Tobacco prevention funding coveted and threatened

It is no accident that the Arkansas Department of Health announced that smoking rates, since the 2002 inception of the state’s tobacco prevention program, have dropped by nearly 100,000 smokers.  There is little doubt that this is monumental and will save countless lives and dollars. The impetus for releasing these stats is more than likely the Arkansas legislature’s perennial targeting of the Master Settlement Agreement funding for these programs is a little louder than usual.  

It is almost baffling that some legislators cannot understand that tobacco use is the leading cause of death and disease, number one, most, more than the top five, combined.  Almost baffling because the limited lobbying ability of publicly funded or un-funded tobacco free advocates is dwarfed by the full time lobbying effort of an industry convicted of fraud and racketeering in Federal court.  The resilience of Arkansas legislators to the facts of challenging  tobacco unfortunately leads to serious concerns about the intellect of some of our solons.

Additionally, questions surround the recent SB922 that would have decimated tobacco prevention specifically.  This bill had sponsorship enough in both the house and senate to pass but mysteriously was pulled by the bill's main sponsor.

Justification for raiding Initiated Act 1 of 2000, that delegates Arkansas’ MSA funds for “health related issues” is far from clear.  This act has actually really distinguished Arkansas’ spending of these monies.  Nationally only about 3% of states’ MSA is spent challenging tobacco.  Only a little less than a third, $12-15 million annually, are spent on actual tobacco prevention and cessation programs in Arkansas.  Still, there are those that resent any opposition to the status quo subsidy the tobacco industry enjoys.

We should certainly demand results and oversight of these funds.  I will not defend all uses that have evolved with this voter mandated legislation. But 100,000 fewer smokers and going from 6th highest adult use to 10th is a dramatically significant social change.  Just as certainly should the funding for evaluation be the very last budget compromised.

Legislators should protect and enlarge tobacco prevention spending in Arkansas. None of Arkansas’ recently increased tobacco tax goes toward prevention.  The actual increased tax should continue to significantly impact reduced smoking prevalence but the most cost effective tobacco prevention is still comprehensive clean indoor air legislation.  

I said I wouldn’t defend all of the tobacco prevention funds and a particular emphasis on cessation over creating tobacco free space is a problem.  In fact, research published in the American Journal of Public Health says,  

“Smoke-free work-place policies are about 9 times more cost-effective per new nonsmoker than free NRT programs are. Smoke-free workplace policies should be a public health funding priority, even when the primary goal is to promote individual smoking cessation.”  AJPH 2005 Jun;95(6):969-75. (07-17-2009)

Cessation is almost a natural fit for a department of health program but it is not tobacco prevention. It is treatment, treatment for nicotine addiction. ( The efficacy of NRT and pharmacology is a huge discussion) And treatment for nicotine addiction is not the most cost effective use of funds. It is part of an effective comprehensive evidence based plan to reduce tobacco use but it is not the primary means to de-normalizing tobacco use. ( Remember: taxes, tobacco free space, marketing reform)

Regardless, if legislators are interested in affecting the $812 million in annual tobacco related health care cost or the $1.3 billion in lost productivity, tampering with Act 1 is not the way to go.   Even with the new taxes, tobacco will not begin to cover the cost to the community.  Permissive tobacco policies are de facto subsidies for the tobacco industry; an industry whose return to the state is limited and debatable indeed.  

 

100,000 fewer smokers is huge for Arkansas.  Before hampering these results the legislature has a clear need to rectify the exemptions and lack of enforcement for Arkansas Clean Indoor Air act and Act 13 protecting children from SHS in cars and take seriously challenging the subsidy for the rogue capitalists that profit from tobacco.