Indiana is one of the unhealthiest states in the country by almost any measure. It ranks among the states with the highest prevalence of lung and other cancers, obesity, diabetes and most chronic diseases.
Our state’s infant mortality rate is eighth-highest, and our 13.5% maternal smoking rate is well above the national average. Indiana’s overall health ranks 12th-worst in the country. Meanwhile, the Hoosier state ranks 49th-lowest in public health funding.
The Hoosier adult smoking rate is 10th-highest, at 19.2%; the national rate is 13.7%.
Our cigarette tax is 38th-lowest, at 99.5 cents per pack, and has not been raised since 2007. Surrounding states have higher per-pack cigarette taxes: Wisconsin’s is $2.52; Michigan’s, $2; Illinois’, $2.42; Ohio’s, $1.60; and even the tobacco state of Kentucky maintains a tax of $1.10.
What a pathetic situation.
Indiana’s finances are stressed, and the crafters of our state budget are looking for funds to replace decreased revenue caused by the pandemic. What better time to increase the cigarette tax to improve Hoosiers’ health and the workforce and business environment?
There will be non-health-related proposals on uses for revenue from an increased cigarette tax. But there must also be consideration for additional funding for public-health-related purposes, including opioid treatment, increased programming to reduce infant mortality, added support for the expanded Medicaid program and the Healthy Indiana Plan, and increased funding of the state’s tobacco-prevention and -cessation programs.
Once funded at $35 million a year, tobacco-control programs are now allocated only $7.5 million, which is insufficient to affect the needed reduction in tobacco use. This is especially true for our children who continue smoking and vaping their way into lifelong nicotine addiction and eventual premature death. The COVID crisis compels us to also address the dire need for bolstering state and local health department infrastructure and crisis-preparedness capacity.
Despite the great advances in tobacco control in the past half-century—even in Indiana—tobacco is still our greatest public health challenge, continuing to be the leading cause of preventable disease and premature death.
The Hoosier state is mired in the human and economic losses due to tobacco use. One in five Hoosiers dies as a result of smoking (11,000 yearly), while 4,100 kids start smoking every day.
Tobacco use results in $7.6 billion in state losses yearly in health care costs and lost productivity. This includes $590 million in state Medicaid costs and an additional cost of $5,800 yearly to businesses and industries for each employee who smokes.
An unhealthy workforce is a drag on business and a barrier for economic development.
Increasing the tax by $2 per pack would generate $360 million in the first year and $2 billion over five years. That’s not chump change for a state budget in COVID-19-induced financial strain.
We know that raising the cost of tobacco is the single most effective strategy in reducing tobacco use. For every 10% increase in the cost of a pack of cigarettes, smoking is reduced about 7% in children and 4% in adults. A $2-a-pack increase would induce 142,000 smokers to quit and would save a portion of the 151,000 children alive today who are anticipated to eventually die prematurely from smoking-related diseases.
Will we finally increase the cigarette tax this legislative session? It would be big medicine for Indiana’s health and economics.•
Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon.
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