Skin cancer screenings for Eastern Shore watermen. Russian-language newspaper ads urging emigres to give up their cigarettes. And Internet wiring for public schools around the state.
These are some of the tangible benefits Marylanders could see when the state begins to spend its share of the national tobacco settlement -- an estimated $4 billion over 25 years.
Under a blueprint developed by Gov. Parris N. Glendening and nearing final approval in the General Assembly, the state will concentrate its spending on 20 programs scattered mostly across three main areas: education initiatives such as teacher pay raises, efforts to reduce smoking in Maryland, and a stepped-up fight against a variety of cancers, whether they are related to smoking or not.
Lawmakers also have allocated tens of millions of dollars to expand drug treatment and to help Southern Maryland tobacco farmers shift to new crops.
The debate over how to spend the tobacco proceeds is being played out in state capitals around the country -- with different outcomes. California may devote as much as $300 million in tobacco proceeds to settle a host of expected police brutality lawsuits in Los Angeles, while Virginia is devoting some of its money to road-building.
Some Maryland lawmakers worry that the state is spreading its share of the unprecedented windfall -- about $150 million in the next year -- across too many programs. But the governor and legislative leaders say they are generally pleased with the final shape of the spending plan.
"There will be probably 50 percent less children smoking" because of programs funded by the tobacco money, Glendening predicted last week.
House and Senate negotiators have agreed to legislation that lays out a blueprint for spending on the broad health goals of battling cancer and lowering smoking rates.
Legislators opted not to require the governor to spend particular amounts from the fund on specific projects. But they have drafted, in effect, a policy statement that supports Glendening's commitment to earmark about half of the state's expected share of the money -- $70 million a year for 10 years -- for anti-cancer and anti-smoking programs.
Allocating the other half of the funds will be left to Glendening and his successors, with the consent of the legislature.
Debates about disbursement
The legislation culminates more than a year of wrangling among lawmakers and the governor about the tobacco funds. Although Maryland is enjoying a billion-dollar budget surplus, the tobacco money sparked some of the most aggressive debate.
Many legislators saw a chance to secure a share of the fund for their favorite causes -- everything from acupuncture treatment to school-based nurses.
After weeks of sometimes contentious discussions, lawmakers opted to embrace the priorities established by the governor: programs to curb smoking and various cancers. Assembly leaders said a final vote on the measure will come tomorrow, the last day of the legislature's annual 90-day session.
The initiative to reduce Maryland's high cancer rates -- expected to cost $400 million over 10 years -- has raised the most doubts among legislators. The money will be spread across many different fronts around the state.
Local health departments, working with coalitions composed of community representatives, will receive $15 million a year for prevention and screening efforts. Dr. Georges C. Benjamin, the state health secretary, said such spending likely will lead to screening and prevention programs geared to groups with particularly high cancer rates.
On the Eastern Shore, local leaders might choose to spend the money checking watermen for skin cancer. In Baltimore, officials might focus on African-American men, who tend to have high rates of prostate cancer, Benjamin said.
He predicted that the new spending would foster creative outreach efforts -- focusing, perhaps, on a public housing complex and calling upon local residents for help.
"I'm no good at going into a housing project and getting those citizens to move on anything," Benjamin said. "You need people who are currently in those communities to bridge those gaps. That means the churches -- pulling together a meeting of some of the ministers."
Medical institutions benefit
The state's two most prominent medical institutions, Johns Hopkins Hospital and the University of Maryland Medical System's Greenebaum Cancer Center, secured commitments for $15 million a year for the next decade to expand their efforts to fight cancer.
Hopkins will use its share to add wings to two buildings and to increase salaries of researchers involved in an ambitious effort to track cancer rates around the state and identify environmental factors.
Hopkins officials are pleased with the state assistance, particularly with lawmakers' 10-year commitment to the effort -- which is much longer than typical federal research grants.
"This type of long-term commitment is really how we're going to find the answers for dealing with cancer prevention problems that are decades out," said Dr. John D. Groopman, chairman of the Hopkins Department of Environmental Health Sciences.
The University of Maryland will use its tobacco proceeds for clinical care, outreach, prevention and other efforts. Officials plan, among other projects, to build a "tele-medicine" network to provide cancer screening for Marylanders far from Baltimore.
Spending not focused enough
Some legislators worry that the anti-cancer spending might be too diffuse to achieve major accomplishments.
"I'm not sure there are enough resources on the cancer side," said Sen. Christopher Van Hollen Jr., a Montgomery Democrat who helped craft the legislation prescribing how the tobacco money will be spent.
Benjamin has no illusions that the money will allow the state to "conquer" cancer, as Glendening once suggested. "If anyone thinks we're going to wipe out all the cancer in the state of Maryland, that's not going to happen," he said. "But this is a very good start."
At Glendening's urging, the tobacco funds also will pay for a major state effort to curb smoking and to stop teens from taking up the habit. The governor has pledged $30 million a year for 10 years to the program.
About $10 million of that will go to an aggressive "counter-marketing" effort, using commercials aimed at particular groups. The state now spends $600,000 a year on anti-smoking advertising, and legislators said the new commitment will provide a meaningful test of the effectiveness of such campaigns.
"There are enough resources to make it work -- if it can work," said Van Hollen. "If publicly funded programs can work, this will be the model."
A third major area of spending is not addressed in the tobacco bill. In the state budget for next year, lawmakers earmarked tobacco money for a string of education programs -- including $35 million for teacher pay raises, $6 million for textbooks for private schools, and $4 million to wire public schools for the Internet.
The budget also includes $18.5 million in tobacco funds for drug treatment programs and $9 million to help Maryland tobacco farmers turn to other crops.