David Ping, chair of the Eastern States Board of the American Heart Association, and Hudson Valley resident, sent the following letter to Gov. Andrew Cuomo at the end of October, stressing how important the funding of public health programs is to all New Yorkers.
October 29, 2020
The Honorable Andrew M. Cuomo
Governor of New York State
NYS State Capitol Building
Albany, NY 12224
Dear Governor Cuomo,
You know more than most that COVID-19 has thrust public health into the forefront of every New Yorker’s mind. The American Heart Association is redoubling its efforts to improve the health of all Americans – especially where inequities occur – and respectfully urge you to make the health of each New Yorker a priority in your FY 2021-2022 Executive Budget. In your regular COVID briefings, you have also addressed the budget deficit. We suggest the following policies that are an added source of revenue for the state, and are critically important to the health and wellbeing of all New Yorkers.
Increase Tobacco Taxes:
An increase in the State’s tobacco taxes, specifically a $1.00 cigarette tax increase and the establishment of tax parity for other tobacco products including e-cigarettes, cigars, and smokeless tobacco products, is an incredibly effective tobacco control measure. Tobacco use remains the leading preventable cause of death and a significant contributing factor to heart disease and stroke, our nation’s number one, and number five causes, respectively, of mortality. An estimated 23,000 deaths every year are attributed to smoking in New York.
It’s been 10 years since we raised taxes on these deadly products, and in that time, flavored tobacco has become an epidemic. A significant increase in tobacco taxes will have a positive impact on the number of people, especially youth, who smoke. Youth, lower-income adults, and pregnant women are extremely price sensitive, so a higher price goes far in helping them quit or, better yet, preventing them from starting a deadly addiction. The projected health benefits of increasing the cigarette tax by $1.00 per pack in New Yok include:
- Youth under age 18 kept from becoming adult smokers: 29,500
- Reduction in young adult (18-24 years old) smokers: 6,500
- Current adult smokers who would quit: 61,800
- Premature smoking-caused deaths prevented: 24,400
- 5-year reduction in the number of smoking-affected pregnancies and births: 6,000
As an added benefit, a $1.00 cigarette tax increase would bring in $30.40 million in new annual revenue. Moreover, the projected savings in from a $1,00 per pack tax increase includes:
- 5-year health care cost savings from fewer smoking-caused lung cancer cases: $12.05 million
- 5-year Medicaid program savings for the state: $46.11 million
- Long-term health care cost savings from adult & youth smoking declines: $1.86 billion
The State can expect even more financial benefits as these figures do not account for the additional revenue and savings that would come from increasing the tax on other tobacco products. By establishing tax parity with the $1.00 cigarette tax increase, we will ensure youth don’t start or continue their addiction by switching to a cheaper product.
Maintain Adequate Funding for the Tobacco Control Program:
To provide the needed tools to New Yorkers who want to quit, the State must continue funding the Tobacco Control Program at least at its current amount of $36 million.
The Tobacco Control Program is so effective because it funds community-based initiatives that help educate community members about the dangers of tobacco, helps to keep kids from starting smoking, and runs the Quit Line. During this pandemic, tobacco control measures are urgently needed. Tobacco use is a significant contributing factor to cardiovascular diseases, including hypertension. Patients with existing cardiovascular disease or its risk factors may be at higher risk for serious complications from COVID-19, including death and smokers are at risk for more serious, even life-threatening cases.
Establish a Tiered Excise Tax on Sugar Sweetened Beverages:
Existing chronic diseases stemming from an unhealthy diet do not impact all New Yorkers equally. Obesity is a significant risk factor for a number of chronic diseases including heart disease, certain cancers, and diabetes. The health disparities that exist between different communities can be linked to consumption of sugary drinks and the disproportionate marketing done by the sugary drink industry. As sugary drinks are the primary sources of added sugar in our diets, a tiered sugary drink tax would be an effective public health policy tool that can reduce consumption of sugary drinks, and thus improve health and overall well-being. Reducing sugary drink consumption will ultimately reduce chronic disease rates—helping people live longer and healthier lives, reduce health care costs for families and businesses, and strengthen our local, state, and national economy.
Among NY adults, the obesity rate is 27.6% and 14.4% among youth, both of which have been relatively stagnant, indicating that more needs to be done. When looking at the breakdown of obesity by race, the numbers show a disparity: 25.7% white, 34.1% African American, and 29.4% Latinx. Roughly 1,634,000, or 10.5% of the adult population has been diagnosed with diabetes, and 29.4% have hypertension.
