Whether they are charities or not, campaigning organisations are the part of the wider voluntary sector that forms the awkward squad – dissenting, protesting and fighting for their beliefs by political and other means. Sir Stephen Bubb, former chief executive of Acevo and founder of the think-tank Charity Futures, argued in a lecture in 2017 that campaigning has been an essential function of charities and other voluntary organisations in the modern era:32
“The last 50 years have confirmed the role of charity and civil society in driving change and campaigning against injustice. We can all point to the campaigns that we like, or indeed don’t. The diversity of the sector is demonstrated in such crusading. The Countryside Alliance wants foxhunting back while the RSPCA and many others do not. Looking at many of the major social advances of later years, it’s been relentless and effective charity action that has delivered, from clean beaches and protected woodland, to mandatory seat belts and no smoking in public buildings, access to abortion, gay rights, disability … On a plethora of issues, charity lobbying has driven public sentiment and government reaction.”
The next four parts of this book illustrate and analyse the work of charities under four headings, including ‘Improving lives and communities’, ‘A junior partner in the welfare state?’ and ‘Preserving the past, preparing for the future’. But the first of them – ‘Changing the world’ – uses detailed case studies to amplify the subject of this chapter: campaigning.
One of the incidental effects of the coronavirus crisis was to lift obesity high up the public health agenda. Charities and medical royal colleges in the UK had been campaigning for years for measures to reduce consumption of salt, sugar and fat, especially by children, but had achieved only limited results. The biggest breakthrough had come in 2016, when the government introduced the Soft Drinks Industry Levy, which taxed producers of drinks that contained more than 5 grams of sugar per 100 millilitres. When it came into effect two years later, a minister – making use of a calculation by CRUK – acknowledged that teenagers consume ‘nearly a bathtub of sugary drinks each year’.1 The campaign had been led by Sustain, a charity that runs a variety of projects to improve food and farming, backed by the chef and food writer Jamie Oliver. Once the tax came in, however, campaigners felt that any further measures were being kicked into the long grass by the government.
All that changed after the Prime Minister, Boris Johnson, emerged in April 2020 from intensive care after a battle with COVID-19. Doctors were already becoming aware that obesity was a factor in the disease, and on 25 July Public Health England issued a report saying ‘people with Covid-19 who are living with overweight or obesity, compared with those of a healthy weight, are at increased risk of serious Covid-19 complications and death’.2 Two days later the government announced new measures to combat obesity, including a ban on TV and online advertising before 9 pm of foods high in fat, sugar and salt.3 The announcement was accompanied by an interview with Johnson saying he had been “way overweight … I was too fat”.
The episode was an example of how the personal experiences of people in power can suddenly give momentum to long-standing, but struggling, charity campaigns. As part of its Children’s Food Campaign, Sustain had been pressing for more than ten years for the TV ban, which its deputy chief executive, Ben Reynolds, welcomed as ‘real game-changer’.4 He pointed out that obesity was not just about personal willpower: ‘You just have to look at the environment that we live in – the torrent of unhealthy food that bombards us – dominating advertising, our high streets, through to in-store promotions – it’s everywhere.’
The difficulties of making headway against the opposition of the food industry and some politicians prompted the formation in 2015 of the Obesity Health Alliance, which has more than 40 members including health charities such as Diabetes UK, the British Heart Foundation (BHF) and CRUK, and medical royal colleges. It has agreed ten policy proposals, of which the main ones are restricting the promotion and marketing of unhealthy food and drinks, and reformulating food products to reduce calories and sugar. Caroline Cerny, Alliance lead, says that charities played a vital role in the Alliance:
“The medical royal colleges are useful for their clinical voice, and they can put up some knowledgeable experts who can give real insight into how obesity is affecting their clinical practice. When you’re trying to meet ministers, charities can open doors – they carry weight because they are seen as having credibility with the public. They also have a big reach and can get their supporters involved. The big charities can also get meetings with a broader focus – with the DCMS about advertising, for example.”
Cerny says the proposed ban on advertising before 9 pm was a breakthrough because it was “a population-wide measure”, as opposed to policies focused on individual choice and responsibility, which tend to be favoured by a government sceptical about ‘the nanny state’. But she says there is still a long way to go – the measure needs primary legislation, and the food industry is fighting back.
The charity campaign against tobacco
While progress on obesity remained piecemeal, the campaign on smoking had already scored a big hit. By 2020 it seemed inconceivable that people should ever have eaten meals in restaurants full of cigarette smoke. As recently as the year 2000, smokers could still light up pretty much anywhere, except on aeroplanes and the London Underground. But within a few years that seemed plain wrong – the thought of a pub or sports clubroom thick with tobacco haze became repellent to most people.
Even the power of the tobacco lobby, and the substantial revenues from taxes on tobacco – an estimated £9.1bn in 2019/20, according to the Office for Budget Responsibility – could not prevent the enactment of the law against smoking in public places.5 Public opinion shifted dramatically: when a ban was first mooted in 2003, people were either indifferent or firmly opposed, depending, usually, on whether they smoked or not. But public support for a ban doubled between 2003 and 2005.6 And by the time the Health Act was passed two years later, making it a criminal offence to smoke in premises that are open to the public or constitute someone’s place of work, there was overwhelming support for the change.7 So what happened in a mere four years to turn the issue on its head?
The answer, in short, is a highly effective campaign spearheaded by a tiny charity called Action on Smoking and Health (ASH). It was set up in 1971 by the Royal College of Physicians after the UK government refused to act on the College’s demands for policies to cut smoking. ASH gets nearly all its funding – about £765,000 in 2019 – from two other health charities, the BHF and CRUK, and uses it to influence public policy on tobacco. It coordinates the Smokefree Action Coalition, the umbrella group formed in 2003 to campaign for the ban on smoking in public that eventually comprised more than 60 organisations. When the Coalition started lobbying for smoke-free legislation, the debate was framed very much around what were called the ‘rights’ and ‘freedoms’ of smokers. But ASH opposed this by promoting the rights of employees not to be subjected to potentially lethal second-hand smoke at work.
This health message changed the debate. The former Labour MP Kevin Barron, an ardent anti-smoking campaigner who chaired the health select committee of MPs at the time, says that it was science that won in the end by proving that breathing