Global overview Cigarette smoking negatively affects almost all the body organs, decreasing the immunity and increase the risk of cancer. Quitting smoking lowers your risk for smoking-related diseases and can add years to your life.i High smoking prevalence contributes to a larger burden of disease and reduced life expectancy for several population groups. Due to implementation of the smoking polices world-wide, the prevalence of smoking was reduced as showing in the figure 1. Figure 1, Current adult tobacco smoking prevalenceii In 2013, 21% of adults globally were current smokers – 950 million men and 177 million women.iii Tobacco estimated to kill more than 5 million people each year across the globe, and it is considered as a leading global disease risk factor and underlying cause of ill health, preventable death, and disability.iv Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 6 Demographic Analysis The population of Australia is estimated to be 24,754,000 in 2017. The age structure of the population is as following: 0–14 years – 18%, 15–24 years – 13.30%, 25–54 years – 41.8%, 55–64 years – 11.8%, 65 years and over – 15.1%, see figure 2. Figure 2, Australia’s age and gender structure in 2005.v Near more the half of the population are birthed out of Australia, see figure 3. Figure 3, Country of birth of Australian residents at 2016 censusvi By WHO data, about 16.7% of male in Australia are smokers and 13.1% of females for year2015.vii According to some studies, in the year-2011 it was estimated that 80% of lung cancer burden and 75% of chronic obstructive pulmonary disease burden were attributable to tobacco smoking.viii Smoking kills around 15,000 Australians and has significant social (including health) and economic costs—estimated at $31.5 billion in 2004–05.ix Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 7 National Tobacco Strategy 2012-2018 | Australia National Tobacco Strategy 2012-2018 was found as a sub-strategy of the National Drug Strategy 2010 – 2015, to minimise the harms to individuals, families and communities from alcohol, tobacco and other drugs.x The Strategy aimed to reduce the use of, exposure to and harms of tobacco, promotion of quit smoking and improve the health education about the smoking, especially among disadvantaged groups and improve the services of smoker’s treatment.xi The National Drug Strategy Household Survey NDSHS shows that: • In 2010, 15.1% of people in Australia aged ?14 years old were daily smoker (16.6% in 2007, 24.3% in 1991). • In 2010, 15.9% of people in Australia aged ?18 years old were daily smoker (17.5% in 2007, 25% in 1991). • In 2010, 15.9% of people in Australia aged ?18 years old, 17.4% male and 14.5% female smoked daily. See figure 4. Figure 4, Tobacco smoking status among people aged 14 years or older, Australia, 1991 to 2010 This decrease was associated with a range of legislative, regulatory and public education initiatives, including tax excise increases, mass media campaigns, graphic health warnings on cigarette packets and requirements that cigarette manufacturers remove misleading descriptors such as light and mild from cigarette packets. These achievements were the result of the cooperation between the ICD, SCoT, AHM, MoE, MoHE, MoIT, MoJ, DIBP, WHO, ATSI communities and community-controlled organisations, health agencies, social service organisations, mental health care providers and other NGOs. Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 8 Figure 5, Percentage of adults (aged 18 years and older) who smoke daily by Indigenous status, 2007-08, 2011-12 and 2014-15 (nonIndigenous); 2008 and 2012-13 (Aboriginal and Torres Strait Islander people): non-agestandardized and age-standardized rates. Strategy Analysis In this section, we will note how the implementation of the NTS affects the prevalence of smoking among the hole population in Australia. The National Tobacco Strategy succeed these results by: To protect public health policies from tobacco industry interference, a new policies have been implemented by many jurisdictions in Australia, in order to regulate the formwork of the tobacco industry. Also that affects the mass media and public education campaigns. Hence the tobacco products were easily affordable to consumers, the question about the reduction of this affordability was raised. A serial of increasing of the taxes on the tobacco products was implemented, which shows a significant reduction in the uptake of smoking, particularly among young people. DIBP was also involved to reduce illicit trade in tobacco. The ATSI people have some unique demographical characters among the other Australian population. The NTS focused on the reduction of smoking rates among ATSI people. This focus was due to the difference of age profile of there populations to the rest of Australia and due to increased prevalence of smoking in these areas. The daily smoking rates for ATSI have fallen from 47.7% in 2008 to 44.4% in 2012-13 (non-age-standardised), or 44.4% to 42.1% (agestandardised) by the implementation on NTS, see figure 5. Nevertheless, the smoking rates for ATSI remain 2.8 times higher than the rest of the population, see figure 6. xii Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 9 Figure 6: Percentage of Aboriginal and Torres Strait Islander adults (aged 18 years and older) who smoke daily, by age and sex, 2008 and 2012-13. xiii The studies showed that some groups have a higher prevalence of smoking comparing with other groups. These groups include socioeconomically disadvantaged people, people with mental illness and prisoners, pregnant women and their partners; culturally and linguistically diverse