strategic plan for the prevention of smoking and harm from

Strategic Plan for the Prevention of Smoking and Harm from Smoking 2014-2017

Working together to improve the health and wellbeing of our community

2 | P a g e

Strategic Plan for the Prevention of Smoking and Harm from Smoking 2014-2017

District Executive Unit

South Eastern Sydney Local Health District

Locked Mail Bag 21

TAREN POINT NSW 2229

Phone: (02) 9540 8118

Fax: (02) 9540 8757

This work is copyright. It may be reproduced in whole or in part to inform people about the strategic

directions for health care services in the South Eastern Sydney Local Health District, and for study and

training purposes, subject to inclusion of an acknowledgement of the source. It may not be reproduced for

commercial usage or sale. Reproduction for purposes other than those indicated above requires written

permission from the South Eastern Sydney Local Health District.

Further copies of this document can be downloaded from the NSW Government’s Health website:

http://www.health.nsw.gov.au/seslhn/index.asp

Prepared by the Directorate of Planning and Population Health


May 2014

http://www.health.nsw.gov.au/seslhn/index.asp

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Contents

CONTENTS .................................................................................................................................................................. 3

EXECUTIVE SUMMARY ................................................................................................................................................ 4

1. BACKGROUND .................................................................................................................................................... 6

1.1 OUR DISTRICT ............................................................................................................................................................... 6

1.2 PREVALENCE ................................................................................................................................................................. 8

1.3 HARM FROM SMOKING ................................................................................................................................................... 9

1.4 INEQUALITIES .............................................................................................................................................................. 11

2. STRATEGIC CONTEXT .........................................................................................................................................15

2.1 NSW PLANS AND STRATEGIES ........................................................................................................................................ 15

2.2 DISTRICT PLANS AND STRATEGIES .................................................................................................................................... 15

2.3 OUR LOCAL PLAN ......................................................................................................................................................... 16

3. THE STRATEGY ...................................................................................................................................................19

KEY ACTION AREA 1: PUBLIC EDUCATION AND COMMUNITY PROGRAMS ..................................................................................... 19

KEY ACTION AREA 2: CESSATION SERVICES ............................................................................................................................. 20

KEY ACTION AREA 3: TOBACCO ADVERTISING AND PROMOTION ................................................................................................ 21

KEY ACTION AREA 4: SECOND-HAND SMOKE .......................................................................................................................... 22

SUPPORT STRATEGY: RESEARCH, MONITORING, EVALUATION & REPORTING ................................................................................ 23

4. IMPLEMENTATION PLAN ...................................................................................................................................25

5. REFERENCES ......................................................................................................................................................32

APPENDIX A: EXAMPLES OF STATE & DISTRICT STRATEGIES & PLANS SUPPORTING VULNERABLE POPULATIONS .....34

APPENDIX B: DEVELOPMENT OF THE PLAN ................................................................................................................35

APPENDIX C: ABORIGINAL HEALTH IMPACT STATEMENT...........................................................................................36

CHECKLIST .................................................................................................................................................................37

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Executive Summary Smoking is the leading cause of preventable death and disease throughout Australia.1 Australia’s national

health statistics agency reports that smoking contributes to more hospitalisations and deaths each year

than alcohol and illicit drug use combined.1

There are over 90,000 smokers across South Eastern

Sydney Local Health District today. Half of them

will die early as a direct result of their smoking.

Reducing tobacco smoking and exposure to second-hand smoke are high priorities for our District. They are

strongly emphasised in both the South Eastern Sydney Local Health District Road Map to the delivery of

excellence – 2014-2017, South Eastern Sydney LHD Strategy 2012-2017 2 and the SESLHD Healthcare

Services Plan 2012-2017,3 and are the subject of the major NSW Tobacco Strategy 2012-2017.4

The Prevention of Smoking and Harm from Smoking Plan builds on the District’s strong history of

commitment to tobacco control by describing priorities and actions for the coming three years, aimed at:

preventing people starting to smoke, particularly young people; helping people stop smoking, and

protecting people from second-hand smoke.

More than 500 deaths and almost 5000 hospitalisations each year are attributable to tobacco-related

illness within the South Eastern Sydney Local Health District. Figures indicate that 23% of smokers plan to

quit within the next month, which equates to more than 20,000 people within the District.

Our District Plan reflects the strategic framework provided by the NSW Tobacco Strategy 2012-20171. Our

four key action areas are: Public Education and Community Programs, Cessation Services, Tobacco

Advertising and Promotion, and Second-hand Smoke. The key theme cutting across our action areas is

inequality. It is recognised that the prevalence of smoking and harm from smoking is spread very unevenly

across our community. In addition, we need to improve a wide range of circumstances that lead to unfair

and avoidable health inequalities. Therefore, this plan and others developed by the District include a focus

on priority population groups with a high smoking prevalence and/or high risk of harm from future

smoking, including:

People with a mental illness and/ or alcohol and other drug problems

People from low socio-economic groups

Aboriginal people (including a specific focus on pregnant Aboriginal women)

People living with HIV infection

Some culturally and linguistically diverse communities with high smoking rates

http://seslhnweb/Bulletin_Board/2014/RoadMaptothedeliveryofexcellence2014-2017.pdf

http://seslhnweb/Bulletin_Board/2014/RoadMaptothedeliveryofexcellence2014-2017.pdf

http://www.seslhd.health.nsw.gov.au/HealthPlans/default.asp

http://www.seslhd.health.nsw.gov.au/HealthPlans/documents/FinalSESLHDHCSP2012-withrevisedcover.pdf


http://www0.health.nsw.gov.au/pubs/2012/nsw_tobacco_strategy_2012.html

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Young people are also considered a priority population in our Plan, given that the vast majority of smokers

start in their teenage years

In line with the NSW Tobacco Strategy 2012-2017, a range of key performance indicators are also

described. While some of these indicators are ambitious and may take some time to achieve, the District

has a long term commitment to reducing the smoking prevalence in our community, especially among

priority groups.

Delivery of the plan will be coordinated, monitored and reported by the Planning and Population Health

Directorate. A Tobacco Plan Implementation Group will support this process. This group will be made up of

key stakeholders and those responsible for the delivery of the actions described herein; where appropriate,

this includes external partners. The group will meet three times each year with a focus on strategic

oversight and tracking key performance indicators.

A reporting framework and timetable will also be established by this group, including annual progress

reports to the District Executive Team, District Clinical and Quality Council and the Board. Interim progress

reports will be tabled at Implementation Group meetings throughout the year including those required by

the NSW Ministry of Health (Health Protection NSW) regarding regulatory activities.

Appropriate communication strategies will be developed to ensure the engagement of and regular contact

with other key stakeholders, including the wider community.

Ms Julie Dixon Director, Planning and Population Health


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1. Background 1.1 Our District

Our Vision

Working together to improve the health and wellbeing of our community

Our Purpose

Our Health District exists to:

Promote, protect and maintain the

health of its community.

Provide safe, quality, timely and

efficient care to all who need it.

Address gaps in health service access

and health status.

The District covers nine NSW Local Government Areas

(LGA) from Sydney's Central Business District to the

Royal National Park in the South. The District also

assists Lord Howe Island and Norfolk Island residents

with access to hospital and health services, including

state-wide services. The District has a complex mix of

highly urbanised areas, industrialised areas and low

density suburban development areas in the south. The

District supports a culturally and linguistically diverse

population of over 840,000 people.

The District’s services include: population health

programs and services; ambulatory, primary health

care and community services; hospital inpatient and

outpatient services, and imaging and pathology,

among others. Facilities include six public hospitals

and associated health services: Prince of Wales; Royal

Hospital for Women; St George; Sutherland; Sydney /

Sydney Eye; and Gower Wilson Memorial on Lord

Howe Island. The District also provides one public

residential aged care facility (Garrawarra Centre), and

oversees two third schedule health facilities: War

Memorial Hospital (third schedule with Uniting Care)

and Calvary Healthcare (third schedule with Little

Company of Mary Health Care).

Other public health facilities that deliver services to

the local population include Sydney Children’s Hospital

(Randwick), St Vincent’s Hospital (Darlinghurst) and

Sacred Heart Hospice. Primary Health Care

Organisations located in the South Eastern Sydney

Region include the Eastern Sydney and South Eastern

Sydney Medicare Local. Private hospitals and services

also provide services to our population.

A number of fundamental principles guide our

decisions on the directions and actions to take with

regard to the development and delivery of health care

within the District. These are outlined in the South

Eastern Sydney LHD Strategy 2012-2017.2

Despite the great improvements in average life

expectancy achieved in recent decades, health gains

have not been equally shared across the population of

the District. One of the District’s key priorities is to

reduce inequities in health service access and health

outcomes. Those most at risk of experiencing health

inequities are our most vulnerable population groups.

Vulnerable populations are those at greater risk for

poor health status and access to health care.



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As occurs in the rest of Australia, the starkest variation

in health status between population groups resident in

the District is between Aboriginal and non-Aboriginal

Australians.

Other vulnerable populations in the District include:

the socio-economically disadvantaged; the homeless;

people with disabilities; people with low English

proficiency; refugees; those with Human

Immunodeficiency Virus (HIV); and those with other

chronic health conditions, including severe mental

illness.

The vulnerability of these individuals is enhanced by

age, sex, ethnicity, culture, and factors such as poor

access to health care. Their health and health care

problems can also intersect with social factors,

including poor housing and social capital, and

inadequate education. The numbers within some of

these vulnerable populations are increasing,

particularly as the population ages, e.g. people living

with diabetes and HIV. The health and non-health

service needs of these populations are important, with

social disadvantage likely compounded by poorer

general health than the more advantaged and vice

versa. Chronic illnesses and the impact of these

illnesses are more prevalent among vulnerable

populations.

