In recent years, the Oklahoma Tobacco Settlement Endowment Trust (TSET) has paid at least $1.6 million to an organization that “believes that the most powerful risk factors in health are laws and policies that have perpetuated the legacy of racism, discrimination, and segregation throughout our nation’s history.”

Created by a vote of the people in 2000, TSET is an endowment trust that spends interest earned off Oklahoma’s share of payments from the 1998 Master Settlement Agreement (MSA) between 46 states and the tobacco industry.

On its website, TSET says the funding it provides is focused on “reducing Oklahoma’s leading causes of preventable death—tobacco use and obesity—in order to reduce cancer and cardiovascular disease.”

In recent years, one beneficiary of that spending has been ChangeLab Solutions, a California-based entity.

In a 2019 document, “A Blueprint for Changemakers: Achieving Health Equity Through Law & Policy,” ChangeLab Solutions declares, “Many people in America face discrimination, social exclusion, poverty, disenfranchisement, and unequal opportunities for education, jobs, and housing—all factors that can negatively impact health. These factors are embedded in unjust laws, policies, and practices that have shaped the physical, economic, and social environment over many generations and perpetuated unhealthy communities …”

The document continues, “Communities of color, low-income communities, people with low education, and other underserved groups continue to be disproportionately impacted by inequitable laws, policies, and practices. As a result, these communities experience dramatically poorer health than communities with more political and economic power.”

The ChangeLab blueprint identifies “structural racism” as a “fundamental” driver of health inequity, and says “structural racism” is a “system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. It identifies dimensions of our history and culture that have allowed privileges associated with ‘whiteness’ and disadvantages associated with ‘color’ to endure and adapt over time. Structural racism is not something that a few people or institutions choose to practice. Instead it has been a feature of the social, economic, and political systems in which we all exist.”

The report says “disparities in political power” are also fundamental drivers of health inequity, and decries “voting laws that create barriers to democratic participation.”

“Present-day gaps in health and prosperity are rooted in historical injustice and systemic inequity going back to colonization and slavery,” the ChangeLab blueprint states. “Achieving health equity requires the use of law and policy to create long-term change in the forces that create health disparities.”

The report says laws and policies that address the nation’s “racist legacy” must be “purposefully designed” to accomplish several goals, including influencing “the distribution and use of money, opportunity, and power.”

While many health programs focus on behavior modification, such as encouraging people to exercise or quit smoking tobacco, the ChangeLab blueprint downplays the importance of such efforts.

“Traditional public health interventions such as health education and individual counseling are important activities, but they can’t improve health at the community or societal level on their own,” the document states.

Instead ChangeLab puts more emphasis on changing the power dynamics in government.

“For centuries, this country has systematically oppressed and discriminated against millions of people, especially people of color; they have been denied meaningful opportunities, resources, and the power to effect change,” ChangeLab’s blueprint declares.

To generate change, ChangeLab endorses “providing support to individuals throughout their lives,” including wage and housing subsidies, rent stabilization laws, and the provision of “universal or subsidized health insurance.”

In response to a request for information, TSET provided a document that said ChangeLab Solutions has provided a “robust library of Oklahoma-specific how-to-policy and changes-to-the-built environment resources and materials,” technical assistance to TSET and the Oklahoma State Department of Health, and training to the TSET-OSDH partnership and those agencies’ grantees.

In its response, TSET said ChangeLab has provided “several hundred hours of technical assistance, conducted 15 trainings, and created over 35 products in support of positive environment change that helps Oklahomans eat better, move more and be tobacco-free as part of TSET’s strategic focus on reducing the incidence of heart disease, stroke, cancer and diabetes.”

The document also said ChangeLab has provided “consultation to the TSET-OSDH partnership on program design and outcomes to ensure metrics were evidence-based, impactful and consistent with state law,” and that ChangeLab had “conducted a review of local ordinances within specific communities to identify opportunities and barriers to health-promoting activities and engaged in troubleshooting with grantees on policy implementation challenges and provided technical assistance on specific policy implementation strategies.”

The TSET response showed that ChangeLab received $1.6 million combined from the state of Oklahoma between the 2014 and 2019 budget years.

However, those figures conflict with the amounts reported in TSET’s annual reports.

In its 2018 annual report, the most recent available, TSET reported that $380,000 went to ChangeLab Solutions for “Technical Assistance, Training and Consultation.” In 2017, TSET reported designating $350,000 for ChangeLab. In 2016, ChangeLab received $670,500 in TSET funding, according to the annual report.

In contrast, TSET’s response to the information request showed ChangeLab received only $187,224 in 2018; $290,347 in 2017; and $380,811 in 2016.

The discrepancy between the figures shown in TSET’s annual reports and the information response sent by TSET for those three years is more than $542,000 combined.

A TSET spokesman said the discrepancy is the result of the annual report showing the budgeted amount while the other set of figures represented actual expenditures.