In the December 2011 edition of the American Journal of Public Health a 10 year study of Washington state’s comprehensive tobacco control intervention found that for $1 spent by the state, they saved $5 in hospitalization and treatment costs. Wonderful! What an incredible investment! 5:1 return!
Here is a graph illustrating when their program went into effect and the decline in % Adults who smoke in Washington state (compared to the national rate).
The program consisted of indoor smoking bans, tax increases on tobacco products, media campaigns, a tobacco quit line, and community and school programs, among other components. This state-based program was meant to serve as a model for other states. Well, it looks like they did a great job. In terms of public health programs and cost savings of $1:$5 is excellent. So what happened? Washington Governor Christine Gregoire and the state legislature cut nearly all the programs funding for fiscal year 2012. Wait, What?!
Why would you de-fund a state program that is saving the state millions of dollars? Instead of writing in a little spending on tobacco control, they are essentially writing in five times the spending in state health care costs. The only explanation I can think of is that the state is so hard up for cash in the short-term that they are willing to kick those unfettered health costs down the road (and basically allowing for increased human suffering over the coming years). And/Or, given the current attitudes towards decreasing the roles of government, it may be that some folks view government-run tobacco control as outside the appropriate scope of government. Since tobacco does cost governments so much money in terms of care, it seems to me that they do and should have the authority to control the impact that tobacco has on the monetary bottom line. The health protection aspect is another story, one that gets at the heart of the arguments about the role of government.
Clearly, there is a lot of work that needs to be done in terms of high-quality research that demonstrates the cost-savings and health-savings afforded by public health programs like tobacco control programs. There is also work that must be done to frame the issue as one that governments should and very much need to be involved in.