Big Tobacco: A History of Death, Destruction and Deception

In the summer of 1974, I landed my first real job working in the tobacco fields of Bristol, Connecticut for $1.25 an hour. For the first part of the summer we worked in fields under white tents tying the plants so they would grow straight. The second half of the summer the women were in the sheds sewing the tobacco leaves together and hanging them, so they would dry for processing. The days were long, hot and grueling and the work was monotonous. Nonetheless, I was thrilled to be earning a paycheck and my parents were happy to have me out of the house and gainfully employed.

In the summer of 1974, I landed my first real job working in the tobacco fields of Bristol, Connecticut for $1.25 an hour. For the first part of the summer we worked in fields under white tents tying the plants so they would grow straight. The second half of the summer the women were in the sheds sewing the tobacco leaves together and hanging them, so they would dry for processing. The days were long, hot and grueling and the work was monotonous. Nonetheless, I was thrilled to be earning a paycheck and my parents were happy to have me out of the house and gainfully employed.

This was how I spent the summer of my sophomore year in high school, toiling along side hundreds of other field workers, mostly migrant workers from Puerto Rico. There were a handful of other students from my high school, but we were a minority. My first employer cultivated broad leaf tobacco to be used in the manufacture of cigars.  I didn’t stop to consider the product my employer was peddling and the disastrous and addictive effect tobacco products have on the human body. Like my co-workers, I was earning a paycheck though for me as a privileged white kid from the suburbs it was pocket money not subsistence for my entire family. I learned a lot that summer.

The CDC reports that cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including 41,000 deaths resulting from secondhand smoke. This is about one in every five deaths annually and 1,300 deaths every day.

I worked in the tobacco fields 10 years after the Surgeon General released the landmark report: Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service published in 1964. Though medical researchers had started connecting the dots between smoking and lung cancer by the mid 1950s, this was the first federal government report linking smoking and specific diseases. At that time, two-thirds of men and one third of women in the United States smoked cigarettes. In response to the surgeon general’s report and the growing scientific evidence that smoking harms virtually every organ in the body, major tobacco companies joined forces to mount a defensive strategy to counter the bad publicity by denying the science and misleading the public about the dangers of smoking. The human toll has been tremendous.

Over the next 50 years the battle between Public Health and Big Tobacco raged, and it is a long and complex story. The line graph on page 18 of the Surgeon General’s 50 Years of Change report shows that the per capita number of cigarettes smoked steadily increased from 1900 to the early 1960s. The only two declines are attributed to the period of the Great Depression and then again in the early 1950s when evidence first emerged that smoking is harmful, causing cancer and all sorts of other ailments. Per capita consumption peaked at 4,400 cigarettes per year in the early 1960s then fluctuated following the first Surgeon General’s report in 1964 until the early 1970s at which point there was a steady decline through to 2012.

Against the backdrop of Big Tobacco’s relentless marketing and continued misleading the public about the dangers of smoking, the declines over the next thirty plus years are credited to federal legislation and taxes, continually emerging scientific evidence of the health consequences of smoking, broadcasting and advertisement regulations, availability of over the counter cessation medications and the fallout of the Master Settlement Agreement, a 1998 settlement between the four largest US tobacco companies and 46 states to settle Medicaid lawsuits against the companies to cover tobacco-related health care costs. In exchange the tobacco companies agreed to pay, in perpetuity, payments to states to compensate for medical costs associated with treating people with smoking related illness as well as curtail certain marketing practices.

Over time, sustained and multifaceted public health approaches to smoking cessation have resulted in a steady decline in smoking. According to the Center for Disease Control and Prevention between 2005 and 2015, the percentage of cigarette smokers declined from 21 percent to 15 percent. Yet Tobacco is still the leading cause of premature death across the country and the Tobacco Industry continues to spend billions peddling their product despite a November 2017 ruling that finally forces them to print and broadcast “corrective statements centered on the health risks and addictive nature of smoking. The November ruling stems from a long drawn out court battle that started in 1999 with a lawsuit brought by the Justice Department that was settled in 2006 with an order to place the corrective statements followed by a decade of appeals and wrangling by the tobacco companies to stall and modify the statements.

The end result is certainly a victory for public health, but the impact of the corrective statements will be less effective both because our context has changed (how we access the news) with the explosion of social media outlets and because Big Tobacco successfully argued to modify the originally proposed statements that they said were “forced public confessions” designed to “shame and humiliate them.”

What would have been wrong with that?

Meanwhile, millions more lives were lost during that decade of appeals not to mention millions of dollars in tax payer’s money was spent arguing the case. It makes you wonder, who were the real winners here?

Neighborhood Health Action Centers Offer Pathways to Care

On a late afternoon in early December, a woman and small child enter the large, light-colored building on the corner of 115th Street and Lexington Avenue in Manhattan. The woman, between work shifts, rushes to use the lactation room at the East Harlem Neighborhood Health Action Center. She and many community members file into the offices to access on-site services. The building houses more than 15 social service programs, four community-based organizations, and other New York City Department of Health programs.

