Is enough being done to help disadvantaged groups help beat smoking?
During Anti-Poverty Week much of the focus is on national development goals to reduce poverty in Australia. Scott Walsberger says smoking rates remain high amongst disadvantaged groups and not enough is being done to help them quit.
Over the past few months tobacco control has had some significant wins. Smoking bans will soon be extended to outdoor areas. Plain packaging is about to come into effect. And the tobacco industry continues to lose legal challenge after legal challenge. Social norms around smoking have shifted. The stats confirm it, NSW smoking rates are at an all time low at 14.7 percent. You could easily believe that the battle against tobacco has been won.
It’s a bit naïve though to believe that we are such a homogeneous society that only one social norm exists. For some groups smoking remains the norm and it is inadvertently reinforced every day. Smoking rates remain stubbornly high at between 45 percent and 80 percent amongst disadvantaged population groups such as people who are Aboriginal, live with a mental illness, who are homeless, addicted to drugs or alcohol, or whose families live in poverty.
People who face one or more of these forms of disadvantage are often connected to any number of services that provide a range of supports in their daily living. However, sometimes these services think quitting smoking is a low priority for these groups or simply excused because it is too hard to confront amongst the other challenges in their lives.
This simply isn’t true for most smokers from disadvantaged groups. Just as with other smokers, people who are disadvantaged want to quit smoking and would welcome offers of assistance to quit. The big difference for smokers who are disadvantaged is that their smoking is inextricably linked with their poverty. Smokers on low incomes spend a higher proportion of their income on tobacco, yet smoking increases financial stress and deprivation. Yet, smokers with more financial stress were less likely to quit, and ex-smokers with more financial stress were more likely to relapse: disadvantaged smokers find themselves in a vicious cycle.
So during Anti-Poverty week let’s help people in poverty break out of the smoking trap. We want to break the vicious cycle by challenging support services and workers to ask, ‘would you like help quitting smoking?”.
The crux of the problem is smoking is addictive. Yet the addictive nature of cigarettes is not so widely acknowledged. The World Health Organisation states, “Smokers do not fully comprehend the speed with which people can become addicted to nicotine, or the degree of addiction, and grossly overestimate the likelihood that they will be able to quit easily when desired and before health problems occur.” Big tobacco has taken advantage of this fact, even targeted disadvantaged populations.
So addressing the question, is enough being done to enable people from disadvantaged groups to quit? No, I don’t think enough is being done to address smoking equitably across our population. Ignoring, or at best discounting, the need for more intensive targeted interventions in disadvantaged populations is assuming that tobacco control efforts will have a “trickle-down” effect – hoping that those strategies most effective with the less disadvantaged will have an equal effect on the most disadvantaged. I am not arguing that our current suite of tobacco control measures is ineffective. It is just that if we are seriously committed to tackling tobacco amongst the most disadvantaged, we need to include complementary strategies specifically designed to suit the environments and situations which lead to disparities in smoking amongst people who face disadvantage.
What would a complementary strategy look like? Getting out and building partnerships with social and community service organisations, and their staff, with established trusting relationships with people facing disadvantage. These are the social and community service organisations such as Salvation Army, Mission Australia and others committed to making a difference in these communities. We can do this by increasing their capacity to address smoking and to demonstrate the tangible benefits of quitting smoking with their clients.
Improving their health may not be the number one top priority on a homeless person’s, or a caseworker at a homeless shelter, agenda. But improving their financial circumstances probably is higher up there. Quitting smoking on average can give about $64 a week back to a smoker. That savings could help pay bills, purchase food, and provide spending money that leads to more active social engagement. It could also help improve their quality of life and boost their confidence to tackle other stressors in their life.
That is one of the reasons we have launched Ask the Question Day during Anti-Poverty Week, a day where we want to encourage all social and community service sector workers out there on Tuesday 16th October to ask their clients the question, “Would you like help with quitting smoking?” They may just be surprised with the answer.
For more information please go to the Ask the Question Day website, where you can also download quit smoking resources.
Scott Walsberger is the Manager Tobacco Control at Cancer Council NSW. He leads a dedicated team committed to limiting the devastating effects of smoking, through improving tobacco control policy and practice in NSW. These efforts include the Tackling Tobacco program which aims to reduce smoking related harm among the most disadvantaged groups of people in NSW. Scott has implemented large health promotion strategies in government and non-government organisations for the past seven years. He recently took the role at Cancer Council because of his belief that more complementary targeted health promotion strategies were needed to tackle the health issues of the day. He has a Bachelor of Arts from Beloit College in the USA and a Master of Public Health from University of NSW. He lives in inner-city Sydney with his partner and their 11 month old daughter and seven year old Labradoodle.
