Commentary

The American Heart Association (AHA) is in the small minority of nonprofit organizations that spends money on lobbying—at the national, state and local levels. We believe public advocacy is one of the best and most effective ways we can spend funds that donors entrust to us.

It's inexpensive, too: We spend less than one-half of 1 percent on lobbying. And most of it has nothing to do with advancing the interests of AHA as an institution.

In 2001, the IRS released amazing data showing how few charities actively engage in lobbying. Of the more than 249,000 charities that filed Form 990 returns in 1999, only 1.6 percent reported spending any money on lobbying. Research by Charity Lobbying in the Public Interest, a nonprofit that helps charities advocate for their causes, suggests the amount of reported lobbying may be understated. But even if it is twice that amount, it's pitifully small.

Doubts about lobbying by charities often center on its legality. But in 1976, Congress made quite clear that nonprofits have the right to lobby. And in 1990, the IRS issued rules that give all but the largest nonprofits a great deal of latitude in public advocacy.

Although it's clear that nonprofits have the right to lobby, should they do so?

In our view, they certainly should. Nonprofit efforts are often reluctant to providing a counter-balance to the massive lobbying resources funding opposing efforts that adversely affect one's mission. A clear case in point is illustrated by AHA's continuing fight against the political influence of "Big Tobacco," which spends millions on lobbying each year to keep Americans addicted to tobacco products and to addict a new generation of smokers.

Still, many nonprofits are reluctant to enter the political arena, either because they believe their financial resources are inadequate to the task or because they lack trained staff to organize and direct grassroots activism. In some cases, a tradition of political noninvolvement may continue to dominate the organization's mission strategy by default.

We recently committed AHA to reducing by 25 percent coronary heart disease, stroke and their risk by 2010.

To achieve this goal, we must make progress on many fronts: research, prevention, treatment and survival rates from out-of-hospital attacks. On each of those fronts, we need or may need political influence and action.

Great Need, Little Funding

Influencing public policy is crucial if we're to have an impact in each of those areas. Consider funding. Although AHA currently spends more than $135 million a year to fund research, that's not nearly enough. Heart ailments, strokes and other cardiovascular disorders cost Americans an estimated $330 billion annually—more than any other disease. Yet, despite that enormous burden, the National Institutes of Health (NIH) is able to fund only one-third of the research applications it receives. As recently as 2001, despite large increases, funding for cardiovascular disease and stroke research at NIH remains below $2 billion a year.

Preventing cardiovascular disease involves educating people and working to change behavior that increases their risk of contracting it, such as smoking, poor nutrition and a sedentary lifestyle. But prevention requires more than changing individual behavior. It also includes changing public policies.

Take, for example, our anti-smoking efforts. They entail making it much more difficult for teenagers to buy cigarettes, curtailing the marketing of cigarettes to young people and making public places smoke-free. Most of all, they involve working with policymakers to enact laws at all levels of government to make such changes possible.

Links in a Vital Chain

The same lobbying strategies can also make emergency care and treatment more available and effective. For instance, those of us involved with cardiovascular disease talk about the "chain of survival" as being critical to saving lives. The chain of survival is a series of actions that include an immediate call to 911, followed by early CPR, defibrillation and advanced care.

AHA has lobbied to strengthen each link in the chain. We've advocated for the money to train more emergency workers in responding to cardiovascular emergencies. We've pushed to broaden public access to laptop-size automated external defibrillators (AEDs) that analyze heart rhythms and deliver a shock when a person has gone into cardiac arrest. That work has already made a big difference. During the ten months after AEDs were installed in Chicago's O'Hare International Airport, they were used 14 times and saved nine lives—a 64-percent survival rate.

Lobbying is also critical to eliminating other barriers that can weaken the chain of survival. Many insurance companies require prior approval before a person seeks emergency-room treatment. That may keep some people who suffer heart attacks or strokes from seeking emergency treatment. Others may hesitate if they cannot immediately reach their insurance carrier—or are worried the visit won't be covered if the attack turns out to be a false alarm.

Pumping Up NIH

I'm certainly not saying that lobbying is the only strategy for achieving our ambitious goal. We must also continue to emphasize association-sponsored research, public education and professional development. Yet, AHA has elevated lobbying to the same status as other core elements of our work.

That strategy has already paid off for the people we serve. Together with other large organizations, we're close to completing the final installment of a five-year effort to double the NIH budget by the year 2003, from $13.7 billion to $27.2 billion.

We've also helped to pass important legislation: at the state level, "Good Samaritan" statutes that relieve the fears of building owners who've been hesitant to purchase AEDs because of worries about liability claims; and laws that will expand access to defibrillators in federally owned buildings and help ensure that rural areas have better access to AEDs. All those initiatives will save lives.

During this session of Congress, AHA has backed two pieces of legislation that will save even more lives. The Community Access to Emergency Defibrillation Act, as enacted as part of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, provides in the first year of funding $30 million for communities to purchase AEDs and provide training for emergency responders to use them. We also supported the Stroke Treatment and Ongoing Prevention Act, which will fund a grant program aimed at giving states the resources to ensure that stroke patients have access to high-quality care. The act also establishes a national public education campaign about stroke and the value of emergency treatment.

Public vs. Private Interests

Within AHA, there is broad acceptance of our role as advocates for better public health policy. In a recent survey, 98 percent of our grassroots network and researchers and 96 percent of our volunteer physicians said it's important for AHA to play such a role. The majority of our volunteers and supporters understand the difference between a corporation lobbying for its self-interest and a nonprofit lobbying on behalf of the public interest.

In this area of activity, size need not matter: Organizations far smaller than AHA have managed to establish very effective lobbying efforts with limited resources. A good place to learn more about what nonprofits can do is the website of Charity Lobbying in the Public Interest (www.clpi.org).

Funders shouldn't hesitate to support nonprofits advocating for their causes. It's legal and helps nonprofits fulfill their missions.

More nonprofits should embrace their responsibility to speak out on the issues and people they care about and advocate for better public policies. If they did, I'm convinced, we could dramatically improve not only healthcare, but also many other facets of our national life.