In the age of instant gratification, arguments that preventive care will reduce costs significantly in the long run usually don’t cut it.
And in North Carolina, where tobacco is a staple of the state’s past and tough budgeting a reality of its present, funding is even harder to come by for prevention programs focused on smoking and smoking-related illnesses. Recent cuts, critics argue, ignore the fact that credible public health agencies have continuously reported tobacco as the leading cause of preventable death and disease in North Carolina.
Although the Patient Protection and Affordable Care Act signed into law by President Barack Obama in March 2010 provides some funds to help reduce tobacco use in the Tar Heel state, that money will far from compensate for the cuts the state legislature has recently made to smoking prevention and cessation programs.
The state budget passed in this summer’s short session allocates $2.7 million in non-ACA federal funds for tobacco-use prevention programs, a fraction of the $17.3 million North Carolina spent last year and a mere 16.2 percent of the amount the Center for Disease Control recommends the state spend on tobacco-use prevention.
And despite the fact that North Carolina receives $144 million through the tobacco Master Settlement Agreement in 2012, the state will not contribute any of its own money to anti-smoking efforts this year.
Thus, the Affordable Care Act, albeit not the end-all be-all, stands as one of the only government-supported efforts to reduce smoking and smoking-related illnesses in North Carolina.
One of the cessation efforts that will receive funding through the Affordable Care Act is QuitlineNC, a 24-hour service that provides free cessation counseling to North Carolinians trying to kick the habit.
According to Sally Herndon, head of the Tobacco Prevention and Control Branch of the NC Department of Health and Human Services, QuitlineNC will receive about $1.9 million of the $2.7 million allocated by the state in addition to funding through the ACA.
Herndon said she believes the help line deserves this proportionally large investment due to the service’s accessible nature and evidence-based results. Thus far in 2012, 36,900 people have taken advantage of the free coaching line, representing the highest call volume since the state launched the service in 2005.
Another Affordable Care Act provision is the community transformation grant, which awards the NC Division of Public Health $7.4 million over five years to help North Carolina communities make healthy living easier.
Herndon said the grant makes the healthy option the easy option by promoting tobacco-free living. She believes strategically investing in smoke-free regulations is beneficial for many reasons.
“Smoke-free regulations eliminate exposure to secondhand smoke, produce a social norm that keeps young people from smoking, prevent tobacco users who want to quit from having to be in a space with other smokers, and help eliminate many tobacco-related health disparities,” she said.
But the $7.4 million grant is not completely devoted to anti-tobacco efforts. Other public health provisions like active living and healthy eating will also receive a portion of the funds.
Advertising: Where cuts may hurt the most
“We are utilizing every penny we get from the Affordable Care Act to do the best evidence-based tobacco prevention and control work we can,” Herndon said. “Still, the loss of funds means that there are things we have been doing in North Carolina that we won’t have funding to do.”
One of those things is anti-tobacco media marketing. Pam Seamans, executive director of the North Carolina Alliance for Health, said the recently passed state budget includes a provision strictly prohibiting funds for statewide media campaigns against tobacco.
Although the Affordable Care Act designated $500 million for a nationwide outreach and education campaign, Seamans said there is uncertainty about how and when those funds will materialize in North Carolina — if they ever do. The $500 million for the campaign would be used for a number of public health programs, only one of which is focused on anti-smoking efforts, and the money would be divided between the states.
Because smokers and young people can be especially influenced by media campaigns, Seamans said the loss of the tobacco-free message could equal an additional $220 million in health care costs and 15,000 more North Carolina kids becoming smokers.
In 2011, the state’s teen tobacco-smoking rate reached a historic low, with 4.2 percent of middle schoolers and 15.5 percent of high schoolers reporting smoking. The NC Department of Health and Human Services cited the TRU (Tobacco. Reality. Unfiltered.) Program, a media campaign and community program targeting youth, as one of the most influential contributors to the decline.
But funding for TRU was eliminated in 2011. And while funds for anti-tobacco marketing will total a whopping $0 for North Carolina in 2012, the tobacco industry is unlikely to cut any of its annual $396 million spent on marketing its products in the Tar Heel state.
A matter of priority
According to America’s Health Rankings, a project of the United Health Foundation, almost 20 percent of the adult population in North Carolina smoked tobacco products regularly in 2011, placing the state 36th in national rankings.
But with the American Lung Association giving North Carolina an “F” in tobacco prevention and control spending in 2012, the odds are against the state with its widespread tobacco use and low level of funding.
“And the Affordable Care Act will by no means be enough,” said Amy Barkley, mid-Atlantic region director of the Campaign for Tobacco-Free Kids.
But the lack of funding doesn’t necessarily mean federal and state politicians are against tobacco-use prevention and cessation efforts.
“As we spoke to legislators about this issue this session, we hardly found anyone who was opposed to the program,” Seamans said. “It was more a matter of priorities.
“It’s the nature of the political system. Politicians are not going to see the results of the preventive measures while they are still in office, and politicians need results now.”
Test your knowledge of the Affordable Care Act, including provisions on preventive care