Community Health First submission to inquiry into vaping and tobacco controls

Community Health First submission to inquiry into vaping and tobacco controls

Community Health First welcomes the opportunity to provide a submission to the inquiry into vaping and tobacco controls.

In Victoria, community health organisations are funded to provide place-based health promotion activities that respond to the needs of their local communities. Community health organisations are seeing a substantial increase in the use of e-cigarettes in the community. As a result, there has been a surge in requests for targeted vaping education and awareness programs from schools and local government. Similarly, primary care services have also experienced an increase in individuals requesting nicotine addiction support. This increased demand for support has not always been met with an increase in services and in many areas extensive waitlists to access such services are now apparent.

While new legislative and regulatory reform to address vaping are welcome (including import restriction, intention to restrict supply, and a tobacco retail license scheme in Victoria), Community Health First is urging the government to ensure that such legislative changes are combined with local health responses. As access to vaping products is limited, Community Health First anticipates an increase in request for addition support and an increase in tobacco use in place of vaping products. The government must ensure that health workers are educated and equipped to support people with vaping addictions alongside adequate investment in health promotion activities to limit the uptake of tobacco.

Community Health First’s submission focuses on how community health has responded to the growing impacts of vaping on local communities, lessons learned to date, and critical areas for future investment in health promotion and prevention funding to tackle emerging community needs.

About Community Health First

Community Health First unites all 24 of Victoria’s registered community health services with one shared goal – improving the health, wellbeing and quality of life for all Victorians.

Registered community health services play a unique and important role in ensuring access to essential support for all Victorians. Community health services operate out of more than 190 sites across metropolitan, rural and regional Victoria, employing over 10,000 people to support more than 500,000 Victorians every year.

Working across the full spectrum of healthcare prevention, early intervention and multi-disciplinary care, community health bridges the gap between primary care and tertiary care, to connect people with place-based services that improve health, social and economic outcomes.

Trends in vaping and tobacco use and the associated financial, health, social and environmental impacts on the Victorian community

Smoking continues to be one of the largest causes of preventable illness and death in Australia (i) Within Victoria, vaping has almost doubled among Victorian adults from an estimated 154,895 users in 2018-19 to 308,827 users in 2022, with over 77,000 people who have never smoked currently vape (ii).

Impact on schools
Registered community health organisations work with schools in their community to provide a range of support and programs including dental, healthy eating, diabetes and mental health support. In delivering these programs, community health organisations are witnessing first-hand the steady increase in vaping in communities, and in particular the rise in school-aged children accessing and using vaping products on a regular basis. In regional areas, where students have limited access to recreational activities and e-cigarettes are highly accessible and available, vaping products are being used as recreational fun and a social activity.

“My school students have limited knowledge about vaping, and they think it is cool, we need to educate our young generation” – School Principal, Regional Victoria

“Last week we had a group of grade 4/5 kids making pretend vapes! They all have older siblings who have been discussing vaping and it seems it’s impacting on our kids too!” – School Principal, Regional Victoria

“We have vaping issues in our community, we need evidence-based information and education to educate our young students, parents and educators” – School Principal, Regional Victoria

Since the increase in vaping in younger populations, the number one request made to community health organisations from schools is for support and programs that address vaping. Given existing relationships with school in the local area, community health organisations are well positioned to respond with relevant, and tailored education and prevention programs. Where possible, registered community health organisations are responding to these requests, but the need far outstrips the funding available to support school populations.

With the rise in school-aged children vaping and the evidence that e-cigarette use at a young age can impede brain development in young people, lead to seizures and loss of concentration, exacerbate mood disorders, inhibit sleep and cause irritability and anxiety (iii), there is an urgent need for increased interventions within schools to support and education to compliment the increase marketing and awareness campaigns being targeted at school-aged users.

Recommendation: Increase funding for school-based support through registered community health organisations who have existing and established relationships with their local schools to provide health services and support.

Rising social acceptability of public vaping
Despite vaping being prohibited in certain public places under Victoria's Tobacco Act 1987 (the Tobacco Act), community health staff are concerned about the rising social acceptability of public vaping and the disregard for no smoking/vaping signage in the local communities they work and the impact this may have on individuals, particularly children and vulnerable adults.

Recommendation: Increase public health messaging around the harms of e-cigarette aerosols and vaping, and the right for non-vapers to not be exposed to second or third hand aerosols.

The adequacy of the State and Commonwealth legislation, regulatory and administrative frameworks to minimise tobacco and e-cigarette harm experienced in the community and control illicit trade compared to other Australian and international jurisdictions

Community Health First considers there to be four key intervention points in addressing vaping in local communities:

• Exposure – this is particularly relevant to young children you are being exposed to vaping online and from their peers.
• Access – ability to access products.
• Prevention – this includes education on the harms of vaping, in particular for young children and their parents.
• Support – additional support for those already vaping.

Community Health First welcomes the recent federal and state government joint commitment addressing the importation, manufacture, and supply of vapes which will go a long way to address the access issue, particularly among younger users. However, it is critical that these legislative measures are dovetailed with government interventions to reduce the online exposure to vaping and provide adequate funding to prevention and support as the reforms are rolled out (as per the following section).

Recommendation: Stronger federal regulation to address online exposure to vaping products via social media promotion and marketing aimed at children and young people under the age of 18.

Recommendation: Ensure the health sector is sufficiently resourced to provide support to current users as new restrictions come into place.

