National Tobacco Strategy 2022-2030

My organisation does not receive any funds from the tobacco industry

The Centre for Primary Health Care and Equity does not provide services to the tobacco industry.

Australia has led the world in anti-smoking campaigns involving legislation, taxation and significant public health measures for over half a century, informed by data. This has halved the smoking rates from 35% in the 1960s to 15% today. However, 2.9 million Australians still smoke and around 20,000 Australians die every year from smoking. While previous initiatives have been successful in lowering Australia’s smoking rate, to lower it again by half (i.e. from 15% to 5%) requires even more effort and far more sophisticated, focused campaigns with access to detailed, local data.
Current data sources include prevalence surveys to monitor change over time and estimates of the burden of smoking on deaths using attributable fractions derived from research. For deaths attributed to smoking (arguably a key statistic influencing policy), Australia relies on indirect estimates of tobacco-attributed mortality – using relative risks from the USA – most recently updated in 2011.

The guiding principles of working in partnership are essential to achieve these ambitious gains. Current "Business as usual" anti tobacco / smoking programs will not achieve these. Extending partnerships to significant sub populations which have high smoking rates is essential. Having direct (local) Australian data to improve the accuracy of tobacco attributed deaths overall and especially in important population subgroups where tobacco smoking prevalence is high, is of critical importance. Subgroups include ‘priority populations’ e.g. people living in rural areas, of Aboriginal and Torres Strait Islander origin, who are unemployed, less educated, of low socioeconomic status, with a mental disability, and certain migrant communities. Getting local detailed data will facilitate more precise strategies for tobacco control, especially in marginalised populations. A new partnership between 'Health' and the State and Territory Attorney Generals is required to amend the death notification forms to include simple question on smoking (that incorporates when the deceased stopped).

A priority area should be to collect timely local accurate data to monitor the rise and fall of deaths attributed to smoking in Australia and within its important subgroups, rather than relying on risk estimates gathered from overseas, e.g. from global burden of disease.

An additional action must be to include in State and Territory death notification forms a voluntary question directed to the next-of-kin on the tobacco smoking status of the deceased to identify “never”, “former” and “current” smokers. This question will allow Australian agencies (e.g. the Australian Bureau of Statistics and the Australian Institute of Health and Welfare) to directly and accurately estimate the annual number of people whose death, by cause, was attributed to smoking.

Having direct (local) Australian data to improve the accuracy of tobacco attributed deaths overall and especially in important population subgroups where tobacco smoking prevalence is high, is of critical importance. Subgroups include ‘priority populations’ e.g. people living in rural areas, of Aboriginal and Torres Strait Islander origin, who are unemployed, less educated, of low socioeconomic status, with a mental disability, and certain migrant communities. Getting local detailed data will facilitate more precise strategies for tobacco control, especially in marginalised populations.
The advantages of this approach include: All deaths legally require completion of a death notification form, so they capture almost all the population. Once adopted, such a question will generate data that are perpetual and increasingly statistically valid.
The cost of implementation is low. The forms differ slightly between jurisdictions, so amendments will be required to relevant State and Territory regulations, and to Death Registry IT systems and paper forms to include the question – a small cost. Answering the question will mostly be done by the next-of-kin in the presence of a funeral director or medical professional. This means the reliability of the answer is likely to be high as it is provided by a person familiar with the deceased. The additional time/cost to the funeral director or medical professional in completing the death notification form will be minimal.

I am happy to provide further information. This proposal is based on experience from South Africa (pop 54m) implemented since 1997 and Tianjin Municipality, China (pop 15m), implemented since 2011. Each has now collected information on the smoking habits on over a million deceased individuals. In each case, the tobacco burden measured directly differed significantly to what had been estimated using indirect global burden of disease) estimates and led to better focusing of tobacco programs.