A series of midterm ballot initiatives on tobacco, reproduction and social determinants such as housing throughout the country may dramatically sway the direction of public health, said Dr. Georges Benjamin, director of the American Public Health Association.
"(In) the election, the war is a component, but it's also about issues -- it's about returning our focus to trying to improve our domestic well-being," Benjamin said.
"These kinds of ballot initiatives have an effect on the wellness of the population."
Arizona, California, Nevada, Missouri, Ohio and South Dakota have ballot initiatives related to tobacco, with some states considering raising taxes on cigarettes and using the resulting money to support anti-tobacco programs.
For instance, a proposed law in South Dakota would raise the tax on a 20-stick cigarette package by $1 and a 25-stick package by $1.25. The $30 million in tax revenue would go into a state general fund, and $5 million would be deposited into a tobacco prevention and reduction trust fund.
Nevada is also proposing a Clean Indoor Air act, which would prohibit the smoking of tobacco in indoor places of employment in various public locations such as child-care facilities and movie theaters.
Tobacco is the leading preventable cause of death in the United States, and 400,000 people die each year from its effects.
California, Rhode Island and New Mexico are also holding referenda on housing. Proper housing, especially for low-income Americans, is a social determinant of good health, Benjamin said.
For example, the New Mexico proposition would permit states, counties and cities to donate land or buildings or provide for affordable housing projects.
Several states are also voting on raising the minimum wage. Arizona, for instance, will ask voters to decide whether to raise the minimum wage from $5.15 an hour to $6.75, starting in January 2007.
And several controversial ballots related to abortion are on the ballot in California, Oregon and South Dakota. The South Dakota law would prohibit abortion except when the woman's life was in danger. The California and Oregon laws would require teenaged girls to notify their parents before an abortion.
Also much-debated is Missouri's proposed constitutional amendment, which would allow the state to pursue federally approved stem-cell research, including embryonic stem cells -- a contentious issue in the race between U.S. Sen. Jim Talent, R-Mo., and State Auditor Claire McCaskill, a Democrat.
"We have no doubt that research issues are figuring into the election," said Mary Woolley, president of Research!America, an organization advocating more research dollars for health.
Beyond stem cells, the potential of the human genome project and the pressing need for disease prevention research makes Woolley confident that candidates are turning their attention to health issues.
Her organization recently debuted the first voter's guide for health at www.yourcandidatesyourhealth.org. The guide allows visitors to search their candidate's views on a range of health-related topics, such as science education or funding for federal science agencies.
As of Tuesday, 40 percent of the candidates had responded to Research!America's voter's guide, which asks each candidate to answer questions relating to health research and provide comments.
"We believe this underscores to candidates the importance the American public ... places on research for health," Woolley said.
U.S. Rep. Ben Cardin, D-Md., running for the Maryland Senate seat, wrote on the Web site, "I will oppose any additional cuts in this year's budget, and continue to fight for funding that will enable (the Centers for Disease Control and Prevention) to fulfill its mission of protecting Americans' health."
Says Sen. George Allen, R-Va., on his page: "While Congress has to balance budgetary priorities, which should also include national defense and homeland security, I support a continued commitment to advancing medical and health science and research and supported the doubling of funding for NIH."
Likewise, a random survey of 800 adults in August by Research!America and the Albert and Mary Lasker Foundation showed about 56 percent of Americans support federal funding for medical research using embryonic stem cells.
The survey also reported 55 percent of Americans favored an increase of funding for the NIH as "essential to future health and economic prosperity," and indicated a public lack of support for cuts to the CDC budget. Of the survey participants, 42 percent were Democrats, 37 were Republicans and 14 identified themselves as independent.
Yet some experts predict a troubled outlook for funding health initiatives, regardless of what party takes over. The "big clash" will come in trying to save money in the federal budget while also funding federal agencies such as NIH, said J.B. Silvers, a professor of health systems management at the Weatherhead School of Management at Case Western Reserve University in Cleveland.
"If it hadn't been for the war in Iraq, (healthcare) would have been a huge issue -- the polls don't show it has been as vital," Silvers added.
So far, the country has been failing in improving public health -- a "fundamental human right" -- despite the fact relatively inexpensive solutions, such as disease prevention, are available, Benjamin said.
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