The same message delivered by different people can have completely different credibility, power, and effect.

The Difference the Messenger Can Make

Ira Shapiro served as general counsel to the US Trade Representative. Later, he agreed to serve as a spokesperson for the Framework Convention on Tobacco Control Alliance of tobacco control advocates. In that role, he argued that health concerns must outweigh economic concerns, as WHO members deliberated over whether the FCTC should make this an issue.

If a public health professional had stood up to make this argument, few would have listened. The speaker could be dismissed as a naïve advocate, ignorant of international trade law and policy. But when Shapiro stood up, he introduced himself this way: "I am a former United States trade negotiator. In fact, my first time in this room was on the morning of December 15, 1993, when the nations of the world announced the successful completion of the Uruguay Round of global trade negotiations. I speak to you as a strong supporter of the rules-based international trading system."

If such a strong, credentialed free-trade advocate believed that health rules should override trade rules, then the WHO members would—and did—pay close attention!

In this case, the messenger made the message effective.

In South Africa, an elegant radio advertisement refuted tobacco-industry arguments against an advertising ban: "The tobacco industry claims that a ban on tobacco advertising and promotions is an attack on freedom of speech. We asked a former smoker what he thinks." The ex-smoker replied in a tinny voice: "When you have lost your voice to cancer of the larynx, you don't have much freedom of speech." The advertisement not only made an important advocacy point, but also greatly increased calls to a Quit Line from smokers who wanted to quit.

Organizations dedicated to tobacco control advocacy often spend a great deal of time and care developing their messages, but just as often spend no time considering who would be the most effective person to deliver them. We might assume that our group leader will deliver the messages, or the chairperson of the organized tobacco control coalition. That person could indeed be the most effective spokesperson. But we will know this only after a strategic analysis similar to the one we go through to develop the messages themselves. What we are looking for is a combination of individual legitimacy and personal eloquence.

The dedication of tobacco control leaders does not necessarily make them the best spokespersons in all settings. Leaders need to be self-aware and able to suppress their egos to recognize and admit, for example, "I'm not the right one to lobby parliament" (or to go on TV for this interview). "Someone else can do this better."

Key Questions

In the process of deciding who will be the most effective messengers, we must ask:

• Who is most likely to influence our target audience favorably?
• Whom is our target audience politically responsive to?
• Whom does that audience most want to please?
• Whom does it honor? Trust? Respect? Fear? Like? Perhaps even love?

The companion questions we must ask are in the negative. They are along the lines of:

• Whom among our possible messengers does our target audience dislike? Scorn? Not take seriously? Distrust?"

Suppose we have already determined that the message we will use to persuade a finance minister is: "Raising cigarette taxes will increase tax revenue." Who will bear that message most convincingly to the finance minister (our audience)? An epidemiologist? A consumer activist? A minister of health? Not likely. Perhaps an economist, or even a world-renowned economist, sponsored by the World Bank. Even better, an economist who is the former finance minister of a neighboring country that enacted a cigarette-tax increase and experienced a dramatic increase in tax revenues!

Who Listens to Whom?

Persuading our target audience will depend as much on our messenger as on our message. Parliamentarians are likely to give a great deal of weight to the political advice of their peers. For example, suppose a respected MP who is also a doctor makes a scientific and political case on the floor of Parliament for an advertising ban. Her statement will carry a great deal of weight. Or imagine a prominent political columnist who has the ear of government leaders—or is feared by them—who raises questions about the corrupt influence of tobacco lobbyists. His column will be far more influential than a letter to the editor from an unknown tobacco control advocate.

Tobacco control advocates in Poland found an ideal messenger. Leading cancer-control doctor and epidemiologist Dr. Witold Zatonski was liked and trusted by the national media and was a skilled media advocate. Parliamentarians liked him as much as they respected him. He was warm and humorous, rather than moralistic or lecturing, while he communicated his messages clearly. Parliamentarians felt he respected them, and even smokers understood that he wasn't condemning them. Indeed, Zatonski would often say he "loved" smokers—that was why he worked so hard to help save their lives!

Not every country has a Zatonski. But every policy maker has an individual to whom he or she is more likely to listen with an open mind. Among Zatonski's allies, for example, was the very popular wife of the Polish president. She was not only an extremely effective messenger to the public, but also, of course, to the president.

Indian tobacco control advocates called on Dr. Raj Kumar Anand, whose close friend in medical school was now the health minister. The advocates chose this respected pediatrician and renowned consumer activist to initiate discussion on a national tobacco control law in the mid-1990s. Dr. Anand could draw on his friendship with the minister and on their shared professional commitment as doctors to protect public health.

Whatever your policy objectives, the ideal messenger will probably vary from situation to situation. Here are some examples of messengers likely to be the most effective for different target audiences and for different advocacy initiatives.

