BODY WATCH : State health chief Kimberly Belshe has her share of critics. They railed at her opposition to an anti-smoking initiative. Now it’s her proposed use of agency funds. But tough times, she says, call for . . . : Tough Choices

Kimberly Belshe strides through the day-care center in Irvine and spots a group of tots munching on raisins.

“That’s good!” praises the tall woman in the red blazer as she wags a finger, mommy-style. “Eat your five a day.”

“Five a day” is the state’s campaign to encourage Californians, big and small, to eat at least five servings of fruits and vegetables a day.

And while the 3-year-olds don’t give a raisin that this advice comes from the director of the state Department of Health Services herself, something about Belshe’s manner causes them to turn and peer quizzically at her.

Later this day, at the Sporting Club in Irvine, she presides amiably over a group of older schoolchildren who are building the world’s largest salad as part of an American Cancer Society event on healthy eating.

The new director of the DHS has a way of getting people’s attention, no matter what their age--although with adults, Belshe has had to put up with some back talk.

Since Gov. Pete Wilson appointed the 34-year-old to direct the DHS in November, Belshe has had to defend herself repeatedly against a firestorm of criticism questioning her position on the state’s anti-smoking campaign and her job qualifications--she is not a physician.

Formerly the deputy secretary of the Health and Welfare Agency, Belshe (pronounced Bel-SHAY) is known in Sacramento as a straightforward and smoothly professional administrator. But she has kept a low profile in her first six months on the job, either because of her massive workload as chief of the 5,000-employee department or the opposition her appointment triggered.

Now, with her recent Senate confirmation, Belshe is ready to talk about her agenda--and the item on her resume that threatened to derail her nomination.

While at the San Francisco public relations firm Ogilvy and Mather six years ago, Belshe helped the tobacco industry oppose Proposition 99, the landmark 1988 anti-smoking initiative that increased the tax on cigarettes.

This little factoid floored observers when it came to light in November and led some health leaders to charge that Belshe would be unable to reconcile her past position with her current duty to lead Californians to better health.

During a lengthy interview, Belshe does not shy away from addressing this paradox. She even sighs with some relief: “It’s so nice to actually be asked that question.” Her critics, she says, have not bothered to give her the opportunity to explain.

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It’s like this, Belshe says: She worked at Ogilvy and Mather for only a few months after finishing grad school. She wasn’t working directly for the tobacco industry, but in a lobbyist role for a coalition, including the Republican Party and the California Taxpayers Union, which opposed Proposition 99. She is a nonsmoker who dislikes smoking and thinks that it’s bad for your health. But she viewed Proposition 99 as a tax initiative, not a health initiative.

She says her thinking about Proposition 99 has evolved considerably since 1988, and she now praises the initiative.

She is not, she states emphatically, a tobacco-industry sympathizer who is insincere about her public health agenda.

“What I say to folks when this issue comes up--and it’s rarely acknowledged--is I would hope that my commitment to educating the public about the adverse consequences of smoking . . . be judged not on a three-month stint working for a public affairs firm but be based upon my demonstrated record while in positions of authority over the course of the past 3 1/2 years.”

Belshe is angered that her sincerity is questioned even now.

“My critics point out that it is just unconscionable that I could have done public affairs work opposing the tax initiative,” she says. “That inference I find extremely disconcerting because it’s really questioning my integrity, when if anything, I think I have demonstrated over the last three years (as deputy secretary) that I am someone with a lot of honesty and openness.”

Proposition 99, which taxes cigarettes to raise money for anti-smoking education programs and media campaigns, is recognized by many as one of the most ambitious, innovative and successful public health campaigns in the nation. It is credited with reducing the number of adult smokers in the state by 28%.

Recently, however, a debate has arisen about how to spend the Proposition 99 revenues (which usually amount to about $700,000 yearly) under a reauthorization the bill. Anti-smoking proponents charge that the Wilson Administration wants to divert a significant share of the funds to other health programs instead of anti-smoking programs and that Belshe--again under fire--supports this.

Says Mark Pertschuk, co-director of the Berkeley-based nonprofit group Americans for Nonsmokers Rights: “There are two things we would have wanted from Belshe. The first is a clear, public statement that (her 1988 opposition to Proposition 99) was a mistake. And the second is an opposition to the diversion of funds from Prop. 99, which she has supported. We consider that a violation of the voters’ will and an extremely bad public health policy.”

