If Anti-Smoking Programs Save Millions, Why Are States Cutting Them?

States are slashing or eliminating programs that could save them money.

Although obesity-related diseases are making a charge, smoking still holds a Secretariat-like lead in the nation’s death-race derby. Tobacco use is far and away the single leading preventable cause of disease, disability and mortality in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million live with a serious illness caused by smoking, according to the Centers for Disease Control and Prevention (CDC).

The costs of smoking-related illnesses, of course, are staggering: about $193 billion a year in medical expenditures and lost productivity, the CDC reports. Since Medicaid recipients are disproportionately affected by tobacco-related disease -- smoking is approximately 53 percent more prevalent among them than among the overall U.S. adult population, according to the National Institutes of Health -- states should be looking here to lower their health costs.

After all, there is no clearer link in medicine. Get people to kick the habit and their health improves fast. You no longer have to pay to combat smokers’ lung and other cancers, cardiovascular and pulmonary diseases, or their children’s asthma, respiratory infections, ear infections or a host of other secondhand smoke-induced problems.

Even better, there is a wealth of reliable evidence that smoking cessation programs not only work, they work in wonderfully cost-effective ways. Most recently, a study from George Washington University’s Center for Health Policy Research looked at Medicaid data from Massachusetts and concluded that every $1 invested into the smoking cessation program yielded $3.12 in medical savings. “These results suggest that an investment in comprehensive tobacco cessation services may result in substantial savings for Medicaid programs,” the study concluded.

No-brainer, right? Wrong. States from coast to coast are slashing or eliminating the very programs that could be saving them tons of money, according to the American Lung Association. It gave a grade of “F” to 43 states and the District of Columbia for funding programs at less than half the level called for by the CDC in its 10th annual State of Tobacco Control Report Card.

“There are very few no-brainers in government,” admits Gov. Jack Markell of Delaware, one of the few states that received a good grade on the report card. His state managed to cut the budget elsewhere and leave anti-smoking programs intact. “We know smoking is pretty much the top health problem,” he says, “and we are focusing as much as we can on disease reduction to reduce everybody’s health-care costs.”

The state doesn’t actually track its return on investment, says Dr. Karyl Rattay, director of Delaware’s Division of Public Health. But she has seen other states earn returns as much as 10 to 1. “That’s huge when you’re looking at really high health-care costs,” she says, “and we’ve also observed what happened where other programs were reduced. When funding is cut, you see increases in tobacco use.”

It takes more than just money to beat the marketing might of Big Tobacco. “When you align all the different sectors of public or private partners, you are much more likely to be successful,” Rattay says. “Our governor is a health champion, which is so important. Cancer prevention is very important to many of our legislators. We have a cancer consortium that includes legislators, state health-care leaders, agency heads and strong anti-smoking advocates.”

Still, money is critical, and “no program is hands-off,” Rattay says. “You have to look closely every year and show improvements in our smoking rates.” Markell adds that while budget pressures will continue as far as the eye can see, “we are very pleased with the progress we have made."

Caroline Cournoyer is GOVERNING's senior web editor.