communities; people living in socially disadvantaged areas. The stakeholders focused also on these groups, to reduce the prevalence of smoking among them too. Commonwealth Government support financially replacement therapy, especially transdermal patches, listing them on PBS for these disadvantaged groups. Some legislations were implemented such as: smoke-free enclosed workplace legislation, smoke-free-prisons legislation. CALD communities show lower smoking prevalence than in the general population, nevertheless, other evidence based studies reported that studies have reported high smoking rates among Arabic-speakers, and among men in the Vietnamese community, and that a higher proportion of men born in Europe, North Africa and the Middle East were current smokers compared with Australian-born men. By implementation of Tobacco Plain Packaging Act 2011, the tobacco company branding, logos, symbols and other images that may have the effect of advertising or promoting the use of the tobacco product can NO longer appear on tobacco products or their packaging. The brand name and variant name are only allowed on packaging in specified locations, in a standard colour, position, font style and size. Other procedures take place to reduce and stop the mass-media advertising of tobacco and tobacco products via television, radio and other websites. Additives that make tobacco products more palatable, such as menthol, sugar, honey, liquorice and cocoa are commonly used in tobacco products were forbade, because these additives are masking the aggravating effects of tobacco smoke and/or enhance the ‘taste’ of tobacco smoke. This show a reduction in the smoking rats and prevalence among the young and new smokers. Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 10 Many legislations were implemented to control the licensing of tobacco wholesalers, regulation of outlets, sales to minors, point of sale advertising, mobile (transportable) tobacco sales and vending machines. The smoke-free areas are too complex to monitor, due to the large number of internal legislations for each place where smoking is suspected. The government of Australia continue to monitor and enforce existing smoke-free legislation and strengthen partnerships between the health sector and local governments to enhance the promotion, monitoring and enforcement of smokefree laws. As an idea to improve access to evidence based cessation services, the “Quitline” services were established across Australia. These services provide specialised telephone information and counselling service for people interested in smoking cessation. The NDSHS of 2010 and 2013 reported that 3.8% of people who were current smokers in 2010, and 2.9% in 2013, contacted a “Quitline” service as one of the activities associated with attempts to quit. Another services, such as online services and brief intervention by health professionals, support groups were engorged too, to access an evidence based cessation services. Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 11 Stakeholders Analysisxiv Tobacco industry was interested in tobacco selling as more as possible. Their interest centred on “How to impact the decision of implementation of the NTS”, using their relations with some other strong stakeholders in the governmental part. This effect was clear in the announcement of some stakeholders that Australia is doing well among the other countries according the rates and prevalence of smoking, and the decision of NTS can wait. Nevertheless, tobacco industry welcomed the idea of increasing the tax of tobacco products, manipulating by this their general picture of promoting health and reduction of smoking. CDoH also shows a high support for this strategy, taking the power of being in responsibility to promote the health of the population of Australia and the because it is the fundamental part of the government which in charge of planning for such as health strategies. The role of CDoH was realised in the disclosure of all contacts between the industry and the CDoH on the departmental website, MoF also plays an important role in the process of implementation of the NTS by increasing the taxes on the tobacco products. This step was supported also by CDoH. DIBP throw Australian Border Force (and formerly the ACBPS) played a role in reduce illicit trade in tobacco. NGOs were active in implementing a range of initiatives targeting socioeconomically disadvantaged groups. Such as Tackling Tobacco program, which builds the capacity of community organisations working with socially disadvantaged clients to address smoking cessation with their clients. Tobacco control experts, in general, they support and participate in all activities to implement and evaluate the NTS. There power was influenced by the power of the governmental parts. WHO was also involved in the NTS making, and support the governmental view. WHO focused on implementing the “WHO FCTC” as a fundamental part of the NTS. Policy Analysis | National Tobacco Strategy 2012-2018 | Australia 12 Conclusion As was explained above, the Australian government had successfully implemented the NTS, and the data shows a good reduction in the smoking prevalence rates. Nevertheless, and as an analyser for this strategy, I have to mention the emerging issues of electronic cigarette and water-pipe tobacco. The NTS did not discuss the invasiveness of these methods of tobacco smoking, and the effective policies to stop it. More attention should be given the mass-media role in quit smoking. New studies should be considered to clarify the association of tobacco smoking among alcohol drinkers, and to develop policies to reduce alcohol utilization.