Australia: the healthiest country by 2020
National Preventative Health Strategy – the roadmap for action
Key action area 11: Ensure implementation and measure progress against and towards targets
- Chair's Foreword
Chapter 1: Building preventative health in Australian communities- Chapter 2: Obesity in Australia: A need for urgent action
Chapter 3: Tobacco: Towards world’s best practice in tobacco control- The case for prevention
- Targets
- Key action areas
- Key action area 1: Make tobacco products more expensive
- Key action area 2: Increase the frequency, reach and intensity of social marketing campaigns
- Key action area 3: End all forms of advertising and promotion of tobacco products
- Key action area 4: Eliminate exposure to second-hand smoke in public places
- Key action area 5: Regulate manufacturing and further regulate packaging and supply of tobacco products
- Key action area 6: Ensure all smokers in contact with health services are encouraged and supported to quit, with particular efforts to reach pregnant women and those with chronic health problems
- Key action area 7: Work in partnership with Indigenous groups to boost efforts to reduce smoking and exposure to passive smoking among Indigenous Australians
- Key action area 8: Boost efforts to discourage smoking among people in other highly disadvantaged groups
- Key action area 9: Assist parents and educators to discourage use of tobacco and to protect young people from second-hand smoke
- Key action area 10: Ensure that the public, media, politicians and other opinion leaders remain aware of the need for sustained and vigorous action to discourage tobacco use
- Key action area 11: Ensure implementation and measure progress against and towards targets
- Summary Tables
- References
- Chapter 4: Alcohol: Reshaping the drinking culture in Australia
- Appendices
It will be important to ensure that the Tobacco Strategy is effectively implemented and monitored. Australia has a well-developed surveillance system on tobacco. For most targets, progress can be assessed using existing long-running regular surveys. A few gaps need to be addressed to enable governments to assess whether adequate progress is being made to ensure that targets will be met.
Ensuring implementation
A National Tobacco Strategy Steering Committee should be established, overseeing and reporting to the Minister for Health and Ageing on implementation of the Strategy at all levels. This is especially appropriate for tobacco, where there is so much evidence on the action that is required and such strong support for its implementation.
Measuring progress towards overall target
To assess whether we are on track in reducing the prevalence of daily smoking among adult Australians (aged 18+) – dropping from 17.4% in 2007[24] to no higher than 10% by 2020 – we need to monitor the proportion of adult Australians who report current or daily smoking in the Australian Bureau of Statistics (ABS) Health Survey scheduled for 2011 and subsequent surveys to be undertaken prior to 2020. Prevalence of daily and current smoking among Australians aged 14 and over will be reported in the National Drug Strategy Household Surveys scheduled for 2010, 2013, 2016 and 2019. Rates for Australians aged 18 and over could also be reported in these surveys.
A question about smoking has recently been included in the New Zealand census.[222] Because the response rate for the census is virtually universal, this allows calibration with data collected from other surveys (for which response rates are lower).
Action 11.1
Establish a National Tobacco Strategy Steering Committee
Action 11.2
Include a question on smoking among Australians aged 18 years and over in the Australian Census scheduled for 2011, 2016 and 2021.
If it proves impossible to obtain sufficiently reliable regular data on prevalence of smoking among adults, then the Australian Government will need to consider requiring tobacco companies to provide data on sales of tobacco products at a regional level. This could be built in to legislation requiring reports on promotional expenditure, which could also be supplied at a regional level.
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Measuring progress towards targets for each state and territory
The National Partnership Agreement on Preventive Health sets out the agreement of the states, territories and the Australian Government to meet a benchmark of ‘(jj) reduction in state baseline for proportion of adults smoking daily commensurate with a 2 percentage point reduction in smoking from 2007 national baseline by 2011; 3.5 percentage point reduction from 2007 national baseline by 2013’, Part 4 Clause 15.
The survey instruments for measurement of these targets has not been specified. Annual population health surveys are held in New South Wales, Victoria, Western Australia and South Australia, but not in the other jurisdictions.
Action 11.3
Establish a mechanism to collect reliable data on prevalence in 2011 in Queensland, Tasmania, the Australian Capital Territory and the Northern Territory.
