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The good news about Indigenous health

The urgent need to close the gap across a range of health markers for Aboriginal and Torres Strait Islander people can sometimes obscure the real progress already being made in specific areas. This is the case with Aboriginal and Torres Strait Islander smoking rates, argue the authors of a research paper that has just been named Best Paper in the Sax Institute’s inaugural Public Health Research & Practice Excellence Awards.

The award-winning authors, led by Associate Professor Ray Lovett of the Australian National University, tracked absolute change in the rate of daily smoking among Aboriginal and Torres Strait Islander adults from 2004 to 2015. What they found was a decrease of around 9 percentage points in smoking rates over the period, corresponding to 35,000 fewer Aboriginal and Torres Strait Islander people smoking daily. Thousands of premature deaths will have been avoided, thanks to this reduction in smoking rates.

But this success story is obscured by a focus on comparing the high smoking rates in Aboriginal and Torres Strait Islander people with the lower rates in the general population, says Associate Professor Lovett, who is a Wongaibon man from far west New South Wales.

“If we only focus on the relative rates of smoking, which is often what’s documented in the National Health Performance Framework or Close The Gap reports, then it looks like there’s no change, because there’s a large gap that hasn’t changed much in the past ten years. But if we report that, we lose the context that there is still a decline of 9 percentage points in smoking in the Aboriginal and Torres Strait Islander population. In anyone’s book, that’s success.”

Associate Professor Lovett says there are reasons from a health policy perspective why absolute rather than just relative rates should be publicised.

“It’s really important to report on this progress, because it makes people feel positive about the issue and it increases interest in how to promote healthy behaviours.”

Although the study wasn’t designed to assess the causes of the decline, Associate Professor Lovett points out that the tipping point roughly coincides with the roll out of a national tobacco control program specifically targeting Aboriginal and Torres Strait Islander communities.

“We can’t say definitively that’s what’s causing the decline, but you’d have to say the program has played a part in that.”

The research shows that the decline has not been even across Aboriginal and Torres Strait Islander people. Among older people and those in remote areas in particular, smoking rates have not fallen significantly.

“In very remote areas, you’re starting from a much higher base, with smoking rates of 60% or greater. That means smoking is completely normalised, so it takes a bit longer to de-normalise it. Where we’ve seen the greatest absolute change is in urban areas, where the base rates are much lower.”

Associate Professor Lovett says the way forward is a more comprehensive roll out of the tobacco control program, which currently only covers half the Aboriginal and Torres Strait Islander population.

He says regional control in smoking cessation programs is important, allowing people on the ground to determine what kinds of health promotion, support and education are needed for local populations.

“In remote areas smoking can be seen as a sensitive issue, so if you have local, tailored services that are provided by people from those areas, then you get a better buy-in from local communities.”

The Sax Institute has established the Public Health Research & Practice Excellence Awards to celebrate the high calibre of articles published in the Institute’s peer-reviewed journal. We promote excellence in public health research, practice and policy, and recognise the inspirational work taking place in Australia and internationally.

More information about the Awards and winning papers here. Read the paper referenced in the above story here.