Is Smoking really still that bad in Australia?

One of the leading causes of preventable illness and early mortality in Australia is tobacco smoking. Over 70 of the reported 7000 chemicals in cigarette smoke are known to cause cancer. 15.2% of Australians smoked tobacco products in 2017-2018, of which 13.8% were daily smokers [1].

Tobacco continues to be the leading cause of cancer in Australia contributing a staggering 22% of cancer burden [2]. It is estimated that around 19,000 people die every year due to cigarettes and is said to cause heart disease, diabetes, stroke, cancer, renal disease, eye disease, asthma and emphysema, [3] therefore it is no surprise that tobacco continues to be the leading cause of preventable health burden and injury [4].

According to the Australian Institute for Health and Welfare, those living in remote and very remote communities are 1.5 times more likely to be daily smokers[5]. Hence smoking rates in the Northern Territory continue to top all of the states and territories at a rate of 1 in 5 [6]. Much like trends seen in the US [7], Canada [8], New Zealand [9] and the UK [10], NHS findings for the 2017-18 period showed that communities in the most disadvantaged areas in Australia are 3.2 times as likely to smoke tobacco compared to those living in the highest socio-economic areas. [11]

As of 2018-19, 41.4% of Aboriginal and Torres Strait Islander people ages 15 years and over were smokers compared to 14.4% of non-Indigenous Australians [12]. It has been reported that daily smokers are twice as likely to have high or very high levels of psychological distress as non-smokers and are twice as likely to be diagnosed with or treated for a mental health condition [13]. According to the Australian Institute of Health and Wellness there has been a significant increase in the proportion of smokers reporting high levels of psychological distress (from 11.1% to 14.0%), very high levels of psychological distress (from 6.2% to 7.9%) and mental illness (from 20.7% to 27.7%). The statistics of those in institutional settings such as psychiatric facilities [14] and prisons [15] are also worryingly high.

The estimated social cost of tobacco smoking in 2015-16 period was a staggering $136.7 billion [16] and disproportionately affects the most vulnerable communities in Australia given the geographic and social groups that take up and continue to smoke tobacco.

For the period of 2013-2016 the reduction in the rate of adult smoking in Australia slowed dramatically [17] despite consistently large price increases and the implementation of plain packaging. In comparatively similar countries rates of smoking are falling much more strongly by implementing a broader range of measures, including a range of alternative, lower-risk nicotine-based products. According to a 2019 McKell Institute Report on tobacco harm reduction, ‘smoking rates are declining faster in many other countries than in Australia, especially where tobacco harm reduction strategies are available. Smoking rates in the UK and US are lower than in Australia for the first time.’[18]

Whilst overall smoking rates have dropped, the rapid rate of price increases on cigarettes since 2010 [19] has done little to aid community members living in remote or low socioeconomic areas as tobacco use continues to be a leading cause of health and financial instability [20]. Countries that have introduced a broader

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