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Technical Paper 2:
Tobacco Control in Australia: making smoking history

3.5.1 Indigenous Australians

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Progress against international comparators

In June 2008 the Ministry of Health in New Zealand released data showing that smoking among Maori appears to have declined by more than 20% over the past four years, with the reduction of smoking among Maori men greater than that in the overall male population.[132] Public health experts believe that the decline can be attributed to the effects of smoke-free legislation, vocal advocacy by Maori leaders in tobacco control and social marketing campaigns.

In Australia, in contrast, smoking among Indigenous people does not appear to have declined at all over the past 15 years, although rates in remote communities may have improved slightly.

Figure 22: Prevalence of smoking among Indigenous Australians aged 18+, in all areas 2001 and 2004–2005, and in non-remote areas 1989 to 2004–2005

Sources: ABS National Health Surveys 1989, 1995 and 2001, and Aboriginal and Torres Strait Islander National Health Survey 2004–2005

Research since 2004

A comprehensive assessment of evidence on the effectiveness of tobacco control interventions and their applicability to Indigenous populations has identified several strategies that are likely to be effective.

Table 6: Summary of Ivers assessment of effectiveness of interventions for Indigenous groups

	Likely yes	Not known	Unlikely/ Limited known no.
Brief advice, hps	x
Pharmacotherapies NRT Zyban Varenicline	x x x
Antenatal interventions	x
Hospital-based	x
Media advertising	x
Quit courses			x
Sponsorship		x
Self-help materials (if clear and well illustrated)	x
Graphic health warnings	x
Tax and price	x
Smoke-free public places		x

Source: Ivers, 2008[403] * though with possible adverse effects for some.[404]

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Progress since 2004

Shortly after its election, the government pledged $14.5 million over four years to help tackle smoking in Indigenous communities.[405] This initiative includes:

• supporting research, including an initial project to be conducted by the Cooperative Research Centre for Aboriginal Health (CRCAH), to build the evidence base around what works in helping Indigenous people to quit smoking
• trialling community interventions, including targeted, culturally appropriate communication activities
• offering smoking cessation training to staff working in Indigenous health.

The Department has also funded several Indigenous projects.

Where to next?

A national workshop for key stakeholders was held on 23 May 2008, in partnership with the CRCAH, to consider and set priorities for the next three years. The Centre for Excellence in Indigenous Tobacco Control (CEITC) has prepared a review of interventions effective in Indigenous communities, and a further meeting is being organised to advise on plans for action.

The working group notes that several strategies listed elsewhere in this document are likely to exert positive effects on smoking in Indigenous communities. These include increases in the price of tobacco products; greater investment in hard-hitting advertising tailored in content and placement to be as effective as possible with disadvantaged groups; legislation to restrict smoking in pubs and clubs, cars and other public places; and better enforcement of legislation concerning sales to minors. Broader efforts to reduce socio-economic disparities between Indigenous and non-Indigenous people are also likely to reduce the uptake of smoking.

Small pilot projects, no matter how well designed and run, are not going to make the inroads necessary to reduce smoking rates across the Indigenous population as a whole. While there is a place for trials of innovative new approaches, it is now time to ‘get on with the job’ and scale-up efforts. Time and resources should be allowed for training and sharing of insights, and it should be acknowledged that quality of service will improve as staff become more experienced – the idea of ‘learning by doing’.


Action proposed
To help simultaneously build capacity in the Indigenous workforce and change social norms about smoking in Indigenous communities:

• place Indigenous Tobacco Control Workers in each NACCHO state and territory affiliate to support Indigenous communities, in the context of a coordinated national approach, in order to: raise the profile of tobacco control; create smoke-free environments through changes in organisational and community policies; and develop and deliver prevention and cessation activities
• provide incentives to encourage non-government agencies (such as Quit campaigns, state cancer councils etc) to employ Indigenous workers to improve Indigenous-specific programs
• fund appropriately designed training that is realistic and empowering for health workers, and ensure that they are able to provide their patients with pharmacotherapies
• fund a focus-tested, Indigenous-specific social marketing campaign to be delivered at national and local levels that would complement messages in locally delivered programs
• trial multi-component community-based programs in three sites (urban, rural and remote) to deliver locally managed interventions that might include components such as education campaigns, smoke-free areas, regional stores placement, and pricing policies and training for local workers.

The working group acknowledges the isolation and pressures on the small numbers of people currently working in Indigenous tobacco control, and supports the idea of pairing, job-sharing and other arrangements to ensure that workers aren’t ‘on their own’ in stressful work environments. We believe that many people in mainstream tobacco control would be happy to provide much greater support and assistance to Indigenous workers where this is wanted, and would like to explore how such ‘supporting partnerships’ could be facilitated.
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