From Healthy People 2020 Stories from the Field, a series highlighting communities across the Nation that are addressing the Leading Health Indicators (LHIs).
Tobacco use is the single most preventable 
cause of disease in the United States. It causes more deaths than HIV, drug and alcohol misuse, motor vehicle accidents, suicide, and murder combined. In the state of Minnesota, smoking is responsible for more than $3 billion in annual health care costs and contributes to more than 6,000 deaths each year.
In the face of this, a pair of Minnesota organizations — a public health agency and an independent nonprofit organization — have been collaborating for over 20 years to reduce tobacco use among adults and youth in their state. And their work has had quite an impact.
Working Together for Change
The Minnesota Department of Health (MDH) is part of the National Tobacco Control Program. MDH works in the community, collaborates with other departments, and partners with local organizations to reduce secondhand smoke, promote smoking cessation and prevention, and increase health equity in the state.
When it comes to improving public health through tobacco control, MDH aims to be a “leader in the Nation,” says Tobacco Policy Planner Christina Thill. “We’re a highly collaborative, partner-oriented department,” adds Laura Oliven, who manages MDH’s tobacco prevention and control work.
One of MDH’s primary partners is ClearWay MinnesotaSM. Created in 1998 as part of a $6 billion settlement between the state and Blue Cross and Blue Shield of Minnesota with the tobacco industry, ClearWay Minnesota aims to reduce tobacco use and exposure among Minnesotans. They’re a limited life organization, which means their funding from the settlement is spread out over a certain period of time — in this case, 25 years.
Molly Moilanen, ClearWay Minnesota’s vice president, notes that there aren’t many organizations like it in the country. Their position as a nonprofit with a limited lifespan has allowed them to be “bold and innovative” in working toward their mission of “enhancing life in Minnesota by reducing tobacco use and exposure to secondhand smoke through research, action and collaboration.”
Leading the Way in Multiple Initiatives
Since both MDH and ClearWay Minnesota fund tobacco control efforts across the state, they coordinate their work in order to “maximize impact, success, and efficiency,” as Oliven puts it. Moilanen adds, “I can’t think of much we don’t collaborate on.”
Both organizations lead several initiatives where they work with the community, public health leaders, and other stakeholders to reduce tobacco use. These include efforts to:
- Increase the price on all tobacco products
- Increase the amount of state funding for tobacco control
- Raise the age to buy tobacco to 21
- Decrease the use of flavored or menthol tobacco products by youth, especially among communities that are disproportionately targeted with advertising
- Support American Indian Nations in their efforts to restore traditional tobacco practices, reduce commercial tobacco use, and prevent exposure to secondhand smoke
- Work with members of populations that are most impacted by tobacco’s harm through grants, contracts, technical assistance, training opportunities, and other activities
Another example of their productive partnership is the comprehensive, 5-year Tobacco Control Framework for Minnesota they co-chaired with Blue Cross and Blue Shield of Minnesota’s Center for Prevention. Oliven explains that the Framework builds on CDC’s tobacco control goals — it lays out a vision for tobacco control in the state, outlines 17 bold steps to achieve the vision, and reaffirms the importance of health equity in tobacco control efforts. “It really set the coordinated tasks for tobacco control in our state,” she says.
Increasing Capacity with a Shared Vision
Minnesota has a rich history of statewide coalitions working together to advance tobacco prevention policies and reduce tobacco use. By working together, says Moilanen, MDH and ClearWay Minnesota have been able to effect large changes that have a measurable impact on smoking rates and health care costs. “We’re very proud of this collaboration” she adds.
Oliven agrees. They’ve implemented this collaboration in many ways, she says, including through monthly coalition meetings and shared evaluation and surveillance efforts. Across the board, their focus has been on close communication to achieve a shared goal. She explains that most states have limited funding for tobacco prevention, and few have sufficient resources to support media campaigns. But ClearWay Minnesota is a “powerhouse in the world of tobacco control,” she says, so thanks to them Minnesota has great campaigns.
Both Oliven and Moilanen are also proud to say that their work is informing similar efforts elsewhere. For example, research funded by ClearWay Minnesota is being used by addiction and tobacco programs around the country and the world.
When asked about specific success stories, both organizations highlight their recent efforts around the emerging youth e-cigarette epidemic. Together, they identified specific actions that local governments could take to address rising e-cigarette use among youth. Then MDH mobilized their grantees to increase awareness while ClearWay Minnesota took the lead in advocating for and passing policy.
Success by the numbers
Over the past 20 years, ClearWay Minnesota, MDH, and their partners have worked to save thousands of lives and billions of dollars.
Their efforts have helped:
- Save $5.1 billion in worker productivity and reduced medical costs
- Reduce adult smoking by 35% and youth smoking by 70%
- Reduce cigarette sales by 65%
- Decrease health problems, including an estimated 4,560 cancers, 12,881 respiratory disease hospitalizations, and 31,691 hospitalizations for cardiovascular disease and diabetes
- Prevent an estimated 4,118 smoking-attributable deaths
Recent policy highlights include:
- In 2013, Minnesota passed a significant tobacco tax increase — the highest in state history and second-highest nationally
- After the tax increase, 60% of smokers made a quit attempt and 15% successfully quit
- Over 50 cities and counties have strengthened their clean indoor air laws to prohibit e-cigarette use where smoking is banned
- Over 20 cities and counties have raised the age to buy tobacco to 21
- Nine Minnesota cities have passed tobacco flavor restrictions and 6 of these also passed menthol restrictions
Looking Ahead
Oliven attributes her state’s successes in tobacco control to the strong partnerships MDH has forged over the years. Minnesota is among the 27 states that have comprehensive clean indoor air policies, and its cigarette tax is the eighth highest in the Nation. At $3.04 per pack, the tax is intended to help smokers quit and prevent youth from starting, while offsetting some of the health costs of smoking.
Moving forward, Oliven says, MDH will focus on exploring other avenues, resources, and sustainable funding for tobacco prevention and cessation. This will be critical as ClearWay Minnesota reaches the end of its 25-year settlement funding in 2022. They’ll also continue to focus on reducing disparities in tobacco use among Minnesota residents.
Oliven is confident that MDH — and the public health field in general — is up to the ongoing challenge of tobacco use prevention. “We have the tools that we need to save lives and improve health,” she says. “It’s a very powerful, energetic, positive field where we can make a big difference in people’s lives.”
About Stories from the Field
This series highlights how communities across the Nation are addressing the Healthy People 2020 Leading Health Indicators (LHIs). LHIs are a subset of 26 Healthy People 2020 objectives that communicate high-priority health issues. Tackling the LHIs appropriately will dramatically reduce the leading causes of death and preventable illnesses.
Check out other Stories from the Field on HealthyPeople.gov.