Most of the tax increases occurred before i got there. but i will say that once a group had a part in it. let me say that it got beyond a certain point where legislature saw there wasn't that much resistance to raising tobacco taxes and it was a good source of revenue. so the last tax increase that occurred in new york state happened without a lot of public health encouragement. they just saw it as pure revenue move, which is surprising. it's good in many ways. it's not good if that means they don't also use some of that funding to support tobacco control programs. but i think we've gotten past a certain point now with tobacco tax increases, it's limited.
As well. good to see that what you taught us in the classroom has actually been implemented in practice. i do have one question i am a big proponent of structural information and policy changes, introducing in law. we saw in new york, taxes that came in the form of policy change, tax increases. but our national agenda, we focused a lot on education. do you think we need like a shift in our focus and we should shift more -- shift our focus more towards structural intervention and, as you state in the prevention, focus on changing the shifting the cost instead of cutting the cost. what do you think about that? i do think that policy and environmental change is the best way to reduce rates of disease that are population wide, Cardiovascular disease.
I think we need to look much more at that. now, i will say this, it's a lot easier at the local level than it is at the state level. at the state level and national level. our experience is that the push back for the resistance from industry lobbies are less at the local level and at the state or national level. we have opportunities in new york city that we simply don't have at the national level but we certainly want to take all the opportunities and hopefully set examples for the rest of the country. and then it makes it easier for other places to do it.
Dr. conway, or anyone, what do you think we can do to help the health care system improve their performance rapidly,because we know how diverse the pavers are, providers,challenges of clinical inertia. how do you think we could get as rapid an improvement addss possible?where should we focus our attention in improvements in our health? first, aligned incentives which you're already working on in doing, but i think further that alignment across payers,across private health and medical system to focus, wha tyou're doing, focus on priorities. i used to do external reporting. they all wanted different things.
Focus and alignment go together. third, i think we haven't fully harnessed the models. i applaud places like million hearts, drive improvement, set goals that are aligned and measures that are aligned but then allow localities, states, to innovate to achieve those goals. Thank you. i am going to ask a final question, if i don't -- any envision questions?nope. i'll warn the speakers, this question is going to be about scalability. i'll give you a chance to think about that as i rattle for a moment more. we know that there is a chunk of the country that is between San Diego and new york city. and for those of us who live and work there, i'd like for each ofyou to address either what you think how your models can get scaled to the rest of the country or what's in the way of that scalability.
I guess i go first. everybody missing looking. i was sing looking back, but everyone else was looking at me. so, we had hoped from the very beginning that what we were doing would be applicable to export. and so we tried to design the program that way. i think that there's nothing that we've done in San Diego to this point in time that couldn't be adopted by every other community. the university of best practices is a great model for communities to rally around, and there is evidence that a similar group that's starting up in Sacramento now that's been in touch with us, and they're not close to the ocean, although not in the great flyover.
You know, i think we've been fortunate in terms of philanthropy, but our patient activation campaign, we will share with anyone who wants it. we think it's -- we think it's a good strategy. we think that the material that's been prepared is very effective. so everything we've done is to share with other people or anyone who is interested.
I want to address some of the policy changes and the scalability of those. i think we learned in tobacco control you can be far more innovate innovative, move more quickly at the local level than national level. smokes most smoke free air is at the local area. trans fats, state health departments regulate restaurants so they have the ability to have a hand in our food supply right now. and so those localities shouldn't wait for changes at the national level because just the politics are far more difficult at the national level. i would encourage them to look at what the best examples are anywhere in the country and pick them up locally.
I literally think that's the central question of transforming health care in America, so that will be a short answer. carolyn clancy and i wrote a couple of papers int transformation front line. more of a medical care framework, but i think apply more broadly, as well. essentially, i think the question is how do you decrease the cycle time of learning. how do you test new approaches, rapidly evaluate what works, and then scale that. and i think in this case, you know, it is it's not easy or we would have done it before. but i think the central question is that cycle time of learning,i think with the innovation center at the cms level we're trying to think about how we think about the cycle time in our office and quality improvement and i would encourage all of those in the audience and cdc to work with us and how do we really rapidly evaluate programs and scale and program and learn when they don't work in local -- different local contexts, why don't they work and why do they need to be modified at a local and a state level.
I'm going put one last pitch in to go to this website and show your support by taking the pledge. I think this was a scientific heaven, so i am asking you to give one more applause to the five people you met at cdc. and we'll see you in four weeks, same time, same place. thank you.
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