The District aims to provide high quality appropriate

prevention and care to all people, including those

from vulnerable population groups. To achieve this, it

is guided by a range of state and local key strategies

and plans. See Appendix A for a list of State and

District strategies and plans that inform and support

high quality health service provision for all in need in

our District.

This Strategic plan for the prevention of smoking and

harm from smoking 2014-2017 will contribute to the

District’s Population Health Plan and other clinical

service plans as shown in the District’s Planning

Framework (Figure 1). Implementation will be

coordinated by the Planning and Population Health

Directorate, with input from and partnerships

between the other Directorates and facilities

described herein.

Figure 1: The South Eastern Sydney Local Health District Planning Framework

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1.2 Prevalence

Concerted public health efforts over the last few

decades have led to a gradual decline in smoking

prevalence across NSW, from an estimated 21.8% in

2002 to 14.8% in 2011.5 Over the same period,

smoking prevalence among District residents has

decreased from 20.1% to 13.4%.5

Specifically there has been a decline in smoking in the

25-34 years age group, previously the group with the

highest rates of smoking (see Figure 2). Declines have

also been seen in all other age groups less than 55

years including those aged 16-24 years, who are the

target of many interventions to reduce the uptake of

smoking. However this decline in smoking has not

been evident in older age groups.

Declines in smoking prevalence have been seen for

both males and females. Males are still more likely

than females to be current smokers and to have ever

taken up smoking.6 However the gender difference is

reversed in some age groups, with girls aged 12-17

having a higher prevalence of daily smoking than their

male peers. 6

Despite the progress made in tobacco

control there are over 90,000 smokers across


today. Half of those that smoke will die early

as a direct result of their smoking.

Source: NSW Population Health Survey (SAPHaRI), Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed from Health Statistics NSW

Figure 2: Current smokers, persons aged 16yrs+, NSW 2002 to 2011

Focus on Young People

The teenage years are the most common time for taking up smoking, with 80% of current smokers saying they began before the age of 20 years.

7,8

The younger a person is when they start to smoke, the less likely it is that they will ever stop.9

By the age of 20, more than 80% of smokers wish they had never started, having underestimated the addictive power of nicotine.

10

One of the most significant predictors of the likelihood of young people smoking is whether their parents smoke. Children of non-smokers are more likely to stay non-smokers in the long term.

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1.3 Harm from Smoking

Despite our achievements in reducing the prevalence of smoking, smoking continues to be a major issue for population health. Smoking:

Is the leading cause of preventable disease and death in Australia

1

Reduces the lifespan of long-term smokers11

Contributes to more hospitalisations and deaths than alcohol and illicit drugs combined

1

Smoking harms virtually every body organ and increases the risk of many serious medical conditions.

12 Compared with non-smokers, smoking is

estimated to increase the risk of:

Coronary heart disease by 2-4 times

Stroke by 2-4 times

Dying from chronic obstructive lung disease (such as chronic bronchitis and emphysema) by 12-13 times

Lung cancer by 23 times in men and 13 times in women

Many other cancers: bladder, cervix, oesophagus, kidney, larynx, pharynx, mouth, pancreas, stomach, acute myeloid leukaemia

Infertility

Smoking during pregnancy

Smoking during pregnancy presents serious risks for both mother and child, including:

13

Ectopic pregnancy (embryo outside the uterus)

Pregnancy complications and miscarriage

Premature labour and birth, and low birth-weight babies (who have increased risk of infection and other health problems)

The baby dying at/shortly after birth

Sudden Infant Death Syndrome

Costs

In NSW in 2006/7, the social costs of smoking were an estimated $8.4 billion, comprising:

14

65% intangible costs such as pain and suffering, which are borne by individuals.

35% tangible costs such as hospital costs. Individuals bore 53% of the tangible costs, businesses 42% and governments about 5%.

Deaths and hospitalisations Among SESLHD residents, smoking is responsible, each year, for an estimated:

530 deaths

4,700 hospitalisations5

Smoking attributable death rates among SESLHD residents are highest among residents of the Sydney and Botany Bay Local Government Areas (Figure 3).

5

Smoking attributable hospitalisation rates among SESLHD residents are (Figures 4 & 5):

10% lower than among NSW residents

70% higher among males than females

declining among males but not females

higher among Northern Sector than Southern Sector residents

5

Second-hand smoke

Second-hand smoke (sometimes known as environmental tobacco smoke or passive smoking) is the combination of smoke from cigarettes and the smoke expelled by smokers. There is no risk-free level of exposure to second-hand smoke.

15 It is associated

with a range of serious illnesses and conditions, including:

15,16

Coronary heart disease – Exposed non-smokers increase their risk of developing heart disease by 25–30%.

10 People with existing heart disease are at

especially high risk of adverse events.

Lung cancer – Exposed non-smokers increase their risk by 20–30%.

Infants and children are particularly susceptible to second-hand smoke due to their immature immune systems and smaller airways.

1,15 Exposure is associated

with an increased risk of chest infections, ear infections, asthma, and Sudden Infant Death Syndrome.

1,16,17

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0 20 40 60 80 100

Sutherland Shire

Hurstville

Kogarah

Rockdale

Botany Bay

Randwick

Waverley

Woollahra

Sydney

Figure 3: Smoking attributable deaths (per 100,00), SESLHD residents, by Local Government Area, 2006 to 2007

Source: ABS mortality and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.5 Note: Calculated uding age and sex-specific aetiological fractions from School of Population Health, University of Queensland and AIHW, 2007. Figures are based on where a person resides, not where they are treated.

0

200

400

600

800

1000

SESLHD NSW ES ML/ Northern Sector SES ML/ Southern Sector

Figure 5: Smoking attributable hospitalisations (per 100,000 population), SESLHD & NSW residents, FEMALES, by Medicare Local/District Sector sub-area

Source: NSW Admitted Patient Data Collection, ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health. Note: Calculated uding age and sex-specific aetiological fractions from School of Population Health, University of Queensland and AIHW, 2007. Only NSW residents are included. Figures are based on where a person resides, not where treated.

0

200

400

600

800

1000

SESLHD NSW ES ML/ Northern Sector SES ML / Southern Sector

Figure 4: Smoking attributable hospitalisations (per 100,000 population), SESLHD & NSW residents, MALES, by Medicare Local/District Sector sub-area

Source: NSW Admitted Patient Data Collection, ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health. 5Note: Calculated uding age and sex-specific aetiological fractions from School of Population Health, University of Queensland and AIHW, 2007. Only NSW residents are included. Figures are based on where a person resides, not where treated.

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0 20 40 60 80

Inmates in correctional facilities e

People living with HIV infection d

People with mental disorders 16yrs+ c*

Aboriginal women in pregnancy b

All women in pregnancy b

Aboriginal pop 16yrs+ a

Born in `Other Oceania' 14yrs+ f*

Born non-english speaking country 16yrs+ a

Lowest SES quintile pop 16yrs+ a

Unemployed pop 14yrs+ f*

Age 16-17 years years g

Total pop 16yrs+ a

SES residents NSW/ Australian* residents

Figure 6: Smoking Prevalence in SESLHD and NSW/ Australian Sub-Populations

Data sources: A = NSW Adult Health Survey/ NSW Health 2012; B = NSW Perinatal Data Collection/ NSW Health 2011; C = National Survey of Mental Health and Wellbeing 2007/ ABS; D = Australian HIV Futures 6 study/ The Australian Research Centre in Sex, Health and Society 2009, Latrobe University; E = NSW Inmate Health Survey/ Justice Health 2009; F = National Drug Strategy Household Survey/ AIHW 2010. G = NSW School Students Health Behaviours Survey/ NSW Health 2011

Per cent of population/ sub-population

0.0 2.0 4.0 6.0 8.0 10.0 12.0

Sutherland Shire

Hurstville

Kogarah

Rockdale

Botany Bay

Randwick

Waverley

Woollahra

Sydney

SESLHD

NSW

Figure 7: Smoking at all during pregnancy, NSW & SESLHD residents, by Local Government Area, 2008-2010

Source: NSW Perinatal Data Collection (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.5 Note: Data for total NSW and SESLHD populations are for 2011.

1.4 Inequalities

Certain groups within the community are more likely

to have higher smoking rates than the general

population or experience a greater impact from the

harms of smoking due to a number of life

circumstances (see Figures 6-7).11

These groups include: o People from low socio-economic groups o People with a mental illness o People who access drug and alcohol services o People with HIV o Aboriginal people o Some culturally and linguistically diverse

communities

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Aboriginal people

Since 2002 smoking prevalence has declined among

Aboriginal adults in NSW, from 43.7to 35.2% in 2013.5

While this is encouraging, much more needs to be

done. Compared to non-Aboriginal people, Aboriginal

people:

are at least twice as likely to smoke

take up smoking at a younger age

experience a more substantial burden of illness

due to smoking

are less likely to benefit from prevention

programs.4

Smoking is responsible for an estimated 17% of the

health gap between Aboriginal and non-Aboriginal

people, and 12% of the total burden of disease.18

The drivers of the high smoking rate among Aboriginal

people are complex and include both historical and

contemporary processes. Evidence suggests that

smoking is highly normalised in Aboriginal

communities and strong social factors drive early

initiation and act as barriers to smoking cessation.19, 20

In 2011, SESLHD’s Aboriginal resident population was

just over 6,000 people. The largest Aboriginal

populations live in the Randwick and Sutherland Local

Government Areas; Botany Bay has the largest

community (as a proportion) within the area.21

Smoking rates among Aboriginal women during

pregnancy is of particular concern (see Figures 6 and

8). While a decline has been seen in recent years, the

gap between Aboriginal and non-Aboriginal women

remains substantial, making this one of the top

priorities for action at local, State and National levels.2-

4,19 Aboriginal residents within SESLHDare about 10

times more likely to smoke during pregnancy than

non-Aboriginal residents – 40.7% vs 4.2% in 2012 (see

Figure 8).5

The involvement of Aboriginal community-controlled

health organisations in providing leadership, policy

development, program implementation and the

evaluation of tobacco control strategies will be critical

if we are to achieve further reductions in the

prevalence of smoking among Aboriginal people.

