Public Health Association of Australia: Policy-at-a-glance Tobacco Control Policy Key message: 1. Australia has been a world leader in reducing tobacco-related mortality and morbidity. Nevertheless 12.8% of Australians aged over 14 years continue to smoke daily. 2. Tobacco smoking is the single largest cause of preventable death and disease in Australia, responsible for approximately 15,000 deaths each year and 7.8% of the total burden of disease in Australia. 3. A comprehensive approach to tobacco control is required - no single measure will be effective in reducing the health consequences of smoking. 4. In recent years there has been substantial progress in action to reduce smoking nationally and in all jurisdictions, with encouraging trends, but the case for action remains urgent. Summary: PHAA will continue to advocate for all levels of government to maintain and build on comprehensive approaches to tobacco control, and work collaboratively with partner organisations to advocate for prevention and related programs that will help to achieve the lowest possible smoking rates in Australia and internationally. Audience: Australian, State and Territory and Local Governments, policy makers and program managers. Responsibility: PHAA s Health Promotion Special Interest Group (SIG) Date policy adopted: September 2014 Contact: Mike Daube, Convenor, Alcohol SIG m.daube@curtin.edu.au 1
TOBACCO CONTROL POLICY Refer also to the Public Health Association of Australia Trade Agreements and Health Policy. The Public Health Association of Australia notes that: 1. In May 1996, the World Health Assembly adopted a resolution calling on the Director- General of the World Health Organisation (WHO) to develop a treaty on tobacco. The Framework Convention on Tobacco Control (FCTC) was formally adopted on 21 May 2003. The FCTC is the world s first international public health treaty; it was ratified by Australia in October 2004, and formally came into force on 27 February 2005. 178 states are now Parties to the FCTC. 2. Tobacco use remains Australia s largest preventable cause of death and disease, and is a major global health problem. The WHO estimates that tobacco use causes 1 in 10 deaths among adults worldwide more than five million people a year i. Increasingly, the burden of mortality and morbidity is moving to the developing world, where many countries have higher rates of smoking and less advanced tobacco control educational and regulatory measures, and where multinational tobacco companies are seeking to capitalise on weaker or lack of tobacco control policies and programs. Tobacco will kill an estimated more than 175 million people worldwide between now and the year 2030 ii. 3. Australia has been a world leader in reducing tobacco-related mortality and morbidity. Nevertheless, in 2013, 12.8% of Australians aged over 14 years continued to smoke daily iii. Tobacco smoking is the single largest cause of preventable death and disease in Australia, responsible for approximately 15,000 deaths each year and 7.8% of the total burden of disease in Australia iv. The total social cost of smoking in Australia has been estimated at $31 billion a year. 4. There is no risk-free level of exposure to second-hand smoke. Non-smokers exposed to second-hand smoke at home or work increase their risk of developing heart disease by 25 to 30% and lung cancer by 20 to 30% v. 5. A comprehensive approach to tobacco control is required. No single measure will be effective in reducing the health consequences of smoking internationally or nationally. Tobacco control is a proven way to improve community health and reduce healthcare costs: government-led tobacco control measures over the past 30 years have prevented tens of thousands of premature Australian deaths, vi and it was estimated in 2003 that the $176 million spent on anti-smoking campaigns had delivered at least $8.6 billion in benefits vii. 2
6. Recent authoritative Australian research has confirmed beyond doubt the importance of taxation and sustained, adequately funded media campaigns as crucial components of a broader tobacco control program viii. 7. Pack design and colour have long been seen as key promotional toolsl for tobacco products worldwide. Australia s 2011 (implemented in full from December 2012) tobacco plain packaging legislation has been hailed in Australia and internationally as a momentous win for public health despite ferocious opposition from the global tobacco industry and the most important development in tobacco control for more than twenty years. ix Other countries including the UK, Ireland and New Zealand have announced their intention of following with similar legislation. 8. The Australian Government s Trade Policy Statement released in April 2011 included significant commitments to protect public health in trade agreements, including ensuring the sustainability of the Pharmaceutical Benefits Scheme (PBS) and excluding investorstate dispute resolution processes. The inclusion of investor state dispute resolution procedures would allow companies to sue the Australian Government in relation to any policy initiative which affected the profits of a foreign corporation, including tobacco companies suing for loss of revenue arising from plain packaging. 9. Point of sale displays of tobacco products have also been a key focus in recent years, with evidence they: encourage children and young people seeking to experiment with cigarettes; create a perception of easy access to cigarettes and social acceptability of smoking among children and young people; give quitters a visual cue to smoke and purchase cigarettes; encourage former smokers to relapse; normalise smoking in the community and undermine key health messages; and are among the last remaining advertising avenues for tobacco companies. Bans of point-of-sale advertising and promotion are now the norm across Australia, with minor variations. 