notobacco

ITPC Is Important To Tobacco Control

In State News on February 16, 2010 at 1:47 pm

This ran in today’s Indianapolis Star

Goodbye, tobacco prevention; hello, more disease, death

By Richard Feldman

Posted: February 16, 2010

My proudest moment as state health commissioner was sitting beside Gov. Frank O’Bannon in March 2000 as he signed Indiana’s historic tobacco settlement legislation and handed me the pen. This legislation, the state’s greatest public health achievement, created the Indiana Tobacco Prevention and Cessation Agency to administer a comprehensive tobacco-prevention program with funding adequate to meet guidelines recommended by the Centers for Disease Control and Prevention.

During the settlement legislation deliberations, I was asked if I wanted the program placed at the Indiana State Department of Health. Although tobacco control was my top priority, I supported an independent agency with a governing board to preserve its focus, to maintain some measure of separation from gubernatorial control, and to insulate it from the capriciousness of politics and tobacco-industry influence.

Senate Bill 298 contains a provision that would abolish the tobacco prevention agency, move the program and its funding to the Department of Health, terminate its 14 staff positions, and dissolve its 22-member volunteer executive board, which includes tobacco-control experts and public health professionals. Passed by the Senate and now under consideration in the House, the legislation is likely headed for conference committee.

The legislation would save about $1 million a year in administrative costs, mostly by eliminating all of the staff positions. Moving it to the Department of Health may sound like a good consolidation plan, but, as the department’s former head, I can assure you it isn’t. Department of Health staffing is already marginal and there is no one there to administrate a meaningful program. It will be given to a few individuals with other full-time responsibilities and little or no expertise in tobacco prevention. It will become a backwater program with its funding eventually raided for other uses. Although Department of Health officials publicly say they can efficiently administer the program, privately they admit they lack the personnel and the capacity to work with communities. It is going there to die. The same scenario occurred in Mississippi and Ohio. Their programs have since withered.

Over the past 10 years the agency has received $137 million, nearly half of that appropriated in the first three years. Funding was brutally cut in 2004. The annual appropriation now is only $10.8 million (the CDC recommends $78.8 million) despite Indiana receiving an average of $150 million in settlement funds each year. Meanwhile, the tobacco industry spends $426 million annually in Indiana to promote its products.

Despite insufficient funding, the program has produced impressive results. Although the smoking rate has dropped only modestly for adults 25 and older, smoking declines in Hoosier children have been astonishing and far greater than the national trend. Between 2000 and 2008, smoking declined 42 percent among high school students and 58 percent among middle-school students.

These decreases cannot be adequately explained by the relatively modest increase in the state cigarette tax or the enactment of smoke-free laws. States with functional tobacco-control programs have the greatest declines in smoking. Beyond the numbers, the agency has benefitted the state’s tobacco-control efforts in many ways, including serving as the catalyst for community organization necessary to enact smoke-free ordinances. Also, tobacco prevention is a wise investment. Tobacco costs Indiana $3.5 billion annually in health-care and business-related expenses. Each dollar spent for tobacco prevention reduces that bill by up to $7.

Indiana, which ranks second-highest in adult smoking, should not only increase tobacco-control funding but also retain the prevention program, a nationally acclaimed independent agency with the expertise to deliver results. In one of the unhealthiest states, it is shameful, unconscionable and shortsighted to do otherwise. If this agency is dismantled, a future of more death and disease from increased smoking awaits Hoosier children.

Feldman, M.D., is director of medical education and family medicine residency at St. Francis Hospitals and Health Centers and is a former state health commissioner. Contact him at richard.feldman@ssfhs.org.

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