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And now for some good news on Indigenous health

We are so inundated by bad news about Indigenous health that it’s easy to be overwhelmed by doom and gloom. But when it comes to smoking – a major cause of sickness and premature death – the news may be more encouraging than we’ve previously thought.

Dr David Thomas, a senior research fellow at the Menzies School of Health Research in Darwin, reports:

“In March last year, the National Indigenous Health Equality Summit set a target of reducing Indigenous smoking prevalence by 2% every year.  It sounds great: so much Indigenous suffering would be avoided and so many early deaths averted.

Tobacco control became a big ticket item in Rudd and Roxon’s plans to ‘Close the Gap’, with millions committed in last March’s Indigenous Tobacco Control Initiative and millions more to come as part of their COAG initiatives.  But few would have really believed that the 2% target could be achieved: just aspirational slush like ‘no child will live in poverty’.

Back then, the hard truth was that Indigenous smoking prevalence had not changed whilst smoking was successfully falling in the rest of the population.  This was based largely on three large national Indigenous surveys performed by the Australian Bureau of Statistics in 1994, 2002, and 2004.  All other national survey data had tiny Indigenous samples, and so provided useless estimates.  Each of the ABS surveys reported that about 50% of Indigenous adults smoked, about double the Australian prevalence of smoking.

What most readers have overlooked is that the reports of these surveys used different age cut-offs and different definitions of smoking (daily or all current smokers).  This week in the International Journal for Equity in Health, I described the prevalence of current smoking amongst Indigenous adults aged 18 and over in each survey.

From 1994 to 2004 Indigenous smoking prevalence in non-remote Australia fell in parallel with the total Australian population (by 5.5% in men and 1.9% in women).  In remote Australia, smoking prevalence also fell amongst men (by 3.5%) and appears to have peaked in women.  These two different trends can be neatly explained by international research about the shape of smoking epidemics, with remote Indigenous Australia just at an earlier point in the predictable smoking epidemic curve than Indigenous peoples in non-remote Australia.

Also this week, the ABS released the first results of the fourth national Indigenous survey in this series.  Detailed comparisons are not yet possible, but they too have reported a drop in national Indigenous smoking, from 51% in 2002 to 47% in 2008.

Even though both of this week’s reports have some limitations, we can reasonably confidently say that Indigenous smoking prevalence is not resiliently static, as once thought.  The Indigenous smoking epidemic is not exceptional, and there is no need to entirely re-think and re-fashion tobacco control in this setting.  We can adapt what has been successful in Australia and elsewhere.

Reducing Indigenous smoking is no longer a seemingly impossible task.

Indigenous smoking was slowly falling before a cent of the new money was spent.  How fast it falls now the new money is starting to hit the ground will depend on how that money is spent.

We should feel emboldened by this week’s news.  We should no longer call ‘encouraging’ any future reduction in Indigenous smoking; we should expect a dramatic reduction, maybe even the fabled 2% annual reduction dreamed up last March.”

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