Quit for New Life is a new state-wide program

being implemented across the District from 2014

onwards. The program aims to reduce smoking among

pregnant Aboriginal women and women who identify

as having an Aboriginal baby and other members of

their households. The program objectives are:

Build the capacity of Aboriginal Maternal and

Infant Health Services (AMIHS) and Building Strong

Foundations (BSF) services to provide evidence-

based smoking cessation care to all clients who

smoke as part of routine care.

Provide smoking cessation care and support to AMIHS and BSF clients and other members of their households.

Reduce the rate of passive smoking in households

of Aboriginal women during and after pregnancy.

Reduce the risk of smoking relapse by AMIHS clients in the post-partum period.

Smoking

affects

babies

even

before

they are

born...

Lower socio-economic groups

Socioeconomic disadvantage is negatively associated

with many measures of health and well-being.1

Smoking prevalence varies markedly between

socioeconomic groups. This is reflected, for example in

the differences in smoking rates during pregnancy

between residents of each of the SESLHD Local

Government Areas, as shown in Figure 7. The District

has pockets of distinct disadvantage, including

communities within Botany Bay, Inner Sydney and

Rockdale.21

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Figure 8: Smoking during Pregnancy, SESLHD and NSW residents, by Aboriginality, 1996 to 2010

People with a mental illness

Almost a third of Australians with a mental illness

smoke cigarettes – more than double the rate seen

across the wider community.22

For those with more

severe mental illness, the rates can be much higher,

e.g. 60% for those with specific psychotic conditions

such as schizophrenia.16,23

. Among mentally ill

inpatients with co-existing alcohol and drug problems,

smoking rates as high as 90% have been observed.23

People with mental illness are more likely

to smoke, and smoke more. 16

We estimate that around 70% of our mental

health clients smoke. While it may be

difficult for clients with complex mental

health issues to see smoking cessation as a

priority, it is essential as physically,

psychologically and financially, smoking

makes a difficult situation worse.

In addition to the health consequences described

earlier, people with mental illness who smoke have

additional physical, psychological and social risks, such

as the anxiety and cravings associated with addiction24

and potentially harmful interactions with medications

such as a number of antipsychotic drugs and

benzodiazepines.16

Despite the obvious potential for harm, reluctance by

some health professionals to encourage people with a

mental illness to quit has been reported.24

However,

as recommended by the Royal Australian College of

General Practitioners, mental illness is not a

contraindication to stopping smoking: health

professionals should actively encourage and assist

smoking reduction and cessation, with an intensive

counselling approach and close follow-up, and

following the same smoking cessation interventions

that have been shown to be effective in the general

population.25

People who access drug and alcohol services

The majority of people with substance abuse disorders

smoke tobacco.26

Historically, smoking cessation has

not been a major part of clinical interventions with

these people as the attention is usually focussed on

the substance abuse.26

However there is now good evidence that smoking

cessation can enhance short term abstinence, rather

than compromise the outcome of drug and alcohol

treatments.27

As recommended by the Australian

College of General Practitioners, health professionals

should actively encourage and assist smoking

reduction and cessation in people with other drug and

alcohol dependencies, and as for those with mental

health issues, monitoring and support is particularly

important.25

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People living with HIV

More than 40% of people living with HIV infection are smokers. Almost half of NSW residents living with HIV and about a quarter of Australia’s HIV positive population lives within the District’s boundaries.

21

Smoking can adversely impact on existing complex health issues and care.

28

Improving the health and well-being of people living with HIV, including smoking cessation and reduced exposure to the harm from second-hand smoke, are therefore priorities which can contribute more broadly to their quality of life and allow them to live a more active and healthy life within their communities.

Culturally and Linguistically Diverse Communities

Smoking rates across culturally and linguistically diverse communities vary greatly.

11

More than a quarter (26%) of the District’s population was born overseas and over a third (37%) speak a language other than English at home. People born in China make up the largest population followed by Greece, Indonesia and Hong Kong. Around 7,500 new migrants move to the District each year.

21

More broadly, cultural diversity extends beyond language spoken, and a range of other factors require attention when planning appropriate interventions. Issues such as health literacy, access to services and the cultural appropriateness of interventions are important considerations.

29

Brenda Leung, health promotion officer, received an award in partnership with Pole Depot Community Centre at the Multicultural Health Communication Service Awards.

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2. Strategic context

2.1 NSW plans and strategies

Reducing smoking and the harm from smoking is a high priority at National and State levels. The broad strategic context for this is outlined in:

National Tobacco Strategy 2012-2018 11

NSW 2021 (the NSW State Plan)30

NSW Tobacco Strategy 2012-2017 (NSW Health)4

The NSW Cancer Plan (Cancer Institute NSW)31

Population Health Priorities for NSW: 2012-2017 (NSW Health)

32

The NSW Tobacco Strategy 2012-2017 describes actions across eight priority areas as shown in Appendix A. Responsibility for the proposed actions extends across many agencies, with the NSW Ministry of Health and the Cancer Institute NSW taking a strategic leadership role.

Two major strategies made in NSW are described in: Box 1: Smoking Cessation Services, and Box 2: NSW Tobacco Retailing Laws.

The NSW Cancer Plan 2011-15 reflects the importance of reducing smoking prevalence: this is the first objective described within the priority “to reduce the incidence of cancer”. Consistent with the themes described in the NSW Tobacco Strategy 2012-2017,

the NSW Cancer Plan 2011-15 includes strategies related to:

Behaviour modification

Smoke-free environments

Tobacco Control Policy

Aboriginal specific programs

2.2 District plans and strategies The South Eastern Sydney LHD Strategy 2012-2017 outlines the vision, values, purpose, principles for decision making, our priorities and desired outcomes for our organisation and services over the next five years.

2

This SESLHD Strategic plan for the prevention of smoking and harm from smoking2014-2017 will directly deliver on the following from the District Strategy.

Area of Focus 1: Communities and Patients

Decreased smoking, risky alcohol consumption and obesity in children and adults

Area of Focus 3: Clinical Networks and Services

Patients have brief checks, screening and interventions during their visits (which may include blood pressure, smoking, alcohol, weight, falls risks, immunisation, diabetes, renal, domestic violence and other risk factors)

The SESLHD Healthcare Services Plan 2012-2017 provides the direction for the development of our services and programs to ensure they remain focused on addressing the health needs of the community.

3 This Strategic plan for the prevention of

smoking and harm from smoking2014-2017 will contribute to the following:

1.3.d Develop, implement and evaluate a SESLHD tobacco control plan to drive an increase in smoking cessation and reduce uptake rates among SESLHD residents.

1.3.e Continue to monitor compliance with tobacco legislation (i.e. sales to minors, advertising and Smoke-Free Environment Act) to protect SESLHD residents from unnecessary exposure to tobacco smoke.

1.5.d Further develop, implement and evaluate effective and sustainable programs with and for Aboriginal people, including culturally appropriate and effective health promotion and primary care programs specifically targeting smoking cessation among pregnant women and other adults.


http://www.cancerplan.cancerinstitute.org.au/Download-the-cancer-plan.html




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Issues and actions related to smoking and the broader

harm from smoking extend beyond this Strategic Plan.

For example, there are important linkages to other

District Population Health and Clinical Service

strategies and plans, including:

Aboriginal Health Implementation Plan

Cancer Clinical Services Plan

Drug and Alcohol Operational Plan

Multicultural Health Service Strategic Plan

Population Health Plan

Surgical Services Plan

Youth Health Implementation Plan

Creating connection to these other District plans

through cross-representation on relevant

committees, advocacy for the inclusion of tobacco

actions in future plans and direct communication

strategies with relevant stakeholders will all be

important aspects of this Plan’s effective delivery.

2.3 Our local plan

Developing the Plan

A broad consultation process was undertaken to

develop this Plan. This initially included a small

working group of representatives of the Planning and

Population Health, Ambulatory and Primary Health

Care Directorates and Mental Health Service. A

broader consultation process was then undertaken

with a range of key stakeholders (see Appendix B).

Local opportunities for future action were mapped

against the NSW Tobacco Strategy 2012-2017, as

shown in Appendix A.

In Section 3, these concepts have been expanded to

include their rationale followed by a snapshot of

activity at State level. The focus for action within

SESLHD - and a snapshot of local actions – is then

described within each area. In Section 4 – the

Implementation Plan - the practical implementation of

these concepts within SESLHD is expanded further.

Governance Delivery of this Plan will be coordinated by the SESLHD

Planning and Population Health Directorate.

A Tobacco Plan Implementation Group will be formed

to support this process. This group will be made up of

key stakeholders and those responsible for the

delivery of the actions described herein; where

appropriate, this may include external partners. The

group will meet three times each year with a focus on

strategic oversight and tracking performance.

A reporting framework and timetable will be

established by this group, including annual progress

reports to the District Executive Team, District Clinical

and Quality Council and Board, with additional interim

progress reports to be tabled throughout the year

within the Implementation Group itself.

Appropriate communication strategies will be

developed to ensure the engagement of and regular

contact with other key stakeholders.

Partnerships The development of effective partnerships will be

essential to the delivery of this plan. This will include

but not be limited to the following.

Within Local Health District: External Partners:

Planning and Population

Health Directorate

Ambulatory and Primary

Health Care Directorate

A range of clinical,

community and allied

and health services.

