Report 2019-046 Recommendation 15 Responses

Report 2019-046: Proposition 56 Tobacco Tax: State Agencies' Weak Administration Reduced Revenue by Millions of Dollars and Led to the Improper Use and Inadequate Disclosure of Funds (Release Date: January 2021)

Recommendation #15 To: Public Health, Department of

To ensure that it applies sufficient funding to address tobacco-related health disparities, by June 2021, Public Health should establish a formal procedure for meeting the requirement that it award at least 15 percent of the Proposition 56 revenues funding its Tobacco Control Program to accelerate and monitor the rate of decline in tobacco-related health disparities.

6-Month Agency Response

CTCP updated its Solicitation Manual Chapter 1 in May 2021 to further identify the methodology used to categorize funding awards that accelerate reduction of tobacco-related disparities. The Solicitation Manual Chapter 1 update is provided as supporting documentation. For your reference, the Proposition 56 Tobacco-Related Disparities Policy and Procedures begins on page 8.

CTCP also updated its webpage to include the Story of Inequity and posted an interactive map of its Priority Population funded grantees at: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/Pages/DataHub.aspx#. The Story of Inequity website provides the progress made.

The 2019 Tobacco Facts and Figures report was the last Tobacco Facts and Figures report posted on the CTCB website. The 2020 Tobacco Facts and Figures report is scheduled to be posted later this year which will describe the efforts to monitor the rate of decline in tobacco-related disparities.

California State Auditor's Assessment of 6-Month Status: Fully Implemented

Public Health has established formal procedures that appear to implement the recommendation. However, it remains to be seen whether its funding is accelerating the rate of decline. For example, its claim that the Story of Inequity website "provides the progress made" is not substantiated by the website, which includes point-in-time statistics but fails to show progress resulting from Proposition 56 funding.

60-Day Agency Response

The California Tobacco Control Program (CTCP) updated its Solicitation Manual to incorporate its existing business practices and procedures for awarding funds in compliance with this recommendation. CTCP's Financial Management and Compliance Unit (FMCU) also completed procedures for ensuring that CTCP awards at least 15 percent of its annual revenue toward accelerating and monitoring the reduction of tobacco-related disparities. The Solicitation Manual and FMCU procedures are provided as supporting documentation.

CTCP also added a link to the Story of Inequity website on the Data Section of Public Health's California Tobacco Control Branch website at: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/Pages/Data.aspx. The Story of Inequity website tracks 22 tobacco-related disparity measures for eight population groups disproportionately burdened by tobacco-related disparities. The link was added to improve awareness and access to the website.

Finally, CTCP annually releases a Tobacco Facts and Figures report that summarizes California tobacco-related data. CTCP plans to add a section to this annual report that clearly describes efforts to monitor the rate of decline in tobacco-related disparities and the progress made. This is currently under development.

California State Auditor's Assessment of 60-Day Status: Partially Implemented

The procedure Public Health describes in its solicitation manual does not appear to be sufficient to ensure that it meets the requirement that it award at least 15 percent of the Proposition 56 revenues funding its Tobacco Control Program to accelerate and monitor the rate of decline in tobacco-related health disparities. Specifically, its procedure counts a portion of the funds it awards for grants that are only partially used for priority groups. However, we are concerned that funds that do not address disparities--or differences between two groups--could be counted. For example, a grant that targets both priority and non-priority groups equally would not reduce the disparities between the groups, as required. Full implementation of this requirement should also result in a policy that addresses monitoring the results of these grants, to allow Public Health to demonstrate that its funding is accelerating the rate of decline, as required.

All Recommendations in 2019-046

Agency responses received are posted verbatim.