Tackling Indigenous Smoking Expert Answer

Health promotion programs are designed to engage the community and individuals towards health behaviors that lead to reduce the risk of developing chronic diseases. According to the World Health Organization, health promotion program enables individuals to control their health. This essay aims to critically review and critically evaluate the effectiveness of a national supported health promotion plan and its impact on the health status of the targeted population. The health promotion plan selected for this essay is Tackling Indigenous Smoking. In this essay, the background of the health promotion program will be outlined. Then a critical review of the political environment and evaluation of the finding will be discussed.  In the end, a conclusion will be made.

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Background Context

Smoking is one of the important preventable cause of chronic diseases in Aboriginal and Torres Strait Islander peoples in Australia (Lovett et al., 2017). Tackling Indigenous Smoking (TIS) is a national health promotion program in Australia that aims to reduce the high prevalence of smoking among Aboriginal and Torres Strait Islander peoples through public health promotion activities (Australian Government Department of Health, 2020).

The life expectancy of the Aboriginal and Torres Strait Islander Australians is shorter as compared to the non-indigenous Australians. One of the important reasons for the early death and chronic diseases in the Aboriginal and Torres Strait Islander Australians is tobacco smoking. Moreover, tobacco smoking is associated with many chronic health effects including cardiovascular diseases, lung diseases, and cancer (Chamberlain et al., 2017). Tobacco smoking during pregnancy is responsible for low weight birth, perinatal death, and preterm birth (Gibberd et al., 2019). According to the 2018-2019 National Aboriginal and Torres Strait Islander Health Survey 37% of Indigenous Australian aged 15 years and above reported daily tobacco smoking. Among daily smokers, 49% people were living in remote areas and 36% people in non-remote areas (Australian Bureau of Statistics, 2019). Tobacco smoking is accountable for 23% of the gap in health burden among non-indigenous and indigenous Australians (Australian Government Department of Health, 2020). TIS aims to decrease the gap in the prevalence of smoking between non-indigenous and indigenous Australians by reductions in the uptake of smoking and increasing the rate of sustained smoking cessation. TIS is a multi-component program that works on a systemic approach to change the behavior of aboriginal Australians towards a healthy life. The main elements of the TIS program are the use of evidence-based tobacco control strategies at multiple levels, the use of public health and place-based approach, promoting best strategies to control tobacco smoking, establishing collaboration and partnerships to support innovations and behavior changes towards smoking (Tackling Indigenous Smoking, 2020). The good thing about this program is that it offers flexibility in delivering activities at regional and local levels and also its emphasis on targeting approaches for a particular group with a focus on the results to be achieved. Moreover, TIS also includes evaluation and effective monitoring of the activities to improve the planning and activities of the program to gain the desired outcomes (Upton & Thompson, 2019).

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Activities of the TIS program are set to achieve the desired outcomes which include improving the support and involvement of the community to stop smoking, increasing the community awareness about the harmful effect of tobacco smoking on their health, helping health workers to improve their knowledge about the adverse outcomes of the smoking on public health and how to support the community in quitting smoking, reduce smoking at public places, community area, cars, offices, and homes, informing young adults about benefits of becoming a non-smoker, decrease the rate of passive smoking, improve the approach to support services, help non-smokers to never start smoking, help smokers to quit smoking and find out what works best to stop smoking within the community (Australian Government Department of Health, 2018).

Critically Review of Political Climate and implementation of TIS

Initially, TIS was presented in 2010 as Tackling Indigenous Smoking and Healthy Lifestyle (TIS&HL) Program to provide community education and activities to decrease the prevalence of smoking, increase physical activities, and improve nutrition. The main objective of TIS&HL was to support smoking cessation, decrease uptake of smoking among youth, and promote a healthy lifestyle (Australian Government Department of Health, 2015). In 2014, the Australian Government contracted with the University of Canberra to take an independent review of the program. Stakeholders also participated in providing feedback and recommendation to the Government. After the review and recommendations provided to the Government, an updated version of TIS was launched in 2015 (Australian Government Department of Health, 2015). $116.8 million over three years were provided by the Australian Government for the TIS program out of which $93.4 million were granted to regional areas (Australian Government Department of Health, 2018). In the redesigned TIS program the funds were shifted from the healthy lifestyle activities and workers dedicated to a healthy lifestyle towards activities and programs that were designed for a reduction in the prevalence of tobacco smoking among Australian Aboriginals. Shifting the funds from lifestyle activities and health workers dedicated to lifestyle activity plays an important role in focusing only on tobacco smoking.

