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Monday, 28 February 2011
Page: 1685


Mr LAMING (10:07 PM) —We all welcome a bipartisan approach to reducing smoking. Smoking is a great killer of both mainstream and Indigenous Australia. It is directly correlated with cardiovascular disease, stroke, peripheral vascular disease and a range of cancers. It is not only about the direct impact of smoking; passive smoking is also a killer. That is why both sides of this House are so dedicated to reducing smoking rates. In the Australian mainstream we can be very proud of outcomes. We have seen a fall in smoking rates down to the mid-teens. Apart from a few states in the United States, our smoking rates are the lowest in the world. Governments have worked hard to achieve those figures and they deserve a pat on the back for that. The smoking rate for pregnant mums has fallen from 17 per cent to 14 per cent. That is incredibly important when we are looking at perinatal morbidity and babies coming into this world as healthy as they can be.

But the story for Indigenous smoking is not so good. While there has been interest and support from all levels of government, we now have the ultimate in bureaucratese with the new implementation report for the new partnership agreement struck between the federal government and each of the state and territory jurisdictions. The measures around smoking in Closing the Gap do not for even a passing moment reflect the number of cigarettes being smoked by Indigenous Australians. It takes quite a lot of conception to come up with implementation goals towards closing the gap that do not actually look at cigarette smoking at all in efforts to reduce it. Instead, the bureaucrats have come up with some other ways of measuring smoking initiatives without actually looking at a reduction in smoking.

If we look at the implementation agreement in Closing the Gap between the state jurisdictions and the Commonwealth, we see that Queensland, for instance, focuses on S2 and S4, the Commonwealth will focus on S1 and S4—so they are not even focusing on the same objectives—and S3 has disappeared completely and no-one is looking at it at all. This may sound very Fawlty Towers-esque but let me put this into context. What are S1 to S4? S1 is ‘the number of culturally secure community education/health promotion/social marketing activities implemented to promote quitting and smoke-free environments’. So let us measure the programs—that is S1. You can almost imagine those who drafted these recommendations saying, ‘For goodness sake, if you’re coming up with recommendations on how to reduce Indigenous smoking, whatever you do don’t come up with a recommendation which, at some time in the far-distant future, will be looked back on and seen to have failed!’ Instead, they have come up with S2, which is ‘key results of specific evidence based ATSI brief interventions, other smoking cessation and support initiatives offered to individuals’—that is, simply offered to individuals but not looking at whether they work. S3, which appears to have entirely vanished from all jurisdictions’ attention, is ‘regulatory efforts to encourage reduction/cessation in smoking in ATSI people and their communities’. S4 is ‘the number of service delivery trained staff actually delivering the interventions’. So, as long as we have got more people delivering interventions, we are succeeding.

But the reality is that that is not closing the gap. We know that about 38 per cent of the entire gap is due to cardiovascular disease, and the No. 1 cause behind that is smoking. What every Australian would want is a far better focus on reducing the smoking of cigarettes in an effort to close the gap around smoking. But it is not happening. With this government it is more about the army that measures how many bullets they shoot as a measure of success, or the farmer who measures how many seeds they plant as a measure of their profit. Let us look for a moment at what we are actually trying to do here. We are trying to have Indigenous Australians quit smoking—go to bed tonight as a smoker and wake up in the morning having stopped it. It is fine to deliver the interventions, it is fine to be employing all the public health professionals, but ultimately a government is expected by its people to deliver services that work. We see millions of dollars being allocated to this initiative. But we can do better than this. We can do better than having four truly vague checklist representations of how we are progressing, which measure nothing but inputs—how many people are employed and how many public health programs are delivered. It is time we focused on the outcomes. But it has become lost in this bureaucratic overlay of creating outcomes that can never be proven to have failed—because they never had anything to do with what we are trying to do in the first place, which is to reduce smoking.

This is a great tragedy. We are seeing fantastic work being done by AIHW in an effort to measure the fall in Indigenous smoking. They showed a barely significant three per cent drop between 2000 and 2008. But what we know is that ultimately the only way to be sure is to work with Indigenous Australians and allow them to run these programs themselves and actually count the cigarettes that are no longer being smoked.