In Midst of a Health-Care Crisis, Tobacco Ads Blow a $16-Million Smokescreen

<i> Joseph Van Der Meulen is the vice president for health affairs and Robert Tranquada is the dean of the School of Medicine at USC</i>

The passage of Proposition 99, the Tobacco Tax and Health Protection Act of 1988, would provide substantial public-health benefits to California. By increasing the tax on cigarettes to 25 cents a pack (about $7.50 a month for a pack-a-day smoker), the state would raise an estimated $650 million annually, much of which would go to enhance the ability of health-care providers to deliver services to the poor or uninsured.

Twenty percent of this money would be earmarked for preventive educational programs to teach young people and adults about the dangers of tobacco use. Another 5% would go for needed research on tobacco-related diseases, including cancer. But a major portion of the money--about 45%, or an estimated $300 million--would be allocated to medical and hospital care and treatment for people who cannot afford to pay for these services.

Unfortunately, the tobacco industry has chosen to obscure the purposes of this initiative through a $16-million campaign of sly and grossly misleading innuendo. The industry, from behind the facade of “Californians Against Unfair Tax Increases,” has attacked Proposition 99 by insinuating in a series of slick television and radio commercials that the measure is supported by greedy doctors who hope to profit from it.

Anyone who has attended the parade of human distress at a place like County-USC Medical Center, for example, knows what a cynical argument that is. The health-care workers, nurses and physicians, who are concerned for real people with real ailments, are well aware of the true nature of the challenge facing health-care providers to the disadvantaged.


That challenge is enormous. More than 5 million Californians are without health insurance--a problem touching on virtually every economic and social level of our lives. The problem is worsening because local governments, including Southern California counties, have been increasingly forced to restrict their funding of health care. The director of Los Angeles County health services, Robert Gates, has proposed cutting 147 beds from the General Hospital at County-USC, reducing care at the Women’s Hospital and closing the Pediatrics Pavilion in addition to shutting down the entire Harbor-UCLA Medical Center.

What does all this have to do with tobacco and smoking? A lot. More than 30,000 people in California die each year from tobacco-related illnesses. A disproportionate number of these come from low-income or minority groups, many of whom rely on public-health services for medical care. These are also the very groups specifically targeted by tobacco-industry advertising and promotion. More than half of all deaths among blacks, for example, are caused by the major smoking-related diseases.

Not only has lung cancer become the No. 1 cancer killer of women, but smoking is also related to the rate of miscarriages, affects fetal growth and results in a higher rate of fetal and neonatal deaths than among nonsmoking women. Revenues from Proposition 99,by making medical care available to those without insurance, would provide important information to women about the dangers of smoking and its effects on their unborn children.

Anti-smoking education does work. Funds provided by Proposition 99, an estimated $130 million annually, could keep hundreds of thousands of children from smoking. Sixty percent of smokers start before age 14, but the Centers for Disease Control in Atlanta reports that delaying the onset of cigarette smoking has been a particularly effective form of behavioral change. The USC School of Medicine’s Institute for Prevention Research has been involved for years in a successful smoking-prevention program that has traveled to junior and senior high schools across the country.


Tobacco use costs the California economy more than $6 billion a year in health care, lost productivity, higher insurance premiums to subsidize smokers and destruction by fires caused by cigarettes. That comes to $2.17 for each pack of cigarettes smoked.

The tobacco industry might have gained more credibility by donating the $16 million used for its advertising blitz to the cause of public health rather than buying commercials that malign the very people who are trying to do the job.