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Instead Of Cutting Smoking, We Cut The Stimulus. Ugh.

Harold Pollack is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He is a regular contributor to The Treatment.

By any measure, helping smokers quit remains the most powerful and economical measure to prevent avoidable death and illness in the U.S.  As part of the stimulus debate, I and others proposed greater investments in smoking cessation services. House versions included $75,000,000 for these key services.

Sadly, but predictably, Senate critics derided these measures and essentially stripped them from the final package. This oversimplifies a bit. Some such services could be funded within the $1 billion prevention and wellness fund that did reach the President’s desk. Still, it speaks volumes about the interest group politics of American health policy that most of the modest sum proposed for prevention was silently stripped from the stimulus package, even as billions of dollars were (justifiably) added for medical services and for NIH cancer research.

Such outcomes speak equally loud about the selective attention span of ideological combatants across the political spectrum who claim to support prevention and population health, but who often fail to step up when the votes most count or when the boring work needs to be done.

A recent story in the Grand Rapids Press illustrates the real-world consequences of this imbalance. As detailed by reporter Shandra Martinez (and by a complementary Associated Press account) Michigan sporadically fields a Tobacco Quit Line. The hot line offered callers free nicotine patches, gum or lozenges to help people quit. In five days, the hotline received more than 65,000 calls. Martinez reports that many callers were motivated by a pending 61-cent rise in the cigarette tax, as well as by the prospect of free nicotine replacement products, which the state buys wholesale at a marked discount.  (Callers would also participate in five 15-20 minute counseling sessions to help them quit.)

This is how public health policy is supposed to work. Dozens of clinical studies indicate that telephone-based counseling and accompanying pharmacotherapy are effective in helping people to quit. The quit line is also attractive for equity reasons. Let’s face it: Smokers pay large and growing sums in tobacco taxes. As a card-carrying member of the American Public Health Association, I strongly favor these taxes. The economic burden is still real. Smokers--particularly those trying to quit--have a strong claim on at least some of these revenues. People who call the quit line deserve the help and the modest subsidy.

Unfortunately, the Tobacco Quit Line ran out of free products. In tough budgetary times, Michigan has closed the Quit Line for the rest of the fiscal year, which ends September 31. Oh yeah, the Quit Line employed about 400 smoking cessation counselors to field the crush of calls.

No word on how many of these men and women are unemployed. There is equally little word on the number of people--in Michigan and around the country--who will die prematurely from tobacco-related causes when this doesn’t have to be.

--Harold Pollack