National Drug Strategy
National Drug Strategy

Public Submission by Life Education Australia - Draft National Tobacco Strategy 2010 — 2018

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The purpose of this submission is to express Life Education's concern with what constitutes a significant oversight in the draft National Tobacco Strategy 2012-2018 ('NTS').

At the outset we wish to make clear that there are many aspects of the draft NTS that we strongly endorse, in particular the priority attributed to population wide strategies focused on affordability, availability, promotion, ingredient control and ETS restrictions, as well as more targeted approaches focused on the disadvantaged, including indigenous populations.

However, it is vital that the NTS more directly focuses on reducing tobacco use amongst the next generation of potential smokers. Our concerns relate to children and young people and the critical importance of preventing the uptake of smoking amongst this cohort. Within the prevailing anti­smoking policy mix, this issue is not getting the attention it deserves if we, as a community, are to be successful in removing smoking from the prominent position it occupies on our nation's health agenda.

In summary form, our feedback on the draft NTS is as follows —


The key risk period

The following chart is extracted from the 2010 National Drug Strategy Household Survey report, dated July 2011. It is the latest available data to hand on rates of smoking across our population.

Graphical presentation of Daily smoking percentage of people aged 12 years or older, by 3-year age group (years) averages, 2004, 2007 and 2010
Figure 3.1 : Daily smoking, people aged 12 years or older, by 3-year age group (years) averages, 2004, 2007 and 2010.

Source : AIHW analysis of National Drug Strategy Household Survey 2004 and 2007 data.

The chart highlights that the period of greatest uptake in smoking starts in early adolescence and progresses into early adulthood.

This is acknowledged in the draft NTS which notes that 'the majority of smokers start smoking as teenagers'. Our understanding is that the 'vast' majority of smokers take up smoking during this period.

This was also acknowledged in the recently updated National Drug Strategy which noted that "the secondary school years remain a key risk period for the uptake of smoking, with higher rates in each age group from 12 years onwards through adolescence."

Specific priority

The draft Strategy has as its first objective `to prevent uptake of smoking'. We agree with this objective, whilst again noting that the vast majority of smokers take up smoking during adolescence.

We need to dramatically reduce the level of uptake in smoking across the adolescent cohort if we are to ensure tobacco use across the population more generally is to continue to decline.1

Life Education strongly suggests that the reduction in the uptake of smoking in adolescents is deserving of a specific reference in the NTS Priority Areas.

In relation to priority 1 in the draft NTS, we recommend that it be reworded as follows -

1. strengthen efforts to reduce the uptake of smoking amongst teenagers, motivate smokers to quit, and prevent relapse.

We believe the reference to 'social marketing campaigns', exclusively, to be inappropriate - see below.

Targeted approach

Life Education argues that a well-balanced preventive health agenda around smoking, targeting children and young people, should include a school education component. The relevance of schools as an ideal setting to implement policy was acknowledged in the recently updated National Drug Strategy. Schools are generally acknowledged by leading public health professionals as having a critical role to play in equipping young Australians with the knowledge, skills and attitudes needed to make safe and healthy choices. 2

Education to address smoking uptake across this cohort needs to start in upper primary school. We should take advantage of the opportunity this setting provides to ensure the proper foundations are laid down early — like any good preventive health strategy should. Let's take deliberate steps to ensure our kids have the knowledge, skills and attitudes they need to make good decisions about their health — like not smoking — before they are confronted with the need to make these decisions.

Advertising will play an important role, as part of a population wide educative strategy to discourage the uptake of smoking in this cohort. However, we doubt that an investment in advertising alone will optimise its effectiveness. The NTS should take account of the importance of a complementary investment in more traditional forms of specific health education, delivered in schools, which build the knowledge, skills and attitudes students need to make informed decisions about behaviours such as smoking.

Advertising alone cannot be expected to build this capacity. Education provides the opportunity for properly facilitated, meaningful, face to face interaction with children who have questions that are best addressed in such forums. While complementing an advertising campaign, tapping into and building on issues raised via the campaign, this more intensive learning opportunity extends well beyond what can realistically be achieved through such campaigns.

