When it comes to licit and illicit substance use, it is evident that there are strong correlations between the social determinants of health and disease burden. This essay will discuss tobacco use via the route of inhalation by smoking. Smoking is the leading cause of disease and death in Australia (Cancer Council Australia 2018); it is preventable, and is ‘responsible for more drug-related hospitalisations and deaths’ compared with alcohol and illicit drug use combined (Ministerial Council on Drug Strategy 2012). The Department of Health (2017) enacted the National Drug Strategy to control licit and illicit substance use as they are associated with determinants of health as well as social determinants of health; such as discrimination, unemployment, homelessness, poverty and family breakdown and put an immense amount of financial pressure on the public health care system due to direct and indirect costs. It is estimated that ‘the social and economic costs of smoking (including health costs)’ (Collins D. and Lapsley H. 2008) is an estimated at $31.5 billion per year (Department of Health, 2018). This essay will therefore focus on the use of tobacco by smoking due to its huge financial burden on the Australian economy and society.
There is research to support that various social factors have an impact on the prevalence of smoking; in particular that there are higher rates of smoking within socially ‘disadvantaged groups in the population’ (Greenhalgh, EM et al 2017). According to the Department of Health (2017), populations who smoke vary based on their socioeconomic status, with 21.4% of people living in the most disadvantaged areas smoking daily, compared with 8% of people living in the least disadvantaged areas (Department of Health, 2017). These statistics illustrate that there is strong a correlation between the social determinants of health and the prevalence of smoking tobacco within the population of Australia. Research also shows that people with mental health conditions have higher rates of smoking. A recent study (Sane Australia 2017) found ‘32% of people with mental health conditions smoke, compared with only 18% of the general population’ with mental illness and 60-73% with psychotic illness such as schizophrenia (Australian Government Department of Health and Aging, 2011). Furthermore, daily smoking prevalence among prisoners was estimated to be 74 per cent in 2010 (Intergovernmental Committee on Drugs, 2012). There also is an evidence of different prevalence in smoking tobacco based on states and territories as daily smoking prevalence was at 11.7% in Australian Capital Territory and at 23.9% in Northern Territory in 2011 with people aged 18 and over (Intergovernmental Committee on Drugs, 2012). When it comes to a relationship between social determinants and tobacco smoking, many researches indicate that there are strong connections between being Indigenous Australians and having higher chance of being a daily smoker. It indicates that Indigenous populations smoke 2.5 times more than non-Indigenous Australians. Australian Institute of Health and Welfare (2015) explains the high rate of smoking in Indigenous Australians is due to various social factors including psychological, socioeconomic, environmental and remoteness. This article has analyzed the significant difference between smoking rates of people aged 15 and over live in remote area (50%) and non-remote area (39%) as well. Level of education noted to be having an impact on the smoking rate as 29% of Aboriginal and Torres Strait Islander people smoked who has completed Year 12 or equivalent when the rate is 51% for those who never attended school (Australian Bureau of Statistics, 2017).
How much impact does tobacco smoking have on Australian populations then? Tobacco Australia (2017) indicates that smoking caused a total of 18,762 death in 2011 and this is more than 1 every 8 deaths. Australian Institute of Health and Welfare (2016) also estimates tobacco smoking is responsible for 9.0% of total burden of disease and injury with 80% of lung cancer burden and 75% of chronic obstructive pulmonary disease (COPD) burden. As it was mentioned above, tobacco consumption has financial burden to the government which can be looked into more details. Cancer Council (2018a) describes that there are two major studies of the cost of smoking which is the burden of disease and social costs of smoking. Australian Institute of Health and Welfare (2018) explains the burden of disease is described by ‘Disability-adjusted-life-years (DALY)’ in order to measure the years of healthy life lost from illness and death. A study in 2003 estimated more than 2.63 million DALY was lost due to disease related to tobacco smoking (Cancer Council, 2018a). Tobacco was found to be responsible for the greatest burden and it caused 15,551 deaths and the loss of 204,778 DALYs and these statistics are highly notable given that alcohol was responsible for much smaller rate of only 3.3% of total (Cancer Council, 2018a). The total costs and burden of smoking was assessed in diverse aspects including labour in the workforce and household which estimated to be total of $5749.1 million and $9843.1 million respectively in 2004 to 2005 (Cancer Council, 2008a). There is an emphasis on how smokers lose their productivity at work as multiple studies have shown that smokers take more sick leaves than non-smokers and being more unproductive at work (Cancer Council, 2008a). Collins and Lapsley (2010) stated there are other risks such as fire which was estimated to be $51.4 million in 2006 and 2007. The costs include hospital, medical fire services, property damage and labour.
What is the correlation between the social determinants and disease burden? Cancer Council (2018b) states that cardiovascular disease (CVD) is highly preventable and one of the leading causes of CVD is tobacco smoking and there is also recognition of socio-economic factors and psychosocial factors. As this essay discussed above, there are more chances of people smoking tobacco products with certain conditions such as where they live, level of education, race and low socio-economic status. Moreover, as the researches provided above are showing the social and financial burden smoking has on the government and community is evident and estimated to be a huge. Given that most social determinants of tobacco smoking is not by choice, a government intervention such as policy and services seem to be necessary which will be discussed further in part B.