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An opioid epidemic. High smoking rates. Health care provider shortages. Indiana faces serious public health challenges. Side Effects Public Media provides in-depth coverage of these issues and more.

Tobacco Use Costs Indiana Billions. How Can The State Bring Those Costs Down?

Shira Gal/via Flickr

Tobacco use is costing Indiana taxpayers, healthcare providers and employers billions of dollars each year, according to a new report from the Fairbanks School of Public Health at IUPUI. According to the report, costs associated with tobacco use total $6.8 billion, which includes health care and lost productivity costs.

Paul Halverson, dean of the school of public health and lead author of the report, spoke with Side Effects about why the costs are so high and what can be done to reduce them. This interview has been edited for length and clarity.

What costs go into that $6.8 billion?

Healthcare costs related to smoking were about $2.9 billion in 2009 dollars, and that doesn't include $1.3 billion in health care costs that are related to secondhand smoke. And then if we add the $2.6 billion related to lost productivity and non-medical costs, that's how we get that number.

We need to think about the fact that the money spent on health care is not money that could be spent on wages. We don't get paid X amount more because our employers are spending that money in providing insurance. And these costs are being spent to take care of people who are suffering from diseases which are generally preventable.

That money could go towards education, toward roads, toward any number of things. Frankly, we could use the money to support our health system. We're ranked 48th out of 50 states in terms of our per capita [public health] funding.

Is there way to quantify that is easier to comprehend?

We know in non-economic costs, the number of people dying from tobacco would be the equivalent of two 747's crashing each month. Over 11,100 people died last year related to tobacco-related illnesses. That's just a staggering number of people.

What about secondhand smoke?

Over 1,400 people die each year from secondhand smoke in Indiana. There are people that didn't ask to smoke. They are casualties of other people's activity.

Part of the issue here is, we need to change the culture to make smoking unacceptable in public areas. Many studies have demonstrated that it has had a positive impact on businesses. Tables turn over quicker, more people are apt to come and bring their families and so forth. So the reality is that non-smoking areas, particularly non-smoking in public places, are absolutely a pro-business thing. It's a pro-community initiative.

How does Indiana compare to other states?

That's the thing that's so disappointing. We rank 44th in the nation in terms of smoking, and if you look at our overall [health] rankings as a state, we're actually 41st out of 50 states, which really in my mind, doesn't fit with Indiana.

The bottom line is that tobacco use is the leading reason for why we are such an unhealthy state — it is the leading cause of preventable death. If you look at cancer, heart disease, stroke, these are diseases, which can be, for the most part, entirely prevented. So if we could change the smoking number, we could drive costs down and improve the overall healthiness of our state.

How could Indiana change its smoking rate?

Number one, increasing the cost of tobacco. We know that if the cost of tobacco is high, people will stop smoking or they will greatly reduce it. And most importantly, youth who are most susceptible to the cost of tobacco will quit smoking or never start.

Second, we know that the statistics show us that if we can keep people from starting to smoke by the time they're 19, generally they're not going to start smoking. Right now, tobacco access is set at 18 in Indiana. If we could increase that access age to 21, like some other states and many municipalities have already done, we can reduce the use of tobacco by youth by reducing the initiation of tobacco.

The third thing is related to the funding of tobacco prevention and cessation. Tobacco prevention and cessation are substantially underfunded in Indiana. The CDC recommends that over $80 million each year should be invested in tobacco prevention and control. We barely spend $7 million dollars a year. We certainly don't get the amount necessary from the tobacco settlement that would be necessary to deal with tobacco prevention and cessation.

Smoking is a very addictive experience. It's likened to crack cocaine. The average smoker quits 11 times before they are successful, so what we need to do from a public health perspective, is to make available evidence-based means to quit smoking. That includes nicotine replacement therapy. It may include support services from a quit line or a smoking counselor. Quitting cold turkey is not the most successful. There are people who have done it, but it's not what we would recommend.

Jake Harper is an investigative reporter for Side Effects Public Media, and he is a co-host of the Sick podcast. He can be reached at