Improving heart health by reducing commercial tobacco availability: a First Nations approach

Professor Marita Hefler, Flinders University

Future Leader Fellowship

Years funded: 2026 - 2029

Improving heart health by reducing commercial tobacco availability: a First Nations community-led and co-designed approach

Achieving the Heart Foundation vision of heart health for everyone in Australia by 2050 will only be possible if smoking prevalence is dramatically reduced. A 2019 Australian study estimated that 15% of cardiovascular deaths and 11.5% of the cardiovascular disease burden are attributable to smoking. Coronary heart disease is 1.7 times higher, and the risk of heart attack 2.5 times higher, among people who smoke. Smoking-attributable cardiovascular mortality is 38.2% among men aged 45-54 and 33.7% for women.

Greatly reducing smoking among First Nations peoples is essential to achieve heart health equity. The cardiovascular disease burden among First Nations people is twice that of non-Indigenous people. Smoking prevalence is three times higher and accounts for 34% of cardiovascular diseases, yet a majority of people who smoke want to quit. While overall smoking prevalence among First Nations peoples is declining at a similar rate to non-Indigenous Australians, it is not declining in remote areas.

Higher smoking prevalence among First Nations peoples is linked to the ongoing impacts of colonisation, intergenerational trauma and racism. In Australia and internationally, Indigenous peoples are increasingly leading resistance to the commercial tobacco epidemic; part of a global shift from individual behaviour-focused tobacco 'control' approaches to a tobacco 'endgame' which addresses the structural factors that drive the commercial tobacco epidemic. This recognises that cigarettes receive special treatment as uniquely lethal consumer products which remain widely available for retail sale.

Aboriginal community-controlled stores in remote communities are uniquely positioned to lead retailer action on smoking, as they are owned and governed by community members. In contrast to other retailers, they have an imperative to be both financially viable and improve community health. The Arnhem Land Progress Association (ALPA) runs community controlled stores in East Arnhem Land in the Northern Territory and is a world leader in retail strategies to improve heart health, including to reduce sugar sales.

The aim of this project is to work in partnership with community members and ALPA to co-design innovative strategies which are both culturally acceptable and commercially feasible to reduce retail tobacco supply and availability and reduce smoking in remote First Nations communities in East Arnhem Land. A particular focus will be consideration of the cultural role of tobacco in Yol?u society, and how that can be preserved and respected while addressing the harms of commercial tobacco. The project will complement existing health promotion and smoking cessation services, ensuring a holistic approach.