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Michigan Steps Up. Kimberlydawn Wisdom, MD, MS Michigan Surgeon General National Conference on Tobacco Or Health May 5, 2005. The Surgeon General’s Roles. Serve as Chief Public Health Advocate Rebuild the Public Health System Develop public health policy
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Michigan Steps Up Kimberlydawn Wisdom, MD, MS Michigan Surgeon General National Conference on Tobacco Or Health May 5, 2005
The Surgeon General’s Roles • Serve as Chief Public Health Advocate • Rebuild the Public Health System • Develop public health policy • Build collaborative partnerships
U.P. On the Move and All Ears Mackinac Island Traverse City Cadillac Bellaire Saginaw Muskegon Flint Grand Rapids Lansing Port Huron Battle Creek Kalamazoo Detroit Benton Harbor
Governor Jennifer Granholm’sState of the State AddressJanuary 27, 2004Our Determination, Our Destination: A 21st Century Economy Photo: www.michigan.gov/gov ( courtesy of Gary Shrewsbury) Physical Health = Fiscal Health
Step 1 Promoting Healthy Lifestyles Prescription for a Healthier Michigan Healthy Michigan 2010: Surgeon General’s Health Status Report
Healthy Michigan 2010:Michigan Surgeon General’s Health Status Report A description of priority health problems in Michigan 10 leading health indicators chronic disease, lifestyles, tobacco, substance abuse, mental health, maternal and child health, immunizations, injuries and violence, healthy environments, and infectious and emerging diseases www.michigan.gov/mdch
Tobacco UseMichigan vs. United States 23.1% 25.7%
Causes of Preventable DeathMichigan Residents, 2003 Tobacco kills more people in Michigan than AIDS, alcohol, auto crashes, fires, cocaine, heroin, murders and suicides- combined Deaths/Year MDCH, Vital Records & Health Data Development, SAMMEC 3..1
Healthcare Costs & Premiums in Michigan Altarum Report: Major Findings • Michigan’s high rate of obesity, smoking, coronary heart disease death, and diabetes are most likely increasing healthcare costs and premiums • Michigan’s per capita use of prescription drugs is high • Michigan employees are likely to choose family coverage • Michigan employers pay a greater share of the premium/cost of health insurance (especially for families)
Healthcare Costs & Premiums in Michigan Altarum Report: Recommendations • Expand current state efforts to encourage healthy tobacco-free lifestyles, prevent disease, and promote health • Reform insurance industry structure to regulate the extent to which companies can vary premiums • Reduce prescription drug expenditures • Increase federal reimbursement for low-income populations
Tobacco Climate in Michigan • Tobacco Tax • Weyco • Smoke-free Legislation
The Economic Toll of Tobacco in Michigan • Michigan’s total smoking costs, including health care costs and productivity losses, are more than $6 billion annually • 16% of all Medicaid expenditures are spent on smoking-related illnesses and diseases-$881 million • The cost to Michigan for every single pack of cigarettes sold equates to $7.70 in medical care costs and lost productivity • The average state household’s annual smoking-caused tax burden is $532
Economic Burden of Tobacco Use in MichiganDirect Health Care Costs $4.35 $138.94 Price per pack Medicaid cost per person
Governor Granholm Provides Leadership In Raising the Tobacco Tax Public Message: We have an opportunity and a responsibility to protect children from cigarettes, and to help others to quit, while raising revenue for the state budget. Increased revenue is designated for health care programs. This is one tax that the citizens of Michigan can choose NOT to pay. Image Source: www.michigan.gov
Governor Granholm’s Proposal • Increase the Cigarette Tax 75 cents • Conservatively, this will raise $295 million • The first $30 million goes to public health prevention programs, including tobacco cessation, chronic disease prevention and maternal and child health programs • $265 million goes to Medicaid
Legislative Action A Republican lawmaker introduced HB 5632, March 10, 2004 • Proposed a $.75 tax increase on cigarettes, from $1.25 to $2.00/pack • Proposed tax increase on other tobacco products from 20% to 32% of the wholesale price. • 7.275% of the increase is earmarked for the Healthy Michigan Fund; a portion of this would support tobacco reduction and prevention programs.
