An Olympian fight to reduce the deaths and misery to Aboriginals caused by smoking

Associate Professor David Thomas, a researcher at Menzies School of Health Research ( a NACCHO partner) and the Lowitja Institute, cautions that efforts to tackle high smoking rates amongst Aboriginal and Torres Strait Islander people, prisoners and people with mental illness must not add to the stigma often faced by these groups. Blame the industry, not the people who suffer from its products, he says.

Our thanks to Melissa Sweet CROAKEY and David Thomas for this article

Australia has many gold medalists in the Olympian fight to reduce the deaths and misery caused by smoking.

Australia topped the medal tally at the Luther Terry Awards for worldwide achievement in tobacco control this year.

This Australian tobacco control elite gets its just international recognition and all Australians benefit from the continually falling national smoking prevalence.

Or maybe not all Australians?

The most recent national survey data suggests that only 15.1% of Australians aged 14 and over smoked daily in 2010, down from 22.5% in 1998.

But smoking rates are still much, much higher among the most disadvantaged.

We do not have reliable trend data for all disadvantaged groups, but we do know that smoking rates are falling among lower SES groups and among Aboriginal and Torres Strait Islander people, sometimes slower and sometimes faster than in the rest of the population, but always from a much higher level.

This means smoking is gradually becoming increasingly concentrated in more disadvantaged groups.

And so this is where our tobacco control efforts need to be more and more concentrated.

This week in Croakey, Billie Bonevski and Amanda Baker drew attention to a special issue of Drug and Alcohol Review about tackling smoking among the most disadvantaged groups in Australia.

In order to Close the Gap, Australian governments have allocated more than $138m to tackling smoking among Aboriginal and Torres Strait Islander people.

Smoking rates among Aboriginal and Torres Islander people are more than double those of other Australians.

Similar levels of attention in the new National Tobacco Strategy, and funding, are needed now for tobacco control for the mentally ill and prisoners who have even higher smoking rates.

We need to be sure that all we are doing in tobacco control works in the most disadvantaged populations.  International reviews of the evidence suggest probably similar impacts across the social gradient of the different elements of tobacco control, but that increasing cigarette taxes has a greater impact on poorer smokers.

But the tax rise in April 2010 was the first real increase in Australian cigarette taxes since 1999, with future increases now impeded by the political threat of scare campaigns about new taxes.

We still need more research to better understand and monitor the impact of existing tobacco control strategies in the most disadvantaged populations.

We will probably get a huge impact from just doing more and better, with a bit of tweaking, of what we have been doing so well.  We do not need to entirely reinvent the tobacco control cookbook but we do need to keep trialing new strategies.

I am optimistic.

Increasing numbers of Aboriginal and Torres Strait Islander smokers have been successfully quitting, even before the new government investments in Indigenous tobacco control.  Prisoners say they want to quit.  The mentally ill are also similarly motivated to quit as other smokers; but while they are less often successful in their attempts, when they do quit the symptoms of their mental illness improve too.

The tobacco industry loves to paint tobacco control advocates as a bunch of finger-wagging, hectoring nanny-staters. The most disadvantaged will be part of the solution, but they need not be blamed for the problem.

Care should be taken when offering extra attention to these populations to not further stigmatise these already marginalised people.

The Australian tobacco control community has only has one competitor in this race: the transnational tobacco companies.  They are an evil and conniving bunch.  We continue to learn more and more about them by examining the previously secret internal tobacco industry documents.

The Medical Journal of Australia this month published the first systematic examination of the tobacco industry documents in order to understand the relationship between the tobacco companies and Aboriginal and Torres Strait Islander people.

The documents found no evidence of special targeting of Aboriginal and Torres Strait Islander people by the industry.  The Australian Indigenous market may be too small.

The article re-tells the 1984 story of a Brisbane Aboriginal organisation forcing WD and HO Wills to withdraw a cigarette advertisement because it was racist.

Aboriginal people can celebrate this victory as yet another contribution to our national medal tally in the ongoing competition against Big Tobacco and the suffering it causes.

• Associate Professor David Thomas is a tobacco control researcher at Menzies School of Health Research and the Lowitja Institute.