Smoke-Free Health Facilities Steering Committee

Primary Care

GPs, Practice Nurses

NGOs

Aboriginal

Organisations

Local Governments

Centre for

Population Health

(NSW Health)

Cancer Institute

Community stakeholders

Building effective and respectful partnerships with

local Aboriginal organisations and communities to plan

and deliver appropriate prevention programs will be

particularly important. The Planning and Population

Health Directorate and Aboriginal Health Unit will

establish a process for communication, consultation,

engagement and involvement in Aboriginal Health

projects related to this plan. Local Aboriginal Elders,

communities and organisations will be engaged and an

ongoing process of consultation and feedback relating

to the scope of this plan will be undertaken.

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Box 1: NSW Smoking Cessation Services

The Cancer Institute NSW provides smoking cessation support via the iCanQuit website

www.icanquit.com.au. The site provides advice and support including a quit guide, information about health, willpower and a range of additional resources. The stories and experiences of others are provided, along with links to services including the Quitline telephone service.

Quitline provides a free, confidential and individually-tailored service to assist the quitting

process. Smokers can access this telephone service by calling 13 7848 (13 QUIT) from anywhere in Australia.

Quitline advisors can provide advice about preparing to quit, quitting, avoiding slip ups and staying smoke free.

The NSW Quitline service also offers a free call-back service to provide smokers with extra support and increase the likelihood of successful quitting, and track progress for 12 months.

In addition to the English-speaking Quitline (13 7848), the Multilingual Quitline can

assist NSW callers who speak the following languages: Arabic, Chinese (Cantonese/Mandarin) and Vietnamese.

http://www.icanquit.com.au/

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Box 2: NSW Tobacco Retailing Laws

The Public Health (Tobacco) Act 2008 aims to reduce

the incidence of smoking and use of tobacco products

and non-tobacco smoking products, particularly by

young people. This is in recognition of the fact that

the consumption of those products adversely impacts

on people’s health and places a substantial burden

on health resources. The Public Health (Tobacco)

Regulation 2009 supports the Act. The legislation

includes provisions relating to regulating the

packaging, advertising and display of tobacco

products and non-tobacco smoking products,

prohibiting the supply of those products to children,

and reducing the exposure of children to second-

hand tobacco smoke.

Tobacco retailers operating in NSW must not engage

in tobacco retailing unless they have notified the

Director-General of the Ministry of Health that they

intend to engage in tobacco retailing (Retail

Notification Scheme). Retailers can register their

business details on the free on-line Government

Licensing Service.

The legislation also includes a negative licensing

scheme, such that retailers convicted of selling

cigarettes to children or breaching other regulations

on two or more occasions in any three year period

will automatically be prohibited from selling tobacco

for specified periods.

Public Health personnel monitor and promote the

compliance of retailers with this legislation. This

includes:

Retailer inspections related to points of sale

(tobacco advertising) and sales to minors

Maintenance of a tobacco retailer database

Issue of warning letters

Preparation for prosecutions and

consultation with the Legal and Regulatory

Services Branch at the NSW Ministry of

Health in relation to court appearance

procedures

Public promotion of successful prosecutions,

as a proactive means to improve compliance. Image used with permission: Cancer Council NSW

http://www.cancercouncil.com.au/77758/get-involved/campaign-

with-us/current-campaigns/selling-tobacco-harmful-not-helpful/

http://www.cancercouncil.com.au/77758/get-involved/campaign-with-us/current-campaigns/selling-tobacco-harmful-not-helpful/

http://www.cancercouncil.com.au/77758/get-involved/campaign-with-us/current-campaigns/selling-tobacco-harmful-not-helpful/

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3. The StrategyKey Action Area 1: Public Education and Community Programs Strengthen public education campaigns and community programs to prevent people starting to

smoke, particularly young people, and motivate smokers to quit

Why is this important?

There is strong evidence that public education campaigns are one of the most effective population strategies to reduce tobacco consumption. Public education campaigns help to personalise the health risks of smoking and increase people’s sense of urgency about quitting.

19

Since 2004, over 40 anti-tobacco campaigns have been implemented in NSW using a variety of styles of advertisements, to maximise personal relevance and believability among smokers to motivate quitting.

Actions under this priority area will build on the effective anti-tobacco public education campaign approaches that have been implemented over the past few years. Adult-targeted campaigns will continue to highlight the health consequences of smoking as the key motivator for smoking cessation.

By providing fresh insights and delivering messages that are personally relevant to smokers, campaigns will aim to limit self-exempting beliefs and focus on delivering a strong message to quit, and remain abstinent.

Smoking among certain high risk groups - people with mental illness, prisoners, Aboriginal communities and people from some CALD backgrounds - have shown smaller declines in tobacco use in response to Government anti-smoking messages. Development, implementation and evaluation of new campaigns to highlight the danger of tobacco use among these groups is required.

Effective youth smoking prevention requires a comprehensive approach. A sustained and integrated effort is required because short-term or limited focus interventions targeting young people are unlikely to have lasting results.

16

Critical to these efforts are population health measures to denormalise smoking and public education campaigns to encourage adult smokers to quit.

What will happen across NSW?

The NSW Government (notably the NSW Ministry of Health and the Cancer Institute NSW) will lead action across the State including:

Build on a range of mass media campaigns.

Develop innovative approaches to online advertising and social media strategies.

Develop partnerships to extend the reach and impact of campaigns.

Conduct education campaigns about the risks of second-hand smoke, especially for children.

Develop campaigns for Aboriginal people who smoke.

Build on curriculum strategies regarding the risks of tobacco.

Ensure that information about the health risks of tobacco is available to young people attending youth centres and tertiary education (eg TAFEs, universities, colleges).

What will we do in SESLHD?

The District’s focus will be on:

Providing appropriate support for state-wide campaigns, such as the dissemination of campaign messages and materials to/through relevant health services, partner agencies and community networks.

Identifying opportunities to incorporate the messages and resources from state-wide campaigns into local programs (e.g. the District’s Smoke-free Health Care Program) to extend the reach and impact of both.

Increasing public education regarding relevant legislation, including but not limited to the promotion of successful prosecutions for non-compliance.

Priority populations

Focusing on groups at highest risk a) local Aboriginal communities, b) people with a mental illness and/or drug and alcohol dependencies, c) people living with HIV, d) people from some CALD communities e) young people

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Key Action Area 2: Cessation Services Continue to provide evidence-based cessation services to support smokers to quit.


Cessation support services compliment anti-tobacco public education campaign strategies by helping individual smokers to quit. A range of programs are available including NSW Quitline, online services, specialised cessation services, brief interventions provided by health professionals and workplace programs (see Box 1).

An emphasis of SESLHD actions is to increase the proportion of smokers who access the Quitline and for additional strategies to increase smokers’ confidence in their ability to quit.

Other actions for this priority area focus on enhancing the quality and effectiveness of the Quitline telephone and online services and on better integrating referral pathways to and from Quitline.

There is also a need to increase smokers' awareness and understanding of pharmacotherapies (eg Nicotine Replacement Therapy, NRT), particularly for highly dependent smokers. Evidence suggests that there are considerable benefits in increasing the number of brief interventions provided by General Practice and other health professional groups.

People with severe mental illness often have the same desire to quit smoking as other smokers, and can perhaps benefit more from evidence-based cessation interventions. A range of strategies is underway and planned across SESLHD Mental Health Services, including:

Smoking cessation support, including NRT, individual strategies and healthy lifestyle support.

Bondi Early Psychosis Programme, which includes a lifestyle intervention program "Keeping the Body in Mind", involving routine screening, cessation counselling and NRT provision.

Linking physical and mental health care, a state-wide initiative that prioritises provision of appropriate support and attention to quitting smoking.

Research commissioned by the Cancer Institute NSW revealed that the average number of quit attempts is 5.2 and the top two motivators for quitting are health

or fitness (81%) and cost (38%).



Coordinate, deliver and promote State-wide cessation services such as the iCanQuit website, NSW Quitline and Multilingual Quitline (see Box 1).

Provide training in best practice smoking cessation for a range of health professionals, including Aboriginal Health Workers and organisations.

Promote cessation services and increase referrals of people from high risk groups into cessation services

Improve the cultural relevance and quality of cessation services.

Build partnerships, governance, evidence and coordination for better Aboriginal programs.

Review and fully implement The NSW Health Smoke-free Workplace Policy in mental health and drug and alcohol facilities.

Advocate to General Practice and other professional groups the capacity for, and benefit of, cessation for people with common mental health problems.



Promoting and seeking to maximise referral into existing state-wide cessation services such as the iCanQuit website, the NSW Quitline and the Multilingual Quitline, through a variety of strategies, including referrals via existing local programs such as Smoke-free Healthcare Program and through partnerships with local organisations.

Identifying appropriate and feasible opportunities to implement more comprehensive smoking cessation interventions into routine practice of relevant services and organisations.


Maximising opportunities for referral into and delivery of cessation services/ interventions to groups with the highest prevalence of smoking, such as Aboriginal people, low socio-economic groups (including unemployed & homeless), people with a mental illness and/or drug and alcohol dependencies, people living with HIV and people from CALD communities.

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Key Action Area 3: Tobacco Advertising and Promotion Eliminate the advertising and promotion of tobacco products and restrict the availability and

supply of tobacco, especially to children.


Research suggests that displays of tobacco can influence children’s perceptions about the availability and accessibility of cigarettes in their community.

33 In

addition, tobacco displays have been found to make it harder for intending quitters to quit smoking.

34

Tobacco sponsorship, advertising and point of sale promotions have been restricted and will be progressively phased out over time.

