About

Tobacco control has been supported across the political spectrum in Australia, and Australian governments have invested in tobacco control policies (commencing with mandated health warnings in 1973). Tobacco control investments were associated with declines in daily smoking prevalence across Australia from 23.8% in 1995 to 10.7% in 2020/21, and with an 11.2 percentage point decline in current smoking among Aboriginal and Torres Strait Islander peoples from 54.5% in 1994 to 43.3% 2018/19.

Despite the decline in smoking prevalence, tobacco use remains the leading preventable risk factor in Australia; responsible for 9% of the total health burden and estimated to have resulted in $137 billion in social costs in 2015-16. Australia’s tobacco control policies were considered innovative a decade ago during the implementation of plain packaging legislation and the expansion of graphic health warnings. In 2019, Australia ranked 10th among OECD countries for prevalence of daily smoking. The decline in smoking prevalence in Australia continues to be slow, declining on average 0.4 percentage points per annum since 2010. Large inequities in the burden of tobacco use exist. This includes the tobacco burden experienced by Aboriginal and Torres Strait Islander people with a high rate of smoking (37% daily smoking), and a high health burden attributable to tobacco (12% of the total Indigenous health burden). This burden of tobacco is a direct and indirect result of colonisation which systematically embedded tobacco use among Aboriginal and Torres Strait Islander people through payment in rations of tobacco, in lieu of wages, up until the late 1960s.

A simulation of lung cancer mortality in Australia found that current measures will not reduce smoking prevalence to 5% by 2060. Reducing smoking prevalence to 5% or to 0% by 2025 would avert 209,000, or 361,000 lung cancer deaths, respectively. Adoption of a tobacco endgame would represent a ‘paradigm shift’ in policy as conventional tobacco control strategies have largely relied on ‘consumer’ or demand-side approaches. Endgame strategies, on the other hand, are ’…designed to change or permanently eliminate the structural, political, and social dynamics that sustain the tobacco epidemic, so as to achieve, within a specific time, an endpoint for the tobacco epidemic.’ Tobacco endgame strategies are likely to be contested, as they focus unequivocally on supply-side approaches and/or the broad determinants of smoking, challenging dominant paradigms that are promoted by the tobacco industry such as ’individual responsibility’, libertarian philosophy and neoliberal approaches.

New Zealand (NZ) is the first country to commit to a range of tobacco endgame strategies, including: tobacco free generation legislation; legislation to severely limit the number of tobacco retailers; and a regulatory scheme to reduce the addictiveness and appeal of cigarettes. Modelling studies found these strategies could reduce smoking prevalence to minimal levels, and markedly reduce health inequities attributable to smoking among Māori, Pacific Island peoples, and other populations in NZ. Australia has a stated tobacco endgame goal, to reduce daily smoking prevalence to 5% or less by 2030, but has made no commitment to implement any tobacco endgame strategies.

The goal of the research is to analyse and inform public discourse about tobacco endgame strategies for Australia. The primary research questions are:

• What key learnings from discourse on tobacco control polices, tobacco endgame goals and strategies, and other regulatory reforms in Australia should be considered in an endgame for Australia?
• Among Australian policy actors:
  • what are their views of the key benefits, costs, and constraints to a tobacco endgame for Australia?
  • what are the key values and interests?
  • where is there consensus regarding tobacco endgame goals and strategies?

Foundational research components

In recognition of the influence of the media on public policy, media articles on tobacco endgame strategies will be analysed. As theories of the policy process also highlight the importance of policy actors in policy change, public submissions made toward the Draft Consultation National Tobacco Strategy 2022-2030 will also be analysed. A scoping review of research with Indigenous peoples regarding tobacco endgame strategies will be conducted including exploring Indigenous engagement.

Original data collection components

The foundational components of research will inform the development and implementation of primary qualitative research with key policy actors in Australian tobacco control; and for a separate process with Aboriginal and Torres Strait Islander rights-holders/Indigenous policy actors. A key focus of the original data collection will be to test consensus for tobacco endgame strategies and identify facilitators and barriers to a paradigm shift to tobacco endgame policy. This will include exploration of values and interests that may influence policymaking on this issue.

Thematic analysis will be applied across the foundational and original data collection components of the research program. A customised coding frame will guide analysis across the following themes:

• theories of the policy process (e.g., policy image portrayals and policy narratives);
• existing frames identified in media framing of population health issues (e.g., grouped as market justice or social justice framings);
• dominant theories that inform or influence public health approaches (e.g., the socio-ecological model, the commercial determinants of health); and
• influences on public health governance (e.g., government intervention versus neoliberal perspectives).

It is expected that the research will: promote public discourse and inform public health researchers, advocates, and policymakers in their framing of tobacco endgame policy proposals for the Australian policy context; inform policy deliberation; and contribute to Australia’s National Preventive Health Strategy targets of reducing national daily smoking prevalence to 5% or less, and to 27% or less among Aboriginal and Torres Strait Islander people, by 2030.

Bio

Andrew Perusco graduated his Master of Public Health degree from the University of Wollongong in 1999. He is a tobacco control policy and program specialist with over 20 years’ experience in the public sector. He has contributed to significant tobacco control policies and program implementation, including leading: policy development and program implementation for the Tackling Indigenous Smoking program from 2016 to 2020; development of the National Tobacco Strategy 2012-2018; national policy approaches for electronic cigarettes; and planning, implementation, and evaluation of the seminal Arabic-speakers’ tobacco control project in southwest Sydney. Andrew commenced his PhD in 2021 at the National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, ANU in affiliation with the NHMRC Centre for Research Excellence in Achieving the Tobacco Endgame.