Technical Paper 2:
Tobacco Control in Australia: making smoking history
3 - Progress in Australia on recommended policies and programs
In 2004, in order to achieve the objectives of the National Tobacco Strategy, governments around Australia agreed to pursue the following seven policies:
- Regulation of Price through tax, Place of use, Place of sale, Promotion, Packaging and Products (with support expressed also for the idea of regulating Producers)
- Promotion of Quit and smoke-free messages
- Cessation services and treatment
- Community support and education
- Addressing social, cultural and economic determinants
- Tailoring for disadvantaged groups.
- Research, evaluation, monitoring and surveillance.
Several thousand additional scientific research papers have been published with relevance to tobacco control since the National Tobacco Strategy was published, and thousands of newspaper articles have reported developments in tobacco control in nearly every country in the world.
In its synthesis of international developments and research, this paper has drawn on a wealth of literature from many fields and all over the world, but it has given greatest weight to the findings of
the reports of expert groups, meta-analyses, and Australian and international research examining the impact of policy interventions. A list of the broad categories of sources is set out at the end of this document, followed by a full list of over 500 references used.
Particular emphasis has been given to evidence on the effect of policies among disadvantaged groups.
While much has been achieved, for brevity, the remainder of this paper describes areas where Australia’s current performance falls short in relation to:
- findings of scientific research
- the international Framework Convention on Tobacco Control, to which Australia became a party in December 2003
- international best practice.
To date, success in tobacco control has occurred not through clinical, classroom or workplace interventions but through a comprehensive whole-of-population approach that has profoundly changed cultural values about smoking.[85, 86] As well as regulation, the various campaigns, programs, treatment and efforts of advocates for tobacco control have played a crucial role in keeping smoking and its effects in the news and on the political agenda12
A European analysis showed that quit ratios (the proportion of people who have ever smoked who have quit) were highest in those countries with the most developed tobacco control policies (as measured on a Tobacco Control Scale developed by the WHO). High- and low-educated smokers benefited roughly equally from nationwide policies. A comprehensive review of population-level tobacco control examined the impact of interventions such as smoke-free policies in schools, workplaces and other public places, restrictions on sales to minors, restrictions on advertising, health warnings, increases in prices and multifaceted interventions. It found no evidence of any policies increasing inequalities, and found strong evidence of a reduction in inequalities resulting from increases in prices.
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Most disparities in smoking rates between socio-economic groups in Australia result from differences in uptake rather than in cessation.
Figure 13 shows that around 30% of people can be classified as ‘ex-smokers’, regardless of the level of neighbourhood disadvantage. The percentage of people who have never taken up smoking is 18% higher in people living in the most advantaged neighbourhoods compared to those living in the least
Strategies to prevent the uptake of smoking are not just about education programs in schools or laws banning sales to minors.[95-98] All of the regulatory, educational and policy interventions described below are considered from the point of view of their impact on young people as well as on adults, and their potential impact across social groups.
A major challenge for tobacco control is to work out how best to accelerate social diffusion against smoking – how to make being a non-smoker and smoking cessation more ‘contagious’ – among Indigenous and other disadvantaged communities.