Perils of Preemption: The Tobacco Experience

Decades of painful experience have taught public health leaders that preemption of local or state tobacco control policies is almost always harmful to health. Like many other businesses, tobacco companies understand that shifting policymaking to higher levels, where they wield greatest influence, is key to evading strong regulation. In the words of a former Tobacco Institute lobbyist, “We could never win at the local level. . . . . [T]obacco companies' first priority has always been to preempt the field, preferably to put it all on the federal level, but if they can't do that, at least on the state level . . . ..” Unfortunately, preemption is sometimes accepted by exhausted advocates as the necessary price for adoption of their hard-fought proposals. Time after time, health leaders have acceded to preemptive tobacco control laws, only to learn to their regret and embarrassment that the supposed “solutions” to which they have agreed have, in fact, undermined health. This presentation will review the impact of preemption across a spectrum of tobacco policies, including the regulation of advertising, product content, product labeling, sales practices and smoking policies, and will explore possible lessons for other areas of public health policy.