Position statement - Indigenous tobacco control
The Heart Foundation has identified the cardiovascular health of Aboriginal and Torres Strait Islander peoples as a high priority. We are committed to helping to close the gap between Indigenous and non-Indigenous cardiovascular health outcomes. Reducing the prevalence and uptake of smoking among Aboriginal and Torres Strait Islander peoples is critical to achieving this goal.
In December 2007, the Council of Australian Governments (COAG) agreed to close the gap on Indigenous disadvantage, including closing the life expectancy gap within a generation. This commitment involves the Australian Government contributing $805.5 million to COAG’s $1.6 billion investment over four years to support the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. Approximately $161 million of this money will be used to tackle the key risk factors for chronic disease, including smoking.1,2
With this agreement to ‘close the gap’ in mind, the Heart Foundation is advancing a range of Indigenous priorities to help to define a national tobacco control strategy for Indigenous Australians.
The Heart Foundation currently pursues activities that complement the framework provided by the National Tobacco Strategy (2004–2009).3 Our work involves advocating for a sustained, well-funded Indigenous tobacco control campaign. As part of this campaign, and in light of recent government announcements, the Heart Foundation recommends that funding be allocated to the development and implementation of Indigenous specific priorities that aim to build capacity within the community to make sure that this important health issue is addressed. See page 3 for the identified priorities.
The Heart Foundation’s position is directed by research reports that make recommendations about appropriate policy direction for effective Indigenous tobacco control interventions. These reports include:
- Tobacco Control in Australia: making smoking history4
- Tobacco in Australia: Facts and Issues5
- Tobacco – Time for Action6
- Indigenous Australians and Tobacco: a literature review7
- Galnya Angin (Good Air): Partnerships in Indigenous Tobacco Control.8
Tobacco and cardiovascular diseaseTobacco smoking is a major risk factor for heart attack, stroke, peripheral vascular disease, several cancers and low birth weight babies. Passive smoking can cause an increased risk of asthma in children and sudden infant death syndrome.
In Australia, the proportion of the population aged 18 years and over who smoke declined from 26% in 1995 to 19% in 2007.5 Although this trend is encouraging, smoking continues to be Australia’s leading cause of preventable death and disease,9 contributing 7.8% to the total burden of disease and injury.10 This declining trend also conceals stark differences in prevalence among some population groups.
Tobacco use is particularly high among Aboriginal and Torres Strait Islander peoples. In 2004–2005, 50% of Indigenous Australians aged 18 years and over reported smoking tobacco daily.11 In general, Indigenous Australians take up smoking at an earlier age, smoke for longer, and make fewer quitting attempts than the broader Australian population.12 Indigenous women have a higher prevalence of smoking, and more Indigenous women smoke during pregnancy than non-Indigenous women, increasing the risk of preterm birth and low birth weight babies.13
The high prevalence of smoking among Aboriginal and Torres Strait Islander peoples corresponds with a higher risk of tobacco-related diseases and conditions. Much of the difference in life expectancy between Indigenous and non-Indigenous Australians is due to high rates of cardiovascular disease and other diseases related to tobacco.14
Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander peoples have three times the rate of major coronary events, such as heart attack, and almost one and a half times the out-of-hospital death rate from coronary heart disease. When in hospital, Indigenous Australians have more than twice the in-hospital coronary heart disease death rate.15 Research indicates that the life expectancy of Indigenous Australians could increase by more than six years if deaths from cardiovascular disease were reduced to that of the total Australian population.16
Guiding principlesThis position statement intends to promote an effective and equitable approach to Indigenous tobacco control interventions across all states and territories. The following principles guide this intent.
- Indigenous tobacco control initiatives will be guided by research evidence, where available, and form part of a comprehensive, well-evaluated tobacco control program.
- The development, implementation and evaluation of programs will encourage participation and enable Aboriginal and Torres Strait Islander peoples to increase control over and improve their health.
- Tobacco control activities will be sustainable, promote equity, build capacity and promote supportive environments.
Indigenous specific priorities1. Fund and implement, on a sustained basis, a culturally appropriate social marketing campaign with and for Indigenous Australians.
2. Increase the price of tobacco products through a tax increase to discourage young people from taking up smoking and to help existing
smokers to quit.17 Past experience in Australia and international evidence indicates that an increase in the price of tobacco products is likely to reduce smoking more significantly among Australians on low incomes than those on medium or higher incomes. Additional revenue from this measure should be invested in health promotion, including measures to improve the health of Indigenous Australians.
3. Support Indigenous organisations to move towards smoke-free workplaces and events.
4. Support all Indigenous communities to implement and enforce tobacco control policies and legislation.
5. Provide ongoing smoking cessation training for Indigenous health and community services staff from government and non-government agencies. This measure should include community-based training for remote community health workers.
6. Provide training and funding for specialist tobacco workers, with additional funding for specialist workers to support pregnant women in their quitting attempts.
7. Ensure culturally appropriate tobacco control resources are distributed across all states and territories, and adapted for use by and with Aboriginal and Torres Strait Islander peoples.
8. Ensure Aboriginal and Torres Strait Islander peoples have equitable access, via integrated tobacco control programs, to smoking cessation treatments and services, including Quitline, counselling, group behaviour therapy, and proven pharmaceutical treatments. These should be provided in a culturally appropriate way for Indigenous Australians.
