Missouri Tobacco Settlement
Offers Less Than an
Ounce of Prevention

Americans now live 30 years longer than we did 100 years ago. Five of those years are due to the technological advances in care and medicine. Twenty-five years of the 30-year increase in life expectancy are due to preventing an illness or delaying its onset. Prevention has the opportunity to pay for itself. We are reaping the rewards in life expectancy from preventive actions taken from the 1920s to the 1940s.

Currently, Americans pay over a trillion dollars each year for health care, so one would assume that we have the best health outcomes in the industrialized world…we are not even in the top 20. Businesses and individuals continue to pay increasingly higher medical insurance premiums, but are seeing less and less for their dollars. In 1995, for example, the direct and indirect costs of tobacco-related diseases from smoking in Missouri totaled $3.3 billion.

In 1998, many thought some of those costs would be mitigated when cigarette makers agreed to a settlement that awarded $206 billion to 46 states, including Missouri. After three years of wrangling, however, and only after it was in jeopardy of losing $4.5 billion over 25 years, did the Missouri General Assembly appropriate the 1998 Master Settlement Agreement dollars. Even then, only 15% of the settlement funds have been allocated to prevention. Why? Because prevention is not a priority in this day and age.

When Missouri reached the final hurdle in obtaining the tobacco dollars on May 18, 2001, roughly $338 million was deposited into the Health Families Trust Fund through Missouri House Bills 14 and 15. The funds were allocated as follows:

• $127 million was used to cover the projected shortfall in the budget for 2001
• $89.3 million was placed into the general revenue to pay for the 2002 Tax Credit for Senior Prescriptions
• $24 million went to health care
• $42.8 million has been designated for a new senior prescription program
• $30.7 million will be placed in an endowment fund for Missouri’s future
• $24.5 million was placed into the general revenue for a new State Health Laboratory. Those funds have been placed on hold, as there are to be no capital improvements this year due to the budget crisis.

The funds intended for tobacco prevention and cessation, early childhood education and life sciences will not come until the next tobacco payment in April 2002. Even then, the on-going funding source for the roughly $22 million is unclear. As other programs such as prescription drug reimbursement for the elderly and hospitals reap the benefits of the settlement dollars, prevention advocates sit and wait and watch.

An independent audit of Missouri’s relationship with tobacco documented by the Institute of Health Policy Studies at the University of California—San Francisco details how “the tobacco industry is a major political force in Missouri.” The Institute cites as an example a deal between the tobacco lobby and former Missouri House Speaker Bob Griffin in 1993 that kept Missouri’s tobacco excise tax rate at 17 cents per pack and invoked preemptive language prohibiting local governments from enacting new tobacco taxes.

Prevention can save dollars and lives. Kansas City needs a call to action to put prevention first. To meet our citizen’s highest expectations in terms of quality of life, we need to be able to proactively prevent illness, not just rely on treating the symptoms. Prevention is our best defense.

Rex Archer M.D., M.P.H. is director of the Kansas City, Missouri, Health Department and is Chairman of the Missouri Association of Local Public Health Agencies Tobacco Settlement Committee. For further information about the Missouri tobacco settlement, you may contact Bill Snook of the Health Department at 816.513.6274 or at bill_snook@kcmo.org.