Health Minister Nicola Roxon told the National Press Club yesterday that Australia should take the global lead in reducing smoking. She said:
…it might be possible to set a national target for reducing smoking rates and rewarding states which successfully implement innovative programs to reduce tobacco use. In Australia right now, we have a daily smoking rate of around 16 per cent. This is low. But in California it is close to nine per cent. There is no reason we should not be aiming to be the world’s best — not for the sake of it, but because we know this will deliver benefits to our community.
With 15,500 annual tobacco attributed deaths — mostly heart, circulatory and respiratory disease and lung and others cancers, smoking still kills more Australians than breast, prostate and colorectal cancer combined (total 9,428).
Data from the Australian Institute of Health and Welfare show that one has to go back to 1963 to see rates per 100,000 of male lung cancer as low as they have fallen today. Women’s rates are higher than they have ever been, but are starting to plateau and are today less than half the rate of men. 85% of lung cancer occurs in people with histories of smoking. The differences are explained by historical differences in uptake of smoking between men and women.
With chronic obstructive lung disease — again mostly caused by smoking — you have to go back to 1957 to see male rates as low as they are today. And with heart disease, today’s male death rates were last seen in 1945. Heart disease survival has of course also been enormously affected by improvements in treatment (see all graphs here).
The data on lung cancer are the most indisputable sign that serious efforts at preventing smoking works: improvements in survival after lung cancer diagnosis have barely changed in decades, with 85% of those diagnosed being dead in five years, so the dramatic and continuing falls we have seen cannot be attributed to improvements in treatment.
Both Australian adult and teenage smoking rates are today the lowest ever recorded. The comprehensive approach that Australia has pursued over nearly three decades involving curtailing the tobacco industry’s ambitions keep us smoking as much as possible, wherever possible; tough pack warnings; and unforgettable public awareness campaigns is a model for all chronic disease control.
If Nicola Roxon’s goal is to be achieved, she should take a leaf out of her NSW counterpart Verity Firth’s book and legislate for a national ban on tobacco retail displays, meeting barely a whimper from the politically gutted tobacco industry.
Australia could be the first country to require tobacco to be packaged in plain, drab boxes just like the way prescription drugs are packaged. Or with massive, gruesome health warnings with just the brand name showing.
The tobacco industry will again scream loudly. But the main lesson I’ve learned in 30 years is that we should all start worrying when their screaming stops.
Simon Chapman is professor of public health at the University of Sydney and the NSW Premier’s Cancer Research medallist for 2008
Joseph, some good points which are not clearly answered in the article. My guess would be that the health problems outlined in the article generally take years to surface, and in past decades deaths due to other health problems (eg bacterial infections, accidents in vehicles or workplaces etc) at younger ages (ie before the smoking-related illnesses could kick in) would have been more common, thus skewing the results. Also, the rate of accurate diagnoses would be much higher today than previously. I’ve heard many smokers suggest that the illnesses associated with smoking are in fact related to the health warnings on ciggie packets, not the cigarettes themselves, and the stats in this article seem to back this theory!
The reason for the timing differences in the peaks of the graphs is indeed the time lag taken for someone to develop cancer after exposure to tobacco smoke. The rise in cancer rates post WWII is also due to the fall in deaths from other causes. Prior to WWII there were no antibiotics and pretty well any infectious disease could knock you off the perch long before you got cancer from smoking. The antibiotic era combined with the better treatment for other causes of death meant you got to live longer, smoke more and have a higher chance of getting lung cancer. The feminist movement has a lot to answer for – indirectly they made it fashionable for women to smoke and female cancer rates rose rapidly to almost reach that of males, that peak is only just starting to pass now. Smoking is now almost solely confined to the less educated and less affluent sections of society.
One thing that has always perplexed me is if governments are serious about reducing tobacco smoking why do they still allow a duty free concession on tobacco products? At every duty free store at every airport around the country you can witness the great unwashed queuing after their holiday to exercise their God given right to purchase tax free fags by the carton.
Jackson Harding
Cigarettes should be available legally at the place at which you can obtain dangerous drugs legally, at the chemist with a script.
I have to agree those graphs are puzzling. If anything they suggest more smoking would be equally effective in lowering cancer rates!
As mentioned by Dave Liberts, the most obvious reason for the extreme lack of correlation between smoking rates and related deaths would be shorter life expectancy and a richer variety of ways to die young, but if so, I fail to see what use it is saying “one has to go back to 1963 to see rates [..] as low as they have fallen today”, and then posting the graph as proof.
If it was massive accident rates and infant mortality that led to a lower percentage of smoking related deaths in old age, surely a massive lethal flu pandemic would also reduce the percentage of deaths from smoking related diseases. We all have to die of something after all, and although most smoking related illnesses are a horrible way to go, I reserve the right to die of something slow and expensive if I like.
Back when we were phasing out tobacco advertising, the tobacco companies claimed the ads were designed to convince smokers to change brands; not to convince non-smokers to take up the habit. Why not take them at their word? Neither the public, the government or health care providers are well served by non-smokers taking up smoking. and the industry claims not to be working to that end. We should require all smokers to get a card from their GP (much like asthma-sufferers do), which they must present to the retailer every time they buy cigarettes; like a prescription with unlimited repeats. This way no smokers are denied access to the drug they crave, the tobacco companies have a good idea of what sales they can expect in the short- to medium-term and so can plan their businesses accordingly, and we pretty much wipe out tobacco addiction within a generation.
It might cost a bit to administer the plan, but governments get so much tax money from tobacco sales they would be hypocritical in the extreme if they say they can’t afford it.