Will social change help reduce smoking rates amongst disadvantaged Australians?

Smoking rates in Victoria are at an historic low, according to research released last week by Cancer Council Victoria, which found that 14.4 per cent of Victorians were regular smokers in 2011 compared with 21.2 per cent in 1998. But in the article below, University of Newcastle researchers Associate Professor Billie Bonevski and Professor Amanda Baker argue that smoking rates are still too high among many disadvantaged groups, and that social change and public health measures are needed. For those with an interest in equity and tobacco control, they recommend a special issue of the international addictions journal Drug and Alcohol Review.

  Smoking is a social justice issue

 Billie Bonevski and Amanda Baker write:
 In 1998 the public obtained the right to access internal tobacco industry documents, which blew the lid on the industry’s secrets. We learnt that the industry had evidence that cigarettes caused cancer and other negative health outcomes. Another involuntary disclosure was that the marketing and promotion strategies used by big tobacco targeted vulnerable groups like young people and the poor. They used various techniques. In the US, for example, tobacco companies financially sponsored events hosted by African American community groups and supported civil rights causes. It was not unusual for them to provide free cigarettes to mental health facilities and homeless shelters or to distribute cigarette branded blankets to people living rough on the streets. Similar grants and aid were given to Australian community social services.

“Value” pricing and promoting images and flavours (menthol) that appealed to people living in deprived urban areas were also used. Marketing cigarettes as a way to help you “cope with stress” was common. The entire strategy was labelled “downscaling” and today we are witnessing a globalisation of “downscaling” strategies where low and middle income countries have become the targets for the tobacco industry. Unfortunately even in developed countries like Australia we continue to experience the effects of these strategies. A social gradient in smoking exists whereby smoking prevalence rates rise as one moves down the socioeconomic scale.

 While the latest research from the Australian Institute of Health and Welfare shows that the adult smoking prevalence rate in the general community is about 15-18%, other data show that it is much higher in groups that may be labelled as socioeconomically disadvantaged and often not captured in health census surveys. Population health surveys such as the recent Victorian Smoking Prevalence survey, using the Australian Bureau of Statistics indexes for socioeconomic status (the SEIFA index), indicate that rates of smoking are declining across socioeconomic groups, but these surveys do not capture people who are homeless, institutionalised, without phone access, or mentally or physically unable to respond to surveys.

 Nonetheless, even in population surveys, like the Victorian survey, the socioeconomic gradient in smoking rates persist – the report shows that those who are in higher socioeconomic status postcodes have smoking rates of 11%, compared to 16% and 18% in those who live in middle and low socioeconomic postcodes. Instead, reports focussing on including highly disadvantaged social groups show much larger differences in smoking rates – up to 50% of Aboriginal Australians smoke, 37% of single parents, 73% of homeless people and people with other drug disorders, 66% of people with a mental illness smoke and 60% of people accessing welfare aid from non-government agencies such as Anglicare and the Salvation Army.