Tackling Indigenous Smoking in Remote Communities
Date: Oct 31, 2017
Publication Type: News
At Miwatj Health Aboriginal Corporation in Nhulunbuy, a team of Yolngu community members deliver programs and activities to support tobacco smokers wanting to quit.
Their approach is not to judge or demonise smokers. They know that quitting is a long and hard journey. Rather, Tobacco Action Workers start conversations about the dangers of smoking, support quit attempts, advocate for smoke-free spaces and reduce exposure to passive smoking. All the workers are local Yolngu people based in the communities they work in including Yirrkala, Gunyangara, Gapuwiyak, Galiwin’ku, Milingimbi and Ramingining.
Wherever there is an opportunity to spark up a conversation about smoking – in the home, park or at the clinic – the Tobacco Action Workers will do so. And in the meantime, they encourage people to smoke away from non-smokers, children and elders to reduce the impact of second-hand smoke.
Professor Tom Calma AO is the National Coordinator of Tackling Indigenous Smoking and says the program, which has run since 2010, is seeing success.
“Since the campaign started, in excess of 50% of Aboriginal and Torres Strait Islander people smoked. Now, in the latest census that figure was down to 39%.”
Tobacco smoking is the number one killer of Aboriginal and Torres Strait Islander people, responsible for 20% of all deaths and 12% of the total burden of disease. The proportion of Aboriginal people who smoke is 2.6 times that of other Australians (16%).
And while the national rate has dropped, in remote Top End communities the smoking rate can be as high as 85%. Several surveys since 1986 have documented remote community smoking rates in the Northern Territory range from 61–85%. These have remained relatively unchanged, particularly in the Top End.
That’s why the Australian Government is funding the Tackling Indigenous Smoking program to reduce smoking rates among Aboriginal and Torres Strait Islander people.
“We all know smoking causes lung cancer especially our mob. It also has an impact on all of our health – chronic disease, heart disease, and even on unborn babies,” says Professor Calma.
“You can see on a graph why we’re dying 15 years younger that the rest of the population or sometimes younger, because we’re getting these chronic diseases that leave us disabled,” he says.
As National Coordinator, his job is to provide support and leadership to the regional teams who received grant funding. He sees the impact that smoking is having on the Aboriginal community.
“People being deprived of their health means not being able to participate in cultural events or being able to enjoy good healthy food because they have no money, because all their money is going on cigarettes.”
“Then there’s all the other impacts that we’ve got to look at, the socialisation, the impact on the pocket which is very, very significant. A packet of Drum (tobacco) can be $60 in an urban environment and in a community can be $80.”
Quitline estimates that quitting smoking can save up to $9,000 a year for someone who smokes a 20-pack a day. That can mean a holiday or a new car.
“I was talking to a guy just outside of Dubbo last week and he was telling me he’s given up for 12 months and told me he’s been able to afford to go to Memphis and Tennessee for 2 weeks – he’s a country music fan – and still has $4,000 spending money,” says Calma.
“He’s always wanted to do it and now he’s doing it and he’s so proud of himself and we’re proud of him too. He’s in his 50s. He’s finally realising now the impact of how much money he’s lost and how much he’s deprived his family. Some of his kids are chronic asthmatics and he’s wondering if his smoking had an impact on that.”
Tackling Indigenous Smoking focuses on population health, which means working to reduce health inequities or disparities among a population group, rather than individuals.
Approaches are locally designed and delivered in a way that best suits the community, with a focus on specific groups such as young people and pregnant women. In 2014, 45% of Indigenous mothers reported smoking during pregnancy, a decrease from 50% in 2009. As well as being born premature, this can set babies up for problems including obesity, heart disease, diabetes and respiratory problems.
The program has also partnered with the Quitline campaign to train staff in cultural competency and provide Indigenous counsellors. “If someone rings up, they can ask to talk to a countryman and someone can ring them back so it doesn’t cost them money and they can have a chat to them. Or they can just come in and talk to a non-Indigenous person,” says Professor Calma.
Activities in communities include culturally appropriate community education, health promotion and social marketing, creating smoke-free environments and encouraging healthy lifestyles. A national best practice unit is led by Ninti One to support regional recipients with evidence-based resources and information, advice, mentoring and workforce development.
The message does seem to be getting through to young people. Eighty-one per cent of 15-17 year old Aboriginal and Torres Strait Islander people do not smoke.
“In Galiwinku where I was recently, 32 people have given up in the community,” says Professor Calma. “It doesn’t seem like a lot but it has a flow on effect to other people.”
“Miwatj is working with people who want to have a smoke-free house and providing signs saying Yaka Ngarali which means ‘no smoking’. That will have a snowball effect because people are out to share their stories.”
“That’s the good thing about our mob. The bad thing is we smoke too much, the good thing is those who give up smoking want to help others.”
Northern territory organisations offering support as part of the Tackling Indigenous smoking campaign
Anyinginyi Health Aboriginal Corporation, Tenant Creek
Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs
Danila Dilba Health Service, Darwin
Katherine West Health Board Aboriginal Corporation, Katherine
Miwatj Health Aboriginal Corporation, Nhulunbuy
Sunrise Health Service, Katherine