The commencement of the Public Health (Tobacco) Act 2008 on 1 July 2009 brought into effect significant reforms in NSW to restrict the availability and supply of tobacco, especially to children and young people.

More can be done to further reduce the advertising and promotion of tobacco products.

The Australian Government has significant responsibilities in this area, including the regulation of tobacco products through trade practices legislation, the prohibition of sponsorship and advertising of tobacco products and the regulation of tobacco packaging, including cigarette contents and graphic health warnings on cigarette packs.

NSW will build on the Australian Government commitment to bring restrictions on tobacco advertising and sales on the internet into line with restrictions on other media and physical points of sale by strengthening state legislation to expressly prohibit the sale of tobacco on the internet.



Monitor and enforce the requirements of the Public Health (Tobacco) Act 2008.

Support implementation and increase compliance through strategies including the Retailer Notification Scheme, retailer education, publication of successful prosecutions, and Authorised Inspector training.

Address other relevant issues including plain packaging, tobacco vending machines, sales on NSW Government premises, internet tobacco sales and transparent communication with tobacco industry.

Advocate at the national level for bans on products targeting young people (e.g. fruit and confectionary flavoured tobacco).

Review guidelines for Authorised Inspectors for the sales to minors program.



Enforcing legislation through compliance monitoring, retailer inspections related to points of sale (advertising) and sales to minors, maintenance of a tobacco retailer database, issue of warning letters, and preparation for prosecutions.

Promote awareness among tobacco retailers about regulations and consequences of breaches


Focusing on opportunities to maximise, and publicise, enforcement of legislation where compliance would particularly benefit high risk groups, e.g. targeting retailers servicing CALD communities with a high smoking prevalence

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Key Action Area 4: Second-hand Smoke Reduce exposure to second-hand smoke in workplaces, public places and other settings


Protecting the public from second hand smoke is a priority for action in NSW, given that smoke-free environments:

Have been effective in reducing non-smokers’ exposure to second-hand smoke

Arguably contribute to the denormalisation of tobacco smoking

Reduce opportunities for smoking so reduce the consumption of cigarettes

Support smokers in their efforts to quit

Legislation has been introduced in NSW to protect the public from second-hand smoke:

Cars: Since July 2009, smoking in cars with a child under 16 years is an offence

Enclosed public spaces: The Smoke-free Environment Act 2000, Smoke-free Environment Amendment Regulation 2009 and the Smoke-free Environment Regulation 2007 ban smoking in enclosed public places.

Outdoor public places: Amendments to the Smoke-

free Environment Act 2000 made a number of outdoor public places smoke-free since 7 January 2013: near access to public buildings; near children’s play equipment; within swimming pool complexes; at sports grounds and during organised sporting events; on railway platforms, light rail stops and stations, bus stops, taxi ranks and ferry wharves. From 2015, smoking will be banned in commercial outdoor dining areas

In 2012 an estimated 4.7% of households and 7.0% of cars of SESLHD residents were not smoke free.

4

Supporting our health services to provide a smoke-free environment for staff, patients and visitors, is an important priority for the District. Accordingly, the District has recently made changes to its Smoke-free Healthcare Program. The changes acknowledge that people continue to smoke on our hospital campuses despite the NSW Smoke Free Policy. A harm minimisation strategy (to protect all people who use the campus) to address this issue has been introduced via amendment to the District’s by-law. This allows a specified area on our public hospital campuses to be excluded from our smoke free policy. Under this program free NRT and other cessation services are available to staff and inpatients.


The NSW Government (notably the NSW Ministry of

Health and the Cancer Institute NSW) will lead action

across the State including:

Monitor and enforce the requirements of the Smoke-

Free Environment Act. Conduct a targeted

communications strategy to ensure compliance and

build the capacity of Authorised Inspectors to enforce

the legislation.

Review and fully implement The NSW Health Smoke-

free Workplace Policy, including an enforcement

regime.

Promote smoke-free policies in other settings.

Increase parental awareness (notably in high risk groups) of second-hand smoke risks.



Implementing changes to the District Smoke-free Health Care Program, placing a strong focus on protecting individuals from being exposed to second hand smoke (passive smoking).

Providing appropriate support to other settings introducing smoke-free policies.

Meeting the obligations determined by the NSW Ministry of Health regarding compliance with the Smoke-Free Environment Act, including investigation of complaints and enquiries.

Focusing on population groups at highest risk, including those with highest prevalence of smoking, and young people

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Support Strategy: Research, Monitoring, Evaluation & Reporting Strengthen research, monitoring, evaluation and reporting of programs for tobacco control.


Tobacco control is based on a strong body of Australian and international research that has amassed since the 1950s and continues to develop.

Policies and interventions in tobacco control in NSW are underpinned by a strong research, monitoring and evaluation capacity.

NSW has developed a comprehensive monitoring and surveillance system for tobacco, which enables us to monitor population trends over time and evaluate our success in achieving our targets.

The commitment to reduce smoking and the harm from smoking is clearly outlined at the State level, through NSW 2021

30 (the NSW State

Plan) and the NSW Tobacco Strategy 2012-2017.4 The State level targets

are as follows:

1. Reduce smoking rates by 3% by 2015 for non-Aboriginal people and by 4% by 2015 for Aboriginal people

4,30

2. Reduce the rate of smoking by pregnant Aboriginal women by 2% per year and reduce the rate of smoking by pregnant non-Aboriginal women by 0.5% per year

4,30

3. Reduce the proportion of students who have ever smoked tobacco by 1% per year to 2017

4

4. Increase the proportion of adults living in smoke-free households by 0.5% per year to 2017

4



Explore methods to improve data collection.

Implement research programs to better understand issues such as smoking initiation among Aboriginal children and effectiveness of public education campaigns, cessation services and regulatory strategies.

Develop dissemination strategies and ensure the effective translation of research into policy and practice, notably in priority areas.

Strengthen the evidence around effective interventions to reduce smoking by Aboriginal people, people from CALD communities, low socio-economic groups and other groups with high smoking prevalence.



Ensuring that all programs described in this plan have appropriate evaluation design, including indicators that are routinely tracked and reported within the team and more broadly within the District’s governance structures.

Ensuring that the results of program evaluation are communicated effectively to project partners and the community.

Contributing to the evidence base by disseminating the results of SESLHD program evaluations and participating in broader research strategies as appropriate.

A reporting framework and timetable for the Plan will be established by a Tobacco Plan Implementation Group. This will include:

o Annual progress reports to the District Executive Team, District Clinical and Quality Council and the Board

o Interim progress reports to be tabled throughout the year within the Implementation Group itself.

These progress reports will incorporate the routine reports already required to the NSW Ministry of Health (Health Protection NSW) regarding regulatory activities. A set of performance indicators – at the outcome, impact and process levels – will be monitored to assess progress against the objectives and actions outlined in the Plan, as shown in Table 1 below.

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Table 1: Performance Indicators

Outcome Indicators

Population health outcomes

Age standardised tobacco-attributable hospitalisation rates among SESLHD residents

% SESLHD residents who are current smokers (16 yrs and over)

% SESLHD Aboriginal residents who are current smokers (16 yrs and over)

Public Education and Community Programs

Uptake of cessation services such as Quitline

Cessation Services

% SESLHD patients/ clients whose smoking status is assessed

% SESLHD patients/ clients identified as smokers offered NRT and supported to quit

% SESLHD Aboriginal women giving birth who smoke during pregnancy

Tobacco Advertising and Promotion

Existing relevant indicators related to regulatory activities (e.g. relating to inspections and prosecutions)

Smoke-free Environments

Indicators will be developed for:

Outcomes of the Smoke-free Health Care Program

Outcomes of programs to implement smoke-free policies in other settings

Relevant regulatory activities

Impact indicators

Impact level indicators will provide additional insight to the ongoing delivery of the Plan, e.g.:

Campaign evaluation (at the NSW level but accessing local data where possible) related to engagement, awareness and attitudes

Achievement of objectives of the Smoke-free

Health Care Program

Achievement of objectives of other relevant initiatives, such as working with NGOs

Indicators regarding regulatory activities such as prosecutions

Process Indicators

Local data will be collected to describe the activities that have been undertaken to deliver this plan.

Additional specific indicators

In late 2013, the District’s Board approved indicators for multicultural health including a commitment to action regarding smoking. Additional consultation and planning is underway, and relevant actions and indicators will be included in a multicultural health plan.

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4. Implementation Plan

Action Area 1: Public Education and Community Programs

We will: Within SESLHD health services↓ Wider community ↓ Focus on priority populations

1.1 Provide appropriate support for state-wide campaigns, such as the dissemination of campaign messages and materials to/through relevant health services, partner agencies and community networks.

Disseminate and promote state-wide campaigns through District services, notably those with access to populations at highest risk, including:

o Drug and Alcohol Services o Mental Health Services o HARP Unit, HIV and Sexual Health

Services o Community and Allied Health Services o Respiratory and Chronic Care services o Primary Health Care o Multicultural Health Service o Aboriginal Health Unit o Women and Children’s Services o Other relevant services

Who: Planning and Population Health Directorate (DPPH) and all relevant services listed.

Disseminate and promote state-wide campaigns to the community via:

o Local media o Primary Health Care o Local government o Relevant community

organisations

Who: Directorate of Planning and Population Health

Focus on groups at highest risk e.g. groups with highest prevalence of smoking, such as Aboriginal communities, people with a mental illness and/or drug and alcohol dependencies, people living with HIV and people from some CALD communities, low socioeconomic groups

Disseminate and promote local and state-wide campaigns to groups with a high smoking prevalence:

Relevant community organisations, that provide access to specific population groups

CALD populations with high smoking prevalence: use ethnic media, ethnic medical professionals, local community organisations, interpreter service, and particular services targeting CALD communities with a high smoking prevalence.

