Research

Between $3.3 billion and $28 billion in state health care costs would be saved over five years with a $1 tobacco tax increase, including 20 cents of the revenue going to reinvigorate the tobacco control program, their studies show.

The funding would ensure that smoking and health costs will continue to decline in California, easing the state's budget crisis while reducing tobacco-related diseases and costs to businesses. 

On Thursday (May 12), researchers from two UC campuses briefed state legislators and staff in Sacramento on new estimates of how such a tobacco tax increase would impact Californians' health and economy.

"The health and financial benefits of the tobacco control program in California speak for themselves," said Phillip Gardiner, social and behavioral sciences program officer at UC's Tobacco Related Disease Research Program. "Simply put, there are less people smoking, fewer people dying and billions of dollars in health care cost savings," he said.

Tobacco control efforts concentrate on educating the public through the media and promoting policies to protect Californians from secondhand smoke and counter industry promotion of tobacco use.

"In its first 15 years, the state tobacco control program reduced health care costs by as much as $86 billion," Gardiner said. "Since taxpayers pay a substantial amount of medical costs, the state's $15 billion deficit would be about $3 billion bigger without the program."

But inflation has eroded the effectiveness of the state's tobacco control program, while the tobacco industry continues to promote its products aggressively. That combination will reverse past progress, Gardiner added.

Smoking and smoking-related disease now are concentrated in some minority populations in the state and among the poor, Gardiner said. These groups require increased outreach to reduce their smoking and continue to cut the burden on state health care resources.

Smoking and exposure to secondhand smoke have an immediate effect on heart disease risk, UCSF's Stanton Glantz said at the Sacramento briefing.

"When somebody quits smoking, their heart is working better the next day," he said.  "That's why health care costs have fallen so fast in response to the state's tobacco control efforts."

Glantz is director of the Center for Tobacco Control Research and Education at UCSF. He has conducted seminal research linking secondhand smoke to heart disease and demonstrating that tobacco control programs reduce smoking and save lives.

Smokers are at significantly greater risk of asthma, chronic pulmonary obstructive disease and other respiratory diseases, Glantz said, along with the risk of low birth-weight infants. But all these risks start to drop quickly when people stop smoking or reduce exposure to secondhand smoke. Lung cancer also declines, but more slowly.

Glantz led a study projecting early $30 billion in state health care savings if the proposed cigarette tax increase is put in place. Some other estimates are lower, though still in the billions and comprise a sizeable portion of the state's current deficit.

"Given California's deficit, the important letter is ‘B' (as in billion)," Glantz stressed.

The long-term links between reduced smoking and lower cancer rates were presented by Karen Messer, director of the Moores UC San Diego Cancer Center Biostatistics/Bioinformatics shared resource.  She led a study that documented a significant decline in lung cancer death rates over a 10- to 15-year period due to reduced smoking after implementation of the Proposition 99 tobacco control program.

The degree of benefit may be all the more striking in coming years as a large proportion of baby boomers age, she suggested.

If tobacco control spending remains at the current level of five cents a pack, the program's spending power will continue to decline simply due to inflation, and smoking will increase over five years. This is the conclusion of a third study presented at the Sacramento briefing. But if funding is increased through the proposed tobacco tax, smoking prevalence will fall about 10 percent by 2016, according to study author Wendy Max, co-director of the Institute for Health and Aging at UCSF.

As a result of the increased funding and resulting smoking decline, her team's study projects a $3.3 billion drop in health care costs attributable to smoking over five years — lower than the projections by Glantz's team, but nonetheless a major savings in health, health care costs and state deficit.

The three studies were commissioned by the UC Tobacco Related Disease Research Program (TRDRP).

"The fact is that the state-funded tobacco control program has saved lives and money," concluded TRDRP's Gardiner. "Clearly though, health disparities remain a large issue, and should be addressed. New funding can overcome the loss to inflation and allow us to be as successful in the future as we have been for the past 22 years."