Stories from the Field

Making the Business Case for Tobacco 21 in Kansas City, MO

The Kansas City Chamber of Commerce, partnering with Blue Cross Blue Shield of Kansas City, helped pave the way for new laws across the region restricting tobacco sales to youth under 21.The county health department supported the business case for the initiative with data analytics and connections to stakeholders.

Highlights

1

The Kansas City Chamber of Commerce, in partnership with Blue Cross Blue Shield of Kansas City, spearheaded Tobacco 21/KC, an initiative to raise the legal age for tobacco purchase to 21 in the Kansas City metropolitan area.

2

The health department knew that business had influence in places it could not reach, and worked with the private sector and the Chamber of Commerce to infuse health concepts into economic development models.

3

Businesses and the Chamber of Commerce were willing to dedicate time and resources to tobacco control because they recognized the impact on the bottom line. They saw the health department as an ally that offered a rich network of local connections and access to data.

4

Health and business came to recognize that approaching shared challenges
from differing angles multiplies their influence. By early 2018,25 municipalities across the Kansas City metropolitan area, covering 1.5 million people, had adopted new ordinances to raise the legal age of tobacco purchase to 21.

In the 21st-century, community health is going to be a determining factor in economic development and growth.” Scott Hall, Kansas City Chamber of Commerce

The Kansas City Chamber of Commerce, in partnership with Blue Cross and Blue Shield of Kansas City, forged local consensus for Tobacco 21/KC, an initiative to raise the legal age for tobacco purchases to 21. The health department analyzed and presented data to help build a base of support. Kansas City, Missouri and Kansas City, Kansas both passed Tobacco 21 ordinances in November 2015 and by early 2018, 25 municipalities across the metropolitan area, covering 1.5 million people, had followed suit.

Linking Business and Health

Ever in search of opportunities to grow local businesses and create the labor pool of the future, officials at the Kansas City Chamber of Commerce have grown more aware of health’s influence on the local economy in recent years.

“We realized there was a correlation between those communities that were healthier and those communities that were growing the fastest,” said Scott Hall, JD, MBA, senior vice president of Civic and Community Initiatives at the Chamber. “Young people are choosing where to live before they have a job, and one of the things that is a factor in making that decision is how healthy the people in the community are.”

“In the 21st-century, community health is going to be a determining factor in economic development and growth.”  – Scott Hall, Kansas City Chamber of Commerce

The Chamber convened a working group of 25 people representing many sectors to meet periodically and consider how best to change the image of Kansas City as a less-than-healthy place. An initiative known as Healthy KC was born of those conversations with the aim of creating “a culture of health and wellness in Greater Kansas City.” Through a series of listening sessions, a solicitation of feedback from the public, and one-on-one meetings with stakeholders, tobacco control bubbled to the surface as an area ripe for action.

Healthy KC: Tobacco 21/KC is part of the Healthy KC initiative, which promotes well-being in five priority areas – tobacco cessation, active living, healthy eating, behavioral health, and workplace wellness. The Kansas City Chamber of Commerce is the quarterback for Healthy KC, in partnership with Blue Cross and Blue Shield of Kansas City.

Over a nine-month period, the Chamber built a coalition to advocate for Tobacco 21/KC ordinances. The local effort, part of a nationwide campaign, was designed to raise the legal age for tobacco purchase to 21. Ultimately, more than 160 public and private sector entities, including businesses, health care providers, community organizations, and school districts, called for passage of the legislation. A petition drive showcased the degree of public backing and educational meetings with elected officials also helped to galvanize support.

The Kansas City, Missouri and Kansas City, Kansas legislatures were the first to pass ordinances, in 2015, and from there the effort snowballed, with 25 municipalities in the region ultimately restricting tobacco sales to youth. “Once we had those two marquee cities, other cities began to reach out to us and say, ‘we want to talk to you about this,’” said Hall.

From Idea to Action

It took many steps, and many players, to realize the goals of Tobacco 21/KC. The launch point was the Chamber’s decision to dedicate time and resources to the work. Why did it move into that lane?

One reason, Hall said candidly, is simple: to sell more widgets. As he retells a colleague’s story, “If in making that widget, you can save 1% on health care costs, or improve 1% of the workforce’s productivity, or have a 1% more motivated workforce because workers are healthier, you will be the one who can buy the widget maker down the street.”

“What moves business is their bottom line. A healthy workforce is a means to that end.” – Bill Snook, Kansas City, Missouri Health Department

The next big step was to bring in the right partners. While the Chamber served as the “quarterback” for the effort, in collaboration with Blue Cross and Blue Shield of Kansas City, it drew strength and authority from others at the table, including public health and other government entities, local health systems, businesses, and the nonprofit sector. “We always stand with experts,” said Hall. “We don’t give presentations without someone who is seen as an expert on the issue.”

The Kansas City, Missouri Health Department was one source of that expertise. Business saw its value as providing access to a rich network of local connections and to data, such as the number of retailers who would be affected by a tobacco control ordinance and the cost in productivity losses to employ smokers.

“We have seen a lot of collaboration,” said Hall. “Public health acts as a sounding board for us. “They tell us ‘here is who you need to talk to.’ They provide data for us when it is relevant, and it is often relevant.”

“Data drives decisions in the business world, and public health departments are great places for data. That is a natural connection.” – Scott Hall, Kansas City Chamber of Commerce

Bill Snook, MS.Ed, senior information and policy officer for the Kansas City, Missouri Department of Health, sees public health’s role in the initiative much the same way. “We can provide information, we can provide statistical analysis, we can be a handoff tool if a policymaker or an influencer needs more information,” he said.

Since the Chamber of Commerce was taking the lead, public health had to be willing to step back into a supportive role. Recognizing Tobacco 21/KC as an effective way to drive its own health agenda forward, that proved easy enough to do. “It is not about us leading the charge, it is about being part of the team,” Snook said. “If the Chamber of Commerce needs some support work, they can pass the baton to us, in terms of doing some research. Or we pass the baton to them, because they will be the advocate on some pieces. It is a collaborative space.”

 “It doesn’t matter who drives the bus as long as we get there.” – Bill Snook, Kansas City, Missouri Health Department

The connections ultimately proved advantageous to both business and public health. Had the private sector worked alone to promote policy change, questions about its true agenda might have been raised. If public health experts operated in isolation, they might have seemed predictable in their advocacy, and would not have been as effective. “Business has agency and power that we may not have,” acknowledged Snook. “They can influence influencers that we can not.”

“When elected leaders see the business community and health experts stand united behind such a policy, it sends a strong message.” – Jessica Hembree, Health Care Foundation of Greater Kansas City (blog, December 2016).

Messengers and Messages

The recognition that messengers in every sector tend to frame problems in different ways ultimately helped drive Tobacco 21/KC forward. But initially, that had seemed like an obstacle. “There is a lot of common ideology, but language sometimes gets in the way,” said Snook. “Public health wants public health language, business wants business language, planning wants planning language.”

Eventually, the sectors came to appreciate the value of using different idioms, and approaching shared challenges from multiple angles. “I’m the unexpected messenger,” observed Hall. “When you have that unexpected messenger come with the known expert, your message is much, much stronger.”

Added Snook, “You expect public health to talk about health, but when you have the business community start talking about it, and saying, ‘we may not have all the details but we are partnering with the health department who can get us that information,’ that is very important.”

“If I’m trying to get people to take an action and there is an amazing spokesperson who may use different language, there are ways that I can support that message. That is what I need to do, find ways to support the messaging.” – Bill Snook, Kansas City, Missouri Health Department

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