Shawn Vestal: Raiding of tobacco prevention fund may explain smoking rate

For several years, Washington was a national leader in using money from a landmark tobacco settlement to battle smoking.

Taking millions of dollars from the 1998 settlement with the tobacco companies, and millions more from the state’s own steep tax on smokes, Washington mounted public health campaigns. From 2003 to 2008, the state spent $26 million a year of tobacco settlement money on prevention. From 2003 to 2008, smoking in Washington state dropped as well; in Spokane County, the rate of adult smoking sank from 23 percent to 18 percent.

Then lawmakers stopped putting money into the pot for tobacco prevention. Then lawmakers started taking money out of the pot for tobacco prevention. Now, 16 years after the historic settlement with the tobacco companies, none of the more than $120 million a year that comes to our state goes toward preventing smoking or helping people quit.

We went, in a matter of several years, from the front to the rear of the pack. And progress on smoking rates has leveled off.

Mere correlation? Coincidence? Health officials argue that it’s not. And now that the state is getting another bit of tobacco money, in the form of a $10.5 million arbitration ruling, they’re asking that the state put it toward prevention.

“We’re doing really poorly in Washington state as it relates to funding tobacco prevention,” said Dr. Joel McCullough, Spokane County health officer. “It’s pretty pitiful.”

Washington is certainly not the only state to have raided its tobacco funds. In 1998, as part of a settlement with states who sued Big Tobacco, the companies agreed to pay at least $206 billion over 25 years to cover health care and fund prevention. Instead, most states have treated those checks like birthday money from Grandma.

Here is the assessment of the Campaign for Tobacco-Free Kids, which tracks how states spend their tobacco settlement funds:

“Fifteen years after the tobacco settlement … states are continuing to spend only a miniscule portion of their tobacco revenues to fight tobacco use. The states have failed to reverse deep cuts to tobacco prevention and cessation programs that have undermined the nation’s efforts to reduce tobacco use. In Fiscal Year 2014, the states will collect $25 billion in revenue from the tobacco settlement and tobacco taxes, but will spend only 1.9 percent of it – $481.2 million – on programs to prevent kids from smoking and help smokers quit.”

This is unfortunate and costly. Smoking is the leading cause of premature death; it costs around $133 billion a year in direct health care for smokers, and many millions more in indirect costs such as missed work. Even as fewer people smoke, the habit is responsible for a disproportionate share of health care costs and preventable deaths.

There is a long, positive record associated with the public health campaigns against smoking. It might seem as if nothing further needs to be done. Who, after all, can possibly not know that smoking is bad for them? And yet significant numbers of young people smoke, and the habit is especially persistent in certain populations, McCullough said.

“We’ve come a long way, but we have a long way to go,” he said.

In Spokane County, around 20 percent of adults reported tobacco use in 2010; that’s down from 2003, when it was 23 percent, but it’s also the highest rate in four years, according to Centers for Disease Control and Prevention statistics.

Among 10th-graders, that rate of smoking was 11 percent in 2012, down from 18 percent just four years earlier. Still, 11 percent of 10th-graders. Does this shock you? How about this: Sixteen percent of pregnant mothers in Spokane reported smoking in 2011.

This single statistic – maternal smoking – tells us a lot about the current state of the habit, in Spokane County and elsewhere. It’s double the state and national rate. For a lot of us, this figure is nearly unbelievable. Smoking is, in many ways, as much a class signifier as anything, and maternal smoking is especially so.

The health district measured maternal smoking by neighborhood between 2005-09: The rate in West Central was more than 41 percent. That’s 10 times the rate of the Manito neighborhood. In all, 10 neighborhoods throughout Spokane have a maternal smoking rate greater than 1 in 4.

Public health campaigns are more than simply TV ad campaigns.

A broad, effective strategy might include – and has, in the recent past – helping schools design curricula, working with health care providers and insurers to help move people toward “cessation” programs, enforcing public smoking laws, and developing more smoke-free events and environments.

Just to be clear, it’s not as if there’s no money being spent on the prevention of smoking. Sure, the $120 million to $190 million per year that comes to Washington state has been absorbed into the general fund. But the state budget does provide $500,000 a year for the Department of Health’s anti-smoking efforts.

Tobacco companies, meanwhile, spend $88 million a year on marketing.