Only five percent of money states recently received from a landmark tobacco settlement is headed for anti-tobacco efforts, a report finds. But 36 percent is headed for health care costs. Which is the wiser long-term public health investment?

Only 5 percent of a multibillion-dollar settlement between states and tobacco companies is going towards smoking prevention efforts, a report finds. Officials who negotiated the settlement expected much of the money would go toward anti-smoking efforts. State attorneys general who negotiated the more-than-$200 billion settlement in 1998 expected the money to compensate the states for years of smoking-related health expenses. But a report by the National Conference of State Legislators finds states plan to spend more than half of already-paid settlement money during fiscal years 2000 to 2002 in ways unrelated to smoking. "They act like this money just fell out of heaven or something," said Michael Moore, attorney general of Mississippi. "There's no connection between the way they're spending this money on highways or tax cuts or whatever the political whim of the day is, and the public health fight that we the attorneys general of this country fought." States Spending on Health Care According to the Associated Press, the report found that of the $21 billion being paid out during that period, 36.1 percent had been set aside for health care, 26.0 percent went to bolster endowments or state budget reserves, 9.5 percent was to be spent on schools or youth programs, 5.0 percent was to go into tobacco prevention and 4.5 percent was to be put into research. Smaller percentages were slated for other areas. Only a handful of states, including California, Maine, and Florida, have dedicated sizable amounts of their settlement to smoking prevention, such as mass-media campaigns. The vast majority have allocated very little. And four states, Alabama, Arizona, Michigan and Tennessee, have allocated none. Lee Dixon, director of the National Conference of State Legislatures' Health Policy Tracking Service, said for the most part the states are spending the money wisely. "We're really seeing about two thirds of the dollars go towards primary health care services and that really is the overall umbrella structure that legislatures, governors, and attorney generals were looking for when they got into trying to get the settlement negotiated back in 1998," Dixon said. "The master settlement agreement does not have any strings. The states can use these dollars as they see fit." Tobacco Opponent Still Fighting But Peter Fisher, assistant director of advocacy for the Campaign for Tobacco-Free Kids, said that's not good enough. "We're not going to give up on this," he said. "We're still hopeful we can persuade the states to fund these programs. This is the number one cause of preventable death in the country and it needs to be addressed. "If you invest in tobacco use prevention, you will not only save money in health care costs over the long term, but obviously that then would help with the overall budget situation," he added. "We don't claim that all the money should be spent on tobacco prevention. There's more than enough money in our view to do a good comprehensive job on tobacco prevention first, and then address all the other needs." The federal Centers for Disease Control and Prevention has suggested that 20 percent of the money should go toward tobacco prevention programs in order to effectively cut related health costs in the future. Dixon said the states have spent more than a billion dollars on smoking prevention. "The Centers for Disease Control, … the federal program that funds tobacco prevention, … that $1.1 billion is three times what they spent over the same period of time," Dixon said.

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