public health
12:04 am
Mon April 15, 2013

Changing of guardian for health as smoking reaches crossroads

For the first time since 1998, Washington is getting a new secretary of health. Mary Selecky is retiring, and her replacement starts today.

Selecky has been a familiar face during health emergencies, such as the pandemic flu. She made tobacco her top health priority, and saw smoking rates drop year after year. But, as she steps down, the anti-smoking crusade is at a crossroads.

Her successor, John Wiesman, says tobacco is still important, but new tactics are needed. And his top health priority is reducing childhood obesity.

Why focus so much on tobacco when the Health Department has so many urgent things to worry about, from investigating food-borne illnesses, to inspecting water systems, to infectious diseases like whooping cough? 

It’s simple, says Selecky. Look at what’s killing people.

There’s heart disease, the top national killer, which is fueled by smoking. And there's lung cancer.

"In Washington state, in fact, the number one killer is lung cancer, and again, the culprit is tobacco. So, if we’re going to help the public understand how to be healthy while they age, don’t ever use tobacco. And if you're a smoker, quit," said Selecky in an exit interview with KPLU.

Tobacco was a hot political issue when Selecky was appointed back in 1998 by Gov. Gary Locke. Within a few weeks of her appointment, a historic lawsuit against the tobacco companies was settled, sending millions of dollars to the states to fight smoking.

The payoff?

  • Smoking rates are down by over 30 percent compared to a decade ago.
  • Youth smoking rates are down by 50 percent (and there's strong evidence that anyone who avoids smoking until age 21 will probably never smoke).

The problem?

"Every year, there is a new crop of 11-, 12-, and 13-year-olds, and their interests change overnight," said Selecky. "While the tobacco companies are not supposed to market to kids, look, when they start to market a pack of cigarettes that’s pink, tell me, who is that for?"

Youth smoking appears to still be declining, but by 2010, adult smoking rates were no longer dropping, and seem to have hit a plateau in Washington at around 15 percent.

Wiesman, the new health secretary, agrees on the need for vigilance, but says "dollars have dwindled" and the era of well-funded anti-smoking campaigns is over. That means the new tactics have to be cheaper and more focused.

"Our challenges now are looking at some of those populations where tobacco use is the highest," he said, "for example, in persons with mental health issues, people with substance abuse issues, or gay and lesbian populations."

Wiesman envisions a collaboration with counselors and therapists to help reduce smoking among people with mental illness or drug addiction. But he has a lot on his plate as he starts work this week.

You can read more about Selecky in her interview with the Robert Wood Johnson Foundation.