Discussion—Committee and/or Public Comments
November 6, 2003: Public and Private Sector Roles in Tobacco Use Reduction
Christine Williams, M.Ed., Agency for Healthcare Research and Quality, referring to the situation in Massachusetts where tobacco control funding is being cut due to the state budget crisis, talked about the importance of building a strong business case in support of tobacco use prevention and cessation programs. Not only do these programs pay off in the long run, but there are also short–term savings from investment in tobacco cessation programs.
Dennis Richling, M.D., Union Pacific Railroad, mentioned the need to get the private payer community to view tobacco cessation as treatment for an addictive disorder rather than a preventive service. Dr. Carmona agreed with Dr. Richling's point, and talked about the "perverse incentives" in the healthcare system which favors treatment over prevention.
Aron Primack, M.D., M.A., Fogerty International Center, talked about the need to approach tobacco use not only from a medical perspective, but also from an educational perspective. (He recognized the Department of Education representative present at the meeting.) Liza Veto, Department of Education, introduced herself and talked about her role as one that was doing exactly as Dr. Primack suggested—translating what we think of as traditional public health messages into education messages.
Scott Leischow, Ph.D., National Cancer Institute, mentioned a collaborative project between NCI, the National Institute for Drug Abuse, and the National Institute on Alcoholism and Alcohol Abuse to develop more effective medications to treat tobacco dependence.
Dr. Carmona asked the committee to consider an issue that he has been involved with as Surgeon General which focuses on how to create incentives for prevention efforts and eliminate what he considers "perverse incentives" in our current health care system. Furthermore, he asked the committee to consider whether the responsibility for this shift should come from the private or public sector.
Timothy Condon, Ph.D., National Institute on Drug Abuse, acknowledged that he did not have an answer for Dr. Carmona, but talked about the stigma of addiction and how important it is to educate people about the differences in how addictive and other medical disorders should be treated.
Robert Mecklenberg, consultant with the National Cancer Institute, offered a comment about the need to consider the tobacco industry's influence, and how this had not been directly addressed by the committee.
Dennis Richling, M.D., Union Pacific Railroad, went back to Dr. Carmona's question regarding the need to reorient the healthcare system to provide incentives for preventive efforts. Dr. Richling believes that the business community accepts the importance of prevention, but is also faced with growing healthcare costs and the need to make difficult choices. He believes that national leadership through a public-private partnership could begin this process of change. Dr. Carmona responded by saying he is considering a future Surgeon General report focused on prevention.
Jonathan Samet, M.D., commented that there are models available for estimating health costs, but perhaps there is a need for tools that are easier to use to make these estimates.
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