In the United States, tobacco control is losing out to the focus on obesity, according to Croakey’s Washington correspondent, Dr Lesley Russell.
“In the race for preventive health-care dollars from foundations, charities and federal and state governments, the increasing focus on obesity has meant that anti-tobacco efforts are losing out.
Yet cigarette smoking remains by far the most common cause of preventable death and disability in the United States.
Important strides have been made in tobacco control, in terms of both interventions (tax hikes and laws creating smoke-free workplaces) and outcomes (smoking prevalence that has more than halved since the early 1960s), so it is tempting to believe that the battle is largely won and that we should move on to other pressing public health issues.
One in five Americans still smoke, but one in three Americans is obese. However, tobacco does kill four times as many people as obesity does. (The figures are almost identical for Australia)
A recent article in the New England Journal of Medicine highlighted this issue and the continuing need to support anti-tobacco efforts.
In the US, the situation is aggravated by the continuing impact of the Global Financial Crisis which has led to many states having dramatically reduced budgets. The 1998 Tobacco Master Settlement Agreement between 46 states and cigarette companies provided more than $200 billion in funds through to 2025. This money was to be used for preventive health programs like the media campaigns from the antismoking group American Legacy Foundation. But last year this spending was only $35 million, down form a $104 million in 2000. Most of these funds have been subsumed by the states for other purposes.
And even as states have raised taxes on cigarettes to record levels – a proven way to deter smoking – most of that revenue has been shifted to general funds. State funding for anti-tobacco programs dropped to $517 million in 2009, a 21 percent cut on 2007 funding levels, according to the annual advocates’ report “A Broken Promise to our Children”.
In 1991 the Robert Wood Johnson Foundation (RWJF) provided $700 million to help fight tobacco and Joe Camel. More recently RWJF has pledged to spend $500 million over five years to battle childhood obesity. Last year RWJF spent $58 million on obesity and $4 million on anti-tobacco grants.
However while anti-tobacco advocates are rightly concerned about the shift in focus, the Obama Administration, through health care reform and other avenues, is actually doing a good job of funding broad-based preventive health efforts.
This year the federal government will spend $722 million on tobacco control and research (this includes industry fees to set up the new tobacco regulatory office in the Food and Drug Administration) and $821 million to obesity control and research. About half the tobacco funding and most of the obesity funding goes to NIH research.
There is also funding from two additional sources. The 2009 economic stimulus package (the American Reinvestment and Recovery Act) included $650 million for prevention and wellness strategies; to date $416 million of this has been distributed, and tobacco programs received 45 percent of this.
The health care reform legislation (the Patient Protection and Affordable Care Act) contains a $15 billion Prevention and Public Health Investment Fund for the next decade. To date $500 million of this has been distributed. Of this, obesity prevention and tobacco prevention each got $16 million (50 percent of the funding went to primary care health workers). Next year the total available funding from the Investment Fund rises to $750 million, and then to $1 billion in 2012.
The NEJM article notes that if no further progress is made in preventing kids from starting smoking and getting smokers to quit, 13.5 percent of Americans will still be smoking in 2050.
Most of them will be poor, many will have a variety of other health problems like diabetes and asthma, and people with addictions and mental illness will continue to smoke at rates higher than the general population.”
• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Center for Health Policy, University of Sydney/ Australian National University and a Research Associate at the US Studies Centre, University of Sydney. She is currently a Visiting Fellow at the Center for American Progress in Washington DC.
Croakey writes: I can’t help but feel that this is such a futile contest.
Why should it be either/or? Why can’t tobacco control AND obesity AND other important public health issues be addressed together? It’s not as if people are EITHER smokers OR overweight OR mentally ill..
But perhaps Croakey just lives with her head in the clouds and perhaps there is no other way than contest-based resource allocation.
The other thing I took from this article is that the US stimulus package included funding for prevention and wellness strategies. Was such a thing even discussed here? Does anyone know….