The Labor Government has promised to address the tragic state of indigenous health that is typified by life expectancies that are 15 or more years less than the average life expectancy for non-indigenous Australians.
To do so it will need to tackle the roots of the health problems and not just the branches.
Non-health issues such as the lack of social justice, education, employment opportunities, transportation and affordable healthy food all contribute to the incidence of low birth-weight babies, alcohol abuse, mental illness, hearing and eye problems, heart disease and diabetes, and to the health inequalities that beset indigenous communities.
But while large, social structural changes are essential in the long term to improve indigenous health, we should not ignore the urgent need for a range of small-scale, cost-effective interventions that can make a real difference now, while the harder work is under way.
Foremost among these is the need to reduce smoking rates in indigenous communities.
Unlike the general Australian community, where smoking rates are now at 17.4 per cent, there has been no significant fall in smoking rates among indigenous people. Half the adult indigenous population smokes and smoking rates are even higher in younger age groups, reaching 57 per cent for men aged 35-44 and 54 per cent for women aged 25-44. In some remote communities up to 80 per cent of the population, across all age groups, smokes.
More than half of indigenous mothers report having smoked during pregnancy.
Indigenous smoking is linked with higher rates of disability and long-term health problems, psychological distress and illicit substance use.
Mothers who smoke increase the likelihood of having low birth-weight babies, and there are significant links between low birth-weight and hypertension and renal disease in later life.
Tobacco is responsible for more indigenous deaths than alcohol.
So much of the chronic disease burden borne by indigenous people can be attributed to tobacco use.
The cardiovascular disease death rate for indigenous people aged between 25 and 54 is at least eight to 10 times higher than for other Australians. There are higher rates of smoking-related cancers.
About one in 10 deaths of indigenous people is due to respiratory disease, a rate that is 30per cent higher than the Australian average, and hospitalisations for respiratory disorders are twice as high in the indigenous population.
The smoking rate in the non-indigenous Australian population is now among the lowest in the world. This has taken several decades to achieve, but has been done with a minuscule investment.
Since 1997 a total of $24.93million has been spent by the Federal Government on anti-tobacco campaigns (including media buys, research and production). Tobacco harm reduction measures have received an average of $2.2million a year in federal funds in recent years.
During the election campaign, the Rudd Government committed to boosting funding for the National Tobacco Strategy by $15million during the next three years.
There is an excellent case for directing at least half these funds to culturally sensitive indigenous programs, developed in consultation with indigenous communities and health workers, with a further commitment to extend funding beyond just three years. The puny goal of reducing indigenous smoking rates by just 1 per cent a year would soon add up to a real difference in health outcomes.
This proposal is not radical and it is not expensive, but it has the capacity to make things better for indigenous Australians, regardless of where they live, because of the potential to prevent some forms of serious illness and ameliorate others.
Even non-smokers will benefit from anti-smoking interventions, with the reduction in passive smoking and improvements in community participation due to decreased levels of disability.
Of course, an anti-smoking initiative is not the ultimate solution to the problems of indigenous health, but it will help improve mortality, morbidity and quality of life and it will contribute to progress towards the prime minister's goal of reducing the life expectancy gap between indigenous and non-indigenous Australians.
Moreover, the estimated cost of implementing such a program is minute in comparison with the costs of doing nothing.
Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney / Australian National University