Nick Xenophon (SA, Independent) Share this | Hansard source

I welcome the government’s move to increase the tobacco excise. I do have reservations, though, in the context of the whole issue of preventive health and I believe that this debate ought to be seen in that context. I do welcome that cigarettes are more expensive and that this will lead to a decline in consumption but I am concerned about the overall policy framework in relation to this. I am grateful for the advice and material provided to me over my years both in this place and in my former role in the South Australian parliament by Action on Smoking and Health, in particular its executive director, Anne Jones, who has been a tireless campaigner on the health effects of smoking.

Michelle Scollo and Margaret Winstanley, two of Australia’s leading tobacco researchers, have estimated that in the 50 years between 1950 and 2000 smoking killed approximately 679,000 Australians and in 2004-05 the social cost of tobacco was $31½ billion. Raising the excise on tobacco products and therefore increasing the cost to consumers is a good deterrent, but the deterrent must be seen in the context of a range of other policies.

It concerns me that it has been shown that there is a real difficulty in reducing the rate of smoking amongst young women and teenage girls and that, in some respects, the rate of smoking for that group has gone up. It reminds me of work carried out by Malcolm Galdwell, who wrote TheTipping Point a number of years ago. He talked about social phenomena and how difficult it was to get a change in behaviour. In his book, The Tipping Point, a chapter on teenage smoking was quite instructive about the difficulty in getting the message across and the way that social marketing campaigns had not worked in the United States a number of years ago in relation to tackling teen smoking. I think we should learn from that sort of research and learn from the mistakes of the past in getting the message across to young people.

I note that the government will be raking in an extra $5½ billion in revenue. That is a good thing in the context of what the social objectives are. What is not so good is that the government has committed just $5 million of that to support Quitline and another $27.8 million over the next four years to address social marketing of tobacco. The government is also considering a subsidy for nicotine patches—something I have long campaigned for, which I believe will make it easier for people to quit smoking. I note a study in the British Medical Journal back in August 2000 on the effectiveness of interventions to help people stop smoking and findings from the Cochrane Library. It made the point that, overall, nicotine replacement therapy:

... increased the chances of quitting about one and a half to two times ... whatever the level of additional support and encouragement.

So it is about having that critical mass, in a sense, of a range of measures that actually get people to that tipping point of wanting to quit smoking. I think it is important that the government uses a proportion of these funds, this $5½ billion, to ensure that nicotine replacement therapy is subsidised.

If the government wants to lower our smoking rates, it needs to be serious about providing smokers with that support. The stories I have heard from those who work as Quit counsellors were that they were inundated with calls for help and support and that quit lines around the country have had trouble coping with that. I commend the work that Quitline and the counsellors do at the frontline in assisting people to quit smoking. They need to be adequately resourced, and it is a concern that the government is only throwing scraps at this problem in the context of the revenue that they are getting.

I agree with public health experts, such as Professor Fran Baum from Flinders University, an internationally acknowledged expert in preventative health, who says that we do not spend enough in this country on preventative health. Three per cent of the health budget goes towards preventative health. Whilst it looks good for governments of whatever persuasion to be opening up hospital wards and making more beds available, let us stop people getting sick in the first place. Let us have the philosophy that it is much better to have a fence at the top of the cliff rather than the best equipped ambulance at its base.

My concern with this legislation, the Excise Tariff Amendment (Tobacco) Bill 2010 and the Customs Tariff Amendment (Tobacco) Bill 2010, is that there is an opportunity here to make a considered effort with respect to prevention measures, but I do not believe the government is doing anywhere enough in relation to that. I understand the coalition’s view, in that they do not want to hold this up, but my view is that we should hold this up until we get some more specific undertakings from the government, better funding for Quitline, better funding for nicotine replacement therapy and more money to address social marketing of tobacco. We know how insidious and how cunning tobacco companies are in marketing their wares on, for example, Facebook and in social marketing media in order to continue to get young people to take up smoking—the tobacco addicts of tomorrow. The government needs to be mindful of the money that is going to Quitline and ensure that they have enough resources to assist people.

