Occasionally in the world of public health, advocates have the opportunity to celebrate a major policy win. This happened recently in Mexico, where, after years of advocating for strong front-of-package warning labels on unhealthy food and beverage products, the government signed the labels into law — a move that will impact more than 126 million people, the country’s entire population.
In Brazil, advocates campaigned for a new school policy requiring healthier food options and banning the sale and advertising of unhealthy foods and beverages in the country’s southernmost state, Rio Grande do Sul, and won. And in India, road safety advocates celebrated the passage of a major transportation policy intended to make roads safer for everyone.
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Many factors are behind these policy wins, not least among them strong and diverse coalitions tirelessly advocating for change. Coalitions expand the resources available for advocacy, and let officials know that support for the issue is widespread. This is particularly important for issues like noncommunicable diseases, or NCDs, which may be less well-known than other national priorities.
Coalition building is an essential piece for effective advocacy and long-lasting social change, yet the work, sweat, and time it takes to build a coalition is often underestimated or misunderstood. In the NCD space, we build strength in our coalitions through ensuring diversity and expertise, legitimacy in voice, and a consensus approach to defining a comprehensive, strategic vision, free from conflict of interest.
Here are three key components of strong coalitions:
1. Diversity and expertise
NCDs affect many groups of people, and addressing NCD burdens requires effort across a variety of sectors. While it is critical to include the usual suspects in a coalition — such as those who are focused on a specific risk factor or NCD — it is essential to take a broader and more intersectional view, including organizations that are reflective of the entire issue and whose lives may be impacted by the diseases or the proposed policies.
When advocating for nutrition policies, for example, a broad-based coalition made up of organizations focused on consumer rights, children’s rights, women’s rights, medical associations, food security, the environment, health, hunger and poverty, sustainable agriculture, and water would all have something relevant to say — and are all impacted by such policies.
Different organizations have access to different audiences, but they can share the same clear message. A coalition’s diversity will encourage inspiration and exchange of experiences between partners that generates a more cohesive and better-coordinated coalition overall. Alianza Salud and Aliança Pela Alimentação Adequada e Saudável — healthy food and nutrition coalitions in Mexico and Brazil — are broad-based, diverse and powerful voices in each country. These are both model coalitions that we work with and we have helped to build the one in Brazil in particular.
2. Legitimacy in voice
Organizations that are known for the promotion and defense of human rights and the public interest will have credibility with the public and some key decision-makers that health groups might not, and vice versa. For those organizations that are newer and less recognized, being a part of a broad-based and credible coalition will help to build their voice and legitimacy. Some of the coalitions in Latin America that promote healthy food policy include small scale farmers and producers as part of their membership; being a part of these coalitions helps to bring visibility to their struggles and issues, which relate to the broader healthy food policy agenda.
Overall, more spokespeople on the issue strengthens public and media interest. Additionally, coalition members can tag-team to address contentious issues and protect and support one another when addressing opposition.
For example, in Mexico in 2013, during a heated debate on taxation of sugary beverages, FEMSA — the largest sugary beverage bottling company in Mexico, and in Latin America — argued that the tax would negatively affect sugar farmers. Sugar farmers were members of the healthy food coalition and were able to speak publicly with concrete data and experience, to debunk that argument, noting that the decision by the sugary beverage companies to use high fructose corn syrup over a decade prior is what truly hurt the sugar farming industry.
Their arguments helped bolster the efforts of the health and consumer rights groups who were promoting a tax on sugary beverages to address the burden of obesity, overweight, and related illnesses in the country.
In this case, another example of lending legitimacy to voice would be having members of the medical or academic communities help to give academic and scientific evidence and credibility to arguments in favor of taxation of unhealthy foods and sugary beverages.
3. Comprehensive strategic vision, free from conflict of interest
Because broad-based coalitions have such a variety of expertise and perspective, it is crucial to take the time to build consensus on goals and priorities for the coalition and a common understanding of the coalition’s nonnegotiables and stand on conflict of interest. For example, if a coalition plans to focus on the promotion of tobacco control, ensuring that members do not have any affiliation with the tobacco industry is critical; the same could be said for a focus on healthy food policy and affiliation with the food and beverage industry, ensuring that the coalition is in agreement regarding how they define that industry.
Strong coalitions are built on a foundation of collaboration and trust; creating such an environment takes time and can be labor-intensive, but it is worth the effort.
While diversity, legitimacy, and consensus on vision are core components for effective coalitions, there are other pieces that are just as important: identifying effective leadership — someone that is visionary but humble, and able to identify and cultivate the strengths of others; prioritizing the time needed to build trust and plan strategically together, to create a comfortable space to speak and negotiate frankly and without fear; ensure a governance structure for the coalition, a clear process for decision-making, and a way to process outcomes that may not have necessarily gone as planned.
Coalitions are a living body, and just like each of us, require constant input and attention to thrive.