Thomas Kehoe
Australia is lauded for its leadership in the global fight against tobacco. This is exemplified in passing new tobacco control interventions to tackle tobacco induced disease, which began on 1 July. Measures include graphic health warnings on cigarette packs and sticks, and a ban on menthol and other flavour additives. For the first time, all packets include information on support to quit, directing smokers to quit.org.au and Quitline 13 78 48.
Tobacco business licensing will soon be in effect in every state and territory, with Victoria and New South Wales (NSW) passing legislation in late 2024 for implementation this year.
The National Lung Cancer Screening Program for people who smoke also launched on 1 July. Screening will help to identify early-stage cancer and provide opportunity to seek support to quit.
Such steps should help further reduce national smoking rates from their current, historic lows of below 9% (daily) for adults and 3% for young people and help smokers identify and address potential health impacts of their smoking.
Despite this public health success story, we should also remember the decades of advocacy that helped to reach this point, how arduous the fight has been, and what remains. Tobacco-induced diseases are the leading cause of preventable deaths in Australia, killing 66 people every day. That’s 24,000 families losing a loved one each year.
Smoking is more common among populations such as certain culturally and linguistic communities, LGBTIQA+ people, and First Nations Australians.
Seven decades of tobacco control
Australian tobacco control is a great example of public health success. We’ve been able to reduce smoking and transform a deeply embedded smoking culture. This is due to over 70 years of concerted efforts in which change was often incremental and frustratingly slow, and victories hard won.
Groundbreaking epidemiological studies in the UK and US, followed by Australian confirmation, contributed to statements by the British Royal College of Physicians, the US Surgeon General, and the National Health and Medical Research Council in Australia on the harms of smoking. These galvanised a small, but vocal tobacco control movement across the country in the 1960s, which began to gain victories over the industry during the 1970s, including health warnings and TV and radio advertising bans.
However, by the early 1980s, tobacco advertising in most other forms remained and smoking rates were still at 35%.
The smoking culture and Quit response
The continued prevalence of smoking called for more concerted efforts across the country. In Victoria, it led to the establishment of a new Quit organisation. The new tobacco control measures starting on 1 July coincides with Quit Victoria’s 40th anniversary – the same date that the now nationally used Quitline launched in Victoria in 1985.
After first being used in NSW for the 1978 “Quit. For Life” campaign, the “Quit” brand was shared around the country.
Quit represents shared values and aims that transcends jurisdictional considerations: 1) a focus on de-normalising the culture of smoking through communications campaigns and regulation and 2) providing cessation support.
The movement has a deep distrust in the tobacco industry which seeks to undermine health-focused initiatives by questioning science and resisting regulations.
Smoking was present nearly everywhere in daily life in 1985. Tobacco was advertised on billboards, in print, in cinemas, and in retail settings. Health warnings on tobacco products were barely visible. Smoke-free areas didn’t exist. People smoked in the office, at the pub, in planes, in restaurants and, of course, at home and around children.
Cancer Council Victoria, the Heart Foundation and the Victorian Government launched the “No Butts” campaign in Victoria in 1984 with the same aims as the earlier Quit for Life campaign. Following a successful first run, a year later these organisations founded ‘Quit Victoria’.
‘‘Quit’ quickly became an iconic brand in Victoria. Through the 1980s and ’90s, through the then new structure of VicHealth, it appeared on AFL jerseys, at surf and skating competitions, and at popular youth events.
A significant contribution from Quit Victoria was the now nationally accessible Quitline launched in 1985. It gave resources and counselling for people trying to quit smoking. It was a driver of the National Tobacco Campaign feature in 1997 where in all jurisdictions people saw the same powerful ads displaying the physical damage of smoking and were encouraged to call Quitline. It has since featured in nearly all anti-tobacco campaigns and led to the inclusion of the Quitline number 13 78 48 on tobacco packs.
Taking on the tobacco industry
The cessation support from Quit went hand-in-hand with increasing regulation of tobacco advertising, on smoking zones, and tobacco pricing. At each step, the industry fought back with the cynical purposes of selling more tobacco. They rejected the science on second-hand smoke, argued for “smokers’ rights”, and even brought lawsuits against landmark regulations, such as plain-packaging. In each case, the industry was defeated, but only by a cohesive, national tobacco control effort committed to the values of the Quit brand.
Looking to the future
Smoking is still an addiction that kills. Further, vaping has unwound many milestone achievements in Australia by attracting a new generation. Nicotine pouches may be the next big challenge.
As PHAA CEO Terry Slevin reflects, “I have had the privilege of working closely with the staff and leaders of Quit Victoria since its outset. I’m proud to continue to do so.
“Despite all the successes of the tobacco control movement in Australia, thanks in large part to the dedication of organisations like Quit, we can’t get complacent.
“Countering the tobacco industry and its constant reinvention, remains a critical public health challenge from which we cannot resile. We must continue to dissuade young people from taking up smoking and resist the promotion of novel nicotine products which aim to hook a new generation. We must support all smokers to quit. I have every confidence we’ll continue to fight, and Quit remains at the forefront of those efforts.”
Tobacco control in Australia has been successful in large measure due to advocates’ commitment. The value in the ‘Quit’ story lies in recognising the power of shared action around common values, with a clear and simple message: “quit smoking”, and “there is help”.
Dr Thomas Kehoe is Historian and Manager, Heritage Project at the Cancer Council Victoria.