US Government Funding Roundabout

The US Government relies on a complicated cascade of financial assistance for its various departments. Money flows downwards from the Department of Health and Human Services (HHS), who in turn have to compete with all the other departments in convincing Congress of the value of their services in the fight for a share of the Federal budget. However, once a budget is secured, agencies within the HHS like the FDA, CDC and National Institutes of Health (NIH) are in competition for a slice of the pie. They all understand there is nothing more effective at loosening the public purse strings than declaring an epidemic that must be tackled.

But these agencies need to prove their case – and this is where a co-dependency cascade begins. The hottest health topic before COVID-19 was the outbreak of vaping-related deaths, which helped solidify the dangers of the alleged epidemic of youth vaping. This was the subject most likely to attract HHS budget holders.

Agencies like the FDA and CDC often consult with and take briefings from a number of long-established, well-funded and influential health advocacy groups. To the public, these groups appear to be generating advice that is based on medical and scientific expertise, in the service of public well-being and absent of any bias. However, groups like the Campaign for Tobacco Free Kids, backed by advocacy-driven research, are in fact acting as moral entrepreneurs. They are generating the marketing and press releases which stimulate public concern.

While the media provide the public megaphone, NGOs engage in the kind of political activism forbidden to government agencies, putting pressure on politicians and legislators to act in the face of public clamour. In fact, politicians and government officials need external allies to give the impression they have responded positively to community concerns; proof they are listening to the people. As Franklin Roosevelt famously said, “OK. You’ve convinced me. Now go out there and bring pressure on me.”

See also p.81 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020