War on tobacco winnable? Health care law helps -- Jan. 20, 2011 column

By MARSHA MERCER

Progress in the war on tobacco has slowed. One in five Americans still smokes, and more than a thousand Americans die of tobacco-related illnesses every day.

So why does the director of the Centers for Disease Control and Prevention call tobacco a “winnable battle”? Dr. Thomas R. Frieden says he’s partly encouraged because the new Affordable Care Act provides greater access to free tobacco-cessation programs through insurance plans and Medicare.

Yes, that’s the same, so-called “job-killing” health care law the Republican-controlled House voted Wednesday to repeal. Not that they were thinking about the fight against tobacco, or most of the other individual provisions in the law. The exercise was pure political theater. President Barack Obama would veto repeal, should it pass the Senate, although the Senate’s Democratic leaders say the measure will never come up.

Both political parties believe the health law derided by Republicans as “Obamacare” can be a potent issue in the 2012 campaign. Cheering from the sidelines, Republican strategist Karl Rove wrote in the Wall Street Journal Thursday, “In 2010, Democrats got their law. In the process, Republicans got their issue.” Democrats in turn are using the moment to showcase success stories of the new law, also with an eye to the next election.

This is business as usual in the nation’s capital. Fortunately, while the political animals strut and fret, some in government are actually thinking about how to improve Americans’ health.

Anti-tobacco forces have a strong ally in Dr. Frieden, who became director of the CDC in 2009 after serving since 2002 as health commissioner of New York City. Among his successes is a crackdown on smoking in public places that he says led the ranks of adult smokers to decline by 350,000 and of teen smokers to drop by half.

If there’s one health-related issue on which all Americans should agree, it’s that smoking kills. It’s costly to the economy and in lives. Tobacco use is the country’s leading preventable cause of death, according to the CDC, which calculates the cost of tobacco-related medical bills at $193 billion a year.

Tobacco-cessation programs are among several new disease prevention provisions in the Affordable Care Act. About 70 percent of smokers say they want to quit. Studies have shown that just three to five minutes of personalized advice from a health-care provider doubles the likelihood that a smoker will quit.

The government’s fight against tobacco use was gaining ground until four years ago when the decline stalled at one smoker in five. The 2009 tobacco law bars tobacco companies from marketing to young people. Tough, new warning cigarette labels are to start next year.

What’s also new is the emphasis on smoking as a disease. U.S. surgeon general Regina M. Benjamin issued the 30th surgeon general’s report in December. It said any exposure to tobacco smoke, even occasional smoking or secondhand smoke, causes immediate damage that can lead to illness or death. This matters because 40 percent of adult nonsmokers and 54 percent of children ages 3 to 1 are exposed to secondhand smoke, according to the CDC.

Dr. Frieden this month issued “Health Disparities and Inequalities in the United States – 2011,” the CDC’s first examination of gaps in health between racial and income groups. It found higher smoking rates among American Indians and Alaska natives. Smoking rates decline significantly with increases in income and education, the report said.

Besides tobacco, the CDC has identified five other domestic “winnable battles” in public health. These are healthcare-associated infections affecting one in 20 hospital patients; HIV; motor vehicle injuries; obesity, nutrition, and food safety; and teen pregnancy. The CDC predicts progress on these fronts in one to four years, although it does not plan to redirect resources to pay for the battles.

Among the next steps in the fight against tobacco are raising the price of tobacco products, supporting 100 percent smoke-free environments and increasing awareness through the news media and advertising.

The CDC also wants to work more closely with states. But a new report by the American Lung Association said almost all state anti-smoking efforts are failing because they lack funding. Cash-strapped states are using revenue from cigarette taxes for other programs.

The war on tobacco deserves better.

© 2010 Marsha Mercer. All rights reserved.
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