Smoking has come out of the too-hard-basket in indigenous health. The federal government has been most prominent in this shift, and has put tackling high smoking rates at the centre of its plans to “close the gap”. One of its first pledges after the apology to the Stolen Generations was to spend $14.5 million over four years on its Indigenous Tobacco Control Initiative.

There is also a broader groundswell of change. There have always been some indigenous people quietly giving up the smokes by themselves and with support from health services. There may still be far too many indigenous people smoking and dying and getting sick from their smokes, but now it seems more indigenous people and their organisations are wanting to talk about turning this around.

The political mood about indigenous tobacco control changed after lobbying that followed the release of the Indigenous Burden of Disease study by the University of Queensland. This potentially drab piece of epidemiology identified smoking as the single risk factor causing the greatest burden of disease among indigenous Australians. Yes, more than grog.

Not only that, but high indigenous smoking rates accounted for 17% of the health gap. The politicians leaped on what seemed a single simple solution to this blot on any Australian myth of the “fair go”. Their “yes-we-can” optimism was a much needed tonic for the nihilism and pessimism that had confronted anyone who wanted to talk about the topic in the past.

The recently released National Preventative Health Strategy report has some of that similar optimism in its title “Australia: the healthiest country by 2020” and some of its goals. But the body of the report is notable for its plain-spoken pragmatic tone and tasks and its solid evidence base. Its authors avoid the easy option of just giving us the usual simplistic wishy-washy aspirations and a mire of bureaucratic buzz words and platitudes. Rather, they say this can happen and this is how it is most likely to be achieved.

The tobacco section concentrates on the building on the most successful elements of Australian and international tobacco control: making cigarettes less affordable, anti-smoking social marketing campaigns (and reducing remaining forms of cigarette advertising and promotion), and reducing exposure to second-hand smoke. They remind Australians that we have been very successful in reducing smoking and that the savings that have come from this success are 50 times greater than our modest investment in tobacco control. You won’t find returns like that on the stockmarket anymore.

There is special attention to reducing indigenous smoking. The authors emphasise working with Aboriginal community-controlled health services. This seems more than just the usual rhetorical flourish. It is about pragmatically getting the job done with those most able to help you, with a nod to addressing the underlying determinants of poor indigenous health by promoting the implicit self-determination that comes with indigenous organisations and indigenous involvement.

There has been scant research attention to indigenous tobacco control and so little specific research evidence to call on. The report treads a sensible line between just doing what works elsewhere and the need to re-invent tobacco control entirely in this setting, but they stay closest to what has worked in many other settings. For example, they suggest a “twin track” social marketing campaign combining effective mainstream campaigns with some indigenous-specific campaigns, emphasising that these campaigns need to be based on research and have sufficient reach and be sustained.

While COAG has already made vague promises about further funds for indigenous tobacco control in some of its plans for prevention, the federal government’s Indigenous Tobacco Control Initiative has concentrated on a single strategy: funding multi-component local projects.

The Preventative Health Taskforce fudges by endorsing this funding and such projects, but warning that while this initiative has helped get smoking on the indigenous health agenda, “small projects, no matter how well run, will not make the inroads necessary to reduce smoking rates across the indigenous population as a whole”. They may have an impact in a few communities but they are unlikely to make any headway in closing the gap nationally. This feels like a bit of timidity from the otherwise blunt taskforce.

John Howard’s government began its difficult relationship with indigenous Australia with its promise of “bucketloads of extinguishment” of native title after the Wik High Court decision. It is still too early to tell whether Kevin Rudd and Nicola Roxon will deliver the bucketloads of extinguishment of indigenous smoking that will lead to their promise to close the gap.

David Thomas is a senior research fellow at the Menzies School of Health Research in Darwin.