Colorado Advances Health Priorities by Constitutional Amendment

Chronic diseases, such as heart disease, stroke, and cancer, are the most prevalent, costly, and preventable of all health problems; however, securing resources to enable public health agencies to implement programs to prevent chronic disease is an ongoing challenge. State budgets continue to face shortfalls that limit the capacity of public health agencies to implement, sustain, and enhance chronic disease prevention programs. In Colorado, as in many other states, budget shortfalls have resulted in the re-allocation of funds from the Tobacco Master Settlement Agreement to support other needs. Because of diminishing resources, Colorado has been limited in its ability to fully implement public health programs designed to reduce the use of tobacco through prevention and cessation and to reduce the burden of chronic diseases through education and support of proven clinical preventive services for cancer and heart disease.

In November 2004, Colorado voters approved Amendment 35, a citizens' initiative that added "Tobacco Taxes for Health Related Purposes" to the State Constitution. As a result, on January 1, 2005, a new tax of 65 cents was added to the price of each pack of cigarettes. This new tax raises the Colorado tobacco excise tax to about the national average and generates about $175 million per year in new revenues. The Amendment specifies that all of these new monies are to be used for health purposes. Most of the money will be used to subsidize health care for the uninsured, but 16 percent (about $28 million per year) will be dedicated to tobacco control, and another 16 percent to cancer and cardiovascular disease prevention. The Amendment process assures that these new funds cannot be allocated for other purposes, so long-term strategies and programs can now be implemented to reduce the burden of cancer and cardiovascular disease in Colorado.

The Colorado Cancer Coalition, a broad consortium of organizations and individuals with interests in the prevention and control of cancer in Colorado, played an integral role in achieving this outcome. Working along with its partners, the state's Comprehensive Cancer Program supplied critical data to the Coalition for determining objectives, goals, and priorities in cancer prevention and control to reduce the burden of cancer in Colorado. Because a Colorado Cancer Plan had been developed and publicized, the drafters of Amendment 35 were able to specify earmarked funds (about $28 million per year) to support the implementation of the plan.

The Colorado Cancer Plan is the cornerstone of the Colorado Cancer Coalition. The vital role of the plan in the earmarking of new tobacco tax funds for cancer control in Colorado underscores the value of having a statewide action plan that is collaboratively developed and collectively supported. Equipped with a data-based state cancer plan, partners are better prepared to address their state's specific cancer problems as well as develop strategies to gather support for cancer control. Citizen-initiated constitutional amendment processes are possible in many other states, where cancer control programs could also be funded by designated new tobacco taxes. C