Triggering change through the decades

Triggering change through the decades


Maurice Swanson
Chief Executive, Australian Council on Smoking and Health.

Monday 1 July 2019

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Following a change of government in 1983, the Hon. Barry Hodge, who was deeply interested in promoting health and preventing disease, initiated a priority setting process in his first year as Minister for Health.

 

An extensive amount of data was collected and reviewed by a panel of experts, and information was made available for comment by a wide range of health professionals and relevant stakeholders including the Australian Medical Association (WA).

 

Twelve priority areas were selected on the basis of four criteria:

 

  • the existing magnitude of the related health problem and its likely future course in absence of intervention;
  • the potential for prevention through health promotion or education strategies;
  • the prospect of a reasonable return for the level of resources that would be necessary to invest; and
  • the likelihood of public acceptance.

 

Five priority areas were seen to require immediate action – tobacco, inappropriate diet, alcohol abuse, Aboriginal health and immunisation.

 

Consistent with these recommendations, Western Australia led the nation in its implementation of a comprehensive approach to reducing the prevalence of smoking and led the push for stronger national policies in areas such as pack health warnings.

 

At the state level, following two earlier attempts in 1982 (by a Liberal MLA, Dr Tom Dadour) and 1983 (by the government) to pass legislation aimed at prohibiting the advertising of tobacco products, the WA Parliament finally passed the Tobacco Control Act 1990 . This prohibited most forms of tobacco advertising under State control and established the Western Australian Health Promotion Foundation (Healthway) to replace the sponsorship of sport, racing and arts activities previously sponsored by the tobacco industry. Substantial increases in tobacco tax have been complemented by increasing restrictions on smoking in workplaces, the indoor areas of entertainment and hospitality venues, and in crowded outdoor areas. Tobacco products can no longer be promoted or displayed at point-of-sale. All of these changes in legislation were achieved despite massive resistance from the tobacco industry and its allies.

 

Every year since the mid-1980s, the Health Department, and now the Cancer Council WA, have conducted TV-advertising led public education campaigns to portray dramatically the major health effects of smoking and encourage adults to quit. Tailored strategies for children and youth, and high-risk groups have also been implemented. All of these strategies have done much to de-normalise smoking across the community.

 

Since the early 1980s, the prevalence of daily smoking among adults has been reduced from one in three to one in 10 adults. And the prevalence of regular smoking among 12 to 17-yearolds has been reduced from around 20 per cent in 1984 to less than five per cent in 2017. The prevalence of smoking remains high among some high-risk groups including prisoners and those who suffer from mental illness but encouragingly, is falling among Aboriginal and Torres Strait Islander communities.

 

During this time there have also been marked falls in the death rates from the major diseases caused by smoking such as lung cancer, heart disease, chronic obstructive lung disease and emphysema. However, smoking remains the leading preventable cause of death and disease in Australia.

 

These massive changes in the prevalence of smoking in Western Australia, and the corresponding changes in the pattern of diseases caused by smoking, have been achieved with bipartisan support from the major political parties and the concerted, sustained and committed support from all leading health and medical organisations in this State.

 

Australia has one of the lowest levels of investment in prevention at 1.8 per cent of the total health budget.

 

More than 30 years after Our State of Health, WA’s recent Sustainable Health Review recommends a new benchmark minimum investment of 5 per cent of the State’s health budget be dedicated to prevention. Just imagine what further progress might be achieved if these additional resources were directed at current priorities for prevention such as tobacco, obesity, and the abuse of alcohol and the health of Aboriginal people and other disadvantaged groups.

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