A majority of states are not measuring up on legislative solutions that prevent and fight cancer, according to a new report released today by the American Cancer Society Cancer Action Network (ACS CAN). As the changing health care landscape presents new opportunities to prevent a disease that kills 1,600 people a day in this country, many state legislatures are failing to enact laws and policies that could not only generate new revenue and long-term health savings, but also save lives.
How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality, was released at the National Conference of State Legislatures annual meeting in Minneapolis, MN. The annual report finds that 40 states have reached benchmarks in only four or fewer of the 12 legislative priority areas measured by ACS CAN, the advocacy affiliate of the American Cancer Society. Only nine states and the District of Columbia met between five and eight of the benchmarks. Just one state, Massachusetts, met the benchmarks in nine or more of the 12 policies measured by the report.
"Today we are saving 400 more lives per day from cancer than we did 20 years ago, and we know what we need to do to save even more lives. Cancer won't be defeated solely in research labs or doctors' offices. The activity that goes on inside of state capitol buildings is critical in ending this disease," said John R. Seffrin, PhD, chief executive officer of ACS CAN. "States can save more lives and health care dollars when they enact evidence-based policies to encourage prevention, guarantee access to affordable health care, curb tobacco use and focus on patients' quality of life."
Now in its 12th year, How Do You Measure Up? identifies specific policy actions that state legislatures can take to fight cancer, including adequate breast and cervical cancer early detection program funding; comprehensive smoke-free laws; tobacco prevention and cessation program funding; access to cessation services through Medicaid; tobacco taxes to reduce consumption; restrictions on tanning device use by minors; improved access to Medicaid; balanced pain policies; time requirements for physical education in schools and access to palliative care.
A color-coded system is used to identify how well a state is doing. Green represents the benchmark position, showing that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark and red shows where states are falling short.
How Do You Measure Up? also offers a blueprint for effective implementation of provisions of the new health care law that benefit cancer patients and their families, such as ensuring transparency in health coverage plans on state exchanges, ensuring access to cancer-fighting drugs and providing essential health benefits for chronic disease patients.
"We now have a greater understanding of what we need to do to conquer this disease. Research has shown that nearly half of all cancer deaths could be prevented if everyone were to quit tobacco, exercise regularly, eat a healthful diet and get recommended cancer screenings," said Chris Hansen, president of ACS CAN. "Unfortunately, many low-income families continue to face barriers to achieving healthy outcomes. State lawmakers have clear opportunities to help save lives by enacting laws and policies that reduce the toll of tobacco use and guarantee access to affordable health care and proven prevention programs."
This year, nearly 176,000 of the estimated 585,720 cancer deaths in the United States will be caused by tobacco use and tobacco is still the number one preventable cause of death nationwide. While smoking rates among young people have fallen, the popularity of other tobacco products including little cigars and smokeless tobacco among minors is as strong as or stronger than it has ever been. Additionally, the most recent Surgeon General's report released in January 2014 found that cigarettes have become more deadly. Yet, while Big Tobacco continues to pour billions of dollars into addicting new customers, states are falling behind in passing strong policies to protect their residents.
Evidence clearly shows that raising tobacco prices through regular and significant tax rate increases encourages tobacco users to quit or cut down and prevents kids from ever starting to smoke. Despite this, 13 states have not increased the tax on cigarettes in the last 10 years – Alabama, California, Georgie, Idaho, Kansas, Louisiana, Michigan, Missouri, Nebraska, Nevada, North Dakota, West Virginia and Wyoming. Additionally, while 24 states and the District of Columbia now have comprehensive, statewide smoke-free laws, as of June 2014, no additional states have passed a comprehensive, statewide smoke-free law covering all workplaces, including restaurants and bars, this year.
Three states did increase funding for their tobacco prevention and cessation programs this year – New Hampshire, North Carolina and Ohio. However, only two states, North Dakota and Alaska, fund these programs at the level recommended by the Center for Disease Control and Prevention. Meanwhile, only eight states met the benchmark for providing tobacco cessation coverage in their Medicaid program to help ensure these individuals have access to effective, proven interventions to help them quit these deadly products.
Skin cancer is the most commonly diagnosed cancer in the United States, with rates increasing significantly in the last 30 years. As of today, nine states – California, Delaware (not reflected in report as law was passed post publication), Hawaii, Illinois, Louisiana, Minnesota, Nevada, Texas and Vermont – have passed laws prohibiting minors from using indoor tanning devices, which are classified as class 1 carcinogens, the same as cigarettes, by the World Health Organization.
Many states are also working on policies and programs to reduce cancer risk related to poor nutrition, lack of physical activity and obesity. Legislators can help increase physical activity for young people by setting strong requirements for physical education in schools. Quality physical education is the best way for students to get a significant portion of their recommended physical activity, improve their physical fitness and obtain the knowledge and skills they need to be physically active throughout their lifetimes. Yet for the second year in a row, no state met the physical education time requirement benchmark – at least 150 minutes per week at the elementary school level or at least 225 minutes per week at the middle and high school levels. Though some states do require the recommended level in one or two of the grade categories, none require the recommended levels across all three.
Access to Care and Quality of Life
Research shows that whether or not an individual has access to health insurance plays a significant role in their cancer outcome. Individuals without health insurance are more likely to be diagnosed with cancer at a later stage and more likely to die from the disease. While the new health care law is helping to ensure more people have access to affordable, quality health coverage, lawmakers play a key role in making sure this law is implemented in a way that helps more people access health insurance.
State lawmakers currently have the opportunity to accept federal funds already set aside to increase access to health coverage for thousands of low-income residents through Medicaid. While this category in the report has the most states meeting benchmarks – more than half of states as well as the District of Columbia have chosen to increase access to health coverage in this way – 24 states have not accepted the money and are failing to provide affordable health coverage to some of their most vulnerable residents.
Although the health care law has helped make insurance more affordable for many, there are still barriers to coverage that need to be addressed. While some states like Oregon and South Carolina helped address access to cancer screenings including mammograms and Pap tests by increasing funding for the Breast and Cervical Cancer Early Detection Programs, the majority of states' programs are woefully underfunded. Additionally, only seven states have restricted tobacco surcharges on health insurance premiums that could price out individuals most in need of coverage.
States are making progress when it comes to passing pain policies that help ensure patients who need it have access to effective pain medications through a balanced approach that also addresses abuse issues. However, in terms of increasing access to palliative care, a type of specialized medical care growing in popularity and designed to improve patients' quality of life, only five states measure up.
An estimated 1.6 million people in the United States will be diagnosed with cancer and more than 580,000 will die from the disease this year.
American Cancer Society Cancer Action Network (ACS CAN)