“Hike It for Health” Campaign Education and Advocacy • March 21, 2004 – Poll results on Tobacco Tax Survey (600 registered voters) were released • Resolution of Support – available on the website • April – June 2004, community meetings were held with lawmakers in their home districts • PowerPoint presentation for public distribution
Opposition Tactics • The Michigan Business Alliance for Fair Taxes was formed to oppose the tax increase initiative • Key members of the Alliance included the tobacco industry, chamber of commerce, and retailers and grocers (The website is still active: www.saynotounfairtaxes.com) • The Alliance hired its own PR firm and conducted substantial oppositional media and advocacy activities
Outcomes The Good… • The $.75 tax was approved by the legislature in May and June, signed by the Governor and went into effect July 1, 2004 • A 32% excise tax was imposed on other tobacco products, excluding cigars • Cessation rates are up – quitline calls are up six fold • Tobacco sales are down • Medicaid budget benefited from increased funding
Outcomes The unexpected… • The bill was initially defeated in the Senate; compromise was needed on allocation of revenues • The new law provides that until October 2005, all tax increase proceeds go to the Medicaid Fund • On October 1, 2005, 75% of the proceeds go to Medicaid with the remaining 25% earmarked for the General Fund • Prevention programs were funded at $12M rather than the the $30M proposed by the Governor • Michigan Steps Up campaign added tobacco cessation/ prevention as a major theme
The Weyco Case • Medical benefits company based in Okemos, Michigan (just outside of Lansing) • In January, 2005 the company terminated 4 employees after they refused to submit to a smoking breath test in light of the company's new policy that bans tobacco use • A media frenzy followed…… We are saying people can smoke if they choose to smoke. That's their choice….But they just can't work for us." --Gary Climes, Weyco's chief financial officer Source: Detroit News (online) 27 January 2005
Weyco Inc. made a rule that everyone who is going to work at Weyco has to be a nonsmoker. Employees can't smoke at work or at home, not even on vacation. Weyco will test employees to make sure they are not smoking. I think Weyco's rule is unfair. It is true that one of our core democratic values is common good. This rule helps keep insurance costs down. That's good for everyone. However, smokers give up their right to smoke, even at their homes. Weyco can't go around testing employees and invading their privacy. What about people who are overweight? Is Weyco going to make a rule about them, too? I believe this rule is not fair because the smokers have to give up their right to smoke at work or anyplace else. The individual's rights are, in this case, more important. (written by an eighth grade student) I have read several opinions in favor of the Weyco's firing of employees for smoking. How can one possess such tunnel vision? Yes, smoking is bad, so is high cholesterol, eating fast food, etc. Constitutional rights are not rights if a citizen is denied them. I know, smoking is not a constitutional right, but the pursuit of happiness is, which is hard to accomplish when being fired for a legal activity outside the workplace. I hope people in favor of Weyco live not only as good citizens but like saints, in which case they could still end up being fired - maybe for praying at home?
Smokefree Legislation • Bills introduced on April 19, 2005: • SB 394 (Sen. Ray Basham, D-Taylor)/HB 4624 (Rep. Barb Vander Veen, R-Allendale): Amend the Public Health code and ensure that all restaurants and bars in Michigan are smokefree • SB 395 (Sen. Tom George, R-Kalamazoo Twp)/HB 4625 (Rep. Brenda Clack, D-Flint): Prevents smoking in all other Michigan workplaces • Opposition from Michigan Restaurant Association, Michigan Licensed Beverage Association, others • Over 3500 smokefree restaurants and eateries in the state of Michigan
Step 2 Promoting Healthy Lifestyles Prescription for a Healthier Michigan Healthy Michigan 2010: Surgeon General’s Health Status Report
Prescription For A Healthier Michigan www.michigan.gov/gov
Prescription for a Healthier Michigan Components: 1) Strategic Priorities • Promoting healthy lifestyles • Protecting families • Protecting communities • Eliminating health disparities 2) Recommendations http://www.michigan.gov/mdch
Step 3 Promoting Healthy Lifestyles Prescription for a Healthier Michigan Healthy Michigan 2010: Surgeon General’s Health Status Report
Focus on physical activity, healthy eating, and decreasing tobacco consumption
Goals: Build community capacity Share resources Reduce health risk factors Improve health outcomes Campaign Components: Website Media Campaign Healthy Lifestyle Challenges Stakeholder Groups Other (e.g. Seeking grants for a community component and other projects) Michigan Steps Up
Michigan Steps Up Website: Smoke-Free Resources • Dependence Quiz • Free Smoker’s Quit Kit • Nicotine Replacement Information • Help for Talking to Kids About Tobacco • Smoke-Free Dining Guide
Media Campaign • Radio spots • Print media • Outreach through partnerships • Media collaborations that enhance our message
Healthy Lifestyle Challenges • Legislative Health Challenge • Walk by Faith Challenge • Public Health Steps Up • Promote the Quitline • Work with local businesses to promote smoke-free worksite policies
Call to Action Policy Behavior Environment
Stakeholder Groups • Business • Schools • Healthcare • Faith-Based • Community