Recommendation: Increase public health measures and education resources around the harms of tobacco to ensure that tobacco use does not take the place of vaping and lead to an increase of tobacco use in Australia for the first time in decades.

The effectiveness of current public health measures to prevent and reduce the harm of tobacco use and vaping in Victoria and potential reforms

Community Health First welcomes the increased investment in public health measures to reduce the harm from vaping, including the much-needed expansion of Quitline. However, many of the current health prevention measures are broad based education and awareness campaigns with limited ability to be tailored to local community. Population based strategies must be done in parallel with localised prevention and intervention programs, targeted and tailored services, and place-based face to face support if vaping is to be effectively addressed in Victoria.

Health promotion and prevention
Health promotion and prevention plays a critical role in ensuring better health outcomes for communities across metropolitan, regional, and rural Victoria. Registered community health organisations deliver state-wide health promotion and prevention activities, and in doing so, saves the Victorian Government tens of millions of dollars each year by preventing avoidable hospital presentations and other healthcare costs. With every $1 spent on preventative healthcare measures, $14 is saved in future healthcare costs (iv).

Health promotion services engage with communities to build health literacy and empower community members to take control of their health, ultimately reducing the risks of poor health outcomes and avoiding the associated costs of poor health. This approach works in parallel to the broad-based awareness campaigns run by Cancel Council Victoria, Quit and Vic Health on vaping, by provided targeted and localised support adapted to local community needs.

Using resources available from QUIT Victoria & Cancer Council Victoria a community health promotion team co-designed an evidence-based program to inform students, parents and carers, about the harms of vaping. They had identified that students didn’t always know about ingredients and health effects and wanted to learn more. The program was delivered across ten schools to 500 children and 176 parents, alongside 8 community forums with over 100 attendees. The results showed that 78% of those surveyed were unaware of toxic chemicals in e-liquid, following the sessions 88% increased their knowledge about the health consequences of vaping and 65% could now identify the warning signs of vaping. - Community Health Organisation, Regional Victoria

The impact of these local programs is only limited by the ability to scale them. Currently community health organisations receive Integrated Health Promotion funding to deliver tailored health promotion in their local communities. While this provides some scope to address the increase in vaping supports required at a local level, the increase in demand has reduced services capacity to deliver on the other key priority areas of healthy eating and active living. In addition, the Integrated Health Promotion funding available to community organisations was reduced by 10% in 2023, further limiting the ability of community-based organisations to provide effective and impactful prevention programs. Future investments in health promotion are critical to address the escalating impacts of vaping in Victoria.

Recommendation: The Victorian government commit to spending 5% of the total health budget on health promotion and prevention. This would align Victoria to commitments set out in the National Preventative Health Strategy 2021-2030 and commitments made in other jurisdictions and would expand the funding available to tackling vaping in our communities.

Access to adequate primary health care
Registered community health organisations in Victoria are funded to provide a more effective and accessible healthcare services to populations who may not have otherwise been able to access timely and affordable support. This includes those who experience poorer overall health outcomes, have barriers to accessing adequate healthcare, that are economically and/or socially disadvantaged, and people with complex care needs.

Within these population groups community health organisations are seeing an increasing demand for services as patients accessing primary care services are facing increasing costs for their care and as complex health needs continue to rise. Despite population growth of twenty percent over the past twenty years, expenditure on the Community Health Program has not received any substantive uplift and has gone backwards in real terms as indexation has not kept up with inflation, limiting the ability to provide timely access to support for vaping and related health issues.

As vaping and tobacco use can lead to poorer overall health outcomes and other comorbidities in the future, access to early intervention and support should be prioritised, particularly for vulnerable groups.

Recommendation: Nicotine replacement products should be made more affordable to support individuals to quit smoking and vaping.

Recommendation: Consideration to be given to the financial implications for individuals on low-incomes or income support seeking to use e-cigarettes as a GP recommended smoking cessation option through the prescription model but product is not subsidized by the PBS.

Recommendation: Funding and training is provided to upskill GPs and health professionals around supporting individuals who vape, ahead of the new federal reforms being introduced to ensure our communities have access to cessation support as sales are restricted.

Funding barriers
With limited additional funding to address vaping in local communities, community health services are stretched to capacity in the ability to provide the support and healthcare needed to keep communities healthy. This is further compounded by the limited flexibility in current funding arrangements to provide support and services related to vaping and tobacco.

At present addiction support does not meet the eligibility criteria for Home and Community Care Program for Younger People (HACC PYP) and does not meet guidelines for Alcohol and Other Drugs treatment if there are no other addiction issues present. This means that community health organisations are limited in their ability to provide local services, even if effective programs and interventions have been identified or developed.

Recommendation: Department of Health to address the funding limitations for relevant programs to ensure support for vaping can be provided as required.

For more information on this submission or further information about vaping prevention and support programs codesigned for local communities please contact Sam Blake, Strategic Advisor, Community Health First sam.blake@accesshc.org.au.

Anna Robinson
Chair
Community Health First

i Greenhalgh, EM & Winnall, W. 3.30 Total burden of death and disease attributable to tobacco by disease category. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2021. Available from https://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-30-total-burden-of-death-and-disease-attributable-to-tobacco-by-disease-category

ii Get the facts on vaping, Cancer Council Victoria. https://www.cancervic.org.au/get-support/stories/get-the-facts-on-vaping.htm

iii ibid.

iv Australian Government Productivity Commission (2022) Report on Government Services 2022 – Health