10. Smoking among Aboriginal and Torres Strait Islander populations is one of the major contributing factors to poor Indigenous health and the cause of 20% of Aboriginal deaths. Smoking prevalence of more than 50% and up to 80% has been consistently reported among Indigenous populations. Recent reports have shown some encouraging declines in Aboriginal smoking, but smoking prevalence remains much higher than in the rest of the community. Reducing smoking among Indigenous people is an important component of an integrated approach to closing the life expectancy gap. Individuals with mental health conditions have a higher prevalence of smoking and those who smoke tend to smoke more heavily than the general population. This contributes to higher levels of tobacco-caused morbidity and mortality among people with mental illness. xi Smoking prevalence is also significantly higher among LGBTI people. xii 11. In recent years there has been substantial progress in action to reduce smoking nationally and in all jurisdictions, with encouraging trends, but the case for action remains urgent. 12. The report of the National Preventative Health Taskforce x recommended a comprehensive approach to tobacco control. The Australian Government has accepted 3
and implemented the thrust of these recommendations and implemented a series of newer expanded programs and policies including increased excise duty, a major boost in funding for national media campaigns, the national Tackling Indigenous Smoking Initiative, support for cessation activities and Quit Lines, further curbs on tobacco promotion along with legislation for plain packaging of tobacco products. These developments have been complemented by legislative, educational and cessation support activities throughout all states and territories. The current government has maintained a commitment to tobacco control measures including support for plain packaging, substantial regular annual increases in tobacco excise, and strong public education programs. The Public Health Association of Australia recommends that the Federal and State Governments should: Maintain a comprehensive approach to tobacco control. Progressively increase tobacco excise and customs duty on tobacco. Maintain high levels of funding for the national tobacco campaign, including ensuring coordinated, complementary elements at state/territory level. Continue and develop the national Tackling Indigenous Smoking Initiative and other programs to reduce smoking in Indigenous communities. Ensure continuing implementation of legislation on plain packaging Legislate to curb all forms of tobacco advertising and promotion, including any remaining advertising and displays at point of sale, public relations activities and political donations. Prohibit false and misleading statements by manufacturers about any aspects of the health effects of smoking or exposure to tobacco. Require tobacco manufacturers to report on any remaining promotional activities and expenditure and on sales volumes. Establish mechanisms to monitor and control all tobacco products constituents and emissions. Implement all possible measures to protect non smokers, especially children, from the dangers of passive smoking. Ensure strong support and substantially increased funding to encourage and assist in reducing smoking among people with mental health problems Ensure that smoking cessation supports are widely available and accessible, particularly for disadvantaged groups. Work with the Council of Academic Public Health Institutions Australia (CAPHIA) to promote and encourage all Universities and other tertiary institutions to provide tobacco-free campuses. Phase out smoking from all health care facilities, including psychiatric and drug and alcohol treatment services, both in-patient and out-patient. Ensure that all inmates and staff in adult and juvenile correctional facilities have smokefree environments. Move towards a position where all drug and alcohol and mental health services actively promote and provide free smoking cessation services (including nicotine replacement therapies) as a mandatory component of their client/patient care packages. Promote and protect public health within international trade agreements to limit adverse impacts of trade agreements on health and well-being, both within Australia and in other countries with which Australia has, or is negotiating, trade agreements. Ensure that there are programs addressing smoking in LGBTI populations. Continuously seek new approaches to reducing smoking among adults, preventing onset of smoking among children, and addressing the needs of disadvantaged groups. 4
The Public Health Association of Australia resolves that: it will work collaboratively with other tobacco control organisations to advocate for prevention and related programs that will help to achieve the lowest possible smoking rates in Australia and internationally. ADOPTED 2008, REVISED AND RE-ENDORSED IN 2011 and 2014 Adopted at the 2008 Annual General Meeting of the Public Health Association of Australia. Revised and re-endorsed as part of the 2011 and 2014 policy revision process. References: i WHO Report On The Global Tobacco Epidemic, 2008(page14) ii Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 2006, 3(11):e442. iii Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report, AIHW, Canberra. results. Drug Statistics Series number 20.Cat. no. PHE 98. Canberra: AIHW. iv Begg S, Vos T, Goss J, Barker B, Stevenson C, Stanley L & Lopez AD. The burden of disease and injury in Australia 2003(2007). v The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, June, 2006 vi VicHealth Centre for Tobacco Control 2003, Tobacco Control: A Blue Chip Investment in Public Health. vii Abelson, P. Returns on Investment in Public Health: An epidemiological and economic analysis, Applied Economics, the Commonwealth Department of Health and Ageing, 2003 viii Wakefield et al. Impact of Tobacco Control Policies and Mass Media Campaigns on Monthly Adult Smoking Prevalence August 2008, Vol 98, No. 8 American Journal of Public Health ix Public Health Association of Australia. 2011. Media Release: Plain packaging a historic win for public health. PHAA, Canberra. x National Preventative Health Taskforce. 2008. Australia: the healthiest country by 2020 A discussion paper. Australian Government, Canberra. xi Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. Available from www.tobaccoinaustralia.org.au). xii http://www.lgbthealth.org.au/node/250 5