Policy development issues

It is a significant concern that the relevance of education could be overlooked like it has in the development of the draft NTS. However it is doesn't surprise when the membership of the forums responsible for the development of the draft is considered. 3 Organisations like our own seriously question whether the role and value of health education can ever be properly represented within such forums. It would be disappointing if the opportunity to develop as effective a NTS as possible was compromised because of the perspectives of those involved in its formation.

There exists the erroneous belief that, with the introduction of a new, national health curriculum for schools, students will therefore be provided the opportunity to develop the knowledge and skills to take responsibility for their health and wellbeing. Unfortunately the real situation is not as straightforward as this. The reality is that primary schools, particularly State and Territory Government primary schools, have limited capacity to effectively deliver the existing health curriculum, let alone one that is likely to place more onerous claims on them.4 These capacity constraints are well understood amongst stakeholders familiar with the operating environment in primary schools across Australia.

The challenge facing the Intergovernmental Committee on Drugs is to demonstrate genuine leadership on this issue — to be truly outcome led rather than choose to be constrained by portfolio or jurisdiction — and in the process, to develop a truly NTS. It is not sufficient that it simply assume that State and Territory authorities will play their role, particularly over the short to medium term, when it comes to the effective delivery of health education in schools. The NTS needs to acknowledge the reality of the situation and consider approaches that ensure children and young people are provided the support they need to make informed decisions about their use of tobacco.

Partnerships with qualified third parties are the key if schools are to access the capacity they need to meet the increasing expectations we place on them as a community. Arguably it is far more cost effective to invest in discrete, specialist and readily accessible capacity, in a range of partner organisations, than to invest in building the same capacity in all schools. Given the capacity constraints schools have in delivering health education on their own, the proposed introduction of a new health curriculum, and the importance of effective health education in schools, now would seem the time to be investing in the capacity of valued school partner organisations qualified to assist schools meet these challenges.

It is appropriate to highlight the credentials of Life Education to comment on the draft NTS. Life Education is the largest non-government provider of health education to Australia's children and young people. Our Mission is to empower children and young people to make informed choices for a safe and healthy life. We are national in reach, operating in all States and Territories. We work with and through schools, in particular the class teacher, in the delivery of our program. We work at scale. In 2011 we worked in 3,550 schools, primary schools in the main. Each of these schools self- selected to partner with us, purchase our services and make available our program to the 621,000 students in their care.

We deliver a broad based health education program in schools. When it is age appropriate we deal with issues to do with drugs such as tobacco. We specifically deal with smoking in the upper primary school years. This component of our program builds a student's knowledge of what is in a cigarette and the affect smoking it has on our bodies in the short term and longer term. It promotes in students the importance of accepting personal responsibility for their health, and motivates them to do so. It provides students the opportunity to develop skills and strategies to resist social pressures to smoke.

Over the last 30 years more than 4 million young Australians have participated in our program. We believe that our partnerships with schools to educate children over that time have played an important role in the success achieved in reducing smoking rates in young people.

1 This was recognised in the discussion paper prepared by the National Preventive Health Taskforce 'Australia: The Healthiest Country by 2020' which, on page 22, noted that 'reducing smoking further requires a dramatic reduction in both the number of children taking up smoking and in increase in the number of people trying to quit'.
2 See letter addressed to The Hon Julia Gillard, Deputy Prime Minister, Minister for Education, from Professor Mike Daub, President PHAA, Dr Lyn Roberts, CEO Heart Foundation, Professor Rob Moodie, Chair, Preventive Health Taskforce, Professor Fiona Stanley, Chair ARACY, Professor Ian Olver, CEO, Cancer Council Australia, and others.
3 Of the 22 members of the Intergovernmental Committee on Drugs, 20 are Australian and of these, 9 represent Commonwealth or State Health Departments, 8 represent Commonwealth or State Police, 1 represents the Australian Customs Service, 1 represents the Commonwealth Attorney General, and 1 represents Commonwealth Education (DEEWR).
4 Primary schools in particular have highly varied capacities to effectively deliver the existing health curriculum. ACARA is in the process of developing a new curriculum which it recognises as having strong foundations in the biophysical, sociological and behavioural sciences. Yet school capacity to deliver it will not change, being a function of the increasingly limited time available for the health curriculum (due to what are perceived to be more important, competing claims) and the skill and experience of the general teaching staff to effectively deliver it.

Page currency, Latest update: 30 January, 2013