Measuring targets for uptake and cessation
To achieve substantial reductions in smoking prevalence requires both a reduction in the number of children taking up smoking and an increase in the numbers of smokers quitting.
Reports of the Australian Secondary School Survey of Smoking and the Australian School Students’ Alcohol and Drug (ASSAD) Survey regularly include the percentages of secondary school students (aged 12–15 and 16–17 years) reporting smoking at least monthly, weekly and daily. These will continue to be monitored in reports of ASSAD surveys conducted in 2011, 2014, 2017 and 2020.
Action 11.4
Include in future reports of ASSAD surveys the proportion (and number) of teenagers who have ever smoked more than 100 cigarettes. Trends over time in this indicator would provide a useful estimate of the incidence and number of children taking up smoking each year.
In addition to the proportion of adults who currently smoke, trends in attempts to quit (and also the numbers of cigarettes smoked) provide an early warning sign of any likely stalling in quit rates. This information is currently collected each year in the International Tobacco Control (ITC) Policy Evaluation Study (partly funded by the Department of Health and Ageing), which is tracking a cohort of people who were smokers at the commencement of the study in 2002.
Action 11.5
Report on trends in the proportion of smokers and recent smokers who have attempted to quit in the previous three and 12 months, and the proportion who intend to quit in the next three months.
Measuring targets for smoking and social disadvantage
To achieve substantial reductions in smoking prevalence also requires declines in smoking (preceded by declines in uptake and higher rates of cessation) among less educated smokers and those living in disadvantaged areas to be at least as large as declines among more educated smokers living in more affluent areas. Information on smoking in various SES groups is collected in the National Drug Strategy Household Survey.
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Action 11.6
Report on trends over time in prevalence of smoking and numbers of cigarettes smoked for persons in all various SES groups, both in Australian Institute of Health and Welfare (AIHW) reports on detailed findings of the National Drug Strategy Household Survey, and in reports of the Australian School Students’ Smoking, Alcohol and Drug Survey.
Monitoring progress in indigenous smoking
The National Aboriginal and Torres Strait Islander (NATSHI) Health and Social Surveys provide a reliable indication over time of the percentage of Indigenous Australians smoking. However, sample sizes are not sufficient in either survey to reliably detect small changes over time in Indigenous smoking at the state level and in the Northern Territory.
Action 11.7
Increase sample sizes of the NATSHI Health and Social Surveys to provide reliable indications of changes over time in each state and in the Northern Territory. This should be done in preference to trying to include sufficient Indigenous people in annual state population surveys.
Action 11.8
Use state population surveys to over-sample each year within two or three state health department regions with a high proportion of Indigenous residents, so that reliable estimates of prevalence at a regional level become available on a three-yearly basis.
Action 11.9
Analyse percentage changes in the prevalence of Indigenous smoking compared with percentage changes in previous periods, and compared with absolute and percentage changes in the non-Indigenous population.
As with the general population, smoking uptake and cessation also needs to be monitored in Indigenous people.
Action 11.10
Extend the ASSAD Survey to more remote areas of Australia and to Indigenous schools to ensure the inclusion of greater numbers of Indigenous children. 9 This would enable a reliable indication of changes over time in Indigenous smoking in each state and territory.
Action 11.11
Establish a panel of Indigenous people who are currently smokers to enable the monitoring of intentions and attempts to quit, amounts smoked and the prevalence of smoking indoors and around others. The panel could also be used to monitor the impact of tobacco control policies among Indigenous people.
Measuring targets for exposure to second-hand smoke
Data on levels of exposure to second-hand smoke in the community is currently being collected, but is not being reported on (or consequently monitored) in a systematic way.
Action 11.12
Report on trends over time, by SES, in the proportion of Australians aged 14 years and over exposed to second-hand smoke at work and indoors at home.
Action 11.13
Report on long-term trends in the percentage of students (smokers and non-smokers) who have one or more parents who smoke, and who live in homes that are smoke-free.
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Action 11.14
Report for each state and territory, for women living in areas of varying levels of social disadvantage, and for Indigenous and non-Indigenous women, the proportion of pregnant women who report smoking at early and late stages of pregnancy.
9 Over-sample schools in both urban and rural areas that are listed with Education Departments as having high numbers of Indigenous students.