Editor’s Note: This op-ed is by Theodore W. Marcy of Ferrisburgh, professor of medicine at the University of Vermont College of Medicine and past chairman of the Vermont Tobacco Evaluation and Review Board. His commentary originally appeared in the Burlington Free Press.
My passion for reducing tobacco use comes from seeing patients each day in my pulmonary clinic whose lives are harmed by smoking. The vast majority of these people became addicted when they were children — too young to make an informed choice. Of those who still smoke, almost all want to quit, but need help to do so. Ten years ago, I did not have much to offer my patients other than advice.
During the past decade, however, Vermont took three important steps to reduce the harm from tobacco. First, all workplaces are now free of second-hand smoke. Second, the taxes on a cigarette pack have been substantially increased to encourage quitting and discourage starting. Third, a comprehensive tobacco control program with cessation services was launched in 2001, in part so that those for whom tax increases motivated a quit attempt have the help to do so successfully. Now, I can direct my patients to the Vermont Quit Network that provides an assortment of counseling options and free or highly subsidized cessation medications.
As a result, the number of Vermont adults who smoke has decreased from 22 percent in 2001 to 17 percent currently, and the youth smoking rate has decreased over the same time period from 33 percent to 16 percent. This past year, however, has been very frustrating. There has been another significant cut in the budget that funds these cessation programs. The 38-cent tax increase that passed the Legislature is likely too small to encourage smokers to quit, or youths not to start. Is there a message here? Have we done all that we need to do? Is it time to turn our attention and resources to other issues?
The answer is a definite “no.” Smoking remains the most important cause of premature death and disability, responsible for over 830 Vermonters’ deaths each year. As a state striving to insure everyone, we cannot control escalating health care costs without addressing tobacco use, the largest single driver of those costs. Vermont spends $233 million each year to treat smoking-related health care costs, $72 million of which are taxpayer-funded Medicaid expenditures.
Despite our successes, we could do much better. In California — the state with the longest sustained tobacco control program — only 12 percent of adults smoke to our 17 percent. The smoking prevalence among some of our residents is much higher: 36 percent of those with low income smoke, as do 42 percent of those with moderate or severe depression.
Our efforts also do not occur in a vacuum. We are budgeted to spend $3.4 million in the next fiscal year to reduce tobacco use; the tobacco industry will spend in Vermont eight times that — approximately $27 million — to encourage tobacco use. And yet, California’s experience is that for every $1 invested on tobacco control programs there was $50 in savings. That is an impressive return on investment.
Recently, the American Lung Association and the C. Everett Koop Foundation honored me as this year’s national “unsung hero” in recognition of my work in tobacco control. However, no one person is responsible for what Vermont has accomplished. I accepted this award on behalf of the many unsung heroes dedicated to reducing tobacco use in Vermont. But as California has shown us, we cannot rest on our laurels. We need to restore funding to Vermont’s comprehensive program. We should increase taxes further — a pack of cigarettes still costs almost $1.75 less in Vermont than in New York. We need to be certain Vermont continues to do all that it can to avoid lung cancer, COPD and other tobacco-related diseases in my patients, my neighbors and my friends.
