While there are numerous hypocritical actions that the Campaign has taken over the years that warrant its induction into the Hall of Shame, on the occasion of its induction I choose to highlight just one of them. However, it is an important one that has had massive implications for the near destruction of effective state-level tobacco control in the United States.
The Rest of the Story
In 1988, voters in California passed Proposition 99, a ballot measure which increased the cigarette tax by 25 cents per pack and allocated the revenues toward a statewide tobacco control program that included research on the prevention and treatment of smoking-related diseases as well as smoking education and prevention campaigns. This strategy in tobacco control - increasing cigarette taxes and using the revenue to fund a comprehensive, statewide tobacco control program that directly benefits smokers - quickly became the standard in the movement.
The public health benefits of California's strategy were immense. Cigarette consumption and smoking prevalence dropped substantially in California, both among youths and adults. There is now evidence that even long-term outcomes, such as lung cancer, have declined in California thanks to the approach approved by voters in 1988. Much of the evidence for what works in tobacco control is based on the successful program in California.
California's program became a model for the nation, and tobacco control advocates embraced this approach as the gold standard in tobacco control and public health. Several other states soon followed suit. One was Massachusetts, in which a similar program was established and led to immense public health benefits, as both adult and youth smoking prevalence declined after its passage of Question 1 in 1992, which also allocated money from a cigarette tax to a comprehensive, statewide tobacco control program. Massachusetts soon followed California to become the second state with a model tobacco control program. Arizona and Oregon would follow soon thereafter.
However, in the late 1990s, there was a huge change in the tobacco control movement that led to a devastating outcome: the enactment of cigarette tax increases in order to establish comprehensive tobacco control programs came to an end. What might have become an exponential growth in these model programs and reached a tipping point (following a diffusion of innovations curve) was halted.
Instead of pursuing the strategy of urging states to enact cigarette tax increases specifically to fund comprehensive tobacco control programs, tobacco control advocates began to support cigarette tax increases for any purpose under the sun: building bridges, repairing tunnels, providing essential government services, closing budget shortfalls, etc. The use of the revenues didn't matter. All that mattered was that cigarettes be taxed at a higher rate.
This change was a pivotal moment in tobacco control history. It marked the point at which tobacco control advocates renounced the long-held-dear strategy of insisting that tobacco revenues be used specifically for tobacco-related purposes, not simply to close budget shortfalls or fund essential government programs that should have been funded through other means.
And what was the reason for this sea change in thought and strategy in tobacco control?
You're right. The Campaign for Tobacco-Free Kids. Because in the late 1990s, the Campaign abandoned the approach of only promoting initiatives to implement cigarette revenue-funded tobacco control programs. Instead, it instituted a series of campaigns throughout the country dedicated simply to raising cigarette taxes, regardless of the purpose for which the revenues would be used.
Here in New England, the Campaign spearheaded a campaign to increase the cigarette tax in every state in New England. But the thrust of the campaign was not on establishing comprehensive statewide tobacco control programs in these states. It was simply on raising cigarette taxes. The Campaign did not insist that tobacco revenues be used for tobacco-related purposes. This represented a critical change in the long-standing strategy in tobacco control.
However, it represented a much easier way to make a name for itself. It is far easier to pass a cigarette tax to close budget shortfalls than to pass a cigarette tax when the money is going to be used for a statewide tobacco control program. The Campaign took the easy way out, which made it more profitable for it in terms of having successes and attracting donations, but which destroyed the prospect of having effective statewide tobacco control programs by undermining the concept that tobacco revenues must be used for tobacco-related purposes.
There are three important reasons why the dedication of tobacco revenues for tobacco purposes is critical. First, the failure to insist upon this turns a fair cigarette tax into an unfair and regressive one. It is unfair to ask smokers to shoulder the burden of providing the revenues to fund essential government programs or to close budget shortfalls. The burdens of the tax accrue to smokers, but the benefits do not accrue specifically to smokers. However, with a dedicated tax that is used largely for research into the treatment of tobacco-related diseases (of which yesterday's failed initiative in California is a prime example), while the costs accrue to smokers, so do the benefits.
Second, raising cigarette taxes to pay for essential government programs or to close budget shortfalls (of which the recently enacted cigarette tax increase in Illinois is a prime example) ties these essential programs as well as the fiscal solvency of the state to the continued sale of cigarettes. It destroys any incentive for the state to take actions to substantially reduce cigarette consumption. It has had devastating effects on the public's health. But this is not the case when the revenues support smoking-related programs. If the revenue falls because of reduced smoking, then the program is working and less money is needed as there are fewer smokers and less of a problem.
Third, the original purpose of increasing cigarette taxes was to support cigarette-related programs. The Campaign for Tobacco-Free Kids undermined this basic principle by abandoning the long-standing strategy in tobacco control for what I see as short-term political and financial gains.
That the Campaign for Tobacco-Free Kids has abandoned the principle that tobacco revenues must be dedicated to tobacco-related purposes is evidenced by its press release the other day which praises the cigarette tax increase in Illinois, even though the revenues will be used to close a budget shortfall and provide health care for the poor. It is unfair to ask smokers to be responsible for providing health care for the poor. That is a state responsibility. By tying health care to the poor to cigarette consumption, the Campaign is now stating that continued cigarette consumption is the key to ensuring that the poor can obtain health care. It is a preposterous concept that undermines the incentive for the state to take any action that will substantially reduce cigarette smoking.
So where does the hypocrisy come in?
At the same time that the Campaign is largely responsible for the abandonment of the principle that tobacco revenues must be used for tobacco-related purposes, the Campaign continually whines and complains about the fact that the states have abandoned this very principle. The Campaign recently bemoaned the fact that so few states are spending their cigarette tax revenue and MSA tobacco revenue on tobacco-related programs.
The Campaign writes: "A report released today by the U.S. Centers for Disease Control and Prevention confirms that states have spent a small and dwindling portion of their tobacco revenues on programs to prevent kids from smoking and help smokers quit. From 1998 to 2010, the states collected a combined $243.8 billion in revenue from legal settlements with the tobacco industry and from cigarette taxes, but appropriated only $8.1 billion for tobacco prevention and cessation programs (counting both state funding and federal grants). Total funding for these programs amounted to just 3.3 percent of the states’ tobacco revenues and less than 28 percent of the CDC’s recommended amount. This is particularly tragic because, as the report also found, states that have made sustained investments in comprehensive tobacco control programs have seen cigarette sales drop about twice as much as in the United States overall."
And the Campaign goes on to say: "most states have broken the promises they made at the time of the 1998 tobacco settlement to invest a significant portion of their settlement funds in fighting tobacco use, especially among kids. The states' failure amounts to an enormous missed opportunity to accelerate progress against tobacco use in the United States. It's also no coincidence that smoking declines have slowed at the same time that states have slashed tobacco prevention funds. For our nation to continue making progress against tobacco, states must increase funding for tobacco prevention and cessation programs."
But from the other side of its mouth, the Campaign was the entity largely responsible for the fact that the principle of tying tobacco revenues to tobacco-related spending was abandoned. It was the Campaign that promoted the elimination of that concept by supporting - throughout the nation - the use of tobacco revenues for every program under the sun, other than tobacco-related programs.
There is no organization more deserving of induction into the Benjamin Church Hypocrisy Hall of Shame in tobacco control than the Campaign for Tobacco-Free Kids.