Your turn
HALF FOR TOBACCO PREVENTION
by Luke L. Burchard. M.D.
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.
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.
• 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
Illustrations by Daisy luarez
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
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.