Back to Front PageVOLUME 6, NUMBER 4
 

Cheryl Healton, DrPH, President and CEO, American Legacy Foundation Professor of Clinical Public Health, Mailman School of Public Health, Columbia University

In November 1998 a coalition of attorneys general representing 46 states and five U.S. territories entered into a historic agreement with tobacco manufacturers to recompense states for costs incurred in treating those with tobacco-related illnesses.

The resulting Master Settlement Agreement (MSA) changes the landscape of tobacco control by limiting the exposure of minors to tobacco advertising and sales, providing significant funding to states and localities, and creating a new foundation to combat tobacco use in America. It will ultimately provide $206 billion to states over the next quarter century.

While the nation's medical schools already play a crucial role in both tobacco addiction research and the treatment of patients afflicted by tobacco-related illnesses, the settlement and its newly formed foundation provide additional opportunities for academic medical centers.

Specifically, the settlement creates partnership and funding prospects for improving tobacco-related curricula, designing prevention and treatment programs, and strengthening tobacco control activities. Together with the new American Legacy Foundation, medical schools have an unprecedented opportunity to squarely confront the one product (tobacco) and practice (smoking) that cause by far the greatest amount of preventable death nationwide.

The American Legacy Foundation, established by the settlement, is dedicated to educating the American public, especially its young people, about the risks of tobacco; reducing exposure to environmental tobacco smoke; and increasing the successful quit rate among tobacco users. To that end, the foundation receives $300 million per year and has a $200 million annual operating budget.

The foundation is a public charity with a board composed of elected officials and medical and public health leaders. For a full listing of the foundation's board members, visit www.americanlegacy.org.

To meet a broad, 11-point program mandate set forth in the MSA, the foundation has established nine scientific and program advisory panels; convened a series of special population forums to reach out to racial and ethnic minorities and those living in poverty; and undertaken a strategic planning process with broad input from various constituencies. Emerging from these advisory groups and forums will be comprehensive programs in the areas of counter-marketing, applied research and evaluation, technical assistance and training, and multiple grant opportunities.

The foundation has already established a highly visible counter-marketing program to prevent youth smoking. Dubbed "Truth," the effort is intended to create an alternative to smoking for young people by engaging them in a consumer protection effort against tobacco and heightening knowledge about the tobacco industry's marketing efforts. The campaign, largely developed by youth themselves and communicated through TV, radio, and print advertising, raises awareness concerning the health effects of smoking as well as its social consequences and addictiveness.

Academic medical centers, in concert with the foundation, can now play a larger role in public health approaches to population-based tobacco control; the routine availability of behavioral health interventions; and the extent to which tobacco use as a risk factor is comprehensively addressed in curricula, residency training, and continuing medical education.

The nation looks to medical schools and academic health centers to provide leadership in the formation of national health policy that ensures national health objectives for the year 2010 can be achieved. These objectives address not only specific morbidity and mortality targets, but also the importance of reducing disparities in health status across socio-economic and racial and ethnic groups.

We are enthusiastic about the many opportunities for collaboration which exist in the areas of curricula development on prevention, treatment, and public health strategies; development and promulgation of model treatment programs; design of novel reimbursement approaches to enhance the proportion of people who can access treatment; and applied research and evaluation partnerships that address a full range of questions about what works best in tobacco control.

The foundation has already released a joint request for proposals with the CDC to encourage the nation's academic research centers to become more engaged in tobacco research. These grant awards will provide one more venue for bringing interdisciplinary teams together to address tobacco control strategies.

We have also begun discussions with a broad range of groups on how public funds can be leveraged to encourage curriculum innovation in health sciences schools. Similar efforts to promote model smoking-cessation programs may also be initiated. We are certain that our joint efforts with the nation's medical schools can lead to considerable advances in the prevention of tobacco use and the treatment of nicotine addiction.

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