California Tobacco Control Program threatened by Dept of Public Health's interpretation of anti-outsourcing law

A couple years ago the California Legislature passed a sensible law designed to stop inappropriate outsourcing of state government positions, a favorite ploy of Republicans to give tax money to their corporate pals at the expense of middle class workers.  While I support this position the reality is that there are some times when it does make sense for the Department of Public Health to contract with outside agencies.  The way that the California Department of Public Health has interpreted this law has led to some longstanding elements of the California Tobacco Control Program being defunded.
 
The Tobacco Education and Research Oversight Committee, which has responsibility to oversee the program and advise the department and State Legislature has been pressing the Department on this issue.
 
Given the potential seriousness of this situation I decided to add my voice to the discussion by sending the following letter:
 
November 21, 2013
 
Secretary Diana Dooley
California Health and Human Services Agency
1600 Ninth Street, Room 460
Sacramento, CA 95814

Ron Chapman, MD, MPH
Director and State Health Officer
California Department of Public Health
1615 Capitol Avenue
Sacramento, CA 95814

Dear Secretary Dooley and Director Chapman:

As someone who has chronicled the history of the California Tobacco Control Program since its inception (including in my book Tobacco War), I am writing to express urgent concern over the current changes to business practices by the California Department of Public Health that will have the effect of seriously damaging California’s world-renowned tobacco control infrastructure.

The defunding of contracts with independent, statewide tobacco control technical assistance providers will quickly hinder the ability of the California Tobacco Control Program to deliver the legislatively mandated tobacco control services mandated by the voters of California in 1988 with the passage of Proposition 99. California’s structure of combining effective leadership from the CDPH with contracts with partner organizations who have technical expertise and community connections that do not exist in the Department has been one of the keys to its success and made it a model for the world.

The resulting program, which combines a hard-hitting media campaign and local efforts that have saved one million lives and $134 billion in health care costs. This is a government program that works and yet you are risking the very integrity of the program by dismantling its current infrastructure and gambling on a potential new one with no understanding or assurances that it will work.

In addition to California, I have conducted detailed case studies of tobacco control policies all over the country (see http://tobacco.ucsf.edu/states). There is no question that the current structure of the California Tobacco Control Program is the most effective way to fight the tobacco industry and reduce the burden of disease and death is causes. Moreover, while I recognize that the motivation for the changes you are implementing is due to your interpretation of California Government Code Section 19130 (which was passed to address the legitimate problem of unnecessary and wasteful outsourcing of basic government functions), the fact is that shutting down external partners has been a key strategy of politicians sympathetic to the tobacco industry in other states.

Indeed, the changes that you are implementing now are the greatest threat to the California Tobacco Control Program since the mid-1990s when Republican Governor Pete Wilson allied with Democratic Assembly Speaker Willie Brown to destroy the program.

The lack of appreciation by the Department for the specialized skills and expertise required to conduct training and technical assistance is troubling. The California Tobacco Control Program’s statewide training and technical assistance system has blended a unique mix of skill sets which have collectively provided local health departments and community-based organizations the tools, knowledge, and skills that are largely responsible for transforming tobacco use norms in California.

It is my understanding that there is the possibility of making exemptions in GC 19130. Rather than interpreting these provisions narrowly, I urge you to consider the negative impact that the interpretation of CDPH’s Office of Legal Services that the functions that are best done by outside contractors not be forced “in house” or performed by the University of California, California State University or some other state department.

There is a strong track record to support using these exceptions to maintain and expand the Tobacco Control Program’s effectiveness. Please do not destroy it.

I sincerely hope you are able to resolve this issue by the next Tobacco Education Research Oversight Committee meeting on December 11, 2013.

If I can be of any assistance in resolving these matters, please contact me.

Best wishes,

Stanton Glantz, PhD
Professor of Medicine
American Legacy Foundation Distinguished Professor in Tobacco Control
Director, Center for Tobacco Control Research and Education

cc: Michael Ong, MD PhD, TEROC Chair
Alexandria Simpson, California Department of Public Health, Staff to TEROC