By Christie L. Carter

"A Broken Promise to Our Children: The 1998 State Tobacco Settlement Six Years Later,” released by the Campaign for Tobacco-Free Kids, the American Cancer Society, the American Heart Association and the American Lung Association, says tobacco use remains the nation’s leading preventable cause of death. Tobacco was responsible for five million deaths worldwide in 2004, a yearly total that will rise to 10 million by 2020, according to the American Cancer Society.

The tragedy is that states are using the anti-tobacco funds for other purposes—despite the fact that nearly 90 percent of lung cancer cases in the United States are tobacco-related.

"We have a lot of sympathy for the states because they have many competing interests for limited funds,” says Thomas Glynn, the American Cancer Society’s director of cancer science and trends. “But having said that, those funds were made available to them to reduce the states’ burden from healthcare costs due to tobacco. And what they’re doing, essentially, is reneging on their promise.”

But the most startling figure that resulted from the recent report may be that tobacco companies spend more than $23 to market cigarettes and other tobacco products for every $1 states spend on tobacco prevention. States will collect a record $20 billion this year alone from the tobacco settlement and tobacco taxes. And while a mere 8 percent of that total would fund tobacco prevention and cessation programs in every state at minimum recommended levels set by the Centers for Disease Control and Prevention (CDC), states are spending only 2.7 percent of their tobacco revenue on tobacco prevention and cessation.

"The bottom line is that it’s a shame, it’s a lost opportunity, and in the long run, it’s fiscally irresponsible,” says Glynn.

According to the report, there is some good news for tobacco prevention. A few states, including Maine, Mississippi and Delaware, are funding anti-tobacco efforts at CDC-recommended levels and are “enjoying significant public health benefits as a result.” Maine, which has a comprehensive smoke-free workplace law, has seen smoking rates decline by 59 percent among middle school students and 48 percent among high school students between 1997 and 2003.

MaryBeth Welton, program manager for the Partnership for a Tobacco-Free Maine, says that even in the face of state budget deficits it’s important to focus on health issues. To ensure that settlement funds are allocated properly, the Maine legislature created the Fund for a Healthy Maine in 1999.

"Maine’s legislative leadership, government administrators and health advocates feel strongly that the settlement dollars should be dedicated to health programs,” says Welton, “and to expanding the Partnership for a Tobacco-Free Maine into a comprehensive, statewide program with all of the CDC-recommended components.” In addition, Welton says the state’s ability to implement effective tobacco prevention and control programs is due largely to the strong partnership between the Maine Bureau of Health and the Maine Coalition on Smoking or Health.

There is some hope on the horizon for anti-tobacco advocates. In May 2003, the World Health Organization unanimously adopted the world’s first public health treaty, the Framework Convention on Tobacco Control. Though many countries, including the United States, have signed but not yet ratified the Framework Convention, which went into effect in February 2005, it’s a good start, says Glynn.

"In the short run, we’re not going to see any revolutions,” he says. “But in the long run, it’s essential to addressing the global tobacco issue. ‘Framework’ is actually a very descriptive term because this isn’t a set of absolute rules, but it’s a framework by which countries can begin addressing the tobacco control problem.”

The Framework Convention has already accomplished something no one has been able to before. “In virtually every country in the world, a coalition of tobacco control experts and advocates now exists to promote tobacco control,” says Glynn. “So it already had an effect even before it became official.”

To read a copy of the report, visit www.tobaccofreekids.org/reports/settlements. For more information on the WHO’s Framework Convention on Tobacco Control, visit www.who.int/tobacco/en.