Who: Directorate of Planning and Population Health, Directorate of Ambulatory and Primary Health Care.

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We will: Within SESLHD health services↓ Wider community ↓ Focus on priority populations

1.2 Identify opportunities to incorporate the messages and resources from state-wide campaigns into local programs to extend the reach and impact of both.

Incorporate the messages and resources from state-wide campaigns into the SESLHD Smoke-free Healthcare Program.

Who: SESLHD Smoke-free Health Facilities Steering Committee.

Incorporate campaign messages and resources into any other relevant local health service projects, including those with a broader focus than smoking.

Who: Directorate of Planning and Population Health to identify and coordinate with project teams.

Incorporate messages and resources from state-wide campaigns into any other relevant community-based local projects, including those with a broader focus than smoking.

Who: Directorate of Planning and Population Health to identify and coordinate with project teams.

Build effective and respectful partnerships with local Aboriginal organisations and communities to plan and deliver appropriate prevention programs.

Who: Directorate of Ambulatory and Primary Health Care and other relevant services

Explore feasibility of developing, implementing and evaluating a community tobacco intervention program with Arabic-speaking community organisations and health facilities who serve Arabic-speaking people.


Ensure an appropriate focus on young people, with intervention delivery via settings and through communication channels which will effectively reach young people, including:

o Ensure that information about the health risks of tobacco is available to young people, notably through partnerships with TAFE and in other relevant settings.

o Provide appropriate support for the introduction of smoke-free policies in settings frequented by young people (e.g. TAFE) (see Key Action Area 4).

o Explore other appropriate actions for relevant services, such as Youth Health


1.3 Increase public education regarding relevant legislation, including but not limited to the promotion of successful prosecutions for non-compliance.

Not Applicable Promote awareness among retailers of regulations and consequences of breaches of tobacco legislation (see Key Action Area 3).


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Key Action Area 2: Cessation Services

We will: Within SESLHD health services Wider community Focus on priority populations

2.1 Promote and seek to maximise referral into existing state-wide cessation services such as the iCanQuit website, the NSW Quitline and the Multilingual Quitline.

Promote and facilitate increased referrals to cessation services through District services, building upon current activities which include but are not limited to:

o Pre-admission clinics o Public oral health services

Who: Directorate of Planning and Population Health and relevant services.

Incorporate promotion of, and increased referrals to, cessation services within the SESLHD Smoke-free Healthcare Program.

Who: SESLHD Smoke-free Health Facilities Steering Committee.

Promote and facilitate increased referrals to cessation services across the community.


Maximise opportunities for referral into and delivery of cessation services/ interventions to groups with the highest prevalence of smoking, such as Aboriginal people, low socio-economic groups (including unemployed & homeless), people with a mental illness and/or drug and alcohol dependencies, people living with HIV and people from CALD communities

Identify SESLHD services and other local organisations that have contact with high risk groups, and help build their capacity to sustainably deliver best practice brief interventions for cessation. These may include but are not limited to:

o Drug and Alcohol Services (e.g. High risk clients, Cannabis Clinic)

o Mental Health Services o HARP Unit, HIV and sexual health services o Multicultural Health Service o Aboriginal Health Unit o Services for pregnant women (e.g. Maternal

Health), particularly those who provide services to high risk groups such as Aboriginal women

Who: Directorate of Planning and Population Health to coordinate.

Identify opportunities to increase referrals to cessation services through other relevant local programs/projects that provide access to populations with high smoking prevalence, even if smoking is not the primary focus of that project.

Who: Directorate of Planning and Population Health to identify

2.2 Identify appropriate and feasible opportunities to implement more comprehensive smoking cessation interventions into routine practice of relevant services and organisations.

Build upon and evaluate cessation intervention activities already undertaken, which include but are not limited to:

o Cardiovascular rehabilitation and community-based

clinics (including focus on Aboriginal communities)

o Drug and alcohol services including outpatient

counselling, specialist support and quit smoking

clinic

o Mental health services, e.g. Bondi Early Psychosis

Program

o Nurse initiated NRT for inpatients o Supportive nicotine withdrawal management o Wellness and fitness programs o Sensory Modulation

Who: Relevant services

Work with NGO programs to explore the feasibility of including sustainable best practice brief interventions for cessation as part of their funding agreements.

Who: Planning and Population Health Directorate, notably the Health Promotion Service.

Engage other relevant organisations to explore the feasibility of developing and implementing best practice brief interventions.

Who: Directorate of Planning and Population Health.

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Explore the feasibility and appropriateness of implementing more comprehensive smoking cessation interventions (such as accredited staff training and brief intervention protocols) in relevant clinical services.

Who: Relevant health services.

Promote and ensure consistency and compliance of SESLHD clinical practice with relevant policies, protocols and guidelines related to smoking (e.g. the Australian and New Zealand College of Anaesthetists Guidelines related to smoking before surgery).

Explore opportunities to expand evidence-based interventions in:

o Drug and Alcohol Services (see pending D&A Operational Plan 2013-15)

o HARP, HIV and sexual health services o Youth Services

Who: Relevant health services.

and coordinate with project teams.

Identify opportunities to build the capacity of SESLHD and other local Aboriginal Health Workers and organisations to routinely deliver brief interventions for cessation to their clients and communities.

Who: Directorate of Planning and Population Health and other relevant services

Focus on the Quit for New Life program as an opportunity to deliver a relevant and appropriate program, and to build partnerships and respect for future program planning and delivery. Implement the program in two Aboriginal Maternal and Infant Health Services and Child and Family Health Services:

o Malabar Community Midwifery Link Service o Narrangy-Booris Maternal, Child and Family Health

Who: Directorate of Planning and Population Health and other relevant clinical services.

Develop local actions targeting people from CALD communities with high smoking prevalence.

Who: Directorate of Planning and Population Health and other relevant services

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Key Action Area 3: Tobacco Advertising and Promotion

We will: Wider community Focus on priority population Explore

3.1 Enforce legislation through compliance monitoring, retailer inspections related to points of sale (advertising) and sales to minors, maintenance of a tobacco retailer database, issue of warning letters, and preparation for prosecutions.

Undertake compliance monitoring and enforcement activities as required by the NSW Ministry of Health, such as:

o Retailer inspections related to points of sale (tobacco advertising) o Issuance of warning letters o Preparation for prosecutions and consultation with the Legal and

Regulatory Services Branch at the NSW Ministry of Health in relation to court appearance procedures.


Focus on opportunities to maximise, and publicise, enforcement of legislation where compliance would particularly benefit high risk groups, e.g. targeting retailers servicing CALD communities with a high smoking prevalence

Undertake compliance monitoring and enforcement activities related to sales to minors as required by the NSW Ministry of Health, including:

o Retailer inspections o Issuance of warning letters o Preparation for prosecutions and consultation with the Legal and

Regulatory Services Branch at the NSW Ministry of Health in relation to court appearance procedures.


3.2 Promote awareness among tobacco retailers about regulations and consequences of breaches

Increase public education regarding relevant legislation, including but not limited to the promotion of successful prosecutions for non-compliance (see Key Action Area 1).


Explore opportunities for more pro-active contact with and engagement of tobacco retailers to increase legislative compliance.

Who: Directorate of Planning and Population Health.

Explore a specific project targeting retailers servicing CALD communities with a high smoking prevalence


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Key Action Area 4: Second-hand Smoke


4.1 Implement changes to the SESLHD Smoke-free Healthcare Program.

Implement program strategies, including:

o Implement by-law o Monitor compliance with by-law o Identify designated smoking areas on health campuses

Who: Smoke-free Health Facilities Steering Committee with support from relevant services and teams.

Conduct an awareness campaign for patients and staff, including communication of rationale for provision of designated smoking areas to build understanding of and support for the program.

Who: Smoke-free Health Facilities Steering Committee with support from relevant services and teams.

Facilitate access to smoking cessation services by patients and staff, including:

o Brief tobacco cessation training for relevant staff o NRT for staff and inpatients, including a review and follow-up

process (see Key Action Area 2)

Who: Facilities across the District.

Liaise with local General Practitioner (GP) networks to promote the Smoke-free Healthcare Program and advise their patients prior to admission to hospital.

Who: Smoke-free Health Facilities Steering Committee.

Explore the feasibility including NGOs administered by the District in the Smoke-free Health Care Program.


Focus on groups at highest risk, including groups with highest prevalence of smoking and young people

Ensure priority implementation in services for high risk groups.

Who: Smoke-free Health Facilities Steering

Committee, relevant services.

Ensure relevance to and effectiveness with Aboriginal people by:

o Promoting to Aboriginal staff o Promoting through Aboriginal

services, Aboriginal Medical Service and other Aboriginal community controlled organisations to inform their clients prior to referrals

o Providing free NRT to Aboriginal staff

Who: Smoke-free Health Facilities Steering Committee, Aboriginal Health

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4.2 Provide appropriate support to other settings introducing smoke-free policies.

Not Applicable Engage the District’s NGO program and other interested community organisations (e.g. TAFE) to extend or adapt the SESLHD Smoke-free Healthcare Program to their settings Review and consolidate current strategies, including:

o Develop new District Smoke-free Implementation Procedure o Systems to prioritise provision of supports o Develop and trial outcomes for selected initiatives


Pilot a tobacco control project in one TAFE college and advocate for adoption of smoke-free policy in all TAFE colleges (see Key Action Area 1)

Who: Directorate of Planning and Population

Health

4.3 Meet the obligations determined by the NSW Ministry of Health regarding compliance with the Smoke-Free Environment Act, including investigation of complaints and enquiries.

