Division of Health Administration and Policy, Medical University of South Carolina, Charleston, SC 29425-6300, USA.
Chest. 2010 Mar;137(3):692-700. doi: 10.1378/chest.09-0982.
The issue of tobacco industry responsibility for population health problems and compensation for their treatment has been growing since the 1960s. In 1999, the state attorneys general collectively launched the largest class action lawsuit in US history and sued the tobacco industry to recover the costs of caring for smokers. In what became known as the Master Settlement Agreement (MSA), states were rewarded billions of dollars and won concessions regarding how cigarettes could be advertised and targeted to minors. Ten years after this settlement, much is known about how MSA monies were distributed and how states have used the money. There is some understanding about how much of the money went toward offsetting the health-care costs attributable to smoking and whether resources were allocated to efforts to reduce smoking in a particular state. However, there are few data on what effect, if any, the MSA had on tobacco control locally and nationally. This commentary explores these issues, as well as how the tobacco industry has evolved to offset the losses incurred by the settlement. Finally, an analysis of the complexities of current tobacco policy making is provided so that physicians and other health-care advocacy groups can more completely understand the present-day political dynamics and be more effective in shaping tobacco control policy in the future.
自 20 世纪 60 年代以来，烟草业对人口健康问题的责任以及为其治疗提供赔偿的问题日益突出。1999 年，州检察长集体提起了美国历史上规模最大的集体诉讼，并起诉烟草业，要求赔偿吸烟者的护理费用。在被称为《总和解协议》（MSA）的协议中，各州获得了数十亿美元的赔偿，并就香烟广告和针对未成年人的问题赢得了让步。在该和解协议达成十年后，人们对 MSA 资金的分配方式以及各州如何使用这些资金有了很多了解。人们对这些资金中有多少用于抵消与吸烟相关的医疗保健费用以及资源是否分配用于减少特定州的吸烟行为有了一些了解。然而，关于 MSA 对当地和全国的烟草控制产生了何种影响的数据却很少。本评论探讨了这些问题，以及烟草业为弥补和解协议所造成的损失而采取的演变措施。最后，对当前烟草政策制定的复杂性进行了分析，以便医生和其他医疗保健倡导团体能够更全面地了解当今的政治动态，并在未来更有效地制定烟草控制政策。
