By Steve Metzer
The Journal Record
OKLAHOMA CITY – Julie Bisbee’s goals are so lofty, to the point of being almost ethereal, that it’s stunning even to hear them said out loud.
“In my lifetime,” she says, “I hope that we’re no longer talking about tobacco … that cigarettes are no longer being sold.”
In a state that still sacrifices 7,500 lives every year to tobacco, more than 20 years after big tobacco companies agreed that they had lied to Americans for decades about the deadly effects of smoking, to say that Bisbee’s goals are extraordinarily ambitious would seem to be a vast understatement. But said she is committed to lifting the pall of tobacco that’s hung over Oklahoma for generations.
Bisbee was selected recently to be the new executive director of the Tobacco Endowment Settlement Trust, or TSET. But she has been with the state agency responsible for fighting not only tobacco use but also cancer, heart disease, obesity and diabetes since 2012. In that time, she has seen Oklahoma continue to take great strides toward becoming healthier. Consider, for example, that the number of high schoolers who identify themselves as smokers has declined by well more than half since 2005. Declines in smoking overall have resulted in an estimated billion fewer packs of cigarettes sold in the state since 2001.
Those successes only partially explain Bisbee’s hopeful outlook, however. She’s also convinced that her “small but mighty” state agency has adopted the right strategies for achieving much more.
The Tobacco Settlement Endowment Trust was created by Oklahoma voters in 2000. The state, along with 44 others, had previously sued the tobacco industry for immense damages that resulted from its lies and deceitful marketing aimed at getting people, including kids, hooked on cigarettes and other forms of tobacco. Just as the case was scheduled to go to trial, a multibillion-dollar settlement was reached. Part of it requires the companies to make annual payments – continuing for as long as cigarettes are sold nationally – to the states. In Oklahoma, three-quarters of the money goes into TSET. The rest goes to the Legislature and to the office of the attorney general.
Bisbee said that historic vote by Oklahomans nearly two decades ago called for the TSET money to be invested and carefully managed, with only interest earnings used to fund things like a statewide helpline and program designed to help people quit smoking, local grants to help schools and communities improve health and other initiatives, including cancer treatment and research.
While Oklahoma started out behind many other states in measures of overall health, in recent years Bisbee said the state arguably has achieved more successes than others in turning things around.
“Oklahoma is a model for the nation in the way we have continually protected that voter-created fund and have followed the mandate of voters on how to use it on initiatives to improve health,” she said.
As an example, she said TSET “healthy living” grants have launched or advanced programs in 62 of the state’s 77 counties and positively affected an estimated 94% of Oklahomans. The grants have encouraged communities to cultivate partnerships to help reduce local rates of cancer and cardiovascular disease – and there’s tangible evidence that they’ve worked. TSET reports that an independent analysis found that rates of smoking in Oklahoma have declined faster than they’ve declined in states that started out in similar shape. Researchers concluded that at least 42,000 lives have been saved, and that Oklahomans have managed to avoid $1.24 billion in direct medical costs.
“We support setting policies at the state level but recognize that change really occurs at the local level,” Bisbee said. “So we support local-control grants for statewide initiatives.”
Bisbee said an important reason why TSET grants have succeeded is that they are continually assessed and evaluated. Milestones for progress are identified before grants are awarded and then are documented after programs are initiated. If an initiative is found to deliver exceptional results, it’s quite likely to be replicated, but if it doesn’t meet expectations, changes no doubt will be made.
“We are very aware that these are public dollars,” Bisbee said. “So we hold accountability very high. I feel like we operate at a high level of integrity.”
Other programs and initiatives are similarly evaluated.
For example, the statewide Oklahoma “helpline” set up to take calls from people in need of help quitting tobacco has been found to work very well. Bisbee said the line has taken more than 400,000 calls since its inception, and that follow-ups have shown that nearly a third of people remain smoke-free a month after their initial calls. That success rate beats a national benchmark.
“We have one of the top quit lines in the country,” she said. “We’re not just encouraging people to quit smoking. We’re actually helping them.”
Seven members of the trust’s board of directors also place high value on adaptability, Bisbee said. They’re “passionate” not only about addressing current health care challenges but also about recognizing trends and responding with innovative new programs and initiatives. A few years back, when a shortage of doctors in rural parts of Oklahoma was becoming more acute, TSET responded by launching a loan assistance program to attract physicians to small towns. If doctors agreed to set up practices and stay for at least four years, the program would pay their student loans. In the past five years or so, 48 doctors have signed up, and their practices in rural areas have handled at least 264,000 patient visits. But possibly the best news of all, Bisbee said, is that eight doctors who have reached the end of their four-year commitments all have opted to stay on in their adopted communities.
“It was a theory and always our hope that that would happen,” she said, “that they would decide ‘Hey, this is a really nice place to be.’”
As TSET initiatives have matured over the years, they’ve evolved to put more focus on choices for healthy living that Oklahomans should make, like encouraging children to play or otherwise get an hour’s worth of physical activity in every day (adults should strive for at least 30 minutes’ worth each day). More emphasis also is being placed on encouraging healthy eating. Health care costs related to obesity now outpace costs related to tobacco use, Bisbee noted.
Bisbee said TSET also has a vested interest in the Stephenson Cancer Center, which has earned national recognition for cancer research and treatment. The center at the University of Oklahoma Health Sciences Center allows Oklahomans to get world-class care close to home, she said, and also is involved in cutting-edge research on new drugs and therapies.
“For a lot of folks, that’s hope,” she said. “We have folks coming from other states because we’re doing trials here that they can’t get in their home states.”
Looking forward, she said she is encouraged by the state’s direction, and especially by the priority that’s been placed by Gov. Kevin Stitt and the Legislature on making Oklahoma a “Top 10” state.
“I hope we can help to fuel that progress,” she said. “We are the state’s largest funder of prevention (of cancer and other health care problems), and prevention is where you get the most bang for your buck. You would want someone to have a healthy life rather than to come into your health care system with an acute, advanced condition that you then have to manage. We’re in that space, looking at root causes, trying to create environments that support healthy choices.”
She said TSET will continue to invest in local programs, statewide initiatives and in things like innovative cancer research and treatment. Additionally, public education efforts will continue to focus on exposing deceptive practices of the tobacco industry, dangers of secondhand smoke and on dangerous trends, like the “dramatic and alarming” recent rise in e-cigarette use.
“If there’s an innovation (in helping people to quit smoking or make healthier life choices) we’re going to look at it and ask ‘How can we apply that?’” Bisbee said. “How can we do that for the maximum impact for Oklahomans? We realize that we’re going toe-to-toe with the tobacco industry, so we have to make sure our dollars are used to the best of their potential.”
As things now stand, fully three-quarters of people in Oklahoma don’t smoke, Bisbee said. While she recognizes that making the state entirely smoke-free remains an immense challenge, important progress has been made and mighty efforts will continue.
“Changing social norms is slow,” she said. “We recognize that, but that’s the goal, to assure people that the social norm is to be smoke-free.”