Implementation of the TIS program was planned and systematic. Based on the review report and recommendations from stakeholders seven key components were developed for the delivery of the TIS program. The first key component was regional tobacco control grants. Funds were granted to 37 regional organizations throughout Australia to provide evidence-based tobacco control activities at multiple levels with a focus on favorable outcomes for reducing the prevalence of smoking (Tackling Indigenous Smoking, 2020). This component enables the TIS program in providing flexibility to regional grant recipients for adopting evidence-based activities that suit the local settings. Another key component of the TIS program is the National Best Practice Unit Tackling Indigenous Smoking (NBPU TIS) which support regional grant recipients in utilizing the evidence-based and target focused activities for the reduction of smoking rate among Australian Aboriginals (Upton & Thompson, 2019).

The third key component of the TIS program is the National Coordinator for Tackling Indigenous Smoking. Professor Tom Calma is currently the National Coordinator for Tackling Indigenous Smoking. This component provides advocacy in the national implementation of the program, high-level advice regarding the evidence-based activities, and practical leadership (Australian Government Department of Health, 2020). Another key component of this program was the innovation grants. These grants aim to provide evidence-based effective tobacco control strategies and activities (Australian Government Department of Health, 2020). Due to this component, TIS offers flexibility in adopting those evidence-based activities which seem suitable to the regional population. Implementation of this component makes sure that the latest and appropriate evidence-based activities are carried out in this program. TIS also involves the Quitline in this program and helps in enhancements of Quitline to provide accessible, accurate, and appropriate service to Australian Aboriginals especially young people and pregnant women (Australian Government Department of Health, 2018). For the appropriate implementation of the TIS program, the health professionals associated with this program were given Quitskill training. Quitskill training aims to provide brief intervention and motivational training to health workers to make them qualified professionally and suitably trained to work with Aboriginal and Torres Strait Islanders and their community (Tackling Indigenous Smoking, 2020). The last but important component of the TIS program is National evaluation. The Cultural and Indigenous Research Centre Australia (CIRCA) was independently appointed to evaluate the effectiveness and appropriateness of the TIS program (Australian Government Department of Health, 2020). CIRCA also assesses how well the TIS program is proceeding towards its long-term outcomes.

Findings and Impact of TIS

CIRCA in collaboration with the Incus group, Renee Williams and Professor Shane Hearn (University of Adelaide) was contracted to conduct the national evaluation of the TIS program. This evaluation aimed to assess the extent of change that has occurred after the implementation of the TIS program (effectiveness), suitability amongst the TIS program and requirements of the of Aboriginal and Torres Strait Islander communities (appropriateness), and how good TIS is proceeding towards its long-term goal (Australian Government Department of Health, 2018).

Community engagement and participation is an important factor for the success of any public health program. Evaluation findings show that there has been a success in gaining support and confidence of the community (Australian Government Department of Health, 2018). It is evident by the increase in the number of participants and organizations throughout Australia. Formation of community reference groups, youth leadership groups, participation in the main regional advisory group, and yarning conferences with Elders are the evidence of community engagement and consultation. Moreover, the evaluation report also suggests that the community should continue to support the TIS program and community members should be involved in the evaluation and delivery of the TIS continuously (Australian Government Department of Health, 2018).

The national evaluation has found that short-term and medium-term goals were achieved by adopting the multi-level localized approach. These goals include increased knowledge of the adverse effect of smoking, increased acceptability of the quitting pathway, more focus on priority groups, increase in the number for smoke-free homes, workplaces, and public places, and increased advocacy role and leadership against tobacco control in the community. The national evaluation also suggested that the grant recipient should continue the goal-directed, multilevel localized health promotion and also have more focus on pregnant women (Australian Government Department of Health, 2018).

The evaluation found that there was an increase in access to quit support. New referral access points were made by the grant recipient which made it easy for the community to participate in quitting activities (Australian Government Department of Health, 2018). The evaluation report made a good comparison of the numbers of referrals coming from urban, rural, and remote areas. The report suggests that the higher number of the referral were coming from the urban areas as compared to the remote area (Australian Government Department of Health, 2018). This may be due to the language barrier or the infrastructure of the remote areas. It is suggested that data sharing should be increased between the regional grant recipients and Quitline and policy activities should be reviewed in the regional areas (Australian Government Department of Health, 2018). Overall, the evaluation report shows success in achieving short-term and medium-term goals and suggests that the TIS program is on the right track. The evaluation report also points out the challenges which were faced during the delivery of the TIS program and achieving the required outcomes. Most of the challenges were reported in the regional and remote areas. These challenges include data collection, communication, governance, competing priorities in community, lack of senior management (Australian Government Department of Health, 2018). A study shows that one of the main issues was giving concern to traditional values. Care should be taken to make sure that the TIS program activities maintain correspondence with the local expectations and values (Tane et al., 2018). However, despite these challenges the TIS program showed significant progress in a delivery evidence-based targeted focused multilevel and localized activities to reduce the prevalence of smoking among the Aboriginal and Torres Strait Islanders. Evidence of the success of the TIS program can be judged from the Australian Government announcement, made on the 11th of February 2018, that the TIS program will continue and the Australian Government made a commitment of $183.7 million over 2018 to 2022 (Australian Government Department of Health, 2018).

