Lessons Learned from the Tobacco Taxes' Impact on Smoking

Dennise D. Whitley, MHA

Lessons Learned from the Tobacco Taxes' Impact on Smoking

Dennise D. Whitley, MHA

�Progress in tobacco control required high level,sustained advocacy and political acumen;progress in addressing obesity will require the same

Tobacco smoking remains a major global threat

Improving diet and physical activity: 12 lessons fromcontrolling tobacco smoking

Derek Yach, Martin McKee, Alan D Lopez, Tom Novotny for Oxford Vision 2020BMJ 2005;330;898

�Tobacco smoking remains a major global threat despite a shift in media attention

�Opportunities for joint approaches to nutrition and tobacco related health problems have been neglected

�The potential for positive interaction with the food industry in finding common solutions remains high provided the industry shows transparency

Progress in tobacco control required high level,sustained advocacy and political acumen;progress in addressing obesity will require

Tobacco smoking remains a major global threat

Improving diet and physical activity: 12 lessons fromcontrolling tobacco smoking

Derek Yach, Martin McKee, Alan D Lopez, Tom Novotny for Oxford Vision 2020BMJ 2005;330;898-900

Tobacco smoking remains a major global threat despite a shift in media attention

Opportunities for joint approaches to nutrition and tobacco related health problems have been neglected

The potential for positive interaction with the food industry in finding common solutions remains high provided the industry shows transparency.

"The brakes on the obesity epidemic need to be policyled and governments need to take centre stage,"

Swinburn, a researcher at Deakin University in Australia, told Reuters at the 2008 European Congress on Obesity. "Governments have to lead the way they did with the tobacco epidemic. We need hard

"Commercial drivers around food have been the biggest influence over the past 30 years," he said. "The product,

the price, the promotion and the placement has changed dramatically

"The brakes on the obesity epidemic need to be policy-led and governments need to take centre stage,"

Swinburn, a researcher at Deakin University in Australia, told Reuters at the 2008 European Congress on Obesity. "Governments have to lead the way they did with the tobacco epidemic. We need hard-hitting messages."

"Commercial drivers around food have been the biggest influence over the past 30 years," he said. "The product,

the price, the promotion and the placement has changed dramatically.

Kelly D. Brownell and Kenneth E. Warner.Ignoring History: Big Tobacco Played Dirty and Millions Ignoring History: Big Tobacco Played Dirty and Millions Ignoring History: Big Tobacco Played Dirty and Millions Ignoring History: Big Tobacco Played Dirty and Millions

Died. How Similar Is Big Food?Died. How Similar Is Big Food?Died. How Similar Is Big Food?Died. How Similar Is Big Food?

"The world cannot afford a repeat of the tobacco history, in which industry talks about the moral high history, in which industry talks about the moral high

ground, but does not occupy it," the authors write. "The question is whether they [the food industry] will behave in honorable, healthpromoting ways or will sink to the

depths occupied by tobacco."

Kelly D. Brownell and Kenneth E. Warner. The Perils of The Perils of The Perils of The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Ignoring History: Big Tobacco Played Dirty and Millions Ignoring History: Big Tobacco Played Dirty and Millions Ignoring History: Big Tobacco Played Dirty and Millions

Died. How Similar Is Big Food?Died. How Similar Is Big Food?Died. How Similar Is Big Food?Died. How Similar Is Big Food?

"The world cannot afford a repeat of the tobacco history, in which industry talks about the moral high history, in which industry talks about the moral high

ground, but does not occupy it," the authors write. "The question is whether they [the food industry] will behave in honorable, healthpromoting ways or will sink to the

depths occupied by tobacco."

In an interview, Brownell said the two industries are different in many ways, but share a number of strategies: "One is heavypaying scientists to produce results that favor

industry positions; three is fighting to frame the issue as a matter of personal rather than corporate issue as a matter of personal rather than corporate responsibility and the fourth is funding front groups

to do their dirty work," he said

In an interview, Brownell said the two industries are different in many ways, but share a number of strategies: "One is heavy-duty lobbying; two is paying scientists to produce results that favor

industry positions; three is fighting to frame the issue as a matter of personal rather than corporate issue as a matter of personal rather than corporate responsibility and the fourth is funding front groups

to do their dirty work," he said.

