Unwise to cut tobacco control funding in tough times

The U.S. and many other economies across the globe are going through tough financial times just now. In these tough times, legislators and policy makers have to make tough choices about how to spend limited budgets. In recent times in the United States, one of the targets for cuts has been tobacco control funding.

Using my home state as an example, I’d like to summarize some of the reasons why cutting tobacco control funding is not a wise policy, even in tough financial times.

Here in New Jersey, our Comprehensive Tobacco Control Program (CTCP) started in 2000, with funding of $32.5 million via the Master Settlement Agreement. At that time the Centers for Disease Control (CDC) recommended a minimum of $45 million annual expenditure on tobacco control. The program was set up to follow CDC guidelines to have components for media, evaluation, community activities, youth prevention, and smoking cessation. With the post 9/11 recession causing severe budget problems for the state, funding was drastically cut by 66% to $11 million in 2004 and has remained at that level. The state brings in approximately $1 billion per year from tobacco sources (MSA plus tobacco taxes) and so is currently spending around 1% of tobacco revenues on tobacco control. In 2007 the CDC updated its funding recommendations for New Jersey to $120 million ($13.75 per person per year, and 12% of total tobacco-related revenue to the state).

Despite being drastically underfunded, the New Jersey CTCP has had many noteable achievements. Just a few of these are:

- Over the years 2000 to 2007, cigarette taxes were increased from 80 cents per pack to $2.575 per pack (highest state tax in the country).
- Legislation was passed to ban smoking in all workplaces and indoor public places, and implemented in 2006, adding casinos in 2008.
- The number of cigarettes being smoked by New Jersey youth was cut by 50% from 1999 to 2006.
- Adults cigarette smoking fell from 21% during the mid 1990s to 17.1% in 2007, the lowest level recorded.

Some may ask for early signs of a health impact. One early response to reduced smoking is a reduced rate of heart attacks. The number of acute myocardial infarctions causing reported inpatient hospitalizations in New Jersey was above 22,000 every year from 1995 to 2003 (24278 in 2000), but dipped below 22,000 in 2004 and has continued to fall to below 20,000 in 2006. This reduction from the year 2000 to 2006 was evident for every age group over age 15. Clearly all of this reduction cannot be entirely attributed to the CTCP, but it is highly likely that many heart attacks were prevented by the reduced smoking in the state. In tough financial times, one has to consider the cost savings to the healthcare system from reduced hospital admissions for MIs, lung cancer, premature babies, respiratory disease and all the other diseases caused by smoking.

Some point to the successes in reducing smoking and seem to be under the misguided impression that smoking is so rare nowadays that there is no longer a need for robust tobacco control programs. The reality is that according to our latest data (2006), New Jersey’s 7th through 12th graders smoke 90 million cigarettes a year. This does not include the significant proportions smoking cigars and bidis, or chewing tobacco.

Per capita cigarette consumption is currently 43 packs per year (down from 69 packs in 1999), and lower than the average for the country (69 packs).

To put New Jersey’s investment in tobacco control into perspective, on an annual basis it is less than the amount of revenue the state receives in excise taxes from illegal cigarette sales to kids ($11.5 million)!

Yet in that scenario of incredible success despite serious underfunding, New Jersey’s Comprehensive Tobacco Control Program is currently threatened with further cuts. I don’t think we can really say that with New Jersey’s youth smoking 90 million cigarettes per year, and with 43 packs being consumed annually for every person in the state, that the work for tobacco control is done. We are only beginning to see the return on investment in terms of reduced health effects from tobacco. To cut the program now would result in a reversal of the progress, and directly cause more heart attacks, more cases of lung cancer and emphysema, and more premature babies.

Tobacco control spending provides an excellent return on investment, and it is for this reason that CDC recommends that New Jersey should spend $120 million, rather than be considering cutting from $11m. Even in tough financial times, a dollar spent on tobacco control is a dollar well spent on improving health and reducing healthcare costs.

So when times are tough, and money is needed for other important causes (like healthcare for uninsured smokers), a far better way to fund these is to increase the excise tax on cigarettes.

Full details and evaluation of New Jersey’s Comprehensive Tobacco Control Program can be found at:

For more details on the toll of tobacco in New Jersey, click on:

For the CDC’s best practices for Comprehensive Tobacco Control (2007), click on:
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.