Tobacco use was responsible for 9.3 per cent of the total disease burden in Australia in 2015, the latest year for which data is available.
A report by the Australian Institute of Health and Welfare shows that's more than any other risk factor contributing to the deaths of almost 21,000 people in 2015.
Richard Juckes, head of the Health Group at the Institute, says the risks vary greatly across communities.
"The burden of tobacco use on people's health was unevenly shared across Australians, for example the impact was 50 per cent higher for men than women. It was 80 per cent higher in remote areas compared to major cities. But the biggest disparity we found was between people living in really disadvantaged areas - their health burden was more than 2.5 times higher than that of people living in advantaged areas."
Almost half of tobacco-related health harms came through cancer: mostly lung cancer, followed by coronary heart disease and stroke.
People living in the Northern Territory experience disease rates 2.1 times higher than the national average, while people living in remote and very remote areas experience rates higher than those in major cities.
Photo of a man smoking a cigarette. Source: AAP
The reasons for that include higher rates of smoking in certain areas, and differences in access and use of health services.
But it's all not all bad news, says Mr Juckes, with the report showing the overall burden of disease due to tobacco use has fallen substantially since 2003.
"Smoking rates are decreasing: smoking rates in Australia have gone down from 24 per cent in the mid-1990s to 12 per cent now and that's expected to continue. The report does project all the trends to do with population and health and smoking rates up to 2025 and found the impact of smoking on health would continue to decline but that it would still be very large and would still be by far the biggest modifiable risk factor for your health."
Multicultural health groups would like to see more programs targeting different ethnic communities who may be missing out on mainstream quit campaigns.
Lisa Woodland is from New South Wales Multicultural Health.
"One of the things that is really interesting is that in tobacco smoking we are making great gains with mainstream population. However there are some groups in the community that we know need more targeted interventions to decrease their rate of smoking and the health impact affecting their communities and that includes the CALD communities such as the Arabic-speaking communities, Chinese communities and Vietnamese communities."
And while the research focuses on the harms of traditional cigarettes, Ms Woodland says shisha smoking, popular among younger people and in Middle-Eastern communities, is also a cause for concern.
"We know that one session of shisha smoking which lasts for about 45 minutes is the equivalent of smoking 100 cigarettes."
The Federal Government recently announced an extra $5 million towards its National Tobacco Campaign, which started in 1997.
A person who smokes shisha is at risk of the same health problems that a person who smokes cigarettes. Source: AAP Image/AP Photo/Frank Franklin
But health advocates say more targeted investment is needed to help close the gap.
"Part of it is really around high prevalence communities create an environment where smoking is more normal. So in higher economic environments, smoking has become unpopular and almost a social taboo, and that's not the case in many of these environments. And we have also had less education and less health literacy in those communities. And tackling Indigenous tobacco campaigns for example are a good way of addressing that," says Professor Sanchia Aranda, CEO of the Cancer Council Australia.
The Institute of Health and Welfare says Australia has made significant progress in reducing smoking rates, with daily smoking almost halving since the early 1990s.
In 2016, 12 per cent of Australians smoked daily—one of the lowest rates among Organisation for Economic Co-operation and Development (OECD) countries.