In 1954 the tobacco industry paid to publish the "Frank Statement to Cigarette Smokers" in hundreds of U.S. newspapers. It stated that

the public's health was the industry's concern above all others and promised a variety of goodfaith changes. What followed were goodfaith changes. What followed were decades of deceit and actions that cost

millions of lives.

In 1954 the tobacco industry paid to publish the "Frank Statement to Cigarette Smokers" in hundreds of U.S. newspapers. It stated that

the public's health was the industry's concern above all others and promised a variety of goodfaith changes. What followed were goodfaith changes. What followed were decades of deceit and actions that cost

millions of lives.

ConclusionsConclusionsConclusionsConclusions: Food is obviously different from tobacco, and the food industry differs from tobacco companies in

important ways, but there also are significant similarities in the actions that these industries have taken in response to concern that their products cause harm. Because obesity is now a major global problem, the world cannot afford a

repeat of the tobacco history, in which industry talks about the moral high ground but does not occupy it.

Kelly D. Brownell and Kenneth E. Warner.Ignoring History: Big Tobacco Played Dirty and Millions Died. Ignoring History: Big Tobacco Played Dirty and Millions Died. Ignoring History: Big Tobacco Played Dirty and Millions Died. Ignoring History: Big Tobacco Played Dirty and Millions Died.

How Similar Is Big Food?How Similar Is Big Food?How Similar Is Big Food?How Similar Is Big Food?

Milbank Quarterly. 87(1):259

: Food is obviously different from tobacco, and the food industry differs from tobacco companies in

important ways, but there also are significant similarities in the actions that these industries have taken in response to concern that their products cause harm. Because obesity is now a major global problem, the world cannot afford a

repeat of the tobacco history, in which industry talks about the moral high ground but does not occupy it.

Kelly D. Brownell and Kenneth E. Warner. The Perils of The Perils of The Perils of The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. Ignoring History: Big Tobacco Played Dirty and Millions Died. Ignoring History: Big Tobacco Played Dirty and Millions Died. Ignoring History: Big Tobacco Played Dirty and Millions Died.

How Similar Is Big Food?How Similar Is Big Food?How Similar Is Big Food?How Similar Is Big Food?

Milbank Quarterly. 87(1):259-294.

Adult per Capita Cigarette Consumption and Major Environmental and Policy Changes in

the US 1900

3

4

5Thousands per year

First Medical reportslinking smoking and cancer

Fairness Doctrinemessages on radio

and television

0

1

2

Year

1900 1910 1920 1930 1940

Great Depression

End ofWW II

Adult per Capita Cigarette Consumption and Major Environmental and Policy Changes in

the US 1900-1990

US Surgeon General’s first report

Fairness Doctrinemessages on radio

and televisionNonsmoker’s rightsmovement begins

Year

1950 1960 1970 1980 1990

End ofWW II

Broadcastadvertising ban

Federal cigarettetax doubles

Lessons from Tobacco Control

• Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco related deaths, and diseases caused by smoking.

• Research shows that the more states spend on comprehensive tobacco control programs, the greater the reductions in smokinglonger states invest in such programs, the greater and faster the impact.

Lessons from Tobacco Control

based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco related deaths, and diseases caused by smoking.

Research shows that the more states spend on comprehensive tobacco control programs, the greater the reductions in smoking—and the longer states invest in such programs, the greater and faster the impact.

State Tobacco Program Components

• Statewide programs (e.g. technical assist, promote media advocacy, smokefree policies)

• Community programs

• Chronic disease programstobacco related disease (CVH, asthma, oral, tobacco related disease (CVH, asthma, oral, cancer)

• School programs to prevent tobacco use and addiction in youth

• Enforcement (restrictions on minors, smoking in public places)

State Tobacco Program Components

(e.g. technical assist, promote media advocacy, smokefree policies)

Community programs to reduce tobacco use

Chronic disease programs to reduce burden of tobacco related disease (CVH, asthma, oral, tobacco related disease (CVH, asthma, oral,

to prevent tobacco use and

(restrictions on minors, smoking in

State Tobacco Program Components

• Counter-marketing/health communication interventions

• Cessation programs

• Surveillance and evaluationcosts)costs)

• Administration and managementcosts)

State Tobacco Program Components

marketing/health communication

Surveillance and evaluation (10% program

Administration and management (5% program

CDC’s Current View, Tobacco

1. State and Community Interventions

2. Health Communications

1. Multiple societal resources working together have the greatest longpopulation impact.

2. Media interventions prevent tobacco use initiation, promote cessation, and shape social norms.

3. Tobacco use treatment is highly cost3. Cessation

Interventions

4. Surveillance

5. Administration and management

3. Tobacco use treatment is highly costeffective.

4. Publicly financed programs should be accountable and demonstrate effectiveness.

5. Complex, integrated programs require experienced staff to provide fiscal management, accountability, and coordination.

