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Editorial: Missed Opportunity; Battle Against Tobacco Waits to Be Won



Saturday, December 14, 2013
For a textbook example of a slam-dunk case, we refer you to the argument made recently in a report issued by the Campaign for Tobacco-Free Kids, which contends that states are doing a poor job in battling the scourge of tobacco use. The report’s argument goes something like this: Tobacco remains the No. 1 cause of preventable death and disease in the U.S. The effectiveness of tobacco-prevention and -cessation programs has been demonstrated repeatedly. States have ample money to fund such programs, but spend only a tiny portion of it for that purpose. States are not just squandering an opportunity to save many of their residents from death and disease, they are also saddling themselves with avoidable expenses that result from shortchanging important public health programs.

The report, Broken Promises to Our Children: The 1998 State Tobacco Settlement 15 Years Later, notes that the country has made remarkable progress in reducing smoking and protecting people from exposure to tobacco smoke: The adult smoking rate has been reduced by more than half, from 42 percent in 1965 to 18 percent in 2012, and the high school smoking rate dropped from 36 percent in 1997 to 18 percent in 2011. But tobacco use still claims the lives of 443,000 Americans annually — more than the combined toll of car accidents, drugs, murders, suicides, AIDS and alcohol. Declining smoking rates presumably will be reflected in future statistics, but there are still too many who continue to smoke or take up the habit.

Numerous studies over the years have demonstrated that tobacco prevention and cessation programs work, and that whatever states spend on them is eventually rewarded several times over in reduced medical costs associated with the treatment of heart disease, respiratory illness, strokes and, of course, cancer.

Might it be that public health efforts have already reduced the smoking rate to an irreducible minimum? Hardly seems so: A well-funded tobacco-prevention program in Florida reduced the high school smoking rate to 8.6 percent in 2013.

Here’s the galling aspect of the situation: Tobacco-related revenue has furnished states with more than enough money to fund effective programs. According to the report, in the coming fiscal year states will receive a total of $25 billion from tobacco taxes and the annual payment resulting from 1996 settlement of a suit against tobacco companies. But they have budgeted less than 2 percent of that for programs to reduce tobacco use. Put a different way, total state spending on anti-tobacco programs amounts to just 13 percent of what is recommended by the Centers for Disease Control and Prevention.

It comes as little surprise that New Hampshire is no model in this regard. Legislators have spent far more time figuring out how to maximize sales by calibrating the state tobacco tax to gain advantage over neighboring states than how to adequately fund tobacco-prevention programs. According to the Campaign for Tobacco Free Kids, the state ranks 48th based on what percentage of the CDC-recommended amount it spends; the $125,000 budgeted for New Hampshire’s fiscal year 2014 budget is only 0.7 percent of the guideline. Vermont is doing better; its budgeted amount of $3.9 million places it 11th among states, but still amounts to only 37.5 percent of what the state should be spending.

Nothing requires states to spend their tobacco-settlement money or tobacco-tax revenue on prevention and cessation programs. And considering the budget pressures of recent years, there’s little doubt that tobacco money has been channeled to other worthy purposes. But considering how much money has been generated by sales of a product that has killed or sickened so many of their residents, the fact that states haven’t spent a greater percentage of it to prevent many more from suffering similar fates strikes us as a tragic missed opportunity.