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DATE: February 16, 1999
TO: Board of Supervisors
SUBJECT: Reducing Smoking Deaths in San Diego County (Districts: All)

SUMMARY: Overview
In 1964, the Surgeon General determined that smoking kills. According to the Centers for Disease Control (CDC), 1,800 San Diegans die each year from smoking-related diseases. Smoking kills more people every year than alcohol, AIDS, car crashes, murders and suicides combined. Forty-six states, including California, have recently worked out settlements with the nation's major tobacco companies. As a result, San Diego County will receive nearly $945 million in tobacco settlement revenue by the end of 2025. The tobacco settlement revenue provides a remarkable opportunity to develop a healthcare-based policy that will reduce smoking-related illness, deaths and improve the health of children and families in San Diego County during the next millennium.

Recommendations
SUPERVISORS ROBERTS AND JACOB
Direct the Chief Administrative Officer to do the following:
1 Authorize the Director of the Health and Human Services Agency to work with representatives from the American Cancer Society, American Heart Association and the American Lung Association to develop a healthcare-based policy for expenditure of anticipated tobacco settlement revenue in San Diego County;

2. Receive input from the Regional Healthcare Advisory Council on the draft policy and bring back to the Board within 90 days;

3. Establish a Tobacco Settlement Trust Fund for receipt of anticipated tobacco settlement revenue; and

4. Assure that tobacco settlement monies will not be used to supplant existing health care revenue.

Fiscal Impact
There are no funds budgeted for this project. Projected tobacco settlement revenue is estimated at $11.57 million in FY 1998-99 and $30.9 million in FY1999-2000. Total estimate for San Diego County through 2025 is $945 million.

BACKGROUND:
Tobacco kills. According to the Centers for Disease Control (CDC), 1,800 San Diegans die each year from smoking-related diseases. Despite this fact, nearly 17% of San Diego adults still smoke. These deaths and their associated costs have not slowed the rate of smoking in kids. The 1997 Youth Behavior Risk Survey reports that smoking use by San Diego high schoolers has doubled since 1991. Smoking kills more people every year than alcohol, AIDS, car crashes, murders and suicides combined. This data strongly suggests that smoking is a major health problem requiring immediate attention. If we are to reverse the current trends, it will require the creation of a new policy that includes the application of sustained health care resources to reduce smoking-related sickness and death.

On November 16, 1998, the attorneys general of eight states (including California) and the nation's four major tobacco companies settled a number of pending lawsuits. More recently, 38 states have joined the settlement with the tobacco companies. Although the appeals process is ongoing and the federal government is likely to make changes, the tobacco settlement is imminent.

According to a January 14, 1999 report by the non-partisan, California Legislative Analysts Office (LAO), the projected tobacco lawsuit settlement for California will total $25 billion through 2025. Fifty-percent of these monies will go to the state and 50% will be distributed directly to local government. Of the local government allocation, 90% will go to the 58 counties and 10% will go to four cities (Los Angeles, San Diego, San Francisco and San Jose). That is, $12.5 billion will be distributed to California's counties over the next twenty-five years. Allocations are based on a variety of factors including population and cigarette sales.

The 1999-00 Governor's Budget assumes tobacco settlement revenue of $562 million. LAO projections for San Diego are $11.57 for FY 1998-99 and $30.9 million for 1999-00. By 2025, San Diego's projected revenue is $945 million. Due to pending appeals and ongoing negotiations with other states, the closest estimate for our first installment is sometime before June 30, 2000. In the meantime, it makes sense for the Board of Supervisors to develop a policy for how these funds should be used.

The tobacco settlement, in large part, has resulted from a long history of smoking-related deaths, and out of control health care spending on treatment and prevention. According to the most recent available figures (UCSF 1993), San Diego spends $788 million annually on smoking-related illness. That is, each San Diego County resident contributed nearly $300 of their hard-earned money toward the health care cost incurred by their fellow, smoking taxpayers. For these reasons, it is timely and appropriate to use tobacco settlement revenues to address the unmet health care needs of the San Diego community, especially those that will reduce the incidence of smoking-related sickness and death.

The American Cancer Society, American Lung Association and American Heart Association have provided commendable regional leadership on smoking prevention and treatment over the years. The purpose of this Board letter is to establish guidelines and a process to receive and appropriate the tobacco settlement funds that is inclusive and non-redundant. Specifically, this letter seeks Board approval to invite representatives from each of these groups along with the County's health officer to develop a healthcare-based policy that guide the Board on appropriating San Diego County's tobacco settlement funds.

The Regional Healthcare Advisory Council is an inclusive body of local health care stakeholders with a proven track record. It has been discussing regional health care issues since its inception, March 18, 1997 (1). There are numerous recent and ongoing studies analyzing various aspects of San Diego's health care system. In the report, Partners in Health: Report of the National Panel on Public-Private Strategies to Improve the Health of San Diegans, (February, 1998) several action plans were discussed to improve health care access, quality, efficiency and prevention. This report along with other resources will provide valuable, formative information. Other reports with valuable information include the Community Health Improvement Partners (CHIP) 1998 Community Health Needs Assessment and the San Diego County Child and Family Health and Well-Being Report Card. Using the RHAC and these resources will limit duplication of effort and provide a foundation of data that will help design a healthcare-based policy to guide Board appropriation of tobacco settlement funds.

Because of the RHAC's commitment to health care, their existing sub-committee structure and their history of advising the Board of Supervisors, it is further suggested that the proposed policy be reviewed by the RHAC before it is brought back to the Board of Supervisors.

Tobacco-related illness and death has major societal consequences. In 1964, the Surgeon General determined that smoking kills. Since then, many innocent teens started smoking only to become adults with significant tobacco-related disease. Many have since died. According to the CDC, at the current rate of smoking, over 22,440 San Diego children under eighteen will die from smoking. This is a tragedy that we can prevent. The tobacco settlement revenue provides a remarkable opportunity to reverse observed trends by designing a healthcare-based policy and instituting a process that will reduce smoking-related illness, deaths and improve health status of children and families in San Diego County during the next millennium. This Board can make a decision today to use these funds for their intended purpose - to improve the health and well-being of our residents.

We urge your support.

Respectfully submitted,

DIANNE JACOB
Supervisor, Second District

RON ROBERTS
Supervisor, Fourth District