

Define civil society and differences with Define civil society and differences with government and commercial organizationsgovernment and commercial organizations

Describe major roles of civil societyDescribe major roles of civil society

Describe major tools of civil societyDescribe major tools of civil society– AdvocacyAdvocacy– Coalition buildingCoalition building– Public information and media campaignsPublic information and media campaigns– Monitoring and evaluationMonitoring and evaluation



Key message

Governments of the Caribbean and PAHO Governments of the Caribbean and PAHO are already working on the implementation are already working on the implementation of the POS Declarationof the POS DeclarationCivil society must be a major partner in Civil society must be a major partner in this effort and it can make the difference this effort and it can make the difference between success and failurebetween success and failureCivil society must play its role forcefully, Civil society must play its role forcefully, strengthening its present role and using strengthening its present role and using the tools at its disposalthe tools at its disposal



Health education and individual approaches frequently help the higher SES groups

Individual responsibility

Changes to the "toxic" environment

Adapted from Puska P, 2001

Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention

Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention

POLICY CHANGE

Smokefree environments

Warning labels

Food labeling

Safe spaces for physical activity

Availability and affordability of fruits & vegetables

INDIVIDUAL CHANGE



What is civil society

The totality of voluntary civic and social The totality of voluntary civic and social organizations and institutions organizations and institutions

Forms the basis of a functioning Forms the basis of a functioning democratic society democratic society

As distinct from As distinct from – statestate (regardless of that state's political (regardless of that state's political

system) and system) and – commercial institutions/businesscommercial institutions/business

From: Center for Civil Society, London School of Economics and Political Science



BusinessBusinessBusinessBusiness

s

GovernmentGovernment

Civil Society or Civil Society or Third SectorThird Sector



Civil society includes

registered charities registered charities non-governmental organisations non-governmental organisations community groups community groups women's organisationswomen's organisationsfaith-based organisationsfaith-based organisationsprofessional associationsprofessional associationstrades unionstrades unionsself-help groupsself-help groupssocial movementssocial movementsbusiness associationsbusiness associationscoalitions and advocacy groupscoalitions and advocacy groups



Government

Power of the statePower of the state

Is responsible for public healthIs responsible for public health

Limited by political changes Limited by political changes

Possible changes in prioritiesPossible changes in priorities

May apply large financial resources if May apply large financial resources if there is political will, or lose themthere is political will, or lose them

Government employees have to Government employees have to present official position onlypresent official position only

Gov’t networksGov’t networks



Civil Society

Independent of gov’tIndependent of gov’t

Greater freedom to actGreater freedom to act

Altruistic mission towards common goodAltruistic mission towards common good

Greater consistency—not as influenced by Greater consistency—not as influenced by political windspolitical winds

May support and pressure gov’t from the outside May support and pressure gov’t from the outside

Other networks (scientific, businesses)Other networks (scientific, businesses)

Expert volunteersExpert volunteers

Relation to mediaRelation to media

Additional funding to causeAdditional funding to cause



The roles of Civil Society



Role of Civil Society: Advocate

Promote a favorable public opinion Promote a favorable public opinion

Support gov’t if doing what is necessarySupport gov’t if doing what is necessary

Identify legislative priorities and help develop Identify legislative priorities and help develop legislative measureslegislative measures

Presents a powerful, respectable and Presents a powerful, respectable and trustworthy image. trustworthy image.



Role of Civil Society:Provider of evidence-based info

Inform policy decisionsInform policy decisions

Translates science for use by policy makers, Translates science for use by policy makers, media and the publicmedia and the public



Healthcare Guidelines



Technical and Scientific support



Role of Civil Society: Watchdog

““Report cards” and Report cards” and “shadow reporting”“shadow reporting”

Independent Independent monitoring & monitoring & evaluationevaluation



Role of Civil Society: Service provider

Screening for risk factorsScreening for risk factors

CounselingCounseling

Provide medicationsProvide medications

Rehab for cardiac patientsRehab for cardiac patients

Provide treatment to the poorProvide treatment to the poor



Service Provider

Watchdog

Evidence base info

Advocacy



Civil Society to do what?



It turns out we know exactly what to do:

Prevention works

It’s simple, affordable and effective



Tobacco

Objective: “To protect present and future generations Objective: “To protect present and future generations from the devastating health, social, environmental from the devastating health, social, environmental and economic consequences of tobacco and economic consequences of tobacco consumption and exposure to tobacco smoke.” consumption and exposure to tobacco smoke.” (FCTC, Art. 3)(FCTC, Art. 3)ACTIONS: Implement FCTC (legal obligation for ACTIONS: Implement FCTC (legal obligation for those that ratified)those that ratified)

Warning LabelsWarning Labels

Banning publicity, Banning publicity, sponsorship and sponsorship and promotionpromotion

Taxation Taxation

Smokefree Smokefree environmentsenvironments

Reducing smugglingReducing smuggling



Obesity

Objective: Reduce overweight and obesityObjective: Reduce overweight and obesity

ACTIONS: ACTIONS:

Nutritional standards for food in all government facilities/schools

Limit/abolish all marketing to children

Policies supporting breast feeding

Economic and other Economic and other incentives to sugar, fat incentives to sugar, fat and salt in diet and and salt in diet and fruits and vegetablesfruits and vegetables

Community-wide Community-wide consumer educationconsumer education

Food labelingFood labeling

Ban trans fatsBan trans fats



Physical Activity

Objective:To increase physical activityObjective:To increase physical activity

ACTIONS: ACTIONS:

Daily school Daily school physical activity (60 physical activity (60 min.) min.)

Community after-Community after-school physical school physical activityactivity

Availability and Availability and accessibility of spaces accessibility of spaces for physical activityfor physical activity

Progressively adapt towns to favour pedestrian/cycling with car restrictions



Individual approaches

Treatment for smokersTreatment for smokers

Screening, early diagnosis, counseling Screening, early diagnosis, counseling and treatmentand treatment– HypertensionHypertension– DiabetesDiabetes– ObesityObesity

Rehabilitation programs Rehabilitation programs



Civil Society’s Tool Kit



Strategic planning for policy change

Q1: What do we want? Q1: What do we want? Q2: Who in Government can make it happen? Q2: Who in Government can make it happen? Q3: Who in Gov’t can influence the process?Q3: Who in Gov’t can influence the process?Q4: Q4: What do they need to hear to persuade them to act?What do they need to hear to persuade them to act?Q5: What messages speak to the Brain & the Heart? Q5: What messages speak to the Brain & the Heart? Q6: Q6: Who are the most effective messengers for our Who are the most effective messengers for our target audience? target audience? Q7:Q7:What are the most effective means for delivering our What are the most effective means for delivering our messages?messages?Q8:Q8:What are effective ways to gain the media's attention What are effective ways to gain the media's attention with stories that best convey our messages?with stories that best convey our messages?Q9: Q9: What other materials do we need for our campaign?What other materials do we need for our campaign?

1



Advocacy: What is it

Can mean different things for different Can mean different things for different people.people.Advocate for a cause…Advocate for a cause…The act of speaking or of disseminating The act of speaking or of disseminating information intended to influence:information intended to influence:– individual behaviour or opinionindividual behaviour or opinion– corporate conductcorporate conduct– public policy and lawpublic policy and law

Advocacy - lobbying, government relations, Advocacy - lobbying, government relations, influencing legislators/bureaucratsinfluencing legislators/bureaucrats

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Advocacy

Regular contact with legislatorsRegular contact with legislators

Press politicians to document and make Press politicians to document and make public their supportpublic their support

Provide Gov’t Ministries and legislators Provide Gov’t Ministries and legislators evidence-based information and options evidence-based information and options for legislationfor legislation

Contact representatives of key MinistriesContact representatives of key Ministries

Watch for political change within gov’tWatch for political change within gov’t



Different styles of advocacy

AggressiveNegotiate, Collaborate

Activism and Collaboration



How to influence government

Two strategies: Pressure or CooperationTwo strategies: Pressure or Cooperation

Situations:Situations:– Does not take on responsibility: PressureDoes not take on responsibility: Pressure– Sensible to issue: CooperationSensible to issue: Cooperation– Different positions within government: Different positions within government:

cooperate with some and pressure otherscooperate with some and pressure others



Ex: International/Domestic Letter-writing Campaigns

Electronic petitions Electronic petitions http://http://petition.globalink.orgpetition.globalink.org//

http://http://fctc.orgfctc.org//actionaction//index.shtmlindex.shtml

Fax, letters, phone callsFax, letters, phone calls



Coalition Building

An alliance of groups that have formalized their collective relationships for joint action on one or more issues.

Around a platform or declaration that many can join

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Mobilise others

Your

interests

Their

interests





Reasons for Coalition

Increases resources (and allows economic Increases resources (and allows economic use of shared resources)use of shared resources)Increases visible support for goalIncreases visible support for goalCreates common front (and consistent Creates common front (and consistent messages)messages)Educates and mobilises concerned Educates and mobilises concerned citizens & groupscitizens & groupsExpands reach of campaignExpands reach of campaign



Media campaigns

Reach the public and policy makers via Reach the public and policy makers via the mediathe mediaEarned mediaEarned media– Unpaid publicityUnpaid publicity– Press conference, media briefingsPress conference, media briefings– ““Creating” newsCreating” news

Paid mediaPaid media– TV and radio to reach massesTV and radio to reach masses– Very costlyVery costly

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Public information campaigns

Direct to the public informationDirect to the public information

Ex: Caribbean Wellness DayEx: Caribbean Wellness Day55



Independent monitoring and evaluation

Public opinion pollingPublic opinion polling

Report cardsReport cards

Policy analysisPolicy analysis

Media monitoringMedia monitoring

Industry monitoringIndustry monitoring

Social and political environment Social and political environment

Specific: air monitoring, store Specific: air monitoring, store shelf space, compliance with shelf space, compliance with bans bans

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Conclusions

Enormous opportunity at this conference Enormous opportunity at this conference to rev up the engine of civil society in the to rev up the engine of civil society in the CaribbeanCaribbean

Civil society must be a major partner in Civil society must be a major partner in this effortthis effort

Civil society must play its role forcefully, Civil society must play its role forcefully, strengthening its present role and using strengthening its present role and using the tools at its disposalthe tools at its disposal



Finally…

If citizen action is to be successful it requires If citizen action is to be successful it requires careful preparation,careful preparation,

effective organization and stamina.effective organization and stamina.

Lots and lots of stamina.Lots and lots of stamina.

- John Gardner in - John Gardner in Common CauseCommon Cause

Documents

InterAmerican Heart Foundation H EALTHY C ARIBBEAN 2OO8 Civil Society as the agent for Change: What Works Healthy Caribbean 2008 Barbados, October 16,