On a late afternoon in early December, a woman and small child enter the large, light-colored building on the corner of 115th Street and Lexington Avenue in Manhattan. The woman, between work shifts, rushes to use the lactation room at the East Harlem Neighborhood Health Action Center. She and many community members file into the offices to access on-site services. The building houses more than 15 social service programs, four community-based organizations, and other New York City Department of Health programs.

“It’s a hub,” says Jessie Lopez, referral specialist at the Health Department’s Center for Health Equity. “People come here at all hours of the day for reasons that range from lactation services to signing up for personal identification cards.”

The Center for Health Equity’s East Harlem Neighborhood Health Action Center is one of three centers located in revitalized Health Department buildings with co-located health services, community health centers, public hospital clinical services, community-based organizations and various service providers. The other two centers are in Tremont, Bronx and Brownsville, Brooklyn. The Health Department expects to open four more centers in 2018.

“It’s a holistic approach to care,” says Jaime Gutierrez, action center coordinator at the Center for Health Equity. “The Action Center is not only a place for health care services, but it’s also a place for organizing and planning, where residents can come and connect to a variety of social services.”

In fact, an Action Center offers primary care, mental health care, and in some cases, even dental care. If visitors seek services not offered at one location, a referral specialist or health navigator helps them access services at other locations. In addition, the centers offer health and wellness classes, and workshops.

While the Neighborhood Health Action Centers’ current iteration is new, the concept isn’t exactly novel. “Neighborhood-based programs have a long history in New York,” said Gutierrez. “It’s been a model for improving health citywide dating back over a century with District Health Centers.” The Neighborhood Health Center Movement began in 1921 in East Harlem through a demonstration project conceived by the American Red Cross and the New York City Health Commissioner.

In 2002, then-Deputy Commissioner Dr. Mary Bassett sought to focus on resource-deprived neighborhoods by establishing District Public Health Offices (DPHOs) in the South Bronx, East and Central Harlem, and North and Central Brooklyn. These DPHOs (which would become today’s Neighborhood Health Action Centers) promoted health equity, reduced health disparities and improved community health.

Nearly 100 years later, using a similar but revamped effort, the Action Centers offer key strategies, including multiple health services in one location, data- and evidence-informed practices and diverse groups working together to improve services.

Neighborhood Health Action Centers aim to serve community members, improve linkage to services, identify coverage gaps and reduce service duplication. More specifically, the Action Centers aim to: expand access to high-quality clinical care to help address high premature mortality rates; connect community members to support services and health education; and address root causes of health inequities, including the physical environment, housing and employment.

“The Action Centers are exemplary because their very program infrastructure is designed to address the social determinants of health,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “They are social and physical environments that promote and support good health for everyone.”

Neighborhood Health Action Centers

East Harlem Neighborhood Health Action Center
158 E. 115th St., Manhattan
Monday to Friday, 8 a.m. to 8 p.m., and Saturday, 8 a.m. to 4 p.m.

Brownsville Neighborhood Health Action Center
259 Bristol St., Brooklyn
Monday to Friday, 8 a.m. to 8 p.m., and Saturday, 8 a.m. to 4 p.m.

Tremont Neighborhood Health Action Center
1826 Arthur Ave., Bronx
Monday to Friday, 8:30 a.m. to 5 p.m.

FPHNYC and NYC Department of Health Awarded Funding to Increase HIV Treatment Access for Newly Diagnosed Patients

The Fund for Public Health in New York City (FPHNYC) and the New York City (NYC) Department of Health and Mental Hygiene have received funding from M∙A∙C Cosmetic’s charitable foundation, the M∙A∙C AIDS Fund to increase prompt access to antiretroviral therapy (ART) for patients newly diagnosed with HIV at NYC’s Sexual Health Clinics.

The Fund for Public Health in New York City (FPHNYC) and the New York City (NYC) Department of Health and Mental Hygiene have received funding from M∙A∙C Cosmetic’s charitable foundation, the M∙A∙C AIDS Fund to increase prompt access to antiretroviral therapy (ART) for patients newly diagnosed with HIV at NYC’s Sexual Health Clinics.

FPHNYC and the Health Department’s Bureau of Sexually Transmitted Disease Control will collaborate with community HIV providers to improve services within the Sexual Health Clinics located throughout New York City, as part of the Ending the Epidemic (EtE) strategy. Under this initiative, the Sexual Health Clinics aim to provide high-quality, status-neutral prevention and treatment services.

Funding from the MAC AIDS Fund will support the Bureau’s work on engaging communities with a focus on providing affirming services to transgender and gender non-conforming patients. In 2016, MAC AIDS Fund provided funding for a pilot JumpstART, a program providing immediate access to ART for patients newly diagnosed with HIV, at the Sexual Health Clinics. The key element of these services is to improve access to sexual health services, regardless of insurance, HIV status, immigration or other potential parries to accessing treatment. Patients will also receive high-impact prevention and care services, including benefits assistance, case management, adherence support and mental health support.

“It is imperative that we treat HIV like we treat other infections and give individuals the option to be treated at the time of diagnosis,” said Sara Gardner, executive director of FPHNYC. “Early initiation of HIV treatment will improve outcomes and help accelerate the decline in HIV related deaths and transmitted infections.”