Budget cuts cause shake-up in Iowa smoking cessation efforts

Iowa Department of Public Health Director Mariannette Miller-Meeks insisted on August 1 that state efforts to reduce and prevent smoking will continue deep despite budget cuts, which just cost a senior department staffer her job.

In an open letter distributed to Iowa media, Democratic State Senator Herman Quirmbach said he was “dismayed to learn” that Miller-Meeks “quietly fired Bonnie Mapes, administrator of the Division of Tobacco Use Prevention and Control. Miller-Meeks has told some members of the Tobacco Use Prevention and Control Commission that she intends to seek legislation to disband the Division entirely and that she has little interest in developing effective tobacco control policy, despite a statutory responsibility to do so.” Quirmbach is one of the legislature’s leading advocates of smoking prevention as a way to reduce rates of cancer and other life-threatening conditions.

Speaking to me by phone on August 1, Miller-Meeks emphasized, “We are not going to stop our work on tobacco cessation and prevention.” She said Mapes had been presenting strategies for dealing with expected budget cuts for months, and had planned to retire in March 2012 in any event. Mapes told IowaPolitics.com that she wasn’t “ousted” or “fired,” but opted for early retirement after her division’s budget was cut by two-thirds. Iowa’s longtime state epidemiologist and IDPH medical director Dr. Patricia Quinlisk is now also the interim director of the Iowa Division of Tobacco Use Prevention and Control.

Iowa House and Senate Republicans have sought to slash smoking prevention and cessation funding for years. The Democratic-controlled Senate took smoking-related provisions out of a major “deappropriations” bill early in the 2011 legislative session. However, the final health and human services budget allocated only $2.8 million for the Iowa Division of Tobacco Use Prevention and Control in fiscal year 2012, down from $7.8 million in fiscal year 2011. The biggest casualty is the multi-million-dollar “Just Eliminate Lies” advertising campaign, which sought primarily to discourage young people from smoking.

Miller-Meeks told me that in her conversations with state lawmakers, they had made clear the “legislative intent” for the IDPH to continue the Quitline, which helps smokers trying to kick the habit, as well as community partnerships with local organizations seeking to reduce smoking. She mentioned the American Lung Association’s work in Polk County as one among scores of such partnerships around the state.

Miller-Meeks noted that it’s “not uncommon in other states” for smoking cessation and prevention efforts to be integrated into other aspects of public health policy. Conversations about restructuring IDPH to eliminate the separate Division of Tobacco Use Prevention and Control have been ongoing since 2007, she said. The department’s Division of Behavioral Health already operates other quitlines as part of its work on substance abuse and treatment for compulsive gambling. Miller-Meeks mentioned that some smoking prevention work could be folded into the Bureau of Chronic Disease Prevention & Management. IDPH staffers are looking to improve services offered through Quitline, for example by using more social media or offering more internet-based counseling for smokers.

Tony Leys reported for the Des Moines Register,

Tim Albrecht, a spokesman for [Governor Terry] Branstad, said the governor remains committed to combating smoking. He said the governor signed off on Miller-Meeks’ decision to terminate Mapes’ position, and he said the governor understood the need to cut programs, including the anti-smoking ads.

“Given Iowa’s severe budget constraints, most departments and agencies saw a decrease in funding,” Albrecht wrote. “Gov. Branstad believes tobacco cessation programs are important and necessary, and believes the money should be spent in a more effective manner. Blanket television advertisements, when 80 percent of the population does not smoke, is probably not the most efficient means of tobacco cessation. The governor continues to look for efficient, effective ways to educate the public on the harmful effects of smoking.”

I can’t recall Branstad lifting a finger this year to preserve state anti-smoking programs. Most departments are dealing with budget cuts, but not nearly as deep as what happened to the Division of Tobacco Use Prevention and Control. Statehouse Republicans didn’t merely propose to end an advertising campaign. They wanted to eliminate funding for all state smoking cessation efforts, including the Quitline. If Branstad ever criticized that proposal publicly, I never saw or heard his comments.

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