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

Peter Fray

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