JEFFERSON CITY - Where's the best place to throw a pebble into a lake so that it makes the most waves? That was the question before Missouri's Health Department with the money it received for prevention of tobacco use.
Missouri has received two-thirds of a $1 billion from the settlement with big tobacco companies, but less than $1 million of that was given to the Health Department for tobacco use prevention.
By contrast, in estimates released by the federal Centers for Disease Control, the tobacco industry spends $222.3 million marketing products to Missouri.
Deborah Markenson, administrator of the department's Health Promotion section, said the department had planned to form several prevention programs with the $22.1 million that had been budgeted for the department during 2002. However, most of the money was redirected to make up for the state government's budget shortfall, so the Health Department received only half a million dollars.
Rep. Vicky Riback Wilson, D-Columbia, said that the use of settlement funds for the deficit was necessary.
"If we weren't able to use that money, we would have had to reduce the programs, the few programs, that we do have even more," she said.
Since the Health Department's $500,000 portion would not start a new program, Markenson said the department chose to use the money it did receive to help community based prevention programs.
The department ran a community-level survey that tracked several health risks in all of Missouri's counties. The survey of 15,000 Missourians contained questions not only about smoking habits, but issues such as diabetes, asthma and cholesterol levels.
Using the numbers it compiled in 2003, the department is putting together what it terms a "Comprehensive Tobacco Use Prevention Program" document to aid community based programs to more effectively combat tobacco use.
Markenson described the strategy as "going forward with pieces that do not cost us money, moving forward and providing technical assistance to communities to do policy based strategies."
One example of these strategies would be pushing for legislation that prohibits secondhand smoke in public areas.
Missouri consistently remains one of the top 10 smoking states. According to state Health Department estimates, 10,300 Missourians die prematurely due to tobacco every year.
Despite state and local efforts, Missouri seems to be gaining no ground. The state has seen no changes in smoking rates for men, women or youth. Janet Wilson, chief of the department's Health Promotion Unit, said changes have been negligible.
"From year to year over the last 10 years or more, the adult prevalence has been rather stable," Wilson said. "It hasn't changed significantly either up or down."
Rep. Chuck Purgason, R-Howell County, said that the main factor for not providing funds for prevention was lack of concern for the tobacco issue.
"Basically the tobacco settlement is not going where it's intended, nor do I ever think it will," Purgason said. "There's too much of a desire to fund pet programs than to actually go by what the tobacco settlement is all about."
Wilson said she would like to see money used for tobacco prevention, but noted the difficulty in determining how state funds should be used.
"There's always a tension between wanting to make the investment for long-term saving and long-term health versus having to pay for mandated or necessary costs at the present," Wilson said. "That's a very difficult balance."
Missouri began receiving money from the 1998 Master Settlement Agreement in 2001. The settlement should bring Missouri $4.5 billion from big tobacco companies over 25 years.