[ Pobierz całość w formacie PDF ]
.[71]In the end, the bills did not come to a vote.The health groups agreed to a last-minutecompromise in which most funding for the media campaign, competitive grants, andschools was restored.The LLA programs, however, took a major cut from $24million to $12 million.According to Najera,  In assessing where to amputate, thepoliticians had to make flash comparisons of the relative return between the differentparts of the anti-tobacco program.One strong argument on cutting local leads was thatmuch of the county funds were already spent on direct medical services, and thus theloss of local funding was diminished by whatever amount went to non-tobaccoservices. [69] From the standpoint of a county's total revenues, this statement mighthave been true.But the cuts to the LLA would not be offset by money for localmedical services.Moreover, the requirement that one-third of LLA money be divertedinto the CPO medical services program remained, which amplified the effects of theLLA cuts.The local programs would be forced to absorb large cuts just as they werehitting their stride.The LLAs were eventually rescued because of the fallout from an unrelated politicalbattle between the Legislature and the governor over funding for community colleges.It turned out that the Legislature did not 204 need the Health Education money to pay for medical services; they instead diverted$21 million from the Health Education Account to community colleges.The governorvetoed this appropriation, and on October 1, 1992, the Department of Finance issued aletter returning this money to CDE, competitive grants, and the LLAs, as specified inAB 99.[72]The attacks on the LLA budgets in both 1991 and 1992, along with the 1992 attack onthe media campaign, were consistent with the tobacco industry's strategy to reduceProposition 99's effectiveness.The LLAs were costing the tobacco industry time andmoney with their local ordinance work.Further, by educating minority communitiesabout tobacco issues and bringing them into the tobacco control network, the LLAsand the competitive grants were weakening an industry power base.The erosion of Proposition 99 continued.Positioning for 1994The continuing failure of CHDP and CPO to provide tobacco use prevention serviceswas becoming an increasing irritant for tobacco control advocates.CPO was, in fact,mainly being used to get federal matching funds.At the county level, CPO programswere supported from two sources: Proposition 99 Health Education Account moneyand federal matching funds.This money had to be used exclusively for outreach; nonecould be used to deliver services.Counseling services, which included smokingcessation, did not qualify for federal matching funds.[73] Dr.Rugmini Shah, thedirector of the state-level DHS Maternal and Child Health (MCH) program, whichadministered CPO, defined outreach as  finding individuals who are not accessingservices and bringing them into the service area system. Cessation classes could notbe funded because  the women are already in here for the classes, so it's notoutreach. [74] Thus, any Proposition 99 dollars that generated federal matching dollarscould not be used for tobacco-related services.At the November 1992 TEOC meeting, the CPO program was on the agenda.TEOCwas concerned that the money was being used illegally to meet a federal match forperinatal outreach services and that the federal rules prohibited the use of statematching funds for any anti-tobacco activities.[75] At the January 1993 TEOCmeeting, MCH was able to tell TEOC that $7 million of the Health Education dollarsgiven to MCH went to the federal matching program and that only nine of the fifty-eight counties provided cessation training components.[76] By the March 1993meeting, 205 the dollar figure for matching had gone up to $8 million, with only $216,000 notqualifying for matching funds.TEOC chair Carolyn Martin called this  a gigantic rip-off of the Health Education Account dollars. [76]In contrast to their earlier positions, the health groups and their representatives onTEOC were now openly challenging the appropriateness of using Health Educationfunds for medical services.In submitting the 1993-1995 Master Plan for California'sTobacco Control Program to the members of the Legislature, Cook and Martin wroteto the legislators on behalf of the TEOC:We are particularly alarmed by the fact that funding for the CHDP Program continuesto expand, yet we have little idea of what CHDP is doing with these funds and noevaluation of its impact.Physicians in CHDP respond to three vague and inexactquestions related to tobacco use, second-hand smoke and counseling.The datagenerated through this protocol is essentially useless.Improving the protocol, whichthe California Department of Health Service has indicated its willingness to do, mighthelp.However, to date as far as we can ascertain, despite the large funding providedto it, the CHDP Program has contributed nothing to tobacco control.In addition, the one-third of the money set aside in the Local Lead Agency grants fortobacco-related Maternal and Child Health activities is being used for outreach,without any tobacco education component, despite the legal requirement inProposition 99 that funds be used only& for programs for the prevention andreduction of tobacco use.[77] [emphasis added]Tobacco control advocates were beginning to be openly critical of the diversions fromthe Health Education and Research Accounts to medical services.Coye resigned as DHS director in September 1993.On November 9 the governornamed S.Kimberly Belshé as her successor.Although Belshé had been working inthe administration since 1989, she was not a physician, as both Coye and Kizer hadbeen.At thirty-three, she had worked primarily in public relations.More alarming totobacco control advocates was the role that Belshé had played in 1988 as the tobaccoindustry's Southern California spokeswoman against Proposition 99.[78] Belshédefended her past association with the tobacco industry, saying that she had opposedProposition 99 for fiscal reasons.[79] Her proposed appointment did little to reassureadvocates of the Health Education and Research programs that they would receive theprotection for which Kizer had fought.Her lack of medical credentialsnotwithstanding, the CMA supported her appointment [ Pobierz caÅ‚ość w formacie PDF ]