7.20 National policy and progress in encouraging and supporting cessation
Australia has had significant successes in reducing the prevalence of and harm from tobacco use. Far fewer Australians are smoking and being exposed to secondhand smoke as a result of comprehensive public health approaches. The daily smoking rate has almost halved since 1991, from 24.3% in 1991 down to 12.8% in 2013.1 However, many people continue to smoke despite a strong regret that they ever started2 and numerous attempts to quit.3 Smoking rates continue to be unacceptably high, particularly among Aboriginal and Torres Strait Islander people; 42% were daily smokers in 2012–13.4 (Refer to Chapter 8, Section 8.3) Smoking rates among those with mental health problems and those in prison are also substantially higher than those in the general population. (See Section 7.12 and Chapter 1, Section 1.10)
The prevalence of smoking is predicted to continue declining in Australia in response to strengthened and effective population based approaches, including making tobacco products expensive, highly regulated, non-advertised, plain packaged, and out of consumers’ sight in retail outlets.5 These population-wide strategies not only reduce uptake and encourage attempts to quit, but also reduce the likelihood of relapse. In recent years, governments have also increasingly invested in services and treatments demonstrated to increase the likelihood of success of individual smoker’s quit attempts. The need to institutionalise such efforts in Australia’s healthcare system has been set out in several important policy documents, outlined below.
7.20.1 Australia’s National Tobacco Strategy
Australia’s National Tobacco Strategy 2012–186 aims to ‘improve the health of all Australians by reducing the prevalence of smoking and its associated health, social and economic costs, and the inequalities it causes.’ As part of a comprehensive approach to meet this aim, one of its key priority areas is providing greater access to a range of evidence-based cessation services to support smokers to quit. The Australian Government, state and territory governments, non-government organisations, and/or Quitline services have been charged with responsibility to:
- Increase the availability and range of smoking cessation services such as Quitline, particularly for populations with a high prevalence of smoking and people receiving specialist treatment for chronic health conditions.
- Enhance Quitline services for pregnant women (in particular Aboriginal and Torres Strait Islander women), including call-back services and feedback to obstetricians, GPs, midwives and Aboriginal health workers.
- Enhance Quitline services for Aboriginal and Torres Strait Islander people, including cultural competency training for tele-counsellors, culturally appropriate quit materials, call-back services and partnerships with Aboriginal community-controlled organisations.
- Continue to promote Quitline services to smokers and the community through mass media campaigns and other communication channels.
- Increase the range of interactive web-based programs provided as part of Quitline services to provide greater opportunities to interact with smokers and encourage them to quit, and ensure the information is regularly updated to reflect best practice.
- Improve the integration of Quitline with other programs across the health system, primary care services and relevant non-government organisations, with a priority focus on populations with a high prevalence of smoking (as outlined in Priority Area 6.5).
- Develop systems that encourage health professionals to routinely ask patients about their smoking status and provide smokers with appropriate advice and support to quit, including appropriate referral to specialist cessation services.
- Improve management of smoking cessation for all patients in healthcare facilities, particularly for patients on admission to hospital.
- Provide policy guidelines and accredited training in best practice smoking cessation (particularly brief interventions) to a range of health professionals and health, community and welfare workers, and ensure these are regularly updated to reflect best practice.
- Provide policy guidelines and training in brief interventions to social service organisations that are already working with populations with a high prevalence of smoking to build their capacity to support quit attempts in these groups, including by appropriate referral, and ensure these are regularly updated to reflect best practice.
- Increase awareness among relevant organisations and populations with a high prevalence of smoking of the availability of subsidised NRTs.
- Improve appropriate use of pharmacotherapies and services demonstrated to assist with smoking cessation, especially among populations with a high prevalence of smoking, through increased education and improved referral to smoking cessation services.
Several other international and national documents are relevant to national policy related to smoking cessation. They include strategies to encourage and assist tobacco cessation as a key component of tobacco control.
7.20.2 Framework Convention on Tobacco Control
The World Health Organization (WHO) has stated that a crucial part of reversing the tobacco epidemic is increasing smokers’ access to effective and comprehensive cessation treatments. Article 14 of the WHO Framework Convention on Tobacco Control (FCTC) states that governments shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence.7 Australia is a full Party to the FCTC, and is therefore required to perform, in good faith, the full range of obligations set out in this treaty. Progress in tobacco control in Australia is now intimately connected with FCTC processes.