9. Ensure the availability of state/territory level data on smoking prevalence among Aboriginal and Torres Strait Islander peoples in all areas. This should be achieved through comprehensive data collection and ongoing monitoring of tobacco control issues among Indigenous Australians.
10. Build alliances to help government and non-government agencies, health professionals and other stakeholders to work in a collaborative manner to develop, implement and evaluate Indigenous specific priorities.
11. Ensure funding is available to evaluate the impact of all Indigenous tobacco control interventions, including health care, community and legislation interventions.
References1. Council of Australian Governments. Council of Australian Government’s Meeting: Communiqué. December 2007. Available at: www.coag.gov.au/coag_meetingoutcomes/2007-12-20/cooag20071220.pdf (This website link was valid at the time of submission) (accessed October 2009).
2. Australian Labour Party. $4 Billion to help Close The Gap for Indigenous Australians; 2008. Available at: www.alp.org.au/ media/1108/msiapm300.php (This website link was valid at the time of submission) (accessed October 2009).
3. Ministerial Council on Drug Strategy. Australian National Tobacco Strategy 2004–2009. Canberra: Department of Health and Ageing; 2005. Available at: Department of Health website (accessed October 2009).
4. Tobacco Working Group. Technical Report No 2. Tobacco in Australia: making smoking history. Canberra: National Preventative Health Taskforce; 2008. Available at:www.preventativehealth.org. au/internet/preventativehealth/publishing.nsf/Content/tech-tobacco (This website link was valid at the time of submission) (accessed October 2009).
5. Scollo MM, Winstanley, MH [editors]. Tobacco in Australia: Facts and Issues. 3rd edn. Melbourne: Cancer Council Victoria; 2008. Available at: Tobacco in Australia website (accessed October 2009).
6. Lindorff K. Tobacco – time for action. National Aboriginal and Torres Strait Islander Tobacco Control Project. Final Report. Canberra: National Aboriginal Community Controlled Health Organisation (NACCHO); 2002.
7. Ivers R. Indigenous Australians and Tobacco: a literature review. Darwin: Menzies School of Health Research and the Co-operative Research Centre for Aboriginal and Tropical Health; 2001. Available at: www.smokefreezone.org/site_files/s1001/downloads/ IndigenousTobaccolitreview.pdf (This website link was valid at the time of submission) (accessed October 2009).
8. Adams K, Briggs V. Galnya Angin (Good Air): Partnerships in Indigenous Tobacco Control. Melbourne: Centre for Excellence in Indigenous Tobacco Control; 2005. Available at: www.ceitc.org.au/images/ ceitc/Galnya_Angin.pdf (This website link was valid at the time of submission) (accessed October 2009).
9. Australian Bureau of Statistics. Tobacco smoking in Australia: A snapshot, 2004–05; 2006. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4831.0.55.001/ (accessed October 2009).
10. Begg S, Vos T, Barker B, et al. The burden of disease and injury in Australia 2003. PHE 82. Canberra: Australian Institute for Health and Welfare; 2007. Available at: AIHW website (accessed October 2009).
11. Trewin D. National Aboriginal and Torres Strait Islander Health Survey. Australia 2004–05. Cat. No. 4715.0. Canberra: Australian Bureau of Statistics; 2006. Available at: www.ausstats.abs.gov.au/ausstats/ subscriber.nsf/0/B1BCF4E6DD320A0BCA25714C001822BC/$Fi le/47150_2004-05.pdf (This website link was valid at the time of submission) (accessed October 2009).
12. Centre for Excellence in Indigenous Tobacco Control. Smoking and death rates; 2007. Available at: www.ceitc.org.au/smoking_and_death_ rates (This website link was valid at the time of submission) (accessed October 2009).
13. Department of Health and Ageing. Aboriginal and Torres Strait Islander Health Performance Framework – 2006 Report. Canberra: Department of Health and Ageing; 2006. Available at: www.healthyactive.gov.au/internet/main/publishing.nsf/Content/A218D9F5F5A751DBCA2575 1400165873/$File/framereport.pdf (This website link was valid at the time of submission) (accessed October 2009).
14. Australian Bureau of Statistics. Causes of Death, Australia 1993. ABS Catalogue number 3303.0. Canberra; 1994. Available at: www. abs.gov.au/ausstats/abs@.nsf/mf/3303.0 (This website link was valid at the time of submission) (accessed October 2009).
15. Mathur S, Moon L, Leigh S. Aboriginal and Torres Strait Islander peoples with coronary heart disease: further perspectives on health status and treatment. Cardiovascular disease series no. 26. Cat. no. CVD 34. Canberra: Australian Institute of Health and Welfare; 2006. Available at: AIHW website (accessed October 2009).
16. Australian Bureau of Statistics. Australian Social Trends, 2007. ABS Catalogue number 4102.0. Canberra: Australian Bureau of Statistics; 2007. Available at: www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/F4B15709EC89CB1ECA25732C002079B2?opendocum ent# (This website link was valid at the time of submission) (accessed October 2009).
17. Heart Foundation and Cancer Council of Australia, Submission to the Henry Tax Review; 2008. Available at: taxreview.treasury.gov.au/ content/submissions/pre_14_november_2008/Cancer_Council_and_ National_Heart_Foundation.pdf (This website link was valid at the time of submission) (accessed October 2009).
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The information contained in this position statement is current as of August 2011.
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