Overview of Cancer Health Policy Landscape Erica Palmer Smith Government Relations Director, Kentucky American Cancer Society Cancer Action Network

I’m sure I don’t need to outline the importance of tobacco control for reducing the rate of lung cancer in Kentucky, but I’d like to take a moment before going into specific policy issues to take a quick look at this slide from the CDC. 50 Years of Death. It really underscores how vital it is to make sure that proven tobacco control policies are always at the core of our work. Kentucky has the highest rate of cancer, the lung cancer incidence rate, the highest lung cancer mortality rate, and the highest rate of smoking-related cancer deaths in the nation. Not surprisingly, we have the second highest adult smoking rate in the nation… and a youth smoking rate that rivals the national adult average.

The Three-Legged Stool: Evidence-Based Policies that Work Tobacco Taxes Smoke-Free Laws Cessation and Prevention Policies

Tobacco Taxes #43 National Avg: 1.69

Tobacco Taxes Projected Public Health Benefits for Kentucky from a $1.50 Cigarette Tax Rate Increase Percent decrease in youth (under age 18) smoking: 16.8% Youth under age 18 kept from becoming adult smokers: 34,900 Reduction in young adult (18-24 years old) smokers: 7,300 Current adult smokers who would quit: 44,100 Premature smoking-caused deaths prevented: 22,200 5-Year reduction in the number of smoking-affected pregnancies and births: 8,900 5-Year health care cost savings from fewer smoking-caused lung cancer cases: $7.98 million 5-Year health care cost savings from fewer smoking-affected pregnancies and births: $22.10 million 5-Year health care cost savings from fewer smoking-caused heart attacks & strokes: $17.46 million 5-Year Medicaid program savings for the state: $9.37 million Long-term health care cost savings from adult & youth smoking declines: $1.60 billion Nationally, estimated smoking-caused health costs and lost productivity totals $19.16 per pack. We anticipate a special legislative session later in the year to focus on comprehensive tax reform. Governor Bevin has been clear that this reform cannot be revenue-neutral – taxes will have to go up somewhere. What a better time to discuss the $352 million that could come from a substantial tobacco tax increase. One thing I would like to note- an insignificant increase, an increase of less than $1 – will have NO public health benefit. It will not reduce smoking and it will not reduce cancer related to smoking. It would just be a tax. It’s critical that as we move forward, the messaging stays “$1 or more”. Projected New Annual Revenue from Increasing the Cigarette Tax by $1.50 Per Pack: $352.37 million

Smoke-Free Laws

Local Smoke-Free Progress

Tobacco Cessation I quit so I’d be more than a memory to my daughter. Rico, age 48, California Gabby, daughter, age 20 Rico and Gabby, 1999

Tobacco Cessation – SB 89 70% of smokers report that they want to quit. 50% have attempted in the last year. 6% have been successful. Right now, Kentuckians are denied access to proven smoking cessation treatments because many Kentucky insurers impose harmful barriers that impede access to these critical tools.   While Kentucky insurers “cover” many treatments, each plan is different and many impose complicated step therapies and prior authorizations. These inconsistencies cause confusion among providers and patients about the availability of treatments, meaning fewer Kentuckians attempt to quit smoking. SB 98 will require all Kentucky insurers—private and Medicaid—to provide barrier-free coverage for all recommended and FDA-approved treatments.

Tobacco Prevention

Tobacco-Free Schools – SB 78 Kentucky’s 100% Tobacco Free School Districts

2015 Youth Risk Behavior Survey Kentucky Department of Education (KDE), Kentucky Department for Public Health (KDPH), and Centers for Disease Control and Prevention (CDC). Kentucky Youth Risk Behavior Surveillance System. Frankfort, Kentucky: Cabinet for Health and Family Services, Kentucky Department of Education, [2015].

100% TFS Rationale Youth spend 1/3 time in school environment Youth who see teens or adults smoking in public see smoking as socially acceptable Attending a school with a high smoking rate increases susceptibility to smoking among non-smoking youth, increases odds of smoking Strictly enforced TFS policies can reduce youth smoking by 30%! Moore L, Roberts C, Tudor-Smith C. School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tobacco Control 2001; 10: 117-123.

Radon

Palliative Care For Better and Longer Survival… Best usual care + 3 to 4 palliative care team visits from the onset of illness delivered improved QOL and 2.7 months increased survival. (Temel, NEJM 2010) Better quality of life Symptoms are more under control Lower rates of depression More likely to understand their prognosis Receive less intensive medical care at the end of life The Temel study from MGH released in 2010 was the gamechanger. It showed both improved quality of life and nearly 3 months additional survival in lung cancer patients who had palliative care team visits alongside their oncology care. Dr. Temel and several of her colleagues have been supported by ACS research grants.

Recap of Moving Issues SB 89 – Tobacco Cessation Coverage SB 78 – Tobacco Free Schools SB 108 – Palliative Care Advisory Council Tobacco Tax – Tax Reform is Coming We’ve discussed a number of policy initiatives that can help ease the burden of lung cancer in Kentucky. As noted, many of these issues are more viable than others at this given time, so I’d like to take just a couple minutes to recap those specific issues or pieces of legislation that are seeing movement at this time:

Thank You! Questions?