Advancing Health in California

By David Beier

“One of the biggest problems in healthcare,” says Diana Dooley, chief of staff to California Governor Jerry Brown and the state’s longtime secretary of health and human services, “is that we pay for the treatment of illness but we don’t pay for the advancement of health.”

Her comment is inconveniently timely, considering the decision last month by Governor Brown to ban new city-level soda taxes anywhere in California for twelve years. Yes, Governor Brown reluctantly signed legislation he opposed because of the threat from the beverage industry to hamper local government tax measures by requiring every tax increase to pass by a supermajority. And yes, Governor Brown has a longstanding commitment to public health. But these points don’t change the fact that policymakers have now lost an important tool in the fight against obesity: the possibility of implementing soda taxes like the ones in Berkeley, Oakland and San Francisco.

That’s why it’s encouraging to see the counter move by the California medical and dental associations, which have filed a ballot measure for 2020 to overturn the ban and enact a statewide tax on sugary beverages. If we want the measure to pass and the tax to succeed, the following points are critical.

Just win

The single most important point for advocates of the 2020 effort to keep in mind is that the measure must be designed to win on Election Day, not on moral grounds. To score an electoral win the 2020 ballot measure will need to:

1. Deliver a clear, simple message. Effective “no” campaigns thrive on creating confusion among voters. Counter this approach with a message that gives voters something to be FOR.

2. Avoid unforced errors. With social media, it’s easier than ever to overreact to a critique. Media analytics and opinion research can help campaigns understand which attacks are resonating and need to be addressed.

3. Invest appropriately. If history is any indication, Big Soda will spend tens of millions of dollars fighting this measure. It’s less expensive to run an effective campaign for something, but to compete, the campaign’s proponents will need to be in the same spending range.

4. Focus on opinion elites. Opinion elites are a highly informed and civically engaged group who help shape public opinion on a range of matters. To take on an issue across a state as big as California, supporters of the tax measure will need to win this group of leaders over and convert them into advocates.

An effective tax

Alongside the electoral strategy, we should consider what an effective new tax regime would look like. Key considerations include the following.

1. Keep it modest. Taxes of this sort are regressive, since people with less money pay the same tax rate as people with plenty of money. Further, Big Soda companies provide good jobs, particularly for blue collar workers. The tax should be designed to limit the impact on employment.

2. Support public health. The tax’s proceeds should go exclusively to public health projects, rather than the state’s general fund. This sort of guarantee is not just good policy but good politics, since voters like to know the measure will have its intended impact.

3. Prioritize farmers’ markets. The tax could make grants to underserved communities for farmers’ markets to increase access to healthy foods. These markets should in turn prioritize California products to encourage local investment and employment.

4. Encourage investment in food deserts. Up to one million Californians live in so-called food deserts, where they lack access to supermarkets or large grocery stores. The measure should be designed to expand access to healthy foods for people in these areas.

5. Step back and review. The tax should be designed to sunset after seven years so that it can be assessed with an eye to health benefits and health spending. If it’s not working, it should be modified.

Critics will say there are better ways to craft policy than by ballot measure. But obesity is an urgent enough matter that it calls for immediate solutions. California can’t wait twelve years to advance its health.