Tobacco Documents Online

The Nation. July 13, 1992 S2.25 U.S./S2.75 Canada = PREVENTION'S THE ISSUE Your Money or Your Life Style MICHAEL F. JACOBSON T o listen to the presidential hopefuls, induding those who fell by the wayside earlier this year, you'd think that America's health care crisis is solely one of ac- cess and payment. Lost in the duels over "play or pay;' "single payer" and "small-group-market insurance re- form" is the fact that a good chunk of our health costs are preventable. Every year, hundreds of thousands of deaths could be avoided and billions of dollars saved if Americans lived a little differently and if federal tax and other policies were teoriented toward health. But we hear nothing about this from Bush, Clinton or Perot. Consider booze. Alcoholic beverages cause more devasta- tion in our society than any other product. For startess, booze accounts for 100.000 deaths each year due to cancer, auto cnshes, liver cirrhosis, stroke, etc. According to the National ltutitute on Alcohol Abuse and Alcoholism, drinking is a fac- tor in half of all homicides and in three out of ten suicides. Alcoholism is a major cause of family violence, birth defects, workplace injuries and other tragedies. Cigarettes may kill more people, but alcohol ruins more lives, beginning even in grade-school years, and destroys millions of families. For can- didates who claim to be "pro-family," attention to alcoholism is mandatory. Thcdirect and indirect costs to society of alcohol problems total more than 5100 billion each year. By contrast, state and federal excise taxes on alcohol amount to only about S1S bil- lion. Should taxpayers be subsidizing the booze barons? Former Surgeon General C. Everett Koop's 1988 Workshop on Drunk Driving reported that raising excise taxes "could have the largest long-term effect on alcohol-impaired driving of all policy and program options available." The workshop recommended raising beer and wine taxes to equal the higher liquor rate and to make up for the inflation that since 1970 has severely eroded the value of tax revenues. The Koop workshop's recommendation would generate more than S16 billion in new revenues annually. Part of that sum could be applied to treating and preventing alcoholism, with the remainder funding critical health and social programs. But even if not one dime were appliedto alcohol programs, the higher prices caused by the tax hike would slash alcohol consumption by almost 10 pertxnt-and by even more among grade school and high school students. That's a lot fewer ca: crashes and teen pregnancies, less mental retardation and lower health care costs. While tax hikes are generally considered political poison, Michael F Jacobson is executive director of the Cenrer Jor Science in rhe Public Interest, a nonprofit organization based in Washingron. D.C polls show that the vast majority of Americans support higher alcohol and tobacco taxes. Any regressiveness could be cured by lowering income-tax rates for low-income families. On another front, a broad coalition, which includes groups ranging from the Christian Life Commission of the South- ern Baptist Convention to Public Citizen, from the National P.T:A. to the American Medical Association, is calling for reforms of alcohol advertising. With support from such un- likely bedfeUaws as Senator Strom Thurmond and Represent- ative Joseph Rennedy, the coalition is seeking legislation that would require health information in all alcohol ads. Curtent- ly. TV commercials imply'that beer is the elixir of health and key to social and sexual success, while magazine ads and bill- boards suggest that the road to economic sucoess is paved with empty liquor bottles. A concern for health must be factored into every aspect of a government's policies Beyond supporting higher excise taxes and restrictions on advertising, the presidential candidates should be calling for educational programs in schools and the mass media, univer- sally available treatment for alcoholism and other drug addic- tions, and the prohibition of alcohol purchases and alcohol advertising as tax-deductible business expenses (the last mas- urc alone would raise S2 billion annually). A s with alcoholic beverages, higher taxes and comprehen- sive educational campaigns could save billions in medical treatment for victims of tobacco smoke. In a 1998 referettdum. Californians voted to boost the state tax on cigarettes from 10 cents per pack to 35 cents. One-fourth of the revenua- 1115 miliion in 1991-was earmarked for tobacco research and aggressive antismoking campaigns. The result: Cigarette smok- ing declined by 17 percent between 19g7 and 1990, a far sharp- er decline than in any other state. One-third of California's quitters said the state's antismoking ads were the main reason they stopped. The Canadians, too, have gotten serious about smoking. They raised taxes so that an average pack now costs U.S.14.72, compared with 51.73 in the United States. As a direct result, 16 percent fewer Canadians smoked in 1991 than in 1990; a decline in lung-cancer, emphysema and heart-disease death rates will surely follow. Although Congress has voted modest increases in tobacco taxes, they barely keep up with recent inflation. Boosting the tax from the current 20 cents a pack to, say, $1.20 a pack would generate about S21 billion in needed revenues and cut smoking rates by more than 15 percent. Boosting the tax by S2 would still leave the price of a pack less than it is in Canada and bring iti more than $30 billion in new revenues. As for cigarette advertising, Congress has considered tighter restrictions, but without presidential leadership that notion has died a quiet death on Capitol Hill.