In November 2010, the fourth Conference of the Parties (COP4) to the WHO FCTC adopted guidelines for the implementation of Article 14 (tobacco cessation and treatment) of the convention. Article 14 asks Parties to develop national guidelines and effective measures to encourage and assist tobacco cessation.8
- designing and implementing effective programs aimed at promoting tobacco in such locations as educational institutions, healthcare facilities, workplaces and sporting environments
- including diagnosis and treatment of tobacco dependence and cessation counselling services in national health and education programs, plans and strategies with the participation of health workers, community workers and social workers as appropriate
- establishing in healthcare facilities and rehabilitation centres programs for diagnosing, counselling, preventing and treating tobacco dependence
- facilitating accessibility and affordability for treatment of tobacco dependence including pharmaceutical products.
Few countries internationally have well-developed tobacco dependence treatment services and treatment for tobacco dependence is not yet a priority in most countries.9 For more information on the FCTC, see Chapter 19.
7.20.3 National Preventative Health Strategy
The National Preventative Health Taskforce was established in April 2008 to develop the National Preventative Health Strategy, focusing initially on obesity, tobacco and excessive consumption of alcohol. The main report, Australia: the Healthiest Country by 2020,10 and the Technical Report No. 2 Tobacco Control in Australia: Making Smoking History11 set out several recommendations to encourage and support smoking cessation. In May 2010 the Australian Government set out its response to the taskforce report including proposed action on each of the recommendations in Taking Preventative Action—A Response to Australia: The Healthiest Country by 2020—The Report of the National Preventative Health Taskforce.12 The taskforce’s recommendations concerning support and assistance to smokers and are set out below together with the Government’s responses—refer pages 71 to 73.
Key action area 6
Ensure all smokers in contact with health services are encouraged and supported to quit, with particular efforts to reach pregnant women and those with chronic health problems
- 6.1 Ensure all state or territory funded healthcare services (general, maternity and psychiatric) are smoke-free, protecting staff, patients and visitors from exposure to second-hand smoke both indoors and on facility grounds.
- 6.2 Ensure all patients are routinely asked about their smoking status and supported to quit, both while being treated and post-discharge.
- 6.2.1 Include requirement in hospital accreditation procedures.
- 6.2.2 Include a requirement in service funding agreements and performance contracts with senior staff.
- 6.2.3 Provide training in institutional or health-service procedures for assessment and referral.
- 6.2.4 Provide training in smoking cessation in pre-service training and continuing professional education for all health workers.
The Commonwealth Government strongly supports the value of brief interventions for lifestyle-related risk factors, including smoking. The Commonwealth Government will consult the Safety and Quality Commission (which will be established permanently as part of the National Health and Hospitals Network) on these actions in the context of the Commission’s development of clinical safety and quality standards. The Commonwealth will raise this with the states and territories at the Australian Health Ministers’ Conference. As par t of the National Smoke-Free Pregnancy Project, which received funding of $1.85 million (GST inclusive) over two years from the Commonwealth Government, midwives in 41 public hospitals were trained to conduct brief smoking cessation interventions for pregnant women and their partners at each visit.
- 6.3 Improve the quality and use of pharmacotherapies and services demonstrated to assist with smoking cessation.
The Commonwealth Government will task the Australian National Preventive Health Agency, in consultation with the Quitlines and other expert stakeholders, to bring together the evidence on best practice in this area and commission regular updates of best practice guidelines.
- 6.4 Increase availability of Quitline service.
Commonwealth Government officials will work with state and territory Quitline officials to conduct an evaluation and review of Quitline hours and services by 2012.
- 6.4.1 Ensure that Quitlines are resourced to respond to projected demand from media campaigns.
The Taskforce’s report notes that the Quitlines are currently under-utilised. Consistent with existing practice, the Commonwealth Government will keep state and territory governments and Quitlines informed as new social marketing campaigns are rolled out so that demand on services can be monitored and resourcing can be considered if necessary.
- 6.4.2 Fund the development and delivery of interactive smoking cessation services using approaches such as internet, mobile phone and web-enabled mobile devices.
The Commonwealth Government will task the Australian National Preventive Health Agency to investigate options in this area.
- 6.4.3 Establish special Quitline counselling services for pregnant women, including call-back services and feedback to treating obstetricians/GPs/ midwives.
- 6.4.4 Establish a group of counsellors within one or more Quitlines who would deal specifically with people needing to use interpreter services.
- 6.4.5 Establish a group of counsellors within one or more Quitlines who would deal specifically with people receiving specialist treatment for chronic health conditions (asthma, diabetes, arthritis, CVD, etc.), mental illness, providing call-back services and feedback to treating health professionals.