Best Practices for Comprehensive Tobacco Control Programs

CDC’s Current View, Tobacco

Multiple societal resources working together have the greatest long-term population impact.

Media interventions prevent tobacco use initiation, promote cessation, and shape social norms.

Tobacco use treatment is highly cost-Tobacco use treatment is highly cost-effective.

Publicly financed programs should be accountable and demonstrate effectiveness.

Complex, integrated programs require experienced staff to provide fiscal management, accountability, and coordination.

Best Practices for Comprehensive Tobacco Control Programs—2007, CDC

33%

38%37%

31%

25%25

30

35

40

45

High School Smoking Rates, Maine, 1993Data Courtesy of the Youth Behavioral Risk Survey

Cigarette tax is $.37Cigarette tax is $.37

0

5

10

15

20

1992 1994 1996 1998 2000

Cigarette tax is $.74Cigarette tax is $.74

High School Smoking Rates, Maine, 1993-2011Data Courtesy of the Youth Behavioral Risk Survey

21%

16%

14%

18%

15%

2002 2004 2006 2008 2010 2012

Cigarette tax is

$1.00 Cigarette tax is $2.00

• Deaths in Maine Caused by – Annual average smoking– Youth ages 0 -17 projected to die from smoking 27,000

• Annual Costs Incurred in Maine from – Total medical – Medicaid medical – Lost productivity from premature death

• State Revenue from Tobacco Excise Taxes and SettlementTaxes and Settlement– FY 2006 tobacco tax revenue – FY 2006 tobacco settlement payment

• Total state revenue from tobacco excise taxes and settlement

• Percent tobacco revenue to fund at CDC recommended level

Deaths in Maine Caused by SmokingAnnual average smoking-attributable deaths 2,200

17 projected to die from smoking 27,000Annual Costs Incurred in Maine from Smoking

$602 million$216 million

Lost productivity from premature death $494 millionState Revenue from Tobacco Excise

FY 2006 tobacco tax revenue $157.0 millionFY 2006 tobacco settlement payment $44.9 million

Total state revenue from tobacco excise taxes and $201.8 million

Percent tobacco revenue to fund at CDC recommended 9%

• Deaths in Maine Caused by – Annual obesity-attributable deaths

(ave. is 54% of smoking deaths) • Annual Costs Incurred in Maine from

– Total medical – Medicaid medical – Lost productivity Overweight/Obesity

Inactivity • State Revenue from Obesity Related Taxes and

Settlement• State Revenue from Obesity Related Taxes and

Settlement– Obesity related taxes– FY 2006 FSNE and CDC funding ~$3 million– FY 2006 tobacco settlement (PAN related) ~$2 million

• Total state revenue from federal funding and tobacco settlement

Deaths in Maine Caused by Obesityattributable deaths 485 - 1907

(ave. is 54% of smoking deaths) (1196)Annual Costs Incurred in Maine from Obesity

$357 million$137 million

Lost productivity Overweight/Obesity-$2 billion

State Revenue from Obesity Related Taxes and State Revenue from Obesity Related Taxes and

$0 millionFY 2006 FSNE and CDC funding ~$3 millionFY 2006 tobacco settlement (PAN related) ~$2 million

Total state revenue from federal funding and ~$5 million

PAN Related Expenditures

• Recommended level of investment for Maine using tobacco model and ratio of

attributable deaths = $10 million

• Maine’s actual ~ $5 million from

– CDC $450K

– FSNE ~ $2.5 million (low SES focus)

– FHM ~ $2 million (proportion effort on PAN compared to Tobacco)

PAN Related Expenditures

Recommended level of investment for Maine using tobacco model and ratio of

$10 million. When we grow up we want to be like

the tobacco program!

Maine’s actual ~ $5 million from

~ $2.5 million (low SES focus)

~ $2 million (proportion effort on PAN compared to Tobacco)

program!

Thank you.Thank you.