Indiana's tobacco control agency will remain largely intact as a division of the State Department of Health after being stripped of its independence in the state's upcoming budget, but supporters still worry about its future now that it's come under the direct political control of the governor's office.
The $28 billion, two-year budget bill signed earlier this month by Gov. Mitch Daniels abolishes the executive board of Indiana Tobacco Prevention and Cessation with the start of the new state fiscal year on July 1. Its assets and duties will be transferred to the State Department of Health.
ITPC Executive Director Karla Sneegas and Health Commissioner Dr. Gregory Larkin sent a letter May 11 telling local health departments Sneegas would remain in charge of the division as an assistant health commissioner.
"We're feeling much more positive than we did the day that budget passed," said Rev. Dan Gangler, co-convener of the Hoosier Faith & Health Coalition, an organization of 500 congregations and faith groups active in anti-smoking efforts and lobbying against cuts to tobacco-control spending.
Dr. Richard Feldman, a former state health commissioner instrumental in the creation of ITPC in 2001, said maintaining ITPC as a separate division within the health department is "the best scenario that could be achieved under a very bad situation."
Feldman said he met with Larkin to express his concern that ITPC no longer was independent, but the commissioner told him he was bringing over all of the ITPC staff, except for some staff that would be lost because of redundancies with the health department staff.
"The good news is Dr. Larkin is committed to tobacco prevention. I am sure Dr. Larkin is going to do his very best to maintain the very best program possible under these circumstances," Feldman said.
The budget bill provision culminated years of efforts to strip ITPC of its independence and make it a more integrated member of the state government bureaucracy and a decade of up-and-down funding for Indiana's tobacco-control efforts.
The General Assembly created ITPC 10 years ago with some of the initial proceeds from Indiana's $4.5 billion share of the tobacco industry's 1998 settlement with multiple state attorneys general over tobacco-related health care costs and illegal marketing to youth.
"It was done very purposely and deliberately for the purpose of protecting the tobacco control program from politics and the tobacco industry," Feldman said. Now, as part of the health department, he said it's "half a step away from the governor and the whims of the governor and the commissioner. ... The program is much more vulnerable to change, it's more vulnerable to future cuts."
Dr. Stephen Jay, a public health expert at Indiana University and longtime member of ITPC's executive board, said the tobacco industry now has a significantly greater ability "to meddle and fiddle and dilute out tobacco control in Indiana."
But Jay said keeping Sneegas onboard was critical, because her departure would have demoralized tobacco control activists and local public health workers. He said a top health official in a "major state" that he declined to identify had called him after the budget bill cleared the General Assembly to see if Sneegas would be available for a job there.
"Karla is extremely well respected by people all over the country," he said.
The health department provided a copy of the letter Commissioner Larkin and Sneegas sent to local health departments and a statement attributed to Larkin that repeated much of its contents, but had no additional comment on the ITPC transition.
Sneegas was out of town on a personal matter last week and unavailable for comment.
David Sutton, a spokesman for Philip Morris USA, the nation's top cigarette maker, said the company had no comment on ITPC's transition. However, he said Indiana should use the money it receives from cigarettes — more than $816 million in 2009 from the tobacco settlement and excise and sales taxes — on initiatives to prevent youths from smoking and the health care costs caused by smoking instead of diverting it to other purposes.
ITPC funding, as high as $32.8 million in 2003, fell to $10.8 million just a year later. Funding in the new budget bill is set at $8.1 million per year.
A fiscal impact statement on the budget bill by the nonpartisan Legislative Services Agency said moving ITPC into the health department "should result in minor savings to the state."
Jay said the transition of the agency should be seen in the context that Indiana has some of the lowest per-capita spending for health in the nation, obtains little health funding from the CDC and other federal agencies, and has relatively few front-line public health practitioners.
"It's within this context that many of us who have been around are worried about the $8-plus million budget — whether it's going to stay or whether it will be eroded or nibbled at," Jay said.
He said success will be measured by Indiana's smoking rates, whether it falls from its current 23 percent among adults to 15 percent or lower and to about 10 percent among high school-age youth.
"We will know fairly quickly if the machinery of Indiana Tobacco Prevention and Cessation is being carried forward," Jay said.