Quitlines are operated by states and territories. The Government will discuss these recommendations with states and territories through the Quit Group. The Australian National Preventive Health Agency will be tasked with reporting biennially on progress in this area as part of its report on the state of preventative health in Australia. In addition, from 1 July 2010, the National Pregnancy Telephone Counselling Helpline will refer callers seeking help with smoking to Quitlines.
- 6.5 Ensure that NRT is affordable for all those for whom it is clinically appropriate.
- 6.5.1 Investigate options for provision including through the Quitline and through the PBS.
- 6.5.2 Ensure availability of NRT and Quitline services for patients and clients of all state and territory health services.
The Government currently provides over $60 million annually in subsidies for smoking cessation aids under the Pharmaceutical Benefits Scheme (PBS). The smoking cessation aids Bupropion (Zyban) and Varenicline (Champix) are subsidised. Nicotine patches are also available on the PBS for Indigenous Australians and on the Repatriation PBS. The Pharmaceutical Benefits Advisory Committee has recommended the listing of nicotine patches on the PBS as an aid to smoking cessation for smokers more generally. The Government will consider this recommendation in due course. The Commonwealth will raise action 6.5.2 with the states and territories through the Australian Health Ministers’ Conference.
- 6.6 Explore whether financial incentives might be effective in helping people to quit or stay non-smokers.
- 6.6.1 Consider exempting from Fringe Benefits Tax employers who cover the costs of cessation therapies or who provide financial incentives to quit.
- 6.6.2 Trial incentive program for young Indigenous children to stay smokefree, remain at school, etc.
- 6.6.3 Trial projects that use incentive payments to help people to retain their resolve to stay stopped after quitting.
The Government does not support the proposed exemption from Fringe Benefits Tax for employers who cover the costs of cessation therapies or who provide financial incentives to quit
The Government will task the Australian National Preventive Health Agency to keep the evidence on financial incentives for quitting smoking under review.’
(Australian Government, Response to the national Preventative Health Taskforce, 201012, pages 71 to 73)
7.20.4 National Partnership Agreement on Preventive Health
The National Partnership Agreement on Preventive Health (NPAPH)13 is an agreement between the Commonwealth of Australia and all states and territories, which is providing up to $932.7 million over nine years from 2009–10 to address the rising prevalence of lifestyle-related chronic disease. It has set the aim of reducing the proportion of Australians who smoke daily to 10% by 2018, through the cessation initiatives highlighted above in the Australian Government’s response to the taskforce report.
Relevant news and research
For recent news items and research on this topic, click here
.(Last updated January 2019)
1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Cat. no. PHE 183 Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3
2. Fong G, Hammond D, Laux F, Zanna M, Cummings K, et al. The near-universal experience of regret among smokers in four countries: Findings from the international tobacco control policy evaluation survey. Nicotine & Tobacco Research, 2004; 6(suppl 3):S341–S51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15799597
3. Borland R, Partos TR, Yong HH, Surname KM, and Hyland A. How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control 4-Country cohort survey. Addiction, 2011; 107(3):673–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21992709
4. Australian Bureau of Statistics. 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander health survey: Updated results, 2012–13. 2014. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.006main+features12012-13
5. Scollo M, Bayly M, and Wakefield M. Plain packaging: A logical progression for tobacco control in one of the world’s ‘darkest markets’. Tobacco Control, 2015; 24:ii3-ii8
6. Intergovernmental Committee on Drugs, National Tobacco Strategy 2012–2018. Commonwealth of Australia; 2012. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/national_ts_2012_2018
7. World Health Organization. Framework Convention on Tobacco Control. New York: United Nations, 2003. Available from: http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf
8. Framework Convention on Tobacco Control (FCTC). Article 14 guidelines. 2010. Available from: http://www.who.int/fctc/Guidelines.pdf
9. Raw M. Framework Convention on Tobacco Control (FCTC) article 14 guidelines: A new era for tobacco dependence treatment. Addiction, 2011; 106(12):2055–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21827557
10. National Preventative Health Taskforce. Australia: The healthiest country by 2020. 2008. Available from: http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/discussion-healthiest
11. National Preventative Health Taskforce. Australia: The healthiest country by 2020. Technical Report No 2. Tobacco Control in Australia: Making smoking history, 2009. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/content/96cac56d5328e3d0ca2574dd0081e5c0/$file/tobacco-jul09.pdf
12. Commonwealth of Australia. Taking preventative action. A response to 'Australia: the Healthiest Country by 2020. The report of the National Preventative Health Taskforce', 2010. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/6B7B17659424FBE5CA25772000095458/$File/tpa.pdf
13. Council of Australian Governments. National Partnership Agreement on Preventive Health, 2009. Available from: http://health.gov.au/internet/anpha/publishing.nsf/Content/npaph