Public health policy on tobacco control must be guided by evidence, not vested interests

Australia's smoking rate has fallen from nearly one in five adults in 2001 to just 5.6% has occurred despite the growth in the illicit tobacco market.

Around 1.3 million Australians now smoke daily, compared with three million in 2001. Australia is within reach of the National Tobacco Strategy goal of reducing daily smoking prevalence to 5% or less by 2030.

This success did not happen by chance. It reflects decades of evidence-based policy including tobacco taxation, plain packaging, smoke-free laws, advertising restrictions, graphic health warnings, mass media campaigns and cessation support. Together, these measures have changed behaviour, reduced disease and saved lives.

As clinicians we have seen the benefits firsthand: Fewer Australians smoke and more people understand the risks tobacco poses to their health. 

Smoking remains deadly, even as rates fall

While smoking rates are at historic lows, tobacco use remains one of Australia’s leading preventable causes of illness and premature death. 

The Australian Institute of Health and Welfare names it as the second-leading risk factor for Australia’s disease burden, accounting for 7.6% of total disease burden and 11.6% of all deaths.

Recent Australian research estimates smoking kills more than 24,000 Australians each year — about 66 people every day. It roughly doubles the risk of death from heart disease and stroke and remains a major contributor to cancer, chronic respiratory disease and vascular disease.

The public debate is increasingly focused on crime, not health

In recent years, public debate about tobacco control has become dominated by concerns about illicit tobacco and organised crime. These are legitimate concerns that governments must address. 

Cheap, unregulated tobacco makes it easier to start smoking and harder to quit. 

In our submission to the Senate Inquiry for Illicit Tobacco Control, we urged the Australian Government to take a national, best-practice approach that closes regulatory and enforcement gaps across the illegal tobacco supply chain. Existing tobacco taxes should remain, backed by sustained investment in public education and cessation support.

While some argue that illicit tobacco could be eliminated by cutting excise duties and making legal tobacco cheaper. In my view, that would be deeply misguided. It would risk triggering a price war that only strengthens criminal operators.

Public health policy should ultimately be judged by its ability to reduce smoking, prevent disease and save lives. When debate centres on markets, taxation or law enforcement, the health goal can become obscured. 

Big tobacco has changed its product, not its business model 

As cigarette sales decline, the tobacco industry has expanded into e-cigarettes, nicotine pouches and other nicotine products.

These products are often marketed as safer alternatives or harm-reduction tools. While the risks differ from combustible tobacco, emerging evidence regarding cardiovascular health, addiction and long-term population impacts is concerning. 

History shows the tobacco industry adapts quickly to protect markets and recruit new customers. Public health professionals should remain cautious when commercial interests present themselves as partners in solving problems they helped create.

The greatest risk to public health is the re-normalisation of smoking and nicotine use

One of Australia's greatest public health successes has been changing social norms around smoking. Generations have grown up viewing smoking as abnormal, undesirable and harmful. Sustained policy action and public education built that cultural shift.

This is now at risk unless we act quickly to counter false narratives about safer tobacco products. No form of smoking is safe. 

While smoking among young Australians continues to decline, the use of alternative nicotine products remains comparatively common in younger age groups. Daily vaping among Australians aged 18 to 24 remains comparatively high at 8.3%, and nicotine pouch use is most common in this age group.

If a new generation develops lifelong nicotine dependence through alternative products, the consequences may emerge over decades in preventable disease, healthcare costs and reduced quality of life.

Support people who want to quit, and prevent a new generation of nicotine addiction 

Smoking cessation remains one of the most effective clinical interventions available. Evidence consistently proves that quitting smoking reduces cardiovascular risk, lowers cancer risk and prolongs life expectancy. Even people who quit later in life experience substantial health benefits.

Australians who want to quit should continue to have access to evidence-based behavioural support and approved pharmacotherapies. For some people, prescribed nicotine products, and prescribed vaping products, can have a role in quitting under clinical supervision. These pathways should remain accessible and affordable. 

Clinical guidelines allow GPs to prescribe listed therapeutic vaping products as a third-line choice when nicotine replacement, oral medicines and behavioural support have not helped a patient quit. These products appear on the Therapeutic Goods Administration’s notified vape list.

Strengthen and modernise tobacco control, don't unwind it

The answer to current challenges is not to unwind the policies that have delivered historic reductions in smoking. The answer is to strengthen and modernise them.

Enforcement against illicit tobacco should be enhanced. Regulation must continue to adapt to emerging nicotine products. Public education campaigns must evolve with changing consumer behaviours and marketing tactics. Access to help people quit smoking for good must continue to expand.

Australia is co-signatory to the WHO Framework Convention on Tobacco Control and is bound by Article 5.3 which requires governments to protect public health policies from the commercial and vested interests of the tobacco industry. 

If we stay focused on those goals, Australia has a realistic opportunity to become one of the first countries in the world where smoking is no longer a common part of everyday life.

That is a public health achievement worth finishing.

Professor Garry Jennings AO has a distinguished career as a cardiologist in clinical practice and was previously Director of Cardiology at The Alfred Hospital, Melbourne, and Chair of the Division of Medicine. He is the Heart Foundation’s Chief Medical Advisor.