To persuade a prime minister to support comprehensive national tobacco control legislation:

A prime minister is likely to listen to:

• Trusted aides
• Former aides the PM respects
• Cabinet members
• Political leaders of the PM's party
• The PM's personal political campaign manager
• Campaign supporters and financial contributors
• Leaders of important constituent groups-for example, labor leaders, teachers, or local business leaders
• Media owners, powerful political columnists, and other prominent media figures
• Nationally known medical and scientific leaders
• Doctors who are members of Parliament of the PM's party
• Nationally respected religious leaders · Leading businesspeople and business associations

To persuade a finance minister to support tobacco-tax increases:

Your most effective messengers might include:

• Respected national economists
• Respected international economists from the World Bank or other prestigious financial institutions
• Finance ministers from neighboring countries who can speak with authority about the economic benefits to their own country of tobacco-tax increases
• European Union officials who favor tax increases, if the country is seeking admission to the EU

To persuade the general public to support enforcement of clean-indoor-air regulations:

In the early stages of a campaign to enact and enforce clean-indoor-air regulations, you will need to begin by increasing public awareness of the serious health risks of passive smoking.

A variety of messengers can be helpful in raising awareness of the dangers of secondhand smoke. The general public is most likely to be persuaded by respected scientists and doctors and by those in positions of authority—teachers, priests, nurses, doctors, professors of medicine, presidents of national medical societies, or scientific stars such as Nobel Prize winners.

Celebrities, sports figures, television and movie stars, musicians, and political figures can also serve as excellent messengers to help you motivate and educate the public on the hazards of secondhand smoke.

Another powerful messenger is a nonsmoker who has become seriously ill as the result of the smoking of coworkers or family members.

An Indian NGO enlisted the support of a famous brand name in home electric fans to sponsor its clean air advertisements in the newspapers. Here, the partnership spoke louder than words!

To persuade doctors they have an important role to play in tobacco control:

The most effective messengers are likely to be nationally or internationally honored doctors, well respected by their colleagues, who are tobacco control advocates. As Krzysztof Przewozniak of the Polish Health Promotion Foundation says: "Doctors believe doctors."

David Simpson is the author of Doctors and Tobacco: Medicine's Big Challenge, an important resource which provides information for medical associates and individual doctors on effective action in tobacco control. While not a medical professional, Simpson has been working in tobacco control for more than twenty years and is well respected by his colleagues. [text deleted] It can be found online at http://www.tobaccocontrol.org/tcrc_Web_Site/Pages_tcrc/
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Doctor-advocates with institutional and economic influence over other doctors or over hospital administrators may be the most powerful messengers for other doctors. Health ministries and tobacco control NGOs often include doctors known to be leaders among their medical peers.

In some countries, leading physicians have access to the mass media. Usually they appear as guest experts on news programs and talk shows, but some have their own regularly scheduled health guidance programs. Such media access may give them the opportunity to target messages to their colleagues about the importance of getting involved in tobacco control.

An excellent example is the experience of one physician-advocate, Dr. Elmer Huerta. A native of Peru, Dr. Huerta hosted a US radio show to discuss health issues in Spanish. This eventually led to his own cable television show. Dr. Huera today is a celebrity in the U.S. Latino community, known especially for his strong beliefs about tobacco control.

Other effective messengers to doctors might include senior health-ministry physicians, WHO regional advisers, medical ethicists, leaders of medical and specialist societies, and medical writers. Medical school professors and their curricula offer a prime opportunity to educate young doctors about the hazards of tobacco use.

The second of the ACS/UICC Tobacco Control Strategy Planning Companion Guides, "Engaging Doctors in Tobacco Control", provides further information on this topic. It is available online at www.strategyguides.globalink.org/doctors.htm

To persuade the public that tobacco companies are corrupt:

To teach the public that multinational tobacco companies and their messages are not to be trusted, the voice of a former tobacco-industry lobbyist or executive can carry enormous weight. During the late 1990s in the United States, Victor Crawford, a former tobacco-industry lobbyist, came forward to tell the truth about the work he had done for the industry. Crawford gained national media attention when he admitted that he had invented and lied about scientific findings and had unfairly attacked public health leaders as "health nazis."

The tobacco industry's own internal documents can serve as messages against them. Examples from tobacco control organizations who have drawn upon these documents include publications by the Campaign for Tobacco-Free Kids and ASH UK and by Profits Over People for Latin America; and the PATH Canada guide International Tobacco Growers' Association: ITGA Uncovered-Unraveling the Spin; the Truth behind the Claims. In Bangladesh, WBB quoted internal tobacco-industry documents to show how the industry has fought legislative changes over the years. With accompanying research that shows the need and support for strong tobacco control legislation, the WBB document has proved a highly useful lobbying tool.

Lawsuits in the United States have forced tobacco companies to release millions of pages of internal documents. For your campaign, you now have easy access to some of the most revealing quotes from the tobacco industry. For example, suppose a tobacco company announces a "youth-smoking prevention program." You can help journalists understand the company's motives with some strategic use of quotes from industry documents that state these programs are designed to forestall regulation.

To persuade film producers to stop portraying smoking as a glamorous route to romance and adulthood:

Our best example comes from the US film industry, where tobacco control activists have had little success among screenwriters. Indeed, writers often resent their efforts as attempts to censor artistic freedom. Joe Eszterhas, a leading screenwriter, had written fourteen movies, many of which glamorized smoking. When Eszterhas contracted lung cancer, he publicly renounced his own work. He told his fellow writers: "What are we doing by showing larger-than-life movie stars smoking onscreen is glamorizing smoking. What we are doing by glamorizing smoking is unconscionable. . . . A cigarette in the hands of a Hollywood star onscreen is a gun aimed at a 12- or 14-year-old. . . . The gun will go off when that kid is an adult."

These words carried enormous potential impact for Hollywood writers, because they came from a peer.