Each year, tobacco use kills nearly 500,000 Americans
(430,000 smokers and 53,000 from secondhand smoke)more than the combined
annual number of national deaths from the acquired immunodeficiency syndrome,
alcohol, automobile accidents, murders, suicides, and fires. The annual cost of
treating tobacco-related diseases is about $89 billion.
Recent reports by the Institute of Medicine and the Centers for Disease
Control and Prevention (CDC) concluded that the best available evidence from
states such as California, Massachusetts, and Florida indicate that large-scale
aggressive state tobacco control programs can rapidly reduce cigarette
consumption.[3,4] In California, the reduction in smoking was accompanied by
substantial reductions in lung cancer rates and deaths from heart disease.[5,6]
If states made a significant and comprehensive effort to fund aggressive
anti-tobacco media campaigns, community programs to encourage nonsmoking, quality
cessation programs, and school programs (as the CDC recently recommended
regarding best practices for state tobacco control), tobacco use could be
reduced by nearly 50% in 1 decade.
By 1998, all states had enough funds (billions of dollars) from legal
settlements with the tobacco industry to conduct such a national effort.
Nevertheless, the states have spent very little on tobacco control programs.
This failure to establish such programs is consistent with the tobacco industry’s
long-standing strategy of seeing that the money that might be used for tobacco
control is used for anything else. Thus, reductions in preventable
tobacco-related illnesses and deaths have been minimal.
With vigorous political organizing efforts in all states, progress can be
made in reversing the dismal current record on tobacco control funding. The
basis for this reversal lies in understanding the historical, legal, and
political framework of how the tobacco settlements occurred, how the settlement
funds have been allocated, and what might be done to organize in response to
these political and legal realities.
State Tobacco Lawsuits and Settlements
In 1994, Mississippi, Florida, Texas, and Minnesota were the first states to
file lawsuits to recover Medicaid costs expended in treating sick and dying
smokers on behalf of the taxpayers (who had traditionally borne these costs).
These lawsuits were filed under new legal theories (and sometimes specific
enabling legislation) that focused on class action suits on behalf of large
numbers of smokers and statistical evidence rather than on the traditional
approach of individual wrongful death cases.
1. Glantz S, Parmley W: Passive smoking and heart disease: Epidemiology,
physiology, and biochemistry. Circulation 83:1-12, 1991.
2. Campaign for Tobacco Free Kids, American Cancer Society, American Heart
Association, American Lung Association: Show Us the Money: An Update on the
States’ Allocation of the Tobacco Settlement Dollars. Washington, DC, 2000.
3. National Cancer Policy Board: State Programs Can Reduce Tobacco Use.
Washington, DC, Institute of Medicine, National Research Council, 2000.
4. US Department of Health and Human Services: Reducing Tobacco Use: A Report
of the Surgeon General. Atlanta, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, Office of
Smoking and Health, 2000.
5. Fichtenberg CM, Glantz SA: Association of the California Tobacco Control
Program with declines in cigarette consumption and mortality from heart disease.
N Engl J Med 343(24):1772-1777, 2000.
6. Cowling D, Kwong S, Schlag R, et al: Declines in lung cancer ratesCalifornia,
1988-1997. Morb Mortal Wkly Rep 49(47):1066-1069, 2000.
7. Centers for Disease Control and Prevention: Best Practices for
Comprehensive Tobacco Control ProgramsAugust 1999. Atlanta, US Department of
Health and Human Services, August 1999.
8. Givel M, Glantz S: The Public Health Undermined: The Tobacco Industry’s
Legacy in Missouri in the 1990s. San Francisco, Institute for Health Policy
Studies, University of California, San Francisco, November 2000.
9. National Conference of State Legislatures: Health Programs Benefit From
Tobacco Settlement1999 to 2001. Washington, DC, 2001.
10. Glantz S, Balbach E: Tobacco War: Inside the California Battles.
Berkeley, University of California Press, 2000.
11. Givel M, Glantz S: Tobacco Policy Making in California 1999-2001: Stalled
and Adrift. San Francisco, Institute for Health Policy Studies, University of
California, San Francisco, July 2001.
12. Fichtenberg CM, Glantz SA: Controlling tobacco use. N Engl J Med