Research proves that price has a big impact on what consumers purchase, which of course impacts consumption. A tiered tax on sugary drinks would generate tax revenue, lower health care costs (New York spends roughly $11 billion every year on obesity-related diseases) and prevent cardiovascular disease events and diabetes cases. Studies show it can generate the largest health gains and cost savings. Encouraging water consumption instead of sugar-laden drinks is a straightforward approach to this problem. As consumers are incredibly price sensitive, especially youth, a nominal price increase on sugary drinks in the form of a tax can save both lives, and money. The breakdown of the tax would be 3 tiers, based on the amount of sugar per oz.:
- Tier 1: Drinks with less than 7.5g of sugar per 12 ounces will not be taxed (less than 30 calories per 12 ounce serving)
- Tier 2: Drinks with 7.5 to 30g per 12 ounces of sugar will have a main rate of minimum 2 cents per ounce; ideally 3 cents per ounce (>120 calories per 12 ounces)
- Tier 3: Drinks with >30g per 12 ounces of sugar will have a main rate of minimum 2 cents per ounce; Ideally 3 cents per ounce (>120 calories per 12 ounces)
Research shows that a tax based on sugar content could reduce overall sugar consumption by 25 percent. A growing number of places have adopted taxes on sugary drinks—including San Francisco, Oakland, Albany, and Berkeley, California; Philadelphia, Pennsylvania; Boulder, Colorado; and Seattle, Washington. These taxes raise much needed revenue for important public health priorities, such as nutrition programs, pre-k expansion, school construction, parks, and public safety initiatives. Early research also shows that they are effective at reducing consumption—for example, a recent study of Berkeley concluded that soda sales dropped by 21 percent in low-income neighborhoods during the first four months of implementation.
In addition to the public health and fiscal benefits associated with a tiered sugary drink tax, this policy also helps to curb dangerous and disparate marketing by the sugary drink industry. The promotion of unhealthy drinks is problematic in and of itself, but even more dangerous is when there is targeted marketing to children and communities of color. From 2010 to 2013, Black youth were exposed to more than twice as many television ads for sugary drinks than their white counterparts. This is because they are subject to a “double dose” of unhealthy food and beverage marketing, in that they are exposed to marketing campaigns aimed towards all youth, as well as marketing tactics targeted to their own communities. Lower-income Black and Latinx neighborhoods have more outdoor ads for sugary drinks than lower-income and higher-income white neighborhoods. In addition to seeing more advertising for sugary drinks, Black and Latinx communities have disproportionately high rates of heart disease, type 2 diabetes and other chronic diseases that are brought on, in part, by consuming sugary drinks.
A sugary drink tax based on sugar content would be a win for kids, a win for families, a win for businesses, a win for the economy, and a win for better health.
Obesity Prevention Program:
Living at an unhealthy weight is a major risk factor for cardiovascular diseases, diabetes, and certain cancers. As obesity continues to plague New Yorkers, more must be done to help with prevention and treatment. The Obesity Prevention Program allows work to be done at the community level, including in the school environment where resources go to help increase the number of schools with healthy nutrition environments and strong physical activity programs. As such, we request that no cuts be made to the $5.9 million included for obesity prevention in the 2021-2022 Executive Budget.
We know that prevention is key when it comes to dealing with chronic diseases. If these programs do not have the funds they need to operate effectively in our communities, schools, and workplaces, then we are subjecting New Yorkers to unnecessary suffering.
Healthy Heart Program:
Heart disease and stroke are the number one and number five causes of mortality nationwide, and a significant risk factors of both heart disease and stroke is hypertension. In New York, roughly 4.9 million people suffer from hypertension. As additional information comes to light connecting the severity of COVID-19 with underlying cardiovascular conditions, specifically, patients with existing cardiovascular disease (CVD) or CVD risk factors, now is time to invest in treatment and prevention.
Importantly, The Healthy Heart Program works to reduce premature death and disability from CVD by addressing sedentary lifestyles, poor nutrition, obesity, high blood pressure, diabetes, high cholesterol, and CVD-related health disparities across population groups. This program is wide reaching and operates in communities, worksites, schools and health care by implementing programs to control and reduce the major risk factors associated with CVD. Ensuring funds to this program are at least maintained at $692,000, as appropriated in the FY 2020-2021 budge, is necessary to provide New Yorkers the cardiovascular care and resources they need.
Thank you for being a continued champion of public health. We look forward to working with your administration during the FY 2021-2022 legislative session.
David Ping, Eastern States Board Chair, American Heart Association
Dr. Howard Zucker, Commissioner of NYS Department of Health;
Paul Francis, Secretary for Health, NYS Executive Chamber;
Richard Becker, Deputy Secretary for Health and Human Services;
Megan Baldwin, Assistant Secretary for Health, NYS Executive Chamber;
Robert Mujica, Director of Division of Budget;
Frank Walsh, Chief Budget Examiner, Division of Budget;
 Independent Evaluation of the New York Tobacco Control Program, October 2019, Matthew C. Farrelly, PhD, American Cancer Society. Cancer Facts & Figures 2020 Atlanta: American Cancer Society; 2020
 Projected numbers of youth prevented from smoking and dying are based on all youth ages 17 and under alive today. Projected reduction in young adult smokers refers to young adults ages 18-24 who would not start smoking or would quit as a result of the tax increase.
 Health care costs are from the U.S. Centers for Disease Control and Prevention (CDC). Savings to state Medicaid programs include estimated changes in enrollment resulting from federal laws in effect as of January 1, 2020 and state decisions regarding Medicaid expansion. Long-term cost savings accrue over the lifetimes of persons who stop smoking or never start because of the tax rate increase. All cost savings are in 2020 dollars. The state Medicaid cost savings projections, when available, are based on enrollment and cost estimates by Matt Broaddus at the Center on Budget and Policy Priorities using data from the Centers for Medicare and Medicaid Services.
 (New COVID-19 patient data registry will provide insights to care and adverse cardiovascular outcomes, 2020)