Introduction

Smoking rates among adults across Australia have been steadily declining over many years as a result of a range of tobacco control strategies. The 2010 National Drug Strategy Household Survey found that there are fewer people aged 14 years or older taking up smoking now than in previous times (57.8% have never smoked in their lives compared to 49% in 1991) and nearly a quarter of the population are ex-smokers.(1) Despite these achievements closer analysis of smoking rates shows that a number of population groups in Australia have a higher prevalence of smoking compared to the general population. Among the most disadvantaged groups smoking rates are up to five times higher than the population average.(2)

Why does this difference in smoking rates need to be addressed?

The difference in smoking rates is concerning for a number of reasons but in particular because high smoking rates result in increased health and financial inequalities in the most disadvantaged groups in our communities.

By the most disadvantaged we mean people who, in addition to low income, face a number of other issues such as mental illness, sole parenthood, unemployment, family violence, homelessness, drug and alcohol problems, criminal justice issues, limited education,
and social isolation.

Those experiencing disadvantage are bearing a disproportionate share of the harm caused by tobacco including higher rates of death and disease from tobacco related illnesses. Research shows that tobacco is a major contributor to the differences in mortality between the least and most advantaged.(3) People with mental illness,(4) severe drug and alcohol dependence,(5) and prisoners(6) are more likely to die of tobacco related causes than the general population. Smoking accounts for 17% of the health gap between Indigenous and non-Indigenous Australians.(7)

The growing disparity in smoking rates contributes to increased social stigma and marginalisation as smoking becomes less accepted in the general community, and is also contributing to financial inequalities. Tobacco contributes to poverty through the cost of tobacco related illness, loss of a family breadwinner, and the impact on family finances and stress.(8) In particular, tobacco use exacerbates the impact of poverty by reducing funds available to cover food, clothing and stable housing.(9, 10)