Prevention Matters

In 1998, Altria's Philip Morris USA subsidiary voluntarily established a Youth Smoking Prevention department, and has long touted its efforts in that area. So how's it doing? According to a new survey by the Centers for Disease Control and Prevention, Altria's Marlboro brand is the most frequently smoked cigarette among middle school and high school students who smoke.

Could it have something to do with the fact that Marlboro is the most heavily advertised cigarette brand in the country? Or that data have shown that youth-oriented anti-smoking media campaigns funded by the tobacco industry tend to increase smoking?

In fact, the CDC study showed that the three most heavily advertised cigarette brands - Marlborough, Camel and Newport - are the brands of preference for nearly 80 percent of middle school smokers and for nearly 90 percent of high school smokers.

This is just one more reason that Partnership feels that Congress needs to introduce and pass legislation to allow the Food and Drug Administration to regulate the tobacco industry and its marketing practices. And it's why we need to fund more mass media campaigns that aren't dependent upon the tobacco industry for support.

Opponents might argue that it’s beckoning back to the days of prohibition, but increasing the alcohol excise tax is a valid strategy to improve the nation’s economy and health status. Tobacco taxes have been increased several times over the last few years for the very same reasons, yet it has been more than 18 years since the taxes on alcohol were raised. A commentary by Steve Heilig in the February 11th issue of Join Together provides a solid argument on the importance of increasing the alcohol tax—at both the state and federal levels.

UPDATE: Kentucky bourbon industry officials emptied bottles of bourbon on the state Capitol's front steps Tuesday to protest a proposed 6-percent sales tax on all distilled spirits. Despite this attempt at a new "whiskey rebellion," the state House Appropriations and Revenue Committee approved the proposal in an effort to offset a projected $456 million revenue shortfall in the fiscal year that ends June 30.

Initial reports indicate that prevention and wellness funding squeezed out a win in the economic stimulus package hammered out by House-Senate conferees today on Capitol Hill.

More details to come, but so far we're told the $789 billion package includes $1 billion under the category of Prevention -Wellness Trust (including 317 Immunizations), and 500 million for the health workforce.

The House had sought $3 billion for those provisions in its version of the bill, while the Senate originally sought $5.8 billion but zeroed out that funding to accommodate moderate Republicans who provided the votes needed to get the bill through the Senate.

While the final $1.5 billion figure falls short of original hopes, it still represents the single biggest infusion of support ever given to the nation's public health system.

As Congress deliberated on an economic stimulus plan, an AIDS worker on the other side of the country eloquently voiced the questions that are on the minds of public health officials everywhere.

"Are positions building highways of more importance than positions promoting good health?" Michael Kaplan, executive director at Cascade AIDS Project in Oregon, asked in a guest column that appeared in today's edition of "The Stump," a blog produced by The (Portland) Oregonian's Editorial Board. "Does a salaried construction worker spend less in our communities than a salaried public health specialist? Are positions focused on green energy -- efforts that save on fuel costs in the long run -- of more value than positions focused on health promotion that save on health care costs in the long run?

"The reality is that some members of Congress have decided which sectors of society they care for more, and it seems those who serve private interests over the public good are winning," Kaplan said. "At a time when the economy will only further decimate the public health system -- a system already ailing -- how is it we can say there is no need to support the return of jobs to help with this important work for our community?"

The Senate's 61-37 vote today to pass its version of an economic stimulus package sends the legislation to a House-Senate conference committee to sort out differences between their respective versions. One of those differences has to do with funding for prevention and wellness agencies and programs. The House version would appropriate $3 billion; the Senate originally sought $5.8 billion, but dropped funding for it entirely to reach a compromise that delivered the three moderate Republican votes needed to secure a filibuster-proof majority vote.

The action over the last 24 hours has been fast and furious, and the final version of the bill could be delivered very quickly. The big question now is: is there any room for compromise, or do the moderate Republicans constitute a "gang of three" that essentially controls the future of the bill?

Partnership for Prevention is urging House conferees to hold firm for the prevention and wellness funding. "At $3 billion, this fund represents less than one-half of a percent of the total funding package," said Partnership Interim President Corinne G. Husten. "However, it will create an estimated 17,000 jobs while providing immediate assistance to State and local public health agencies and programs that are critical components of the nation’s safety net."

House Democratic conferees are expected to be Speaker Pelosi and Representatives Obey, Hoyer, Clyburn, Frank, Gordon, Miller, Oberstar, Rangel, Spratt, Towns, Velasquez and Waxman.

The New Republic's health care blog quotes a senior administration official as saying that health care will be a “central focus” of Obama’s first budget proposal.

“I’ve been in meetings with him and it’s clear this guy is committed to getting health care and getting coverage to everybody,” one high-ranking member of the administration told TNR’s Jonathan Cohn. “There’s no question in my mind.”

The statement is meant to reassure reform advocates who had feared that the recent Daschle debacle and subsequent elimination of public health funding in the economic stimulus plan had taken some of the wind out of their sails.

Disease prevention and health promotion has taken some hits recently on the grounds that it doesn't save money. Health Affairs, the Congressional Budget Office and The Washington Post have all published studies or commentary contending that any savings realized through prevention is offset by the additional expenses incurred when people live longer.

Concerned that prevention could be dismissed as a important part of health reform efforts in Congress, members of the prevention community began pushing back recently. Partnership for Prevention commissioned a white paper from some of the nation's leading authorities on prevention and public health who made the economic case for prevention. One of the authors of that paper, Steven H. Woolf, MD, MPH, of Virginia Commonwealth University, then summarized that paper in a commentary that appeared in the Feb. 4 issue of JAMA. Partnership and the WellPoint Foundation then held congressional briefings on Capitol Hill on Feb. 4 in which Woolf was joined by Partnership Interim President Corinne G. Husten and Marc Manley, MD, Medical Director and Vice President at Blue Cross/Blue Shield of Minnesota.

Their conclusions: some preventive measures save money and some don't, but many provide enormous value in terms of health benefits per dollar spent. It is this value - translated into the ability to stem the increase in chronic diseases that are driving health costs upward - that need to be more closely considered as we seek to reform the health care system. And that should apply to medical treatments as well.

The briefing was recorded and can be watched online by clicking the TV set pictured on the right.