D xt is a third atea.vhete federal action could save untold lives and dollars. Fatty, salty diets ptomote obesity, dia- betes, stroke, heart disease and certain caneers. Those diet- related diseases cause hundreds of thousands of premature deaths each year. Surgeons perform about 400,000 oorottary bypass operations annually at a cost of tnore than S13 billion. If we really.ranted to cut health care costs we'd be better off training dietitians than surgeons. If more people followed a diet based on gtains, beans and vegetables rather than on meat, eggs and dairy products, we could save thotisands of lives and billions of dollars. But the federal government is doing precious little to convey that critical information to Amaiaas. President Bush's only comment on health and nu- trition has been to ridicule broccoli and carrots. The Agricul- ture Department now facilitates programs that enable the meat, dairy and egg industries to spend tens of millions of dollars each year on advertising and public-relations cam- paigns intended to boost sales. (The department also gave 5200 million last year to McDonald's, Gallo, Seagram and dozens of other companies to promote sales abroad of their sometimes less than salubrious products.) The government could be, but isn't, serving healthy meals to employees and others in government cafeterias, federal prisons, military bases, senior dtizat centers and school food programs. While the Food and Drug Adtninistration has sought to implement a law that would require better nutrition labeling on thousands of foods and that would cut down on diet-related illnesses, the food industry, with the help of Vice President Qttayle's Competitiveness Council, is seeking a one- yew delay. T he need to prevent serious health probletns ettends into many spheres of our lives and our economy. Wbrkas need to be far better protected from dangerous machinery and chemicals. Farmers need to be encouraged to reduce their use of dangerous pesticides, veterinary drugs and chemical fer- tilizers in order to safeguard their health and that of consum- ers. Manufacturing facilities and hazardous-waste dumps threaten the health of nearby communities. The life-saving Special Supplemental Food Program for Wontea, Infants and Children must be ettended to every needy mother and child. Childhood immunization campaigns, a fundamental aspect of public heahh, must be fully funded to reverse, for exam- p1e, the sixfold increase in measles cases that occurred between 1985 and 1989. Even more broadly, poverty itself correlates with poor health and must be eliminated. A concern for health must be factored into every aspect of a government's policies. All Cab- inet secrttaries, not just the Secretary of Health and Human Services, must realize that their actions can improNe or worsen the public's health. Yet the presidential candidates ate totally neglecting the pre- vention side of the health issue. It is certainly true that a disease-based economy provides thousands of jobs for physi- cians, nurses, advertising executives, ranchers, candy manu- facturers, tobacco growers, cigatrxte makers, btewets, viatne:s, broadristers, athletes, medicshquipment manufacturers and other potential political supporters. The long list of industries nourished by, and that nurture, Americans' pathogenic life style maloes it difficult for many political candidates to advocate cutting health cat+e costs by improving the public's health. PAC contributions speak loud- er than words. For instance, in the 1989-90 election cycle, alcoholic-beverage companies, trade associations and exec- utives doled out more than $2.8 million in the form of PAC contributions, honorariums and private donations to mem- ben of Congress. In 1991 Americans spent almost $738 billion on health. Thirty-six million of us lacked health insurance. We certainly do need to obtain universal insurance coverage and control skyrocketing costs of drugs, exorbitant doctors' bills, super- fluous operations and unnecessary insurance agents and bill collectors. But disease prevention is even more impottant, whether you're a cold-blooded economist concerned about the budget or a parent concerned about a child's health. Some individuals, without any encouragement from Uncle Sam, will discard their cigarettes, double cheeseburgers and liquor. But many millions more would do so-leading to a healthier pop- ulace and a healthier economy-if our political candidates and elected officials advocated policies that advanced the most sensible way to control the costs of illness: promoting health. 0