Michigan Steps Up

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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 Generals 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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On the Move and All Ears
U.P.
Mackinac Island
Traverse City
Cadillac
Bellaire
Saginaw
Muskegon
Flint
Grand Rapids
Lansing
Port Huron
Battle Creek
Kalamazoo
Detroit
Benton Harbor
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Governor Jennifer GranholmsState 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
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Where did we start?
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Step 1
Promoting Healthy Lifestyles
Prescription for a Healthier Michigan
Healthy Michigan 2010 Surgeon Generals Health
Status Report
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Healthy Michigan 2010Michigan Surgeon Generals
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
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Tobacco Use Michigan vs. United States
23.1
25.7
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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
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Healthcare Costs Premiums in Michigan

• Altarum Report Major Findings
• Michigans high rate of obesity, smoking,
  coronary heart disease death, and diabetes are
  most likely increasing healthcare costs and
  premiums
• Michigans 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

• Michigans 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 households annual
  smoking-caused tax burden is 532

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Economic Burden of Tobacco Use in
MichiganDirect 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 Granholms 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.saynotounfairta
  xes.com)
• The Alliance hired its own PR firm and conducted
  substantial oppositional media and advocacy
  activities

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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

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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

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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
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Source Lansing State Journal (online) 2 October
2004
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Source 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)
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Source Lansing State Journal (online) 7 February
2005
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Source 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

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Source Detroit News online 24 April 2005
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Step 2
Promoting Healthy Lifestyles
Prescription for a Healthier Michigan
Healthy Michigan 2010 Surgeon Generals Health
Status Report
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Prescription For A Healthier
Michigan
www.michigan.gov/gov
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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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Step 3
Promoting Healthy Lifestyles
Prescription for a Healthier Michigan
Healthy Michigan 2010 Surgeon Generals Health
Status Report
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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 WebsitePersonal Plan
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Michigan Steps Up WebsiteDaily Online Journal
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Michigan Steps Up Website Smoke-Free Resources

• Dependence Quiz
• Free Smokers 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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(No Transcript)
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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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Call to Action
Policy
Behavior
Environment
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Stakeholder Groups

• Business
• Schools
• Healthcare
• Faith-Based
• Community