What is the best public health response when government agencies and tobacco companies collaborate?

Tobacco is addictive and deadly, and the tobacco epidemic has a clear industry vector. Tobacco industry contributions to worthy causes and “partnerships” with community organizations aid the industry by silencing potential opposition and helping it rehabilitate its image. For these reasons, advocates have worked to discourage organizations from accepting tobacco industry funding or working with the industry. For example, in 2006, Greenpeace withdrew from an Ethical Corporation conference after learning that a tobacco product manufacturer was a participant; California activists have persuaded elected officials and community organizations to pledge to refuse industry contributions. Yet organizations needing resources continue to accept tobacco industry funding. Since 1985, the Paralyzed Veterans of America (PVA) and the Department of Veterans Affairs (VA) have sponsored an annual National Veterans Wheelchair Games, with additional support from corporate and other donors. In 2012, a tobacco product manufacturer signed on as a National Host Sponsor of the Games in Richmond, Virginia. The VA spends more than $5 billion annually to treat just one tobacco-associated disease (COPD) among veterans. This partnership poses a challenge for the VA and public health advocates, who wish both to support the PVA's efforts, and to prevent tobacco product manufacturers from exploiting the PVA and the VA in image enhancement. Pressuring the VA to withhold support until the PVA rejects tobacco funds may harm – or be perceived to harm – disabled veterans. We discuss the tensions and contradictions of such partnerships between government health agencies and the tobacco industry, and suggest innovative responses.