Not Applicable Respond to and investigate complaints regarding compliance of enclosed public spaces with the Smoke-free Environment Act

Who: Directorate of Planning and Population Health, notably Public Health Unit)

Monitor compliance with outdoor smoking legislation in accordance with performance targets set by the NSW Ministry of Health, at the following locations: o Within 10m of children’s play equipment in outdoor public spaces o Within swimming pool complexes o In spectator areas at sports grounds or other recreational areas

during organised sporting events o On railway platforms, light rail stops, light rail stations, bus stops,

taxi ranks and ferry wharves o Within 4m of pedestrian access point to a public building o From 2015, in commercial outdoor dining areas


Not Applicable

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5. References 1. Australian Institute of Health and Welfare (2012). Australia’s Health 2012. Canberra: AIHW

2. South Eastern Sydney Local Health District (2012). South Eastern Sydney LHD Strategy 2012-2017. Sydney: SESLHD.

3. South Eastern Sydney Local Health District (2012). SESLHD Healthcare Services Plan 2012-2017. Sydney: SESLHD.

4. NSW Health (2012). NSW Tobacco Strategy 2012-2017. SHPN (CHA) 100550, ISBN 978 1 74187 571 3. Sydney: NSW Ministry of Health.

5. Centre for Epidemiology and Evidence. Health Statistics NSW. Sydney: NSW Ministry of Health. http://www.healthstats.nsw.gov.au/

6. Australian Institute of Health and Welfare (2011). National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW.

7. Winstanley M WS, Walker N (1995). Tobacco in Australia: Facts & Issues. Melbourne: Quit Victoria.

8. Lantz PM, Jacobson PD, Warner KE, et al (2000). Investing in youth tobacco control: a review of smoking prevention and control strategies. Tob Control. 2000 Mar;9(1):47-63. PubMed PMID: 10691758. Pubmed Central PMCID: 1748282.

9. Wiencke JK, Thurston SW, Kelsey KT, et al (1999). Early age at smoking initiation and tobacco carcinogen DNA damage in the lung. J Natl Cancer Inst. 1999 Apr 7;91(7):614-9. PubMed PMID: 10203280.

10. NSW Department of Health (2008). Protecting Children from Tobacco. A NSW Government Discussion Paper on the Next Steps to Reduce Tobacco-Related Harm. Sydney: NSW Health.

11. Intergovernmental Committee on Drugs (2012). National Tobacco Strategy 2012-2018. Canberra: Commonwealth of Australia.

12. US Department of Health and Human Services (2004). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

13. NSW Ministry of Health (2007). Smoking and Pregnancy. Sydney: NSW Health.

14. Collins DJ and Lapsley HM (2010). The Social Costs of Smoking in NSW in 2006/07 and the Social Benefits of Public Policy Measures to Reduce Smoking Prevalence. Sydney: NSW Department of Health.

15. US Department of Health and Human Services (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

16. Scollo M and Winstanley M. Tobacco in Australia: Facts & Issues (3rd edition). Melbourne: Cancer Council Victoria; 2008.

17. NSW Department of Health (2008). Protecting Children from Tobacco: A NSW Government Discussion Paper on the Next Steps to Reduce Tobacco-Related Harm. Sydney: NSW Health.

18. Vos T, Barker B, Begg S, Stanley L, Lopez AD (2009). Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. Int J Epidemiol. 2009 Apr;38(2):470-7. PubMed PMID: 19047078.

19. National Preventative Health Taskforce (2009). Australia: The Healthiest Country by 2020. Canberra: Commonwealth of Australia.

20. Cultural and Indigenous Research Centre Australia (2008). Development of anti-smoking campaigns for Indigenous smokers - A report for the Cancer Institute NSW (Unpublished).




http://www.healthstats.nsw.gov.au/

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21. South Eastern Sydney Local Health District (2012). Our Community, Our Services..... a snapshot. Sydney: SESLHD.

22. Australian Bureau of Statistics (2007). National Survey of Mental Health and Wellbeing. Catalogue 4326.0. Canberra: Commonwealth of Australia. Available at: www.abs.gov.au/ausstats/[email protected]/mf/4326.0, Accessed 29 April 2014.

23. Reichler H BA, Lewin T and Carr V (2001). Smoking among in-patients with drug-related problems in an Australian psychiatric hospital. Drug Alcohol Rev. 2001;20(2):231-7.

24. SANE Australia (2012). Smoking and mental illness: A guide for health professionals. Canberra: Australian Government: Department of Health and Ageing.

25. Zwar N RR, Borland R, Peters M, et al (2011). Supporting smoking cessation: a guide for health professionals. Melbourne: The Royal Australian College of General Practitioners.

26. Baker A, Ivers RG, Bowman J, et al (2006). Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention. Drug Alcohol Rev. 2006 Jan;25(1):85-96. PubMed PMID: 16492581.

27. Prochaska JJ, Delucchi K, Hall SM (2004). A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. J Consult Clin Psychol. 2004 Dec;72(6):1144-56. PubMed PMID: 15612860.

28. NSW MInistry of Health (2012). NSW HIV Strategy 2012-2015. North Sydney: NSW Ministry of Health.

29 NSW Ministry of Health (2012). NSW Health Policy and Implementation Plan for Healthy Culturally Diverse Communities 2012-2016. Sydney: NSW Health.

30. NSW Government (2011). NSW 2021: A Plan to Make NSW Number One. Sydney: NSW Government.

31. Cancer Institute NSW (2010). NSW Cancer Plan 2011-2015: Lessening the Impact of Cancer in NSW. Sydney: Cancer Institute NSW.

32. Population and Public Health Division (2012). Population Health Priorities for NSW: 2012–2017. Sydney: NSW Ministry of Health.

33. Wakefield M, Germain D, Durkin S, Henriksen L (2006). An experimental study of effects on schoolchildren of exposure to point-of-sale cigarette advertising and pack displays. Health Educ Res. 2006 Jun;21(3):338-47. PubMed PMID: 16702196.

34. Wakefield M, Germain D, Henriksen L (2008). The effect of retail cigarette pack displays on impulse purchase. Addiction 2008 Feb;103(2):322-8. PubMed PMID: 18042190.

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Appendix A: Examples of State & District Strategies & Plans Supporting Vulnerable Populations

Population NSW SESLHD

Aboriginal Health

Aboriginal Chronic Conditions Area Health Service Standards (NSW) http://www.health.nsw.gov.au/pubs/2005/accahss_report.html

NSW Aboriginal Health Plan 2013-2023 http://www.health.nsw.gov.au/policies/pd/2012/PD2012_066.html

SESLHD Aboriginal Health Implementation Plan

Aged Prevention of Falls and Harm from Falls among Older People: 2011-2015 http://www.health.nsw.gov.au/policies/pd/2011/PD2011_029.html

Dementia Services Framework 2010-2015 http://www.health.nsw.gov.au/policies/gl/2011/GL2011_004.html

Implementation Plan for NSW Dementia Services Framework 2010-2015 www.health.nsw.gov.au/resources/policies/pdf/cd_dementia_services.pdf

SESLHD Falls Prevention Implementation Plan

Carers NSW Carers (Recognition) Act 2010 Implementation Plan 2011 – 2014

www.adhc.nsw.gov.au/individuals/caring_for_someone/nsw_carers_recognition_act_2010

NSW Carers Action Plan 2007 - 2012 NSW Carers Action Plan 2007 - 2012

Walking with Carers in NSW http://www.health.nsw.gov.au/pubs/2012/pdf/walking_with_carers_innsw.pdf

SESLHD Carer Action Plan, 2011-2012

http://seslhnweb/Carer_Support_Services/Local_Carer_Program.asp

Disability A NSW National Disability Strategy Implementation Plan (NSW Government’s initial priorities and actions) is under development.www.adhc.nsw.gov.au/about_us/strategies/national_disability_strategy

Service Framework: to improve the health care of people with intellectual disability www.health.nsw.gov.au/pubs/2012/service_framework_2012.html

Access to therapy services for people with an intellectual disability and their families in NSW www.health.nsw.gov.au/pubs/2010/therapy_mou.html

SESLHD Disability Action Plan 2010-2015

Homeless

NSW Homelessness Action Plan 2009-2014

http://www.housing.nsw.gov.au/NR/rdonlyres/070B5937-55E1-4948-A98F-ABB9774EB420/0/ActionPlan2.pdf

Regional Homelessness Action Plan 2010-2014 - Coastal Sydney (2010) http://www.seslhd.health.nsw.gov.au/homelessness_health/PolicyContext.asp

Multicultural Health

NSW Health Policy and Implementation Plan for Healthy Culturally Diverse Communities 2012-2016.

http://www.health.nsw.gov.au/policies/pd/2012/PD2012_020.html

Multicultural Health Service Strategic Plan (being developed)

Refugee Health

Refugee Health Plan 2011-2016 http://www.health.nsw.gov.au/policies/pd/2011/PD2011_014.html

Asylum Seekers - Medicare Ineligible - Provision of Specified Public Health Services http://www.health.nsw.gov.au/policies/pd/2009/pdf/PD2009_068.pdf

SESLHD Refugee Health Implementation Plan (under development)

http://www.sesiahs.health.nsw.gov.au/multicultural_health_service/

Youth Health Youth Health Policy 2011-2016: Healthy bodies, healthy minds, vibrant futures http://www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_073.pdf

Youth Health

http://www.seslhd.health.nsw.gov.au/Youth_Health/default.asp

Mental Health

The NSW State Health Plan identifies mental health and drug and alcohol as priority areas.

