UICC World Cancer Congress 2006

“Objective” Public policy makers are generally resistant to spending large sums of money on prevention programs as compared to spending for direct medical care services. This is particularly true when it comes to spending for chronic disease prevention. The argument is that the benefits of chronic disease prevention programs will take decades to manifest themselves, and that the overwhelming need and benefit exists within spending the majority of health expenditures on direct medical care services. California in the late 1980's sought to obtain a specified set of funding that could only be used for a chronic disease prevention program, specifically for tobacco use prevention and control. The state achieved this through a voter initiative in 1988, which increased the tax on each pack of cigarettes at 25-cents. Five cents were allocated specifically for tobacco control programs in both the community and school settings.

“Methods” Cigarette smoking is the leading cause of preventable death in the United States and in California. Approximately 440,000 people in the United States die each year from cigarette smoking. The total cost of smoking in California in 1999 (including both direct and indirect costs) was estimated be $15.8 billion. Lung cancer is the number one cause of cancer deaths among men and women. There are several other tobacco related cancers: bladder, cervix, esophagus, kidney and other urinary, larynx, oral and pharynx, pancreas, and stomach. With such a high number of death, disease, and cost associated with its use, something had to be done to address cigarette use.

It has been 18 years since California voters approved the landmark California Tobacco Tax and Health Protection Act in November 1988, which made California the first state to implement a comprehensive tobacco control program. The primary goal of the California Tobacco Control Program (CTCP) is to prevent tobacco-related disease and death in California by reducing tobacco use across the state. The CTCP uses a comprehensive approach that strives to change the broad social norms around the use of tobacco by "indirectly influencing current and potential future tobacco users by creating a social milieu and legal climate in which tobacco becomes less desirable, less acceptable, and less accessible." California's strategy focuses on four broad priority areas for use both in program planning and funding decisions: reducing exposure to secondhand smoke; revealing and countering tobacco industry influence; reducing the availability of tobacco products; and providing cessation services. The combined efforts of 61 local health departments, approximately 50 to 100 community-based organizations including seven priority population partnerships, a statewide media campaign, a tobacco cessation helpline, and other statewide technical support systems, have helped the program achieve significant progress toward a tobacco free California. Hundreds of trained and experienced public health workers, and thousands of adult and youth volunteers have contributed to this effort. More than anything else, the California experience shows that it is difficult but not impossible to succeed against a force as rich and powerful as the tobacco industry.

“Results” California has proven that it does not take decades to see the benefits of allocating funding to prevent tobacco use. When looking at tobacco use rates, adult smoking prevalence has fallen to 14 percent, a 38 percent decline since 1988. Cigarette consumption has declined by 60 percent since 1988, and is half of that in the rest of the United States (in 2005, 44 packs per capita in California versus 88 packs per capita in the rest of the United States). These statistics are impressive in and of themselves, but they translate into very impressive reductions in cancer rates. From 1988-2002, lung and bronchus cancer rates declined at nearly four times the rate of decline in the rest of the United States. In addition, six out of the nine cancer types that have been linked to tobacco use had a lower incidence rate in California than in the rest of the United States. And, what bodes well for the future are the successes seen in youth smoking rates. Youth smoking in California continues to decline, and more rapidly than the rates seen in the rest of the United States. In 2004, 13.2 percent of high school students (grades 9-12) smoked, a nearly 40 percent decline since 2000. The rest of the United States rate is 22.3 percent. Making tobacco use prevention and control a funding priority is an excellent way to control cancer.