michigan steps up kimberlydawn wisdom, md, ms michigan surgeon general national conference on...
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Michigan Steps Up
Kimberlydawn Wisdom, MD, MS Michigan Surgeon General
National Conference on Tobacco Or Health
May 5, 2005
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The Surgeon General’s Roles
• Serve as Chief Public Health Advocate
• Rebuild the Public Health System
• Develop public health policy
• Build collaborative partnerships
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United States Surgeons General
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Benton Harbor
Detroit
Grand Rapids
On the Move and All Ears
Cadillac
Saginaw
Flint
Traverse City
Kalamazoo
Bellaire
U.P.
Battle Creek
Muskegon
Mackinac Island
Port HuronLansing
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Governor Jennifer Granholm’s
State of the State AddressJanuary 27, 2004
Our Determination, Our Destination:
A 21st Century Economy
Photo: www.michigan.gov/gov ( courtesy of Gary Shrewsbury)
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Where did we start?
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Healthy Michigan 2010: Healthy Michigan 2010: Surgeon General’s Health Status ReportSurgeon General’s Health Status Report
Prescription for a Prescription for a Healthier MichiganHealthier Michigan
Promoting Promoting Healthy LifestylesHealthy Lifestyles
Step 1
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Healthy Michigan 2010:Michigan Surgeon General’s
Health Status Report
A description of priority health problems in Michigan
www.michigan.gov/mdch
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
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Tobacco Use Michigan vs. United States
25.7%
23.1%
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Causes of Preventable DeathMichigan Residents, 2003
MDCH, Vital Records & Health Data Development, SAMMEC 3..1
Deaths/Year
Tobacco kills more people in Michigan than AIDS, alcohol, auto crashes, fires, cocaine, heroin, murders and suicides- combined
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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)
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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
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Tobacco Climate in Michigan
•Tobacco Tax
•Weyco
•Smoke-free Legislation
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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
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Economic Burden of Tobacco Use in Michigan
Direct Health Care Costs
$4.35 $138.94
Price per pack Medicaid cost per person
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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
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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
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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.
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“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
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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
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Outcomes
• 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
The Good…
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Outcomes
• 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 unexpected…
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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
24Source: Lansing State Journal (online) 2 October 2004
25Source: Detroit News (online) 27 January 2005
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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?
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)
27Source: Lansing State Journal (online) 7 February 2005
28Source: MSNBC (online) 26 January 2005
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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
30Source: Detroit News online 24 April 2005
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Healthy Michigan 2010: Healthy Michigan 2010: Surgeon General’s Health Status ReportSurgeon General’s Health Status Report
Prescription for a Prescription for a Healthier MichiganHealthier Michigan
Promoting Promoting Healthy LifestylesHealthy Lifestyles
Step 2
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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
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Healthy Michigan 2010: Healthy Michigan 2010: Surgeon General’s Health Status ReportSurgeon General’s Health Status Report
Prescription for a Prescription for a Healthier MichiganHealthier Michigan
Promoting Promoting Healthy LifestylesHealthy Lifestyles
Step 3
Focus on physical activity, healthy eating, and
decreasing tobacco consumption
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Michigan Steps Up
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)
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www.michiganstepsup.org
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Michigan Steps Up Website:Personal Plan
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Michigan Steps Up Website:Daily Online Journal
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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
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Media Campaign
• Radio spots
• Print media
• Outreach through partnerships
• Media collaborations that enhance our message
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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
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PolicyPolicy
BehavioBehaviorr
EnvironmeEnvironmentnt
Call to Action
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Stakeholder Groups
Business Schools Healthcare Faith-Based Community