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Analyses of expenditures from the historic tobacco Master Settlement Agreement (MSA) demonstrate the difficulties in achieving support for long-term disease prevention and health promotion initiatives. We report as a policy case study the successful development, political execution, and program deployment of new state health programs funded by Arkansas' MSA funds. Arkansas' success demonstrates the need for political leadership, the development and insertion of empirical health information into the policy deliberations, in-depth knowledge of the political process, and a broad-based coalition committed to improving health.

The 1998 Tobacco Master Settlement Agreement (MSA) resulted in a singular and unanticipated revenue stream flowing to state governments from U.S. tobacco companies. In response, public health leaders were challenged with an opportunity to secure funding for much needed health programs. However, state leaders have chosen to utilize these new funds for a wide variety of purposes; in many instances, expenditures totally unrelated to health or health care. In contrast, Arkansas is unique among all states in choosing to utilize MSA funds solely to establish new health-related programs. Examination of the educational and developmental process through which Arkansas designed its expenditure plan, secured political support, and initiated new health programs in a time of budgetary constraints will inform public health officials to more effectively engage policy makers at local, state, and federal levels.

Summary The Department for International Development (DFID) is the UK government department with responsibility for managing Britain's aid to poor countries, with an overall budget of £5.3 billion in 2007–8. Our health strategy is to strengthen healthcare systems by working in partnership with governments and other stakeholders in public health in assisted countries. DFID also supports a substantial research programme, principally in health and education.

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