Tuesday's election garnered wins for a number of state and city ballot measures on public health policies that could draw interest from federal agencies and lawmakers.
The legalization of marijuana was considered by a record nine states. Seven measures succeeded. As of Wednesday afternoon, Maine's question was undecided.
California, Massachusetts and Nevada joined four other states in legalizing marijuana for recreational use. Arizona's question was voted down. Measures to legalize medical marijuana passed in Arkansas, Florida, Montana and North Dakota, bringing the total number of states legalizing medical marijuana to 29, plus the District of Columbia.
Public health officials hope support for these measures will entice federal policymakers to draw national policies and legislation.
“Typically what happens is when some progressive cities pass legislation that has the effect of matriculating up so that now a state either has more pressure or more evidence or more comfort with passing a similar bill,” said LaMar Hasbrouck, executive director for the National Association of County and City Health Officials. “The more states that do it then it can go up to the next level.”
Tax hikes on cigarettes and tobacco products were less successful that legalization of marijuana. The measures failed to pass in Colorado, Missouri and North Dakota, while a proposal to raise an excise tax in cigarettes by as much as $2 per pack passed in California.
“It's a notable paradox,” said Cliff Douglas, director of the American Cancer Society's Center for Tobacco Control. “The trend in the U.S. is to substantially reduce cigarette smoking and substantially liberalize marijuana smoking."
Missouri voters rejected two measures to raise the current state cigarette tax of 17 cents per pack, which is the lowest in the country. One proposal would have raised the tax to 60 cents a pack by 2020 and added a 67 cent per pack fee for wholesalers on certain tobacco products. An alternative measure also on the ballot would have increased the tax to 23 cents by 2021.
Both measures were opposed by health advocacy groups such as the American Cancer Society Cancer Action Network, American Heart Association and the Campaign for Tobacco-Free Kids, who contended the proposed increase wasn't enough to encourage smokers to quit.
The tax increase "has to be significant enough to make consumers pause and think maybe it is really time for me to quit,” said Karen Englert, government relations director in Missouri of the American Heart Association.
The tobacco industry poured more than $1 million into efforts to pass the measures.
Despite losses in other states, California's passage of a cigarette tax hike could drive other states looking to drop smoking rates. Over the past decade, such policies have led to a decline in the U.S. smoking rate, which went from 23% in 2001 to 17% by 2014.
According to the World Health Organization, on average, a 10% increase in the price of a pack of cigarettes can reduce demand by about 4% in wealthy countries and about 5% in low- and middle-income nations.
Another so-called sin tax, an excise tax on sugar-sweetened beverages, enjoyed overwhelming success, passing in San Francisco, Oakland and Albany, Calif., as well as Boulder, Colo.
Known as the “soda tax”, the measures led public health advocates and the beverage industry to funnel more than $50 million in ad spending. The policy was once widely rejected in New York state, which tried in 2010 to pass a $.01 tax on soft drinks.
But momentum for soda taxes has gained as evidence showing a link between consumption of sugary drinks and increased rates of obesity grows. The election results will undoubtedly encourage other cities to impose similar measures and that could lead to action on a state and national level.