Our analysis of the participation and arguments employed in legislative debate on workplace smoking legislation suggests that the greater the proportion of arguments focused on science and health effects, the more common it was to see favorable public health outcomes, independent of the affiliations of outside participants who testified on proposed legislation. A key factor in passing public health legislation may be the tacit agreement among participants in the policy making process that a particular policy question is one that should be informed by scientific evidence rather than based exclusively on political, economic, or ideological concerns. Although elected officials are responsible for representing constituent preferences regarding these and other factors, these may not be definitive in all cases, and the pursuit of effective policy may require reliance on scientific evidence, including research on effectiveness that may indicate that one policy is a better means of reaching a particular outcome than another.
Consistent with earlier studies of regulation and legislation development, the main opponents to public health legislation were business interests, while health and government representatives made up most of the supporters.[4
] However, the distribution of these interests does not appear to have been relevant. Our findings suggest that legislators may view testimony in committee hearings as a simplified sampling mechanism for popular opinion, and that achieving a critical mass of supporters at legislative deliberations may be more important than whether these supporters are outnumbered by opponents. This finding is consistent with expectations that legislators discount self-interested testimony, [38
] in this case, protestations by the tobacco industry and other business representatives that the laws would impose economic costs exceeding the public health benefit. One proposed strategy for increasing the success of public health legislation is to encourage and facilitate public health participation in the legislative process.[33
] As Cohen and Jacobson have suggested, this could be accomplished by convening taskforces of scientific experts, as was done in Utah, or by obtaining financial support that would allow public health advocates to testify.[13
] State-university partnerships, including one pioneered with the California Health Benefits Review Program, which provides independent analysis of the medical, financial, and public health impacts of proposed state health insurance mandates, could also facilitate the use of scientific arguments in legislative debate.[44
Although outside participants in the legislative process used economic, ideological, and political arguments in almost all states, such arguments made up a smaller share of the debate in states that passed stronger legislation. One strategy proposed to combat the ideological arguments made by those opposed to public health legislation has been the promotion of ideological counter-arguments.[27
] This strategy contrasts with the alternative approach of emphasizing scientific discourse in legislative debates, a tactic commonly used in efforts to pass public health legislation from the 1970s to the early 1980s.[6
] Our findings, although based on an assessment of the nature of arguments presented in testimony across a limited number of cases, suggest that states where legislative discussion focused primarily on scientific evidence passed stronger public health legislation. Although our research design does not allow us to control directly for factors other than the testimony such as state political culture, the widely varying use of such scientific argumentation across states–particularly states such as North and South Dakota, which have similar political cultures but where legislative debates varied enormously in the share of arguments devoted to scientific evidence and resulted in very different outcomes–suggest that advocacy strategies emphasizing scientific discourse deserve renewed consideration. That said, a useful expansion of this research would investigate the role of other factors that vary across states and appear to influence legislative decision making, including the level of lobbying, extent of campaign contributions made by industry, and the role of affected constituencies within the state (e.g. tobacco growers, cigarette manufacturers). Nonetheless, in the states that passed stronger legislation in our study, more discussion of science appeared to be associated with laws that provided greater protection for public health regardless of whether the discussion was critical or favorable. Moreover, the discussion of science, as coded in this study, was rarely sophisticated; many participants simply introduced the idea that there were studies to refer to on the topic. Further study of testimony could help public health advocates identify the extent to which they should concentrate on different types of arguments.
Analysis of the arguments used in legislative debates helps elucidate the beliefs of supporters and opponents of public health legislation. As predicted by Cohen, both use arguments that appeal to core values about rights, freedom and personal liberty.[27
] However, adherence to these core values appeared unrelated to legislative outcomes. When discussion focused more on scientific evidence than other types of argumentation, public health outcomes prevailed. Our findings suggest that more scientific discourse may help generate policy outcomes that are aligned with the strong evidence that secondhand smoke is harmful; further study might consider whether this finding could be relevant to other public health issues.
The study has several limitations. First, we cannot establish a cause and effect relationship between the frequency and content of arguments in legislative debate and the policy outcome. Furthermore, the underlying social norms of states can influence policy; American states have different political cultures, existing restrictions, legal constraints on legislators (such as term limits), staffing levels, and may have part-time or full-time legislatures. States with a long tradition of supporting the interests of business and with weak campaign finance regulation, such as Louisiana, may be resistant to passing clean indoor air legislation regardless of the extent of scientific discussion. Second, our comprehensive analysis of the public record did not allow us to evaluate the potential impact of ex parte or non-official communications among participants in the legislative process. However, the analysis of public hearings and commentary is an important vehicle for describing and understanding the framing of policy issues and the types of evidence and argument that are considered. Finally, states with part-time legislatures that meet irregularly may not have the time to engage in much substantive policymaking. However, certain consistent themes related to the type of argument emerged when we conducted detailed examination of individual state cases where both context and outcomes differed dramatically.
Our findings suggest strategies for supporting future public health legislation. First, public health advocates and their legislative allies should try to frame the policy debate by making reference to research that supports public health goals. Second, public health advocates may wish to experiment with the mix of ideological counterarguments and scientific evidence they present in the limited time available for public testimony to determine whether emphasizing different types of arguments affects their perceived credibility and effectiveness. Overall, our findings suggest that a renewed emphasis on scientific discourse in legislative testimony may help produce political outcomes that favor public health.