Tobacco Control Policy Making in North Dakota: A Tradition of Activism

EXECUTIVE SUMMARY North Dakota has a long history of tobacco-related legislation dating back to the late 1800's, well before the formal organization of health advocates for tobacco control. Citizens of North Dakota recognized the negative health effects of tobacco smoke before most of the nation and made attempts to regulate the sale and use of tobacco products throughout the early 1900's. In 1913, the North Dakota legislature went as far as prohibiting the use of tobacco products in the state. However, all this early tobacco control legislation has since been repealed. From 1975-1983, clean indoor air legislation was introduced by legislators in North Dakota due to constituent requests and personal dislike of secondhand smoke exposure by some legislators. This legislation was consistently supported by GASP and the American Lung Association of North Dakota. These organizations were unable to pass strong clean indoor air legislation on their own.The mobilization of health advocates for tobacco control policy did not begin until the late 1980's when Dr. Stephen McDonough joined the State Health Department as the Head of the Preventive Health Section and Director of Maternal and Child Health. In 1985, Dr. McDonough joined forces with Marcie Andre of the North Dakota Lung Association to form the first tobacco control coalition in the state, Tobacco Free North Dakota. Tobacco Free North Dakota successfully brought together the State Health Department, voluntary health agencies, and other health organizations to work for tobacco control policy in the state. Tobacco Free North Dakota was in existence throughout the 1990's but became progressively less effective in promoting state level tobacco control policy due to increased tobacco industry involvement in state level politics. Through the efforts of Dr. McDonough and Tobacco Free North Dakota the first North Dakota state tobacco plan, "Tobacco, Health, and the Bottom Line" was developed in 1986. At the time the plan was one of only six that had been developed in the country. Through the leadership provided by McDonough, the active coalition of Tobacco Free North Dakota, and the well-developed plan tobacco control advocates were able to strengthen clean indoor air legislation (HB 1272) and pass a tobacco tax increase in 1987. The passage of clean indoor air legislation which required the designation of a smoking area in places of public assembly was similar to the 1975 Minnesota Clean Indoor Air Act which had been passed 12 years earlier. Although weak by 2004 standards and well behind Minnesota, HB 1272 strengthened clear indoor air law in North Dakota.The mobilization of health advocates for tobacco control led to an increase in tobacco industry involvement in state politics and subsequent decrease in state level tobacco control policy. The tobacco industry has built and strengthened networks of third party allies, including the Tobacco Wholesalers Association, North Dakota Grocers Association, ND Petroleum Marketers Association, North Dakota Retail Association, and the Greater North Dakota Association to fight the public battles against tobacco control policy allowing the tobacco industry to remain behind the scenes.Although the path of tobacco industry money in North Dakota is difficult to trace due to poor reporting requirements, piecing together reported political contributions, tobacco industry budgets, and media reports provides evidence that tobacco industry funds have influenced the political process in North Dakota. The tobacco industry successfully halted the passage of tobacco control policy at the state level. The only state level legislative successes for health advocates beyond the 1987 legislative session was the prevention of the passage of preemptive legislation supported by the tobacco industry.In the early 1990's tobacco control advocates recognized the stall in state level tobacco control policy due to the infiltration of the political process by the tobacco industry. Wisely, tobacco control leadership at the State Health Department including Dr. McDonough and Jeanne Prom, State Health Department Tobacco Prevention and Control Administrator(1992-2001), shifted the focus to local level politics where the force of the tobacco industry was less powerful. In 1992, the State Health Department began funding local public health units for coalition building and the passage of youth access ordinances. Local tobacco control policy flourished throughout the 1990's with a total of 38 youth access ordinances enacted.The most significant local policy success in North Dakota was the passage of a smokefree restaurant ordinance in Minot, North Dakota on April 2, 2001. The STAMP coalition with the leadership of Kelly Buettner-Schmidt working in collaboration with City Council members Andy Bertsch and Stephan Podrygula secured the passage of the ordinance by the Minot City Council. As has happened in many other states following first passage of a smoke-free restaurant ordinance (with undisclosed backing from the tobacco industry), four days after the passage of the ordinance a referendum was forced and the smoke-free ordinance was subsequently brought to a vote of the people. Due to the efforts of the STAMP coalition the ordinance was successfully upheld by a vote of the people and became effective January 1, 2002.On the state level, State Health Officer Murray Sagsveen, under the direction of Republican Governor Edward Schafer, set the stage for the allocation of minimal Master Settlement Agreement funds to tobacco control in North Dakota. Prior to the 1999 legislative session health advocates failed to effectively advocate for the allocation of the funds to tobacco control. Therefore, the Governor and legislature determined that only 10% of the funds would be directed to a Community Health Trust Fund. Prior to the 2001 legislative session health advocates lost the leadership previously provided by Dr. Stephen McDonough and Attorney General Heidi Heitkamp and did not unify behind a plan for the allocation of the funds in the Community Health Trust Fund. The determination of the implementing legislation was largely left to the legislature. However, health advocates did play a role in shaping the Community Health Grants Program. The Community Health Grants Program directed the funds in the Community Health Trust Fund to the local public health units where tobacco control advocates have traditionally been the most successful in North Dakota.In the late 1990's the tobacco control infrastructure built by Tobacco Free North Dakota in the late 1980's crumbled due to loss of leadership and an adverse environment for tobacco control within the State Health Department. In 2003, health advocates in North Dakota were in the process of rebuilding this infrastructure in order to move forward with state level tobacco control policy