Your turn

HALF FOR TOBACCO PREVENTION

' We must not allow this opportunity to pass'

by Luke L. Burchard. M.D.
Illustrations by Daisy luarez

The Illinois General Assembly will soon get a once-in-a-lifetime oppor- tunity to have an enormous impact on the health of Illinois citizens. Over the next 25 years, this state will receive more than $9 billion, an average of approxi- mately $360 million per year, from the historic tobacco settlement reached nationally between the states' attorneys general and tobacco companies.

"Half for Tobacco Prevention" is call- ing on lawmakers to set aside at least 50 percent of Illinois' share of that settle- ment for tobacco control and prevention efforts. The campaign is led by the American Heart Association, the Amer- ican Lung Association, the American Cancer Society, the Cook County Department of Public Health, the Illi- nois Chapter of the American Academy of Pediatrics, the Illinois Academy of Family Physicians and more than 50 other public health and community organizations across Illinois.

Our reasons are clear. The damage tobacco has inflicted is great. Each year, 19,000 Illinoisans die from emphysema, lung cancer and other smoking-related diseases. In fact, tobacco is the cause of more deaths than alcohol, AIDS, car accidents, illegal drugs, murders and suicides combined.

Tobacco apologists are blowing smoke when they proclaim, "It's a legal habit, and most smokers can quit anytime." While it may be true that tobacco use is a voluntary activity, most smokers who started as teens struggle to free them- selves from this deadly addiction. Thirty-five percent of this state's high school students smoke. If current trends continue, 260,000 Illinois kids will even- campaigns in our state. We must not tually die from smoking. That is why effective control and prevention is crucial for those who have not picked up this deadly habit.

During my 18 years in private medical practice, I have counseled more than a thousand smokers through attempts to quit. But tobacco addiction is as power- ful as cocaine or heroin addiction. And a smoker must make an enormous effort to quit. For example, one of my patients underwent a laryngectomy for cancer of the throat. So powerful was his addic-tion that he continued to smoke through the small hole near his voice box, even during his chemo and radiation therapy.i

My personal list of patients, friends and family who have suffered from the health consequences of tobacco use is long and growing. My father endured his first heart attack at age 39 after smoking two packs of unfiltered ciga-rettes every day for nearly 20 years, and my mother was stricken with emphy-sema after years of smok-ing. I hope Illinois legisiators will think of them and tens of thousands of other Illinois citizens who have or will suffer from the ill effects of tobacco use.

The opportunity presented by the tobacco settlement could lead to significant improve-ments in the public's health by giving us the means to counter the tobacco industry's slick, billion-dollar marketing campaigns in our state. We must not allow this opportunity to pass.

Investing half of the state's settlement in a comprehensive control and preven- tion program also is the fiscally responsi- ble thing to do. Illinois taxpayers spend $2.9 billion annually on health care for smoking-related illnesses, including $560 million in Medicaid benefits.

Because the settlement is intended to reimburse the state for billions in tax- payer dollars spent treating needy people who are suffering from tobacco-related illnesses, most people assume they will be spent to address the tobacco problem. Yet this has not necessarily been the case in other states. In New York, for exam- ple, Gov. George Pataki has proposed putting 75 percent of the state's initial settlement money toward reducing his state's debt. Los Angeles Mayor Richard Riordan is reportedly eyeing California's settlement to finance his city's sidewalk repairs. Lawmakers in North Dakota are considering plans to renovate the state's morgue with their tobacco money. Unless we are comfortable with the prospect of saddling our children with the costs of treating poor smokers, we must not let these things happen in Illinois.

Tobacco The experiences of such states as California, Florida, Massachusetts and Oregon have already shown that a comprehensive tobacco control and prevention program can produce tangible and promising results. In fact, by investing $70 million in such a program, Florida saw a

30 / October 1999 Illinois Issues

21 percent decline in the rate of tobacco use among middle school students, and an almost 9 percent decline among high school students in just one year. Thus, members of "Half for Tobacco Prevention" urge Illinois officials to invest at least half of the settlement on a similar program that includes each of the following components recommended by the U.S. Centers for Disease Control and Prevention:

• Conducting a public education campaign that deglamorizes tobacco use and raises awareness about its health and social consequences would require 20 percent of the allotted funds. Although the settlement forced the tobacco industry to spend a portion of its own money on anti-smoking initiatives, that is asking the fox to guard the henhouse. Additional steps need to be taken to counteract the industry's pro- tobacco advertising and marketing blitz. The latest estimates are that $226 million is poured annually into campaigns focusing solely on Illinois.

