The article by Rasanathan and Tukuitonga (Tobacco smoking prevalence in Pacific Island countries and territories: a review—http://www.nzma.org.nz/journal/120-1263/2742) in this issue of the Journal highlights the regional manifestation of global health inequalities with respect to tobacco use.

Progress being made in reducing overall smoking prevalence in Australia1 and New Zealand2 is not being matched in Pacific Island countries and territories (hereafter termed ‘Pacific states’) where rates of tobacco use are higher for males and females. Of particular concern are the high rates of youth smoking that will ensure the continuation of the problem for the next generation in these islands.

Interestingly, smoking rates experienced in Pacific states are not dissimilar to the rates for Pacific and Māori populations in New Zealand.3 Indeed, 30 years of tobacco control in New Zealand have had little impact on the disparity in smoking prevalence between the general population and Māori, Pacific, and low income communities.

Until recently, smoking prevalence rates in the New Zealand Māori population remained stubbornly around the 50% level, with only the most recent survey showing signs of a reduction 45.2%.2 The most recent Pacific smoking rate (37.4%) is higher than previous estimates, while the European rate is now 20.6%.2

Progress has been more successful, however, in reducing per capita consumption across all ethnic groups. However, even this ‘gain’ may be partly offset by remaining smokers switching from packaged cigarettes to “roll your owns,” which they can roll thinner and extract the nicotine more efficiently through inhaling more frequently and deeply.

The currently unmet challenge both within countries and between countries is to address inequalities in tobacco use and not inadvertently worsen them. In approaching tobacco-related inequalities in the Pