Download Section 1: Smoking Matters - Australian Indigenous HealthInfoNet

Section 1:
Smoking Matters
This kit is about Aboriginal and Torres Strait Islander Health Workers
putting together programs to get people in our communities off the smokes.
One of the first things health workers can do is to work out why our people
smoke and how the smokes are killing our communities throughout
Australia. By having a better understanding of tobacco smoking, health
workers are in a stronger position to help others give up the smokes.
In Part 1 of this section, we look at the things that stop health workers from
helping and supporting our mob to quit smoking. Part 2 outlines the hard
facts about tobacco health problems in Aboriginal and Torres Strait Islander
communities. In Part 3 we take a look at the history and culture of tobacco
use among our people.
What’s in Section 1?
Part 1: Facing the challenge ahead
How health workers can help the mob
Part 2: Yes, smoking matters
A hard habit to kick
The price our community pays
Part 3: History and culture of smoking
Before colonisation: Chewing and smoking, only on special days
With colonisation: Control by non-Indigenous tobacco
After colonisation: Too much smoking
Health priorities: Give smoking the top health billing
Acknowledgments
Part 1:
Facing the challenge ahead
We all know that giving up the smokes is good for the individual and the
community—the effects are felt immediately. But there are some real barriers,
or blocks, that health workers need to get over if they want to help our mob
quit smoking. For instance:
Health workers who are smokers themselves may not feel they can help
others quit. The high levels of stress faced by many health workers
mean it is hard for them to stop smoking.
Smoking is not seen as the top health issue facing
Indigenous communities.
Smoking is accepted as a commonplace social activity that
many people do.
It is hard to give up when many people around you smoke.
It can take many attempts to stop smoking—an Aboriginal or
a Torres Strait Islander smoker makes fewer attempts to quit than the
average smoker in Australia.
Some health workers don’t have the right skills to deliver quit programs
confidently to their smoker clients.
Nicotine addiction is linked to cannabis (yandi or gunja) use.
Cannabis is used at high rates in Aboriginal and
Torres Strait Islander communities.
Tobacco was used in the colonisation of Aboriginal and
Torres Strait Islander people, giving nicotine dependence a historical link.
Many health workers simply lack the time, funding, facilities and
health promotion information to help our people.
This can put off those health workers who want to develop
tobacco control programs for their community.
Australian Indigenous Tobacco Control Resource Kit
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How health workers can help the mob
Even given these barriers, Aboriginal and Torres Strait Islander Health Workers
are still managing to help our mob reduce the effects of smoking.
As health workers, we do this by:
lending a non-judgmental ‘ear’ to smokers in our community;
handing out quit-smoking videos, flip charts and brochures
(where available) to our clients;
creating smoke-free areas;
working to restrict the marketing and display of tobacco products;
conducting education sessions for young people on the harm of smoking;
running quit support groups;
providing clients with access to nicotine replacement therapies;
running quit smoking promotions at community events,
such as sports carnivals and music festivals;
organising walking groups, nutrition information sessions and
other activities that promote good health;
asking community members who have quit smoking to become
involved in these activities and to act as role models to support and
encourage others to quit; and
trying to give up smoking ourselves through quit groups,
counselling and nicotine replacement therapies.
Hot Tip #1: Working together
is the only way to stop the smokes…
Aboriginal and Torres Strait Islander Health Workers can help, and are helping,
our communities to overcome tobacco use. At the same time, organisations—
both community and government—can help to knock down barriers that
prevent health workers from delivering good solutions for their clients.
Working together, health workers and organisations can cut down tobacco use
in local Indigenous communities.
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Part 2:
Yes, smoking matters
Tobacco smoking contributes to the poor health and early death of many
Aboriginal and Torres Strait Islander people—even though smoking itself can be
prevented. While the number of people who smoke tobacco in the overall
Australian population has been dropping steadily for many years, the number
of Aboriginal and Torres Strait Islander smokers has not really changed for more
than 10 years. Aboriginal and Torres Strait Islander people are twice as likely as
non-Indigenous Australians to smoke cigarettes daily.
The life expectancy of an Aboriginal or Torres Strait Islander person is
about 20 years less than that of the non-Indigenous population.
Diseases related to cigarette smoking—such as coronary heart disease,
lung cancer, chronic obstructive lung disease (bronchitis and emphysema),
and stroke—are major reasons why Aboriginal and Torres Strait Islander people
die early. This is why it’s so important for our mob to cut down on tobacco use.
Go to CD–ROM:
For more information on how smoking affects your health, see
Section 7: Part 1, ‘Fact sheets about the health effects of smoking’
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A hard habit to kick
Here are some facts about the smoking habits of Aboriginal and
Torres Strait Islander people in Australia:
Smoking is more common among Indigenous Australians
than non-Indigenous Australians—more than double the national rate—
with one out of every two Aboriginal and Torres Strait Islander people
smoking tobacco every day.
Smoking is generally more accepted in Aboriginal and
Torres Strait Islander communities.
Aboriginal and Torres Strait Islander children start smoking younger
than non-Indigenous children. Taking up smoking at a young age
makes it harder to quit.
Of the Aboriginal and Torres Strait Islander people who don’t smoke
tobacco, one out of every three are ex-smokers and two out of
every three have never smoked.
Aboriginal and Torres Strait Islander people are less likely to believe
that they can successfully quit their tobacco smoking.
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The price our community pays
Smoking causes health problems among Aboriginal and Torres Strait Islander
communities in Australia. The health statistics on Aboriginal and
Torres Strait Islander people are alarming:
Aboriginal and Torres Strait Islander people die at a younger age
than non-Indigenous Australians. On average, Aboriginal and
Torres Strait Islander men live to 56 years of age compared with 77 years
for non-Indigenous men. Similarly, on average, Aboriginal and
Torres Strait Islander women live to 63 years of age compared with
83 years for non-Indigenous women.
Aboriginal and Torres Strait Islander people die from heart disease,
stroke and vascular diseases (conditions that affect the heart and blood
vessels) at nearly three times the rate of the non-Indigenous population.
Two out of every three Aboriginal and Torres Strait Islanders die
before the age of 65 years, much of which can be attributed to
heart disease, stroke and vascular diseases. By comparison, the rates
are one in every ten deaths for the non-Indigenous population.
Aboriginal and Torres Strait Islander people are nearly four times more
likely to die from respiratory system diseases—such as emphysema and
lung cancer—than non-Indigenous Australians.
Smoking increases the risk of low birth-weight babies and
sudden infant death syndrome, or SIDS.
Smoking is the most preventable cause of poor health and early death.
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Part 3:
History and
culture of smoking
Before colonisation:
Chewing and smoking, only on special days
For thousands of years, Aboriginal people only chewed the indigenous plants
pituri or mubbudge, and native tobacco. The leaves of these plants, which are still
in use today, are mixed with ash and then chewed to release the nicotine. The
plants were used for ceremonial and recreational purposes, and were shared
among the group and traded widely.
Aboriginal people, mainly in the north of Australia, only started to smoke
native tobacco from the early 1700s. This happened when the Macassans,
who were the people from what is now eastern Indonesia, visited the
northern coast of Australia. They traded and bartered tobacco and smoking
pipes, along with other goods, with Aboriginal people for the right to fish.
Aboriginal people handed around these pipes in ceremonies to celebrate
the social solidarity of their tribe. Tobacco and smoking pipes were traded
into the Torres Strait Islands from New Guinea, as Islanders had strong trading
and exchange relationships with people from New Guinea.
Native tobaccos and tobacco pipes were not used every day, and were limited
by strict controls to ceremonies. Many communities did not smoke tobacco
until its introduction by Europeans. To this day, some Aboriginal and
Torres Strait Islander people continue to use pituri and native tobacco,
and in northern Australia Macassan-style pipes are still in use as tobacco
plays a role in ceremonies.
(Based on research by M. Brady, J. Long and SmokeCheck, Queensland Health,
see Section 7, Part 9: ‘References and further reading’ for full citations.)
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With colonisation:
Control by non-Indigenous tobacco
Many Aboriginal and Torres Strait Islander people came into contact with
tobacco following white settlement and colonisation of Australia.
Introduced tobacco quickly replaced native tobacco among communities—
there was more of it and it was ready to use. For 150 years, Europeans—
government, missionaries and pastoralists—used their tobacco to control
Aboriginal and Torres Strait Islander people.
Introduced tobacco was a popular ration used by the colonists to pay,
reward and bribe Aboriginal and Torres Strait Islander people.