Summary

Overall, the TIS program is showing significant progress in gaining the required goals and seems to be on the right track. More people are getting aware of the harmful effects of tobacco smoking on their health. Increased participation of the community in TIS program activities is the evidence of the short-term goal of the TIS program. The lesson learned from This program is that reducing smoking prevalence among Australian Aboriginals is not a quick process and there is no magic bullet for this. This will take time and a systemic, multi-level, evidence-based approach. There were found some limitations and barriers in the delivery of this program, especially in the remote area. These barriers include the problem in communication, lack of senior management, difficulty in recruiting, training, and retaining the staff due to geographical remoteness and difficulty in the data processing. The effectiveness of TIS programs is based on adaptation, duration, intensity, and reach. Future directions for the success are that the TIS team should continue to work in making collaborations, partnerships, evaluations, and systems which will guarantee the sustainability of the TIS program. Moreover, TIS long-term goals couldn’t be achieved fully unless it includes those remote areas which are not currently being served under the TIS program.

Conclusion

Smoking is one of the important reasons for early death and chronic diseases of Aboriginal Australians.  A systemic, goal-directed, long-term, localized and evidence-based approach is needed to decrease the rate of tobacco smoking prevalence. The TIS program is the one that is working systematically and showing significant results in achieving its short-term goals. TIS program should continue the work continuously and systematically to achieve its long term goal.

References

  1. Australian Bureau of Statistics. (2019). National Aboriginal and Torres Strait Islander Health Survey, 2018-19. https://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0
  2. Australian Government Department of Health. (2015). INDIGENOUS AUSTRALIANS’ HEALTH PROGRAMME: TACKLING INDIGENOUS SMOKING Grant Activity Guidelines. https://www.ehealth.gov.au/internet/main/publishing.nsf/Content/D2046EAB2B87A70DCA257F370017F288/$File/Tackling-Indigenous-Smoking-Grants-Guidelinesv1.pdf
  3. Australian Government Department of Health. (2018). Tackling Indigenous Smoking program – final evaluation report. https://www.health.gov.au/resources/publications/tackling-indigenous-smoking-program-final-evaluation-report
  4. Australian Government Department of Health. (2020). Tackling Indigenous Smoking. https://www.health.gov.au/initiatives-and-programs/tackling-indigenous-smoking?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
  5. Chamberlain, C., Perlen, S., Brennan, S., Rychetnik, L., Thomas, D., Maddox, R., Alam, N., Banks, E., Wilson, A., & Eades, S. (2017). Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: An overview of reviews among Indigenous peoples. Systematic Reviews, 6(1), 1–28.
  6. Gibberd, A. J., Simpson, J. M., Jones, J., Williams, R., Stanley, F., & Eades, S. J. (2019). A large proportion of poor birth outcomes among Aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault. BMC Pregnancy and Childbirth, 19(1), 110.
  7. Lovett, R., Thurber, K., Wright, A., Maddox, R., & Banks, E. (2017). Deadly progress: Changes in Australian Aboriginal and Torres Strait Islander adult daily smoking, 2004–2015.
  8. Tackling Indigenous Smoking. (2020). Elements of the TIS program. https://tacklingsmoking.org.au/about-the-tis-program/
  9. Tane, M. P., Hefler, M., & Thomas, D. P. (2018). An evaluation of the ‘Yaka Ŋarali’’Tackling Indigenous Smoking program in East Arnhem Land: Yolŋu people and their connection to ŋarali’. Health Promotion Journal of Australia, 29(1), 10–17.
  10. Upton, P., & Thompson, D. (2019). Making connections: A systems approach to Tackling Indigenous Smoking. http://www.ruralhealth.org.au/15nrhc/sites/default/files/C3-1_Upton%2C%20Thompson_0.pdf