EDITORIAL

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Collins J. Migrant hat& in a distant Iand. Australia's post-war immigration. 2nd edn. Sydney: Pluto Press, 1991. Australian Bureau of Statistics. Australian social t d , 1994. Cat no. 4102.0. Canberra: ABS, 1994. Australian Bureau of Statistics. &mm born Australians 1988: a sfahtical profile. Cat no. 41 12.0. Canberra: ABS, 1989. Alcorso C, Schofield T. The national non-E@h spmhinglmch- ground women f health strategy Rev. edn. Canberra: Australian Government Publishing Service, 1992. Australian Institute of Health Welfare. Australia's health, 1992. Canberra: Australian Government Publishing Service, 1992: 200-3. Schofield, T. Living with disability. In: Reid J, Trompf P, edi- tors. The health of immigrant Australia Sydney: Harcourt Brace Jovanovich, 1991: 288-311. Bottomley G, de Lepervanche, M. The social context of immigrant health and illness. In: Reid J, Trompf P, editors. The health of immigrant Australia. Sydney: Harcourt Brace

Jovanovich, 1991: 39-76. Lin V, Pearse, W. A workforce at risk. In: Reid J, Trompf P, editors. The health of immigrant Australia. Sydney: Harcourt Brace Jovanovich, 1991: 20649. Minas IH. Mental health in a culturally diverse society. In: Reid J, Trompf P, editon. The health of immigrant Australia. Sydney: Harcourt Brace Jovanovich, 1991: 250-87. Alcorso C. Migrant w d e n a d &s compensation in New South W a h . SWRC reports and proceedings no. 71. Sydney: Social Welfare Research Centre, University of New South Wales, 1988. Alcorso C. Blue collar and b o n d : thc experioirrs of nonEnglrsh speaking background womrn in the Australian labourforce. Canberra: Australian Government Publishing Service, 1993. Clapliarn K, Schofield T, Alcorso C. Munoging the wod injury of women f m m non-Engltsh-speaking backgrounds. National Women's Consultative Council cccasional paper no. 4. Canberra: Australian Government Publishing Service, 1993. Schofield T, Nasser N, Kambouris N. Non-Engbsh-spahang bachpund women's mental healtlr: a cornmunityhsed study Sydney: Immigrant Women's Speakout Association of NSW, 1993. Oflice of Multicultural Affairs. National agmdafor a multicuC tural Australia . . . sharing our future. Canberra: Australian Government Publishing Service, 1989.

Perceptions of the contemporary status of smoking-control strategies Australia is one of a handful of countries in which about a quarter of the population continues to smoke. In some respects, this is a cause for pride, as it contrasts with the rest of the world: adult smoking rates, particularly for males, vary from 38 per cent in France to 60 per cent in China, and we see phe- nomena such as over half the doctors in Spain being persisting smokers.

The social climate in Australia is favourable to reduction in smoking rates, and the tobacco indus- try has been decisively beaten in the political and public arenas. Our 'smoke-free' environment includes work places, aircraft, airports, schools, hos pitals, major public institutions, many restaurants, and even (possibly imminently) the pubs. Our legis lation is advanced, and although something of a patchwork quilt, precludes advertising almost com- pletely. By the middle of next year we will see noth- ing of the tobacco industry except from outside the country and possibly a few exempted forms of motor sport. All of our parliaments, with the notable excep tions of New South Wales and Queensland, have cooperated and taken positive action. We have well- organised Quit campaigns, albeit modestly funded.

Our schools are cooperative, our smokers tolerant of the smoke-free environment (in fact, in favour of it) and we can therefore expect to see smoking pro- gressively diminish.

We are already seeing some important public health outcomes, of which two are dramatic, both in themselves and by world standards. Our death rate from cardiovascular disease is tumbling, and since 1988, death rates in adult males from lung cancer have been declining instead of increasing. Other predictable changes are imminent. Only the handful of countries that share our smoking rates share the same sort of environment and alteration in tobacco- associated disease. The rest of the world persists with its old-fashioned ways and can look forward to a con- tinuing epidemic of deaths from tobacco. The tobac- co industry, while beaten in Australia and supported by only a few troglodytes in the administration of sport, is transferring its attention to developing countries, buying national monopolies at a rapid rate, and while it is likely to meet quite strong resis- tance in China and India, it faces economic condi- tions in Eastern Europe that are highly favourable to its cause and where the antismoking forces are thin on the ground and poorly organised.

Nevertheless, the international antismoking net- work is strong, having grown from a small cadre of individuals in the mid-1970s to a group one-thou- sand-strong, which met recently in Paris to update strategies. The international network has its own communication system, extraordinarily well organ- ised and diverse in its skills. It nevertheless remains weak in developing countries and only a few organi- sations, such as the International Union Against Cancer, are persisting in their endeavours to work in these environments.

Should Australia be complacent? Or even pleased? The answer is certainly no, as a smoking rate of 25 per cent is far to high for a highly devel- oped and educated society. Unhappily, the figure of 25 per cent is an average and includes rates of 16 per cent among people with a university education and 30 per cent among people educated to Year 10 or less. It also includes 35 per cent of people born in the Middle East, 29 per cent of people born in the United Kingdom and Ireland, 26 per cent of people born in southern Europe, and 19 per cent in people born in South East Asia. All of these target groups are in need of very specialised communication skills. There is also a hard core of continuing smokers aged 30 and over which we estimate at over 700 000, and these smokers face immediate and immense risk of smoking-related disease.

So where to from here? More money? Undoubtedly yes. This hard core needs the sort of resources we are throwing, very cost-effectively, at traffic accidents, although the approach would be sharply different. Very detailed behavioural research will be needed for a decade, as each exsmoker r e p resents an important victory and is well worth the $94 per person we spend every year doing mammo- grams on women over 50.

No, all is not well in the Garden of Eden. We are better than most but we could be better.

Nigel Gray Anti-Cnnm Cmincil of Vicloriu, Meburne

AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995 VOL. 19 NO. 2 119