District to Use Tobacco Funds On Health Care

The balance of the fund will go for chronic disease prevention and management. Though that $40 million pales by comparison, the impact could be just as big: $20 million for cancer control, $10 million for initiatives to help people stop smoking and $10 million to target such problems as asthma and hypertension.

"These are hugely important dollars," Catania said.

The D.C. Cancer Consortium, charged with implementing programs to reverse the high incidence of that disease, already is at work. In a city where it is not uncommon for advanced malignancies to be diagnosed in hospital emergency rooms, a top priority is access to care.

"This doesn't begin to reduce cancer," Executive Director Susan Butler said. "This just reduces the human misery. . . . It reduces mortality."

The consortium hopes to develop a citywide "patient navigator system" that would guide a resident, regardless of insurance status, to immediate and appropriate services. All cancer centers in the District are cooperating in this effort, Butler said, to minimize duplication so that resources go farther.

"What we're going to set out to do is to try to coordinate these things," she explained. "I don't mean to make it sound easy. It's not. But it's the only thing that will work."

Early detection is equally critical, and the consortium will use part of the $20 million on public awareness campaigns and screenings. "We need the community to understand they have the right to be screened and a right to get care," Butler said.

Rand faces one large and immediate challenge. The District's health data still have gaping holes that must be identified and filled before an assessment can be completed.

"There are a lot of places where there are deep pockets of no information," said Nicole Lurie, the physician and senior scientist who will lead the study. "There's almost no data in the city on children's health needs, where they go for care, and almost nothing on mental health."

Rand will evaluate health needs specifically for Wards 7 and 8 and assess emergency services citywide. It also will analyze the capital and operating costs of whatever clinics or health centers it considers in its recommendations.

The fund allocates $1.5 million to buy ambulances and $6 million to establish a regional health information exchange program with a secure patient database for use by doctors, health providers and hospitals in the District. The Rand study will cost $1.5 million.