http://www.health.nsw.gov.au/mhdao/Pages/key-plans-mh.aspx

SESLHD Mental Health Clinical Services Plan 2013-2018

http://www.seslhd.health.nsw.gov.au/HealthPlans/

http://www.health.nsw.gov.au/pubs/2005/accahss_report.html



http://www.health.nsw.gov.au/policies/gl/2011/GL2011_004.html

http://www.health.nsw.gov.au/resources/policies/pdf/cd_dementia_services.pdf

http://www.adhc.nsw.gov.au/individuals/caring_for_someone/nsw_carers_recognition_act_2010

http://www.adhc.nsw.gov.au/individuals/caring_for_someone/nsw_carers_recognition_act_2010

http://search-au.funnelback.com/search/click.cgi?rank=3&collection=nsw_health&url=http%3A%2F%2Fwww0.health.nsw.gov.au%2Ftopics%2Fcarers_plan.asp&index_url=http%3A%2F%2Fwww0.health.nsw.gov.au%2Ftopics%2Fcarers_plan.asp&auth=zIgDMQJVys33OZJR2QFe2g&query=carer&profile=_default

http://search-au.funnelback.com/search/click.cgi?rank=3&collection=nsw_health&url=http%3A%2F%2Fwww0.health.nsw.gov.au%2Ftopics%2Fcarers_plan.asp&index_url=http%3A%2F%2Fwww0.health.nsw.gov.au%2Ftopics%2Fcarers_plan.asp&auth=zIgDMQJVys33OZJR2QFe2g&query=carer&profile=_default

http://www.health.nsw.gov.au/pubs/2012/pdf/walking_with_carers_innsw.pdf




http://www.adhc.nsw.gov.au/about_us/strategies/national_disability_strategy

http://www.adhc.nsw.gov.au/about_us/strategies/national_disability_strategy

http://www0.health.nsw.gov.au/pubs/2012/service_framework_2012.html

http://www0.health.nsw.gov.au/pubs/2012/service_framework_2012.html

http://www.health.nsw.gov.au/pubs/2012/service_framework_2012.html

http://www0.health.nsw.gov.au/pubs/2010/therapy_mou.html

http://www0.health.nsw.gov.au/pubs/2010/therapy_mou.html

http://www.health.nsw.gov.au/pubs/2010/therapy_mou.html



http://www.seslhd.health.nsw.gov.au/homelessness_health/PolicyContext.asp





http://www.health.nsw.gov.au/policies/pd/2009/pdf/PD2009_068.pdf




http://www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_073.pdf



http://www.health.nsw.gov.au/mhdao/Pages/key-plans-mh.aspx



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Appendix B: Development of the Plan

This plan has been developed through a wide consultative process, driven primarily by those who will have the most

direct involvement in the implementation of the actions described herein (see below). The subsequent lists

acknowledge the contributions of a wider range of people who have given of their time and expertise to develop a

comprehensive plan to guide the work of tobacco control over the next 3 years.

Plan Contributors

Primary Contributors

Planning and Population Health Directorate Smoke-free Health Facilities Steering Committee

Ambulatory and Primary Health Care Directorate Mental Health Services

Additional Professional Consultation

SESLHD Facility and Service Clinical Councils SESLHD Governance Committees

District Clinical and Quality Council District Executive Team

Northern Hospital Network Clinical Council District Clinical and Quality Council

Mental Health Clinical Council Executive Directors of Nursing Meeting

Royal Hospital for Women Clinical Council District Allied Health Meeting

St George Hospital Clinical Council

The Sutherland Hospital Clinical Council Other Directorates

SESLHD Clinical Streams Clinical Governance

Aged Care and Rehabilitation Nursing and Midwifery

Ambulatory and Primary Health Care Workforce Services

Cancer Facilities within SESLHD Boundaries

Critical Care and Emergency Medicine War Memorial Hospital

Cardiac and Respiratory Calvary Health Care

Medicine

Mental Health Other

Surgical and Anaesthetics Cancer Institute NSW

Women’s and Children’s Health

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Appendix C: Aboriginal Health Impact Statement

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Checklist

DEVELOPMENT OF THE POLICY, PROGRAM OR STRATEGY

1. Has there been appropriate representation of Aboriginal stakeholders in the development of the policy,

program or strategy?

Yes

2. Have Aboriginal stakeholders been involved from the early stages of policy, program or strategy

development? Please provide a brief description

Discussions were held with SESLHD’s Manager, Aboriginal Health prior to the commencement of

the planning process for the Strategic Plan for the Prevention of Smoking and Harm from Smoking to

identify priority issues for Aboriginal people in the District. Since then advice has been sought from

the Manager as required. In addition, as part of the consultation process the draft Plan has been

provided to the Manager for broad distribution and comment.

Yes

3. Have consultation/negotiation processes occurred with Aboriginal stakeholders? Yes

4. Have these processes been effective? Explain

The input from the Manager, Aboriginal Health has been highly valued. The Manager has given a

broader perspective to the Plan in terms of examples of services, identification of Aboriginal people,

as well as highlighting some key documents. All suggestions have been incorporated into the Plan.

Yes

5. Have links been made with relevant existing mainstream and/or Aboriginal-specific policies, programs

and/or strategies? Explain

This Plan has been informed by a number of key documents informing population health policy,

including the NSW Aboriginal Health Plan 2013-2023, Aboriginal Chronic Conditions Area Health

Service Standards, National Aboriginal and Torres Strait Islander Health Plan 2013-2023, The Health

of Aboriginal People of NSW: Report of the Chief Health Officer and the SESLHD Aboriginal Health

Implementation Plan.

Yes

CONTENTS OF THE POLICY, PROGRAM OR STRATEGY

6. Does the policy, program or strategy clearly identify the effects it will have on Aboriginal health outcomes

and health services? Comments

This Plan acknowledges that the needs of Aboriginal people be considered, and recognises that

Aboriginal people are a priority population for population health services initiatives and programs in

the District. The Strategic Plan for the Prevention of Smoking and Harm from Smoking identifies

the need for health promotion and risk management initiatives for Aboriginal people, and outlines

priority initiatives to achieve this.

Yes

7. Have these effects been adequately addressed in the policy, program or strategy? Explain

Consideration of the needs of Aboriginal people, engagement of Aboriginal staff and community

members, the appropriateness of interventions, and better data and indicators to track progress are

described across the Plan. These include primary prevention strategies for Aboriginal people in

community settings, risk triage, and referral into prevention strategies as appropriate.

Examples of specific initiatives to address Aboriginal health outcomes in the Strategic Plan for the Prevention of Smoking and Harm from Smoking 2014-2019 include:

reduced smoking rates for Aboriginal people and reduced rate of smoking for pregnant Aboriginal women number of pregnant Aboriginal women who attend Quit for New Life Program referred to

Yes

http://feedproxy.google.com/~r/AustralianIndigenousHealthbulletin/~3/vv-wb4OTmjE/?utm_source=feedburner&utm_medium=email

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Quitline, are booked in for follow up smoking cessation care, and are provided with NRT.

8. Are the identified effects on Aboriginal health outcomes and health services sufficiently different for

Aboriginal people (compared to the general population) to warrant the development of a separate policy,

program or strategy? Explain

Initiatives for Aboriginal people have been included in the Plan as a whole to ensure that all aspects

of the Plan routinely and systematically consider the needs of Aboriginal people. This will ensure

access to the most appropriate prevention evidence, intervention tools, infrastructure support and

local resources. Underreporting of Aboriginality makes it difficult to measure the effectiveness of

health services and achieve equitable outcomes for Aboriginal people. Improved recording remains

a significant factor for improving equitable health outcomes for Aboriginal people.

Yes

IMPLEMENTATION AND EVALUATION OF THE POLICY, PROGRAM OR STRATEGY

9. Will implementation of the policy, program or strategy be supported by an adequate allocation of

resources specifically for its Aboriginal health aspects? Describe

One of the District’s key priorities is to adequately resource the health needs of Aboriginal people to

reduce inequities of health service access and outcomes. Implementation of actions outlined in this

Plan will be prioritised by the overarching committees responsible for implementation and

monitoring implementation. All actions which require additional resources will be carried out

subject to availability of funding provided by the District, State or Commonwealth.

Yes

10. Will the initiative build the capacity of Aboriginal people/organisations through participation? In what

way will capacity be built?

Capacity building for Aboriginal communities is an important aspect of this Plan, with specific

programs and initiatives targeting Aboriginal people and communities. Directorate staff will

continue to work closely with Aboriginal Health workers and community members to improve the

health outcomes of Aboriginal people.

The development of this Plan will allow all stakeholders, Aboriginal and non- Aboriginal, to learn

more about this priority health issue and build personal and professional capacity through the

development and implementation of this Plan.

Yes

11. Will the policy, program or strategy be implemented in partnership with Aboriginal stakeholders? Briefly

describe the intended implementation process

The implementation of the Strategic Plan for the Prevention of Smoking and Harm from Smoking 2014-2019 will be dependent on a range of important partnerships, including Aboriginal Health. SESLHD Aboriginal Health will continue to provide input and leadership to ensure this occurs.

Yes

12. Does an evaluation plan exist for this policy, program or strategy? Yes

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13. Has it been developed in conjunction with Aboriginal stakeholders? Briefly describe Aboriginal

stakeholder involvement in the evaluation plan

The evaluation of the Strategic Plan for the Prevention of Smoking and Harm from Smoking 2014-2019 will occur throughout the Plan’s life (i.e. 2014 – 2019). This evaluation will include:

evaluation of improvements in identification of Aboriginal people

specific performance indicators for Aboriginal people, including: o reduced smoking rates for Aboriginal people and reduced rate of smoking for

pregnant Aboriginal women o number of pregnant Aboriginal women who attend Quit for New Life Program referred

to Quitline, are booked in for follow up smoking cessation care, and are provided with NRT.

These results will be reported to the Chief Executive through the District Executive Team and the

District Clinical and Quality Council as well as the Manager, Aboriginal Health.

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T

strategic plan for the prevention of smoking and harm from

Documents