8.13 Policy recommendations for advancing tobacco control programs among Aboriginal peoples and Torres Strait Islanders
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Over the past decade the amount of information about the use of tobacco and its impact on the health and wellbeing of Aboriginal and Torres Strait Islander populations has increased dramatically. The preceding sections have drawn on a broad range of research reports, some of which have made specific recommendations about appropriate policy direction for effective tobacco interventions in the Indigenous population.6, 7, 112 Readers are also directed to the reports outlined below, all of which are available online and are supported by substantial backing documentation and resources.
8.13.1 The National Drug Strategy—Aboriginal and Torres Strait Islander
Peoples Complementary Action Plan 2003–2009
Current national drug policy (including both licit and illicit substances) is embodied in the National Drug Strategy—Australia's Integrated Framework 2004–2009.18 A set of companion documents relating to Indigenous drug control has been prepared, with their points summarised in the Aboriginal and Torres Strait Islander Peoples Complementary Action Plan 2003–2009.15 Six 'Key Result' areas have been identified:
- enhanced capacity of individuals, families and communities to address current and future issues in the use of alcohol, tobacco and other drugs, and promote their own health and wellbeing
- whole-of-government effort in collaboration with non-government organisations to implement, evaluate and improve comprehensive approaches to reduce drug-related harm
- substantially improved access to the appropriate range of health and wellbeing services that play a role in addressing alcohol, tobacco and other drugs issues
- a range of holistic approaches from prevention through to treatment and continuing care that is locally available and accessible
- workforce initiatives to enhance capacity of community-controlled and mainstream organisations to provide quality services
- increased ownership and sustainable partnerships of research, monitoring, evaluation and dissemination of information.
8.13.2 The National Tobacco Strategies
The National Tobacco Strategy is produced by the Ministerial Council on Drug Strategy (MCDS), which comprises federal, state and territory government ministers representing health and law enforcement, as well as the Federal Minister for Education.[25] In planning the Strategy, the MCDS consults widely with government and non-government agencies engaged in tobacco control in Australia.21
The current National Tobacco Strategy (2004–2009)21 builds on its precursor (the National Tobacco Strategy 1999 to 2002–03),20 identifying Indigenous tobacco use as a priority area for action, and recommending the introduction of a range of tobacco control policy measures to reduce the harm and inequality caused by tobacco in Australia. These include:
- regulation of all current and emergent forms of promotion
- regulation of supply—so that tobacco products are available only to adults and are not enticing to children and teenagers
- regulation of taxation—subject to further analysis for particular population groups
- regulation of packaging—including package information
- regulation of place of use (smokefree environments)
- regulation of the product itself (ingredients; new product development)
- promotion of 'Quit' and 'Smokefree' messages
- provision of cessation services, including access to treatment for dependence
- community support and education
- addressing of social determinants of health
- provision of programs appropriate to needs of disadvantaged groups
- resourcing and training of workforce (e.g. health professionals)
- ongoing research, evaluation, monitoring and surveillance.
The National Tobacco Strategy also refers to the Aboriginal and Torres Strait Islander Peoples Complementary Action Plan 2003–2009,15 discussed above, and the National Strategic Framework for Aboriginal and Torres Strait Islander Health—Framework for action by Governments.131 Additional documentation supporting the National Tobacco Strategy that relates specifically to smoking in Aboriginal peoples and Torres Strait Islanders is available from the National Drug Strategy website.[26]
8.13.3 The National Aboriginal and Torres Strait Islander Tobacco Control Project
The first National Tobacco Strategy (1999 to 2002–03)20 recognised that concerted action was required to reduce smoking prevalence among Aboriginal and Torres Strait Islander communities. This led to the funding and launch in 2000 of the National Aboriginal and Torres Strait Islander Tobacco Control Project (NATSITCP), a joint initiative between the National Aboriginal Community Controlled Health Organisation (NACCHO)[27] and the Department of Health and Aged Care.6 Undertaking for the first time a process of extensive, national community consultation, the goals of this project were to investigate levels of awareness and knowledge about the health effects of smoking and current tobacco control strategies in place; to examine issues surrounding tobacco raised by the communities involved; and to assess 'best practice' in tobacco control where effective interventions had occurred. The findings of the Project, along with recommendations for action, were published in 2002.6 Much of the research which has informed the conclusions of the NATSITCP report is discussed elsewhere in this chapter.
The key recommendation arising from the NATSITCP report was that broadly based, national coordination for Aboriginal and Torres Strait Islander tobacco control should be facilitated as a matter of urgency.[28]
The NATSITCP identified four guiding principles that should inform all future work in Aboriginal and Torres Strait Islander tobacco control:
- Aboriginal and Torres Strait Islander tobacco control programs should seek to maximise community control.
- All individuals and organisations working on programs in Aboriginal and Torres Strait Islander tobacco control should understand and respect the social context in which Aboriginal peoples and Torres Strait Islanders live their lives and programs should reflect this understanding.
- Tobacco control programs for Aboriginal and Torres Strait Islander communities should be holistic in nature and consider the social determinants of health.
- Tobacco control programs for Aboriginal and Torres Strait Islander communities should be as comprehensive as possible within given resources.
[25]See the National Drug Strategy website at: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/councils-committees-lp
[26]http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm
[27]NACCHO is the peak national body representing Aboriginal community controlled health services. See: http://www.naccho.org.au/
[28]This subsequently occurred, with the establishment in 2003 of the Centre for Excellence in Indigenous Tobacco Control (CEITC). CEITC has been funded with three main purposes: to develop an Indigenous tobacco control clearinghouse; to develop a curriculum for inclusion in Health Worker training that incorporates tobacco control, and to provide a forum for exchange of information and ideas for those currently working in Indigenous tobacco control.132
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