Partyline is billed as “The Newsletter of the National Rural Health Alliance” – but that seems a rather modest description for a publication whose coverage of rural health matters is generally broad and deep, while managing also to be a good read. It’s one not to miss, in other words.
The article below is the March edition’s editorial, and it looks at the challenges for health promotion in rural and remote areas, particularly around tobacco control.
Smoking rates in rural and remote areas need to fall
The National Rural Health Alliance writes:
One of the overriding purposes of the Australian National Preventive Health Agency (ANPHA) is “to support disease prevention and health promotion efforts throughout the Australian community”.
In February, ANPHA released for public comment its stakeholder engagement strategy. This describes the principles and practices that ANPHA will use to build relationships with consumers, industry, professional associations, government, media and other interested parties. Comments on the strategy are due to firstname.lastname@example.org by Friday 4 May, 2012.
Most people will accept that it is necessary for a new national agency to move slowly and to consider very carefully its relationships with interested parties. Some others might be forgiven for feeling some impatience – such as those public health advocates working on smoking, alcohol consumption and obesity who have a clear view of what needs to be done and believe that action should begin as soon as possible.
ANPHA’s challenge in rural and remote areas is summed up in the following table.
The table shows clearly that there is a metropolitan-remote area gradient for all three of the behavioural risk factors on which ANPHA is to focus. It is urgent to find out what can be done to turn this around.
Australia has one of the lowest smoking rates in the OECD, but with almost 18 per cent of people aged 15 years and over smoking every day in 2007, it is still the largest avoidable risk to health in the nation. AIHW data show that smoking contributes 7.8 per cent of the national burden of disease: more than high blood pressure (7.6 per cent), overweight and obesity (7.5 per cent), physical inactivity (6.6 per cent) and high blood cholesterol (6.2 per cent). Smoking also increases the risk of blindness from macular degeneration by a factor of four and has a damaging impact on periodontal (gum) health.
A range of important health promotion, regulatory and fiscal measures succeeded in bringing down the overall rate of smoking in Australia from 31 per cent in 1986 to 19 per cent in 2007. But the major impact was in the major cities. People who live in rural and remote areas are 1.21 times more likely to be daily smokers than those living in major cities. Smoking rates increase with remoteness: from 17.6 per cent in major cities to 27.3 per cent in remote areas.
There are two national targets in place: to reduce the smoking rate to 10 per cent of the population by 2018; and, by the same date, to halve the Indigenous smoking rate. These targets will not be met unless there are targeted and successful anti-smoking efforts in rural and remote areas.
Led by Nicola Roxon, the Government’s unprecedented support for smoking cessation activity is acknowledged and very welcome. But all health promotion work in country areas must be fit for purpose and not merely the backwash from national campaigns.
One in two Indigenous Australians smoke, and one in five die from diseases related to smoking. For Aboriginal people, smoking is the number one cause of chronic conditions and diseases such as cancer and cardiovascular disease.
The work being undertaken to reduce smoking rates among Aboriginal and Torres Strait Islander populations, particularly in rural and remote communities, provides a good example of the targeted approach that is needed. The Government has supported an anti-smoking campaign featuring an Aboriginal woman presenting a very personal message aimed at persuading Aboriginal people and Torres Strait Islanders to Break the Chain and quit smoking.
This is the first time an Indigenous-specific television commercial has been used in a national health campaign. One of the key players in this work is Tom Calma, National Coordinator, Tackling Indigenous Smoking.
The Alliance is interested in research about why it is that health promotion campaigns seem to have been less effective in rural areas than in the major cities.
For smoking, there may be some reason why structured smoking cessation programs are less effective in rural areas and among rural and remote populations. Unstructured approaches depending on the intervention of general practitioners’ advice may be less available and/or less effective in rural and remote areas given the availability of GPs and GPs’ time.
The Alliance looks forward to working with ANPHA on this and other vital challenges.
Note: For help to quit smoking, people should consult their doctor or pharmacist, call the Quitline on 13 78 48 or visit the Quit Now website at www.australia.gov.au/quitnow
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