Tuesday, April 29, 2008

Indigenous smoking yet again

I have been ridiculed at public fora for suggesting that Aboriginal and Torres Strait Island (ATSI) smoking rates are an overwhelmingly important cause of the discrepancy between indigenous and non-indigenous mortality rates. The general response has been: ‘Harry you have a bee in your bonnet about smoking that 'clouds' your judgement’. It is true I do dislike this destructive habit but my claims about aboriginal health and smoking stand – indeed I have posted them explicitly on this blog.

This very helpful report is the most accurate and up-to-date study I have seen on ATSI health issues and read what it says about ATSI smoking:

Tobacco smoking was the leading cause of the burden of disease and injury for Indigenous Australians in 2003, accounting for 12.1% of the total burden and 20% of all deaths....In 2004-05, half (50%) of the adult Indigenous population were current daily (or regular) smokers. While smoking rates have decreased slightly for the total Australian population over the ten years to 2004-05, there has been no significant change in smoking rates for the Indigenous population in this period....
Many of these 2003 findings seem to come from here. The incidence of smoking is just under 3 times that of non-indigenous populations so the significant health effects do not surprise me. Also note that ATSI die on average at around 17 years earlier than non-ATSI populations. Thus, as a rough approximation, aboriginals die in their late 60s rather than their 80s – this is rough since it ignores significant ATSI mortality at much younger ages which will reduce the discrepancy between ages of death at older ages. However the bulk of lung cancer deaths occur in people in their 60s and 70s – for US data see this Table 3. Thus many of the deaths from smoking among ATSI will now not appear because ATSI have generally worse mortality than non-ATSI for various reasons not necessarily related to cigarette smoking.

Thus with a successful attack on ATSI health problems increased effects of smoking on ATSI mortality will become apparent unless such efforts include a clear focus on reducing ATSI smoking levels.


THR said...

Why shouldn't all Australians be permitted to destroy themselves by the means they see fit?

All do anyway.

Who are you to determine what is 'normal' and what is not?

I say this as a non-smoker, leave Indigenous smokers alone.

conrad said...

Can't you just estimate that -- it should be easy to get the numbers.
If you subtract 10 years of life due to smoking, then you still have 20 left to explain in terms of the life expectancy difference.

So if the 30% more Aboriginals smoke than the general population (50 vs. 20%) and they lose 10 years of life on average, you end up losing a bit more than 3 years extra per person due to smoking. So in the scheme of things whilst its important, it isn't especially so.

hc said...

Conrad, That's the calculation I did. It is very, very rough since it ignores the link between smoking diseases and age.

But your conclusuion is bizarre. On the basis of your calculation - whatever its value you can save 3 years life per indigenous person - thart is just under 20% reducdtion in excessive mortality.

In my judgement that is a hige - not an insignificant effect.

Spiros said...

With cigarettes costing $10 or more per pack, smoking is an expensive habit. If you are poor, as indigenous people mainly are, and you smoke a lot, there can't much money left over to buy vegetables and other things that are necessary for good health.

So smoking would contribute to early indigenous death both directly and indirectly.

Got any good ideas on how to get them to cut down?

Wil said...

I don't know why you would be ridiculed, seems a very legitimate concern. but what is to be done, eh?

Anonymous said...

smoking cigarettes and diet would seem to be the main reasons why they die earlier than others.

The Government can't do much here.
It is up to each aboriginal to change.

conrad said...


I'm not thinking of mortality, I'm thinking of average years of life reduced.

So if 1/3 of the population loses 10 years more, it means that, overall, everyone loses 3.33 years.

This means that if the discrepancy between aboriginal and the normal population is around 30 years (for males), it suggests that smoking is 1/10th of this, so 90% of the difference remains unexplained. So its no doubt important, but other things are probably moreso. However, this ignores other consequences -- its probably more important due to chronic health consequences rather than actual mortality. Even if 3 years of life is not such a big deal given the circumstances, having 50% of your population with emphasema etc. is a big deal, especially given that these guys are not exactly a bunch of white color workers where it doesn't matter so much (or have access to super health care in some places).

Simon said...


Rollies ?

Francis Xavier Holden said...

harry - who ridiculed you for suggesting ATSI smoking was a serious health issue? If thats what they snarked you for they are idiots. (Unless you accidently pulled out your John Howard for Noble /Sainthood speech)

ATSI respiratory and cardiovascular disease are worryingly high and combined with diabeties, poor nutrition, eye disease and other issues smoking is one of the reason that an "elderly" male aboriginal, (with all the complications of ageing diseases) is likely to be in his early 50s and trying to access services designed for the majority of males in their 70s. This mismatch compounds access and health problems.

mangoman said...

Smoking has been recognised by practitioners in the field for many years as one of the key factors affecting the health of Aboriginal people. Getting people to stop is the issue. The material that, eventually, caused me to stop doesn't seem to have any real impact particularly on those Aboriginal people living in remote areas.

Accurate information presented in a way that makes sense has worked well in other campaigns -AIDS for instance.

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