Friday, December 9, 2011

NOT Funding Tobacco Prevention Costs Lives and Money

By Vince Fonseca, MD, MPH, FACPM
Population Health Institute of Texas and a member of TMA's Council on Science and Public Health

Dr. Fonseca comments on a new report that found U.S. state funding for tobacco cessation and prevention is at its lowest level in more than a decade. Texas ranks 39th.

“More than ever, this report shows that the states have squandered the opportunity presented by the tobacco settlement to significantly reduce tobacco use and its devastating toll on our nation,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids. “It’s no coincidence that progress against tobacco has slowed at the same time that states have slashed tobacco prevention funds. We cannot win the fight against tobacco unless elected officials at all levels step up efforts to implement proven solutions.”

And step up they should. Why? Tobacco use takes a tremendous toll on Texans and Texas’ economic costs — much of which we could prevent by funding proven community and clinical preventive services. The 1998 tobacco settlement provides a lot of money for this effort; unfortunately, much of it is not being spent on tobacco prevention. In fact the $5.5 million annual allocation for the next two year budget represents only about 0.3 percent of $1.9 billion that Texas collects from settlement payments and tobacco taxes3. These services could benefit workers, employers, insurers, and the public. In fact, while relatively few health services actually save money, tobacco cessation and prevention services do.

Tobacco's Toll in Texas
Adults who smoke15.8%
High school students who smoke21.2%
Deaths caused by smoking each year24,500
Annual health care costs directly caused by smoking$5.83 billion
Residents' state & federal tax burden from smoking-caused government expenditures$563 per household
Annual tobacco company marketing in state$622.4 million
Ratio of tobacco company marketing to total spending on tobacco prevention114.2 to 1

Cost to Texans: Tobacco is the leading cause of preventable death in Texas. It causes about 24,570 adult deaths over the age 35 each year in Texas1: cancer — 9,941; heart disease — 8,305; lung disease — 6,324. Smoking puts all Texans at risk, especially children, through involuntary smoking: breathing secondhand smoke (SHS). SHS is associated with an increased risk for sudden infant death syndrome (SIDS), asthma, bronchitis, and pneumonia in children. Adults exposed to SHS are at increased risk for head and neck, and lung cancers, and heart disease. About 29 percent of Texas adults work in indoor worksites that still allow smoking.

Cost to Texas economy: We all pay for smoking-related costs with our tax and health insurance dollars. The direct medical expenses due to smoking reached approximately $7.58 billion in Texas in 2009, or $7.80 per pack. Lost productivity due to smoking reached $12.82 billion in 2009 or $13.20.2 Thus, the total costs are about $21 per pack, while the smoker pays about $5.52. All of us pick up the rest, including Medicaid costs of about $1.31 per pack. Altogether, the Texas household tax burden (federal/state) for smoking harms is about $563.3

Then there are health and health care disparities related to smoking. In 2007, only 40 percent of Texas smokers (27 percent of Hispanic smokers) stated that they were advised to quit smoking by their provider, and only 22 percent were offered nicotine replacement therapy (NRT) (11 percent of Hispanic smokers). In 2010, 7.7 percent adults with a college degree smoked versus 19.9 percent for those without a high school education.

So we see the human and economic harms from smoking are very large in Texas. Physicians, smokers, and their families/friends know that smoking is very addictive and that quitting is hard. Quitting takes practice. Like other chronic conditions, controlling smoking requires successful self-management. About 70 percent of smokers want to quit, and 50 percent make a quit attempt each year.

What evidence-based efforts can we do in Texas to control tobacco-related harms?

Protect our workers: Your job shouldn’t be hazardous to your health. Smoke-free workplaces will improve employee health, decrease smoking-related health costs and lost productivity among employees and employers, help smokers quit, and prevent others from starting or relapsing. In Texas Medicaid alone, reducing the exposure to secondhand smoke would have saved the state $31 million over the 2011-12 biennium from reductions in heart attacks, stroke, adult respiratory disease, and childhood asthma.4

Warn about the dangers: Remember the 24,507 deaths each year in Texas? And then there are smokers who quit. From the tobacco industry perspective, all of these smokers need to be replaced. The tobacco industry spends about $622 million each year in Texas to market tobacco products to kids and young adults. Compare that number to the $5.5 million Texas spends on tobacco prevention. Quite a contrast, isn’t it?

Enforce the laws that Texas has to prevent sales to minors.

We know that tobacco prevention and control programs work. We just need to fund and implement them. We all deserve it.

1 Average annual estimates for 2000-04, Centers for Disease Control and Prevention, Adult Smoking-Attributable Mortality, Morbidity, and Economic Costs calculator.
2 American Lung Association and Pennsylvania State University. Potential Costs and Benefits of Smoking Cessation for Texas. April 2010.
3 Robert Wood Johnson Foundation. A Broken Promise to Our Children: The 1998 State Tobacco Settlement 11 Years Later. December 2009.
4 Texas Health and Human Services Commission. Comprehensive smoking ordinances and their potential impact on Texas Medicaid Spending. 2011.

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