The revenue from this increased tax can help offset some of the costs associated with tobacco use, such as health care for people with tobacco related illnesses. But let us stop people taking up smoking in the first place or encourage those who do smoke to quit. I believe that subsidising nicotine replacement therapies is a vital part of preventative health care. I still think that there is not enough emphasis on prevention in terms of the overall health framework. I agree with Professor Baum and others who say that we do not have enough of an emphasis on prevention.

The way that tobacco products are sold and marketed also has a huge impact on preventative health, in the way that spending more now to stop people taking up smoking will save money in the long run. There seems to be a blinkered approach by governments—and I am not singling out this government; I think it is just one of the issues of modern government—in that they do not look beyond the next election cycle or the forward estimates, the four-year cycle. However, we know that if we stop people smoking now there will be significant benefits to public health and to the health budget in years to come. It may be 10 or 15 years, but there are still significant benefits in terms of fewer people getting emphysema, lung cancer, gangrene and a whole range of smoking related diseases.

This needs to be seen as part of a broad package. Legislation restricting the sale of tobacco products and stating how they can be displayed and marketed is generally establishing control by state governments. This has resulted in a patchwork of laws across the country, with some states far ahead of others in areas such as the visibility of tobacco products in retail outlets. My home state of South Australia has been lagging behind on this and has been awarded the ‘dirty ashtray’ award for the second year in a row by the Australian Medical Association for the Australian state or territory that made the least progress in combating smoking during 2009-10. I note that on World Tobacco Day the South Australian government made some announcements to the effect that they would be tightening that up, but we have still been lagging behind the rest of the country.

The Commonwealth does have a role to play in this. When it comes to tackling the visibility of tobacco products, the Commonwealth does have the power to deal with it. It can use its various Commonwealth powers—under trade practices laws, for instance—to ensure that there can be further restrictions at a national level if states are lagging behind in relation to that. I think it is something that ought to be done in the context of this big change in terms of tobacco excise.

I have some specific questions to the minister in relation to this. Can the minister advise, in the context of this package of measures, how the government proposes to measure declines in smoking rates amongst various demographics on an annual basis? That information ought to be made available. In terms of demographics, it should include various age groups—teenage girls, for instance—and Indigenous communities.

I acknowledge that, with respect to Indigenous smoking rates, the government recently announced some initiatives which are welcome and should be commended. But how do we measure the success of any measures—not only in terms of our smoking rates overall, but also in terms of specific demographics where there has been a real difficulty in getting smoking rates down? I think that Senator Stephens is aware, more than most, of the devastating effect that tobacco has had on Indigenous communities, and that is why it is good that the government has been moving on that recently in terms of additional measures.

I think that it is also important that the government indicates how it will determine the efficacy of measures such as the $27.8 million set aside to address tobacco’s social marketing. How will that be measured? What independent, objective yardsticks will there be to determine the effectiveness of those measures? And what assurances do we have that, if quit lines are struggling to keep up with the additional demand of people wanting to quit smoking, there is a mechanism to ensure that those quit lines will not be starved of revenue, in order that they can adequately deal with those who want to quit so that they do not get left on hold or called back a couple of days later, as has occurred on some occasions, because the very fine staff of quit lines around the country have been struggling to keep up with demand?

Further, what is the government planning to do in terms of antitobacco ads or tobacco control ads to encourage people to deal with issues such as this? In other words, what campaigns will there be? What emphasis will there be in terms of targeting social networking sites? And how will we deal with the issue of tobacco companies using ways and means to get around bans on tobacco advertising? I think Senator Stephens may well be aware of the tricks that tobacco companies have got up to in terms of Hollywood movies where smoking is featured. There has been a suggestion, which I have been an advocate for, that, if a movie depicts smoking in a favourable light—and this is not about censorship—then at the very least there should be some antitobacco ads before the film is screened as a way of neutralising or dealing with that impact.

So these are some of the questions that I would like answered. How effective will this be? How will it be measured? Will quit lines be getting a look in? And what time frame is there for nicotine replacement therapy to be looked at by the government? I understand that it is being considered, so a time frame for that would be welcome.

My preference is that we should wait to deal with this bill until we receive firm undertakings from the government, because I do not believe that the money that has been set aside for prevention measures is reasonable, given the revenue that the government will be bringing in, and given the nature of the problem and the need to reduce our smoking rates as quickly as possible, particularly amongst young people.