As workers became addicted, their labour was controlled.
Tobacco was used to persuade the Indigenous population to attend church
and give up their traditional lifestyle. Many people who had never used tobacco
were introduced to it, becoming addicted at a very young age.
Although cash wages were introduced mostly after World War II,
tobacco was still included in rations and used as ‘pay’ until relatively recently.
Historically, many Aboriginal and Torres Strait Islander people became
addicted to tobacco because they had suffered from high levels of
personal and social stress caused by colonisation, namely:
the dispossession of Aboriginal and Torres Strait Islander land;
the confinement of many people to missions and reserves; and
the forced removal of children from their families.
For example, children forced on to missions, into domestic service or
children’s homes ended up having a higher rate of tobacco use than
other Aboriginal and Torres Strait Islander people.
Australian Indigenous Tobacco Control Resource Kit
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After colonisation: Too much smoking
Aboriginal and Torres Strait Islander people continue to suffer more
from illnesses that are caused or made worse by smoking than the rest of the
population. The stresses that existed yesterday are still felt today by many in
Indigenous communities. These stresses include social and economic inequality.
So, Aboriginal and Torres Strait Islander people are:
less likely to finish high school than non-Indigenous Australians;
more likely to be unemployed and to have a lower average weekly income
compared with non-Indigenous Australians;
more likely to live in overcrowded and second rate housing;
more likely to live in dusty, rural or remote environments,
and have poor access to clean water and good food; and
more likely to suffer from poor health and early death
compared with non-Indigenous Australians.
All of these effects are linked to high tobacco use. For instance:
Aboriginal and Torres Strait Islander people who have
a low level of education are more likely to smoke.
Aboriginal and Torres Strait Islander people who are
unemployed are more likely to smoke.
Aboriginal and Torres Strait Islander people who live in overcrowded
and second-rate housing are at risk of breathing in second-hand smoke.
Smoking is ‘normal’:
Being part of the mob is what counts
Tobacco use is now a normal part of everyday life in Aboriginal and
Torres Strait Islander communities, and its role in bringing people together
is more important than it is in the overall Australian population.
Smoking is used as a way to strengthen family relationships and friendships.
Not joining in can make people feel like they are not part of the mob.
Aboriginal and Torres Strait Islander people have said that when they are
with other smokers, it is hard to stop smoking and stay stopped.
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Talkin’ Up Good Air
Health priorities:
Give smoking the top health billing
Aboriginal and Torres Strait Islander communities have to deal with
so many issues that smoking is often put at the bottom of the list.
For instance, other health issues—such as drug and alcohol abuse, heart disease,
high blood pressure, diabetes, stress, diet and nutrition, and infectious diseases
like tuberculosis and HIV/AIDS—are seen as more important.
The effects of smoking, on the other hand, can take many years to show.
More urgent issues such as the need for running water, accommodation,
electricity, nutritious food and accessible health care are priorities for many
communities. A survey in the Kimberley showed that other health risks—
including alcohol abuse, too much fatty food and sugar, gambling,
lack of access to washing machines and refrigeration, crowded housing,
and dust and rubbish—were seen as more important than smoking tobacco.
Aboriginal and Torres Strait Islander people need lots of support if they are to
reduce the high rates of smoking-related illness and death in their communities.
Community-based programs that promote healthy living—like those that help
people quit smoking—are an important step in improving the wellbeing of
Aboriginal and Torres Strait Islander communities.
Hot Tip #2: Making your
community’s health a priority…
Many health organisations now see smoking as a major health problem
and are giving tobacco control programs a higher priority.
However, community views of smoking have not changed that much.
The gap needs to close between these two views if we are to see a drop in the
rate of tobacco use in Aboriginal and Torres Strait Islander communities.
Our people need to realise that their health will improve as soon as they
stop smoking, and that they will drastically cut down their chances
of developing heart disease, cancer, breathing problems and infections.
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Acknowledgments
Information from the following organisations was used to compile this section:
Australian Bureau of Statistics
Australian Institute of Health and Welfare
Centre for Aboriginal Economic Policy Research,
Australian National University
Cooperative Research Centre for Aboriginal and Tropical Health
National Aboriginal Community Controlled Health Organisation
Queensland Health
Go to CD–ROM:
For the complete list of references used in this section,
see Section 7: Part 9, ‘References and further reading’
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