Technical Paper 2:
Tobacco Control in Australia: making smoking history
Smoking continues to be Australia’s largest preventable cause of death and disease. Over three million people – just under 18% of Australians aged 14 years and over – still smoke at least weekly. About half of the smokers who continue to smoke for a prolonged period will die early, half of them in middle age when children and grandchildren depend on them, and while they are in the most productive years of their working lives. Tobacco use caused 15,511 deaths in 2003,[18, 19] and cost the Australian community around $31.5 billion in 2004–2005.1  Smoking is responsible for 12% of the total burden of disease and 20% of deaths in Indigenous Australians.
Goal of Australia’s National Tobacco Strategy: To significantly improve health and to reduce the social costs caused by, and the inequity exacerbated by, tobacco in all its forms
Even if the prevalence of smoking were to decline overnight to single-digit figures, the personal and social costs of smoking would continue to be high for many years, not just because the effects are so long term but also because they are so far-reaching. As noted by Collins and Lapsley, their estimates must considerably understate the true costs of tobacco use, given the numerous items for which there was not yet enough research to enable them to plausibly quantify effects. Current estimates of the costs of smoking are based on assessments of the excess risk of premature birth, cardiovascular disease, respiratory disease and cancers of the respiratory, digestive and reproductive organs.
It is indeed hard to think of an organ of the body to which smoking is not harmful, and scientific studies are published literally every day providing new or strengthened evidence of the impact of smoking on dozens of diseases and conditions, including most of the chronic health problems currently driving exponential growth in spending on hospital, medical and pharmaceutical treatments in this country.2 
Beyond the early deaths, the years of debilitating illness and the costs to the public healthcare system, smoking in Australia also contributes significantly to social disadvantage. Spending on tobacco products causes financial stress. It works against the accumulation of wealth, and helps to perpetuate poverty across the generations.[17, 24] Cigarettes increasingly act as a badge and a marker of low educational aspirations, low socio-economic status and unemployment. Smoking by people from disadvantaged backgrounds may be becoming a barrier to acceptance in more advantaged social networks. Doing more to reduce smoking may thus also support the government’s central policy goals of educational excellence and social inclusion.[29, 30]
While tobacco use seems likely to continue to cascade downwards in the most educated groups, the history of tobacco control in Australia shows that smoking in the population as a whole will not reduce without vigorous and consistent action by governments and health organisations.
After an intial decline in the 1960s, smoking increased again in the early 1970s in response to more agressive marketing by tobacco companies, especially advertising aimed at young women.
In the mid-1990s total spending on media campaigns fell as Quit organisations grappled with budget cuts and simultaneous pressures to develop targeted programs for a growing number of population groups. During this time, cigarettes also became more affordable. After a decade in decline, between 1992 and 1998 the prevalence of smoking among adults flattened. It went into decline again following an increase in media spending and an increase in cigarette taxes in 1999, and the stepping up since 2001 of measures to make public places smoke-free.
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Figure 1: Smoking prevalence in adults aged 18+, spending on media campaigns per person $89–90 and costliness of cigarettes, Australia, 1983–2007
Sources: CBRC analysis of National Drug Strategy Household Survey, Average Weekly Earnings compared with recommended price of tobacco products, reports by government and non-government bodies on spending on tobacco control in Australia[32-34]
Figure 2: Changes in prevalence of daily smoking, Australians aged 14+, 2001–2007 – each Australian state and territory
Source: National Drug Strategy Household Surveys 1998, 2001, 2004 and 2007 NB. Rates not age-standardised
1Including net tangible costs of around $12 billion.
2The contribution of smoking to the incidence and costs of treating most of these diseases in Australia has not been documented.
3Percentage of people who smoke every day or some days each week.
410% of adults 18+ smoking daily or at least some days each week.
5The prevalence of daily smoking in California is currently 8.8%. See US Center of Disease Control Behavioural Risk Factor Surveillance system:http://apps.nccd.cdc.gov/brfss/display.asp?cat=TU&yr=2007&qkey=4394&state=CA. To reach prevalence of daily smoking lower than 9% by 2020, smoking rates in Australia would need to reduce over the next 12 years by the same percentage as they have decreased in California over the past 12 years.
69% of Australians 14 plus smoking at least weekly. A target such as this should include a sub-target of an absolute reduction in prevalence among Australians in the most disadvantaged 40% of neighbourhoods at least as great as the reduction in neighbourhoods falling between the 41st and 80th percentile in terms of relative disadvantage. The reduction among Indigenous Australians will need to be considerably greater than this if Close the Gap targets are to be achieved.
7From around three million at present to around two million in 2020.