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Prevention gets the short end of the stick

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Bob Parker was searching for the right word to describe the scenario facing smoking prevention activists late last week, as lawmakers went into final negotiations over the state budget. He finally found it: "ironic."

Parker, a member of the board of the state Health and Wellness Trust Fund--one of two trusts created with money from the national tobacco settlement--was dismayed that lawmakers were considering paying for a new cancer center at UNC-Chapel Hill by using health trust money to cover the debt.

"Why would you take prevention money and build a cancer center?" asked Parker, who is a vice president at North Carolina Baptist Hospital in Winston-Salem. "We can prevent thousands, if not tens of thousands, of cancers by using that same money to prevent teens from starting to use tobacco."

Despite signs earlier this month that lawmakers had moved away from the trust fund strategy, the $15.9 billion budget approved on Sunday includes a substantial list of "vital projects"--including the cancer center, a new cardio institute and pharmacy school at East Carolina University, and a wellness center at Western Carolina University--that will be paid for with "debt service" money from the two tobacco settlement funds. As a result, the amount of money the Health and Wellness Trust Fund will have left to spend on smoking prevention will drop from $35 million in fiscal year 2004-05 to $15 million in 2005-06, according to a fiscal note attached to the budget conference bill. A cap of 30 percent in 2006-07 and 65 percent in 2007-08 is designed to protect the fund's future grantmaking ability. (The cap was one of two concessions progressive lawmakers demanded in exchange for supporting the strategy. The other was that the share of debt service for the projects be borne equally by the two tobacco trust funds.)

This isn't the first time state legislators have looked to tobacco settlement money to pay for items they don't want to support with general fund revenues. Since they were created four years ago, the Tobacco Trust Fund, the Health and Wellness Trust Fund and the Golden Leaf Foundation have all been vulnerable to "raids," as one lawmaker privately described them.

What prevention advocates like Parker find particularly galling is that the Health and Wellness Trust Fund--the pool of tobacco money specifically aimed at curbing smoking--has already spent far less on that goal than on other politically-popular items. In its first year of operation, almost all of the trust fund's money went to pay for a prescription drug assistance program for the elderly pushed by Gov. Mike Easley and Lt. Gov. Beverly Perdue--the wellness fund's chair.

In the past two years, more Health and Wellness Trust Fund dollars have begun flowing to teen tobacco prevention. But the $10 million in grants the fund is now awarding annually to prevention remains far below the minimum $42 million recommended by the national Centers for Disease Control.

Arguably the most effective thing legislators can do to reduce teen smoking, prevention advocates say, is raise the state's cigarette tax. At 5 cents a pack, North Carolina has the second lowest tax-per-pack in the nation next to Kentucky.

Despite gathering some new supporters, that idea didn't go anywhere this session. "The statistics are that for every cigarette pack sold, the rest of the electorate pays $5.90 per pack in terms of health-care costs," says Pam Seamans, director of the North Carolina Alliance for Health. "But this is an election year and raising cigarette taxes is still a tax, even if it's a good tax that does good things for people."

Jennifer Weiss, a Democratic House member from Wake County, was among those who tried to keep the health trust fund from being tapped to pay for big-ticket budget items. But in the end, she says she ended up voting for the plan because it offered a way to address some unmet needs.

"How could I not vote for a cancer center or a juvenile youth center?" Weiss asks. "There's a lot of good in this bill. It's an economic development package, a health package. I am troubled, though, by the number of projects and by how we might be tying our hands for the future" by spending down tobacco trust funds.

Trust funds remain vulnerable to future legislative tampering. And the results of the just-concluded legislative session remind smoking prevention activists that their cause is still a very hard sell in the General Assembly.

"It's like proving a negative," says Peg O'Connell, chair of the health alliance's Excise Tax Committee. "If you say, 100,000 children will not become smokers if we fund prevention, how do you put your arms around that?"

As for ironies, "We in the prevention community know that money from the master settlement should be used for the prevention of smoking and smoking-related illnesses," she adds. "When you get to the place where you are using them only for treatment centers, you are only dealing with the illness."

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