twrama 1841_august_2.. - AMA WA

COVER STORY
Plain SPEAKING
By Professor Jonathan Carapetis
Director of the Telethon Institute for Child Health Research,
and Paediatrician at Princess Margaret Hospital for Children
grew up in a family of smokers. I remember those long trips
I in the back of the Valiant sedan, craning my head to the open
window to get a breath of fresh air, barely able to breathe and
feeling as sick as a dog. I recall well that sense of dread as I saw
my mother reach for her pack of cigarettes, knowing that I would
spend the next 10 minutes taking small gasps of air through
my mouth rather than my nose, to minimise the stench and the
feeling that I was breathing tainted air.
I reacted viscerally, determined never
to smoke in my life. My siblings weren’t
so lucky, taking many years to kick the
habit they picked up as teenagers.
As I went through medical school,
I learned more about the true impact
of tobacco around the world, and
the shameful tactics of the tobacco
industry in peddling their lethal wares.
From time to time, I would also pass
a cigarette billboard that had been
refaced by the Billboard Utilising
Graffitists Against Unhealthy Promotions (BUGA UP), usually
using humour to turn the message of the advertisement on its
head. It turned out that a lot of the BUGA UPpers in Melbourne
were young doctors or medical students as well, so it didn’t take
me long to hook up with a few of them.
Thus my career of clandestine public health advocacy began.
I have many tales of ingenious home-made spray can extension
devices (to reach those difficult billboards in high places), audacious
graffiti-ing during peak hour on busy train platforms, arrests by
unsympathetic policemen (who would often light up a Winfield
during the interrogation), haranguing of the pretty young things
decked out in Marlboro gear at the tennis, and the list goes on…
BUGA UP struck a chord with the Australian population, and
was part of a multi-faceted movement led partly by academics, but
largely by the community and community-based organisations,
that continues to this day. Governments have followed suit, and
legislation has allowed us to accelerate the falling rates of smoking
in all jurisdictions, in women and men, and in all age groups.
In the early years, governments were reluctant starters, taking
quite a while to realise both that being tough on smoking was a vote
winner rather than loser, and that the revenue they received from
tobacco sales was far outweighed by the costs they paid in treating
smoking-related illness. And now, with the failure of Big Tobacco’s
High Court appeal against the plain packaging legislation, Australia
has placed itself at the forefront of international efforts to reduce the
numbers of kids starting to smoke.
Young crusader: Jonathan Carapetis in his younger days, in
front of a billboard he helped to reface.
Make no mistake – this is about the kids. We have all heard
about the impacts of passive smoking on children with respiratory
diseases like asthma. We also know that it is in childhood and
adolescence that most smokers become addicted, and that this is
all too often modelled on the behaviour of their parents and other
significant people in their lives.
But there is more to it than that. We are only now starting to
unravel the long-term effects on
the next generation of smoking
by pregnant mothers and
passive smoke exposure during
childhood – deleterious impacts
that are likely to increase the
risk of chronic diseases and
early death in adulthood,
whether or not that child
becomes a smoker themself.
I feel an immense sense of
pride that plain packaging is
going ahead in this country,
and that other countries are looking to emulate the Australian
Government’s stance. Plain packaging should be the springboard to
further action, and Mike Daube outlines beautifully in the previous
article what that might look like. I would like to emphasise the seventh
point in his 10 Point Plan, about disadvantaged groups. As we see
smoking rates fall, there are some groups that are missing out. We
are making inadequate progress in tackling tobacco use in Aboriginal
and Torres Strait Islander people.
Amid all the rhetoric about Closing the Gap, we cannot lose
sight of the fact that tobacco is the single biggest cause
of early death in indigenous Australians. The emerging evidence
suggests that we need to do more of the established strategies
for Aboriginal and Torres Strait Islander people (because strong
action on adult smoking has strong results for whether kids
start smoking and get exposed to second-hand smoke), but also
consider new interventions within smaller social environments
(families, schools, health clinics) to change prevailing views
within many indigenous communities that smoking is a
“normal” activity.
And of course, let us remember our international
responsibilities. As Big Tobacco has seen its markets shrink in
wealthy countries, it has turned its attentions to booming markets
in low and middle-income countries, where lax regulation often
allows them to use sales and marketing tactics to addict young
smokers that would never be contemplated here. We are on the
right track – now is the time to ramp things up even further.
28 MEDICUS August