Other anti-smoking leaders say they believe that Belshe will support whatever Wilson wants, even if it is not in the best interest of public health goals.

“Belshe may be privately committed (to anti-smoking efforts), but I don’t feel this Administration is,” says Carolyn Martin, an American Lung Assn. volunteer and vice chairman of the Tobacco Education Oversight Committee, which reports to the Legislature on anti-smoking programs.

“This Administration has procured a budget that decimates the smoking education program. This is the premiere prevention program in the United States, and we are on the brink of extinction. We need strong, courageous leadership, and whether (Belshe) has the courage to publicly question some of Wilson’s decisions, I can’t tell you.”

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The controversy thrusts Belshe into a debate on how important anti-smoking programs are in comparison to the other state health programs competing for funding, such as immunization, control of tuberculosis, school-based health programs, HIV prevention and treatment, sexually transmitted diseases, violence and health screening for low-income children.

Belshe says these are all high-priority programs and she supports Wilson’s proposal to share the Proposition 99 funds. “Arguably, all of the programs funded by (Proposition 99) moneys are being used in a manner consistent . . . with the initiative overall,” she says. “What this whole debate boils down to, from our perspective, is a very very difficult decision we have to make in terms of balancing competing public health priorities.”

But it’s in this difficult context that friends and colleagues say Belshe shines.

She is known as someone who can bring opposing factions together in pursuit of a compromise. And she has a reputation for her ability to make hard choices while withstanding the heat.

“She listens very closely to both opposing and supporting arguments about policy decisions,” says her good friend and former colleague Kassy Edgington Perry, now with Greenbaum Public Relations in Sacramento.

“She is not an ideologue in a sense that ‘this is the conservative way to do this.’ Yet at the same time, she is very tough about what she believes in.”

Belshe’s smooth passage through her confirmation hearings reflects the respect lawmakers have for her administrative abilities, says Assemblyman Phil Isenberg (D-Sacramento).

Belshe “understands policy implications intuitively. And she is not a bureaucrat,” Isenberg says. “That does not mean I agree with everything she does. But she does not come up with reams of paper and a cadre of excuses in order to say, ‘Nothing can be done.’ And in government, believe me, that’s rare.”

Belshe also comes across as fun-loving and good-natured. A fifth-generation San Franciscan, she is an athlete who loves tennis, golf and workouts at the gym.

“I think it’s important for the health director to set a good example,” she says.

She is single, and although she puts in long hours--at a salary of $95,052--she argues that she is not, by nature, a workaholic.

“If I continue to work these hours, I will probably always be single,” she says with a laugh. “People say, ‘How do you like your job?’ I say, ‘I love my job. I hate my personal life.’ ”

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Belshe was attracted to politics early on, majoring in government as a Harvard undergraduate. She became interested in health care economic issues while pursuing her master’s in public administration at Princeton.

A thin woman with a no-nonsense short haircut and soft brown eyes, Belshe says she must rely heavily on the physicians in her department for guidance on some issues. Most DHS directors--such as her predecessor, Molly Joel Coye--were medical doctors. (Coye resigned to take a job in the private sector).

But Belshe contends that some of the biggest decisions for the department today are fiscal ones. The Proposition 99 funding controversy is typical of the hard choices that must be made by the state’s leaders in an era of shrinking budgets and fiscal crisis, she says.

“That truly has been the biggest challenge: How do you structure innovative and creative and compassionate solutions to what are clearly some very, very compelling problems in the health care arena at the same time you are enacting millions and millions and millions of dollars in reductions? It hasn’t been easy.”

Belshe has made health care reform a top priority, continuing Coye’s work to restructure MediCal into a more cost-effective, managed-care plan.

She also emphasizes prevention, such as immunization programs and an ambitious program to reduce teen pregnancies, Education Now and Babies Later.

Finally, Belshe says, the state has worked diligently to thwart a resurgence of tuberculosis.

Yet, she differs from many public health leaders when it comes to spending money on undocumented immigrants, taking the hard line that the federal government--and not the state--is responsible for health care of undocumented people. For example, the state recently cut a program to provide prenatal care to undocumented women.

Except for emergency care and efforts to limit the spread of communicable disease, Belshe says undocumented immigrants should be denied services from the state.

“The bottom line? Tough budget times, tough choices,” she says.