Views from Western Australia

Today I will briefly outline how advocacy has been an import tool in the decline in smoking prevalence in Australia, and will note key advocacy targets for decreasing smoking prevalence in the future.

TOBACCO SMOKING: THE DECLINE IN PREVALENCE
In Australia, there has been a largely uninterrupted decline in smoking prevalence since the early 1960s, when an estimated 58 per cent of men and 28 per cent of women smoked.

In  2004 WA smoking prevalence was 15.5 % of people over 14 years of age who smoked on a daily basis.  In 2007  the national figure is down to 16.6%  of people over 14 years of age who smoked on a daily basis.

Recently published figures indicate that smoking rates of Western Australian 12 to 15-year-olds has dropped from 19.4 per cent in 1984 and 15.2 per cent in 1999 to five per cent in 2005.  The percentage of 16 to 17-year-olds who smoke has fallen from 21.4 per cent in 1999 to 9.8 per cent.

HOW HAS THIS BEEN ACHIEVED?
Efforts to explain the rapidly declining tobacco usage usually point to mileposts since 1970, which marked the introduction of various tobacco control policies, laws, and prominent antismoking campaigns. The advocacy that led to the introduction of a law for tobacco control is rarely considered. Yet when you ask, “How did WA manage to ban smoking in pubs and clubs?” any answer must place advocacy at center stage.

Australia has one of the world’s most successful records on tobacco control. The role of public health advocacy in securing public and political support for tobacco control legislation and policy and program support is widely acknowledged.

As a result Australia has:

• among the world’s most expensive cigarettes;

• among the world’s most prominent health warnings on cigarette packets; plans to implement these saw prolonged periods of lobbying by the industry;

• smokeless tobacco - In 1986, the South Australian government became the first government in the world to ban smokeless tobacco, his ban later went national;

• a total ban on all advertising and promotion of cigarettes;

• mass reach media campaigns; In the late 1970s, Australia was one of the first nations to run mass-reach antismoking campaigns;

• Quitline services that provide advice and support to smokers trying to quit smoking;

• relatively high tobacco taxes by international standards; there has been a great deal of industry lobbying to restrain further rises;

• extensive media coverage of tobacco control;

• legislation that prohibits tobacco smoking in enclosed workplaces, (including restaurants, cafes, pubs, clubs and nightclubs) and public transport;

• reduced displays at point of sale and implementation of retailer and wholesaler licenses;

• local government moving on smokefree children’s playgrounds, al fresco and beaches; and

• a smokefree public health system, including all psychiatric facilities.

There have also been recent announcements regarding:

• banning additives and flavourings that make smoking more palatable to children;

• introducing fire-safe cigarettes by 2009, and

• a commitment to fund Indigenous tobacco control.

These initiatives don’t just fall out of the sky; they are the result of an ongoing advocacy campaign.

SOME OF THE HOW
The objectives of advocacy involve changing health policy and laws rather than efforts focused on persuading individuals to quit smoking.

Invariably, the objectives are contested. This means that there are readily identifiable and often determined opponents of the changes being proposed (example Australian Hotels Association fought against the introduction of smokefree pubs and delayed its implementation for ten years).

Since many of advocacy’s goals require political reform, advocacy is unavoidably a political activity.

The ability to frame a public health issue successfully, to attract public and political support, is a core skill of advocacy. Mass media is critical and requires extensive coverage of the issue in the news media. Wide and positive cover by the media is important in developing supportive public and political environments.

Advocacy campaigns, while often highly planned and strategically governed, are also responsive and opportunistic. For example, as recently as April 2008: Major media attention was focused on the announcement to increase tax on ‘alco pops’; this became a catalyst for a call for tax increases on tobacco.

WHERE TO FROM HERE?
In order to achieve a further reduction in prevalence and consumption of tobacco smoking, Australia needs to continue the comprehensive tobacco control programs already in place, as well as:

• providing more funding for sustainable, high profile public information campaigns for tobacco control,

• end donations to political parties by tobacco companies,

• removing any exemptions in existing legislation to ensure that all enclosed workplaces (including Burswood & prisons) are smoke free,

• developing and implementing a regulatory framework to control all aspects of tobacco production, packaging, marketing, and taxation,

• all tobacco products under the counter at point of sale

• smokefree al fresco dining,
• all government agencies to go smokefree (including prisons, people with disabilities and universities),

• smokefree cars,

• funding for public education,

• taxation increase,

• generic packaging,

• smokefree movies, and

• local government (as a broad area).

In closing, advocacy may seem to be a loose and inexact science, developing as an advocate demands a range of communicative, philosophical and technical skills.

As ‘tobacco control’ could now be considered to be ‘on a roll’, a range of strategies to advance its objectives are being considered and that is terrific. However, this should not blind leadership in the public health community to the importance of ongoing, well resourced advocacy that is proven to work.

Stephen Hall
Executive Director of the Australian Council on Smoking & Health