Introduction by Croakey: Leading tobacco control experts have welcomed the expansion of the Tackling Indigenous Smoking program to reduce both vaping and smoking among Aboriginal and Torres Strait Islander people.
Dr Christina Heris, Associate Professor Lisa J Whop, Associate Professor Michelle Kennedy, Dr Raglan Maddox, Professor Raymond Lovett and Professor Tom Calma discuss in the article below how to best build on big achievements so far in quitting rates among Aboriginal and Torres Strait Islander peoples.
Their article was originally published in The Conversation under the headline: ‘New funds will tackle Indigenous smoking. But here’s what else we know works for quit campaigns’.
Christina Heris, Lisa J Whop, Michelle Kennedy, Raglan Maddox, Raymond Lovett and Tom Calma write:
Among all the talk last week about a crackdown on vaping – the most significant tobacco control reforms in a decade has been the roll-out of another major document.
The National Tobacco Strategy 2023–2030 was launched.
A key priority of the strategy is Aboriginal and Torres Strait Islander smoking and Closing the Gap. We heard the Tackling Indigenous Smoking program would be extended and widened – with A$141 million funding – to reduce both vaping and smoking among Aboriginal and Torres Strait Islander people.
Here’s why that’s urgently needed and what needs to happen next to reduce smoking rates among Aboriginal and Torres Strait Islander people.
Tobacco is still a killer
Tobacco legally kills over 57 Australians a day. That’s equivalent to extinguishing an entire country town of 21,000 every year.
It’s still the single biggest preventable risk factor for disease and premature death. For Aboriginal and Torres Strait Islander people, more than a third of all deaths are caused by tobacco. Over the past decade we have lost more than 10,000 Aboriginal and Torres Strait Islander lives due to smoking.
Multiple policy failures beyond health – from poverty, education, employment, housing, family removals, dislocation and the systematic embedding of tobacco as rations in lieu of wages – mean Aboriginal and Torres Strait Islander people are disproportionately impacted by the harms of Big Tobacco.
So the funding to expand the Tackling Indigenous Smoking program is urgently needed to have no more than 27 percent of Aboriginal and Torres Strait Islander smoking by 2030 (5% of all Australians).
There have been huge achievements in reducing Aboriginal and Torres Strait Islander smoking. In 2018–19, 40 percent of Aboriginal and Torres Strait Islander adults smoked daily, down from 50 percent in 2004–05. A target of 27 percent is achievable. But to get there we need something “extra” to accelerate those reductions.
We know what works
Tobacco campaigns are one of the most cost-effective interventions when evidence-based, market-tested, sustained and with support services at the end of the call to action. When they are adequately funded, they can impact inequities.
Campaigns must be personally relevant and meaningful to be effective. This makes the case for targeted approaches, including local level campaigns, reinforced by general, national activity. Audiences engage with the message when they can see themselves and their community members (sometimes actually) in the advertising.
We saw this nationally with Break the Chain starring Aboriginal actor and comedian Elaine Crombie. Originally this was a targeted campaign for Aboriginal and Torres Strait Islander people. But it then aired nationally targeting all Australians in 2014.
Don’t Make Smokes Your Story was launched in 2016, as part of the Tackling Indigenous Smoking program. This was created by Indigenous agency Carbon Media, starring musician Fred Leone alongside real stories from community members.
One of the most successful and innovative Aboriginal and Torres Strait Islander tobacco campaigns, it included a toolkit for Aboriginal and Torres Strait Islander communities to use and adapt the national campaign to their local contexts.
An excellent example of this is from the Apunipima Tackling Indigenous Smoking team with its local campaign Don’t Make Smokes Your Story Cape York.
When Aboriginal and Torres Strait Islander people lead and promote smoke-free behaviours, communities are more interested in quitting.
Product, price, place and promotion
Social marketing campaigns, like the ones we’ve mentioned, really work well when they take on the Four Ps of product, price, place and promotion.
The beautifully produced ads, the “promotion”, can’t have impact on their own. This is where the rest of the National Tobacco Strategy comes in.
- Product
We’ve reduced product appeal with plain packaging and graphic health warnings. This will be enhanced with new warnings, including on the sticks themselves, plus greater uniformity of standardised packaging and tightened rules around additives and flavours that make smoking palatable.
- Price
Price increases reduce smoking and we’ll see a tax increase of 5 percent each year for three years across all different tobacco product types.
- Place
We have known about the harms of commercial tobacco since at least 1950. Yet we still expect individuals to give up nicotine instead of removing this lethal product from sale at pretty much every supermarket, service station and convenience store.
The National Tobacco Strategy is considering a national licensing scheme, removing online sales and delivery services, and potential for reducing the number, type and location of tobacco outlets.
There will also be more action on smoke-free areas and making sure all health professionals (particularly in remote places) are equipped to support quit attempts.
The strategy states it will explore raising the age you can buy cigarettes and monitor how this works overseas.
- Promotion
The commitment to close any last promotional loopholes for tobacco and e-cigarettes, particularly online is also important, along with local and national anti-smoking campaigns. But we know these are not enough on their own.
What we also need
Addressing all four Ps is what comprehensive tobacco social marketing would look like. It’s what’s required to accelerate the declines to get to the 27 percent target for Aboriginal and Torres Strait Islander peoples, and 5 percent nationally.
Targeted approaches are critical and can be effective, but they need to be supported by bigger, whole of population structural changes. The community-led campaigns, supported by national activity, will reinforce and amplify the policy changes that will come through on the tobacco product, its cost and its availability.
That’s how we realise our goals and ultimately eliminate tobacco related disease and death.
About the authors and disclosure
Dr Christina Heris is a Research Fellow with the Tobacco Free Program at Australian National University. Heris receives funding from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.
Associate Professor Lisa J Whop is a Senior Fellow at the National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University. Whop receives funding from the NHMRC and the Australian Research Council. She is also a member and incoming chair of Cancer Australia’s Leadership Group on Aboriginal and Torres Strait Islander Cancer Control.
Associate Professor Michelle Kennedy is Assistant Dean Indigenous Strategy and Leadership for the College of Health Medicine and Wellbeing at the University of Newcastle and the Executive Manager of Research and Knowledge Translation at the Lowitja Institute. Kennedy receives funding from the NHMRC, Medical Research Future Fund and the National Heart Foundation.
Dr Raglan Maddox is a Fellow and the Study Director of the Tackling Indigenous Smoking Evaluation at the National Centre for Epidemiology and Public Health, at the Australian National University. Maddox receives funding from from the NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (NHMRC GNT1198301), and the Australian Government Department of Health and Aged Care for the Tackling Indigenous Smoking – Regional Grants Impact and Outcomes Assessment.
Professor Raymond Lovett is Director of the Mayi Kuwayu Study at the National Centre for Epidemiology and Population Health, ANU. Lovett receives funding from the NHMRC.
Professor Tom Calma is Chancellor of University of Canberra. Calma is the National Coordinator, Tackling Indigenous Smoking (TIS). This position is a consultancy to the Commonwealth Department of Health and Aged Care.
Read Croakey’s story on vaping reforms here.
See Croakey’s extensive archive of articles on Indigenous health.
