A Broken Promise to Our Children: 2009

The 1998 State Tobacco Settlement Eleven Years Later

Despite collecting record amounts of revenue from the 1998 tobacco settlement and tobacco taxes, states have cut funding for programs to reduce tobacco use by more than 15 percent in the past year, according to a report released by a coalition of public health organizations, including the Robert Wood Johnson Foundation (RWJF).

With the nation’s adult smoking rate at a standstill after decades of decline, the report warns that continued progress is at risk unless states significantly increase funding to prevent kids from smoking and help smokers quit. The report also calls on Congress to ensure that health reform legislation includes funding for disease prevention initiatives and mandates coverage in Medicaid and other health insurance programs for smoking cessation medication and counseling.

The report, titled “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 11 Years Later,” was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association and RWJF. These organizations have issued yearly reports assessing whether the states have kept their promise to use funds from the tobacco settlements—estimated to total $246 billion over the first 25 years—to fight tobacco use. The states also collect billions more each year from tobacco taxes.

Key findings of this year’s report include:

  • The states this year (Fiscal Year 2010) will collect $25.1 billion in revenue from the tobacco settlement and tobacco taxes, but will spend barely 2 percent of it—$567.5 million—on tobacco prevention and cessation programs (the states also receive $62 million in federal grants for tobacco prevention, for total funding of $629.5 million).
  • In the past year, states have cut funding for tobacco prevention programs by $103.4 million, or 15.4 percent. New York has made the largest cut—$25.2 million, or 31 percent—despite having a highly successful program that has reduced smoking rates to well below the national average. Other states with large cuts include Colorado, Maryland, Pennsylvania and Washington.
  • Only one state—North Dakota—currently funds a tobacco prevention program at the level recommended by the U.S. Centers for Disease Control and Prevention (CDC). Only nine other states fund tobacco prevention programs at even half the level recommended by CDC, and 31 states and D.C. are providing less than a quarter of the recommended funding.

“The inadequate funding of tobacco prevention and cessation programs is a powerful example of misplaced priorities in our nation’s health care system,” said Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO of the Robert Wood Johnson Foundation. “We spend too much on treating people after they get sick and too little on keeping them healthy in the first place. Investing more in proven tobacco prevention programs and policies, like smoke-free restaurants and workplaces, will help people lead healthier lives and reduce health care costs.”

The report cites conclusive evidence that tobacco prevention and cessation programs work to reduce smoking, save lives and save money. Maine, which has long had one of the best-funded programs, has reduced smoking by 71 percent among middle school students and by 64 percent among high school students since 1997. The state of Washington, before cutting its program by 42 percent this year, reduced adult smoking by 30 percent and youth smoking by 50 percent since starting its program in 2000. An August 2008 peer-reviewed study found that California’s investment of $1.8 billion in its tobacco control program, the longest-running in the nation, saved $86 billion in health care costs in its first 15 years—a return of nearly 50:1.

Tobacco use is the leading preventable cause of death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year. Every day, another 1,000 kids become regular smokers—one-third of them will die prematurely as a result.