• Strengthening and developing community-based tobacco control programs would require 35 percent. This would enable Illinois to take advantage of effective community institutions. Programs run by local health departments, schools, social service providers and voluntary health agencies could focus on tobacco education, after-school programs, youth development, teacher anti-tobacco training, work site education and enforcement of tobacco regulation laws. The biggest advantage of community-based programs is their ability to focus on minorities, often the populations most directly affected by smoking-related diseases.

• Strengthening cessation services for all smokers would require 31 percent. Programs that help people stop smoking and maintain a smoke-free lifestyle must be a priority. To maximize the effectiveness of these services, cessation programs must be provided to smokers of all ages (most specifically teens) social and economic classes, races and genders. Additionally, they must be tailored to ensure they are language, culture and gender appropriate.

• Instituting strong surveillance, research and evaluation components would require 8 percent of the funds. By accurately measuring the state's levels of tobacco use, especially among teens, Illinois could best determine the areas that need work during implementation of an effective program. It also would help to assure that funds are spent on tobacco control policies.

ii9910311.jpg
Other plans for the dollars
Lots of money stirs lots of ideas about how to
spend it. Three of Illinois' constitutional officers
have come up with their own plans for using the
$9.1 billion the state expects to receive from tobacco
companies over the next 25 years.
• Treasurer Judy Baar Topinka wants to invest the
money, about $350 million a year, spending only the
interest. She estimates the payments would accumulate
to around $20 billion over the payout period.
The state would have about $70 million to spend the
first year of her plan.
• Comptroller Dan Hynes thinks the state should
return the windfall to the taxpayers who paid the
medical expenses of people with tobacco-related
illnesses. Under Hynes' plan, taxpayers would
receive a $50 annual rebate, for a total of about
$1,250. The rest of the settlement----about $2.5
billion — would go toward anti-smoking programs.
• Attorney General Jim Ryan would like the state
to spend at least half of the settlement income on
public health and anti-smoking initiatives. He says
protecting children's health was the reason he filed
Illinois' lawsuit, joining a national effort by the
States that eventually led to the settlement.
Lawmakers are expected to debate the issue
over the next year.
The Editors

• Administering settlement funds would require 5 percent. The Illinois Department of Public Health could develop a plan and coordinate tobacco control policy through a special committee. This would ensure that all proceeds are secure, accessible and free from industry influence. The committee could be composed of representatives from government agencies, statewide voluntary health agencies, certified local health departments and the state attorney general's office.

• Enacting and enforcing public policy would require 1 percent of the settlement funds. This is essential to reducing tobacco use in Illinois. Only through mandatory licensing of tobacco retailers, for example, can the enforcement of youth access laws be implemented.

These guidelines lay the foundation for a comprehensive tobacco control and prevention program that would help keep kids from starting to use tobacco and help current smokers quit. It would also help reduce the health risks posed by secondhand smoke.

If the people of Illinois accept anything less than a comprehensive program, funded with the money from Big Tobacco, we won't get another chance. The tobacco settlement precludes us from ever again holding tobacco companies legally liable. Who would pay for our children's tobacco-related health care costs then?

Imagine being here 25 years from now with smoking rates unchanged or even higher, and looking back at the 25 years of failure to act on the leading preventable cause of premature death in the United States today. That would be the ultimate tragedy. The responsibility for the settlement funds now lies with the General Assembly. Led by "Half for Tobacco Prevention," much of Illinois' public health community urges our elected officials to do the right thing and start making up for the immeasurable damage inflicted on the people of Illinois by the tobacco industry.

Tobacco money helped cause the problem. Tobacco money should help fix it. 

Luke L. Burchard, M.D., has been in a private practice since 1982. He is the chair of "Doctors Ought to Care." a national physician-led organization established to combat unhealthy lifestyles, especially among children, and the former chair of the Illinois Interagency Council on Tobacco and Disease. He serves as chair of Family Practice at Provena Covenant Medical Center in Champaign, medical director of the Provena Covenant Family Care Network, and is on the board of directors of the Francis Nelson Community Health Center in Champaign.

Illinois Issues October 1999 / 31