Kaua’i gets 4-star general in war on tobacco

Editor’s note: This is the first in a two-part series on the new Kaua’i district health officer for the state Department of Health. Tomorrow: his attack on cancer.

LIHU’E — Most Kauaians don’t know it yet, but on the island in a leadership position and with every intent to be at the forefront of the ongoing war against tobacco use is something of a four-star general.

Dr. Dileep G. Bal has public-health degrees from Harvard University and Columbia University.

For 25 years before retiring (the first time) recently, he headed the cancer-control branch of the state Department of Health of California, where he went to war against leaders of the tobacco industry in that state.

He prevailed, and his efforts and anti-smoking laws he helped pen helped significantly drive down tobacco use among Californians in an effort to reduce cancer cases.

Bal also headed a public-health department in Arizona that served 800,000 people in the 1970s. He serves as a clinical professor at the University of California at Davis medical school, and gives lectures.

As the new Kaua’i district health officer for the state Department of Health, Bal could easily implement his own programs and decide what direction he wants to take his department in.

Instead, Bal just wants to listen.

At this point, Bal said he has made it his top priority to tap into the “wealth” of experience and knowledge held by his staff.

From them, he hopes to find out what programs can be enhanced, and what might need to be modified, to bring major benefits to Kaua’i residents, he said.

“I have a bunch of skills, but I want to listen to section heads, employees, and the people of Kaua’i, to move the agenda as they see fit,” Bal told The Garden Island. “I am very impressed by my colleagues.”

As the district head officer, Bal said he sees himself “as a servant of the people of Kaua’i.

“One of the fallacies of medicine and government is that something or somebody should come in and tell everybody what to do. That is not my way,” Bal said.

Bal started his new job on Sept. 12, replacing Dr. Ron Metler, who headed the Kaua’i DOH district office for more than 15 years, and retired in January of this year.

Since then, John Hunt has been the acting district health officer for Kaua’i.

Bal will head a score of programs here, including those that deal with bioterrorism-preparedness and response, the control of communicable diseases, services of community-health nurses, services for the developmentally disabled, environmental-health services, clean water, safe-drinking water, food and drug, control of chronic diseases, nutrition, solid and hazardous waste, child and adolescent and mental-health services, and vector control.

In the alternate as well, Bal, because of his extensive experience with cancer-control programs, will serve as a special advisor to Dr. Chiyome Fukino, the state’s DOH director.

Bal will consult with her on statewide programs related to cancer, chronic disease, tobacco and nutrition.

Related to addressing Kaua’i’s health needs, Bal said, “She and I look forward to seeing what are the needs of Kaua’i, and giving the resources to the staff (to tackle the challenges).”

Bal said his job will be to get talented people the resources and equipment they need to do their jobs. “They (public-health workers) are talent-rich and resource-poor, an ongoing condition in public health,” Bal said.

The situation is a perennial problem in the United States, because “it (getting resources and equipment to workers) is not the priority it should be, in my estimation,” Bal said.

In his public-health career, Bal said he has always been a team player.

“I have a repugnance for the word ‘I,'” he said. “Everything done in public health eventually is done by a group of collaborators.”

Bal is most proud of his 25 years as the chief of the cancer-control branch with the California Department of Health Services.

From his point of view, cancer is “quintessentially the latter-day plague,” and he has devoted a good portion of his adult life to beating cancer, Bal said.

He settled into Sacramento, Calif., where the headquarters of the California DOH is located, in 1981, to build a new cancer program, which operated with an annual budget of just $250,000 at the time.

Since then, the program, through his leadership and successful lobbying of members of the California Legislature, the program has mushroomed to a $300-million-dollar-a-year “enterprise,” Bal said.

Partly with the help of Proposition 99, which was passed in 1988 and added a 25-cent tax on each pack of cigarettes sold in California, Bal said he was able to aggressively advance California’s tobacco-control efforts.

His department whipped up an upbeat, anti-smoking campaign that, with the help of legislation, resulted in the prohibition of smoking in restaurants and bars.

In addition, youth-access regulations have been imposed by law, he said. Public-education programs also were successfully mounted to encourage residents not to smoke, Bal said.

California adults now purchase about 45 packs of cigarettes per person per year. That compares with 120 packs per person in 1988, he said. Today’s numbers remain less than half the average pack-per-person rate for the other 49 states combined.

“Cigarette use plummeted at an unprecedented level,” Bal said.

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