In the wake of budget uncertainty, brutal funding cuts and a review of the Tackling Indigenous Smoking program, it is critical to maintain momentum in efforts to reduce smoking among Aboriginal and Torres Strait Islander peoples.
So says Associate Professor David Thomas, head of tobacco control research at the Menzies School of Health Research in Darwin.
Don’t drop the ball on Indigenous tobacco control
David Thomas writes:
The Review of the Tackling Indigenous Smoking program announced in the budget has just commenced. The successful tenderers from the University of Canberra don’t have much time, and must complete their report by the end of November.
This was a flagship health program for the previous Government’s plans to Close the Gap. Reports of falling Aboriginal and Torres Strait Islander smoking prevalence have provided some of the most encouraging concrete statistical news in Aboriginal and Torres Strait Islander health.
The review team will need to avoid the typical terra nullius myth promoted by many Canberra initiators of large new national campaigns. Aboriginal and Torres Strait Islander smoking prevalence was already falling before this program began, albeit too slowly. Aboriginal families and communities were already doing things to reduce the harm smoking causes, with some assistance by health services, NGOs and extant government programs, and have continued to do so alongside the large new program.
It is also still hard to say how much Aboriginal and Torres Strait Islander smokers and their families have benefited from Australia’s world-leading mainstream tobacco control public health policies (plain packs, tax rises, TV campaigns, and smokefree regulations) and access to mainstream cessation support.
The research evidence in Aboriginal and Torres Strait Islander tobacco control is growing quickly, even though there are still many gaps, and the review will be useful to the recommendations for the future for Aboriginal and Torres Strait Islander tobacco control, as will evidence from other settings, often written by Australia’s many world-leading tobacco control researchers.
Much of the criticism of the program by leaders in the Government, when they were in opposition, centred on the large cost of the program and possible waste or inefficiencies due to the haste in its rollout. The completed evaluations of the program do identify some lessons for similarly ambitious new programs.
But decades of relative government inattention and inaction on Aboriginal and Torres Strait Islander tobacco control is almost certainly more to blame than recent government haste and inefficiency for the estimated 600 preventable Aboriginal and Torres Strait Islander deaths each year from smoking.
This increased attention, and maybe haste, has probably helped change views so that reducing smoking and its harms among Aboriginal and Torres Strait Islander peoples is now believed to be quite achievable, as it should be, rather than being left in the too-hard-basket.
I think it may be more important for the Review Team to focus not on the haste of the program in its early years, but on how to correct the loss of momentum in the last year.
The uncertainties of funding for this large program (and of course many other government-funded programs) in the months leading up to and following the election of the new government saw many good staff leave projects for more secure jobs and some projects stall.
The budget cut $130m from the Tackling Indigenous Smoking program. Some projects have been cut and some have reduced funding.
After 11 years of service, the Centre for Excellence in Indigenous Tobacco Control (CEITC) at the University of Melbourne was brutally axed.
For many years CEITC had been the rallying point for people around the country concentrating on Aboriginal and Torres Strait Islander Tobacco Control, and had been critical in convincing the previous government to increase its investment in Aboriginal and Torres Strait Islander tobacco control. CEITC’s Director Viki Briggs was also personally responsible for convincing me and many others to get involved in this work.
I remain optimistic that this slipping momentum can be regained and that the Aboriginal and Torres Strait Islander research evidence and experience on the ground around tobacco control is building.
The Government and the review can build on this evidence and experience, to speed up the decline in Aboriginal and Torres Strait Islander smoking and the preventable suffering it causes for so many families. They do not need to think they must invent a new program from scratch.
• David Thomas leads the Tobacco Control Research Team at Menzies School of Health Research in Darwin.
Declaration by David Thomas: I lead a national research project, known as Talking about the Smokes, which has been funded by the Australian Department of Health. I also made contributions to Menzies’ Sentinel Sites Evaluation of the Indigenous Chronic Disease Package and have been interviewed by the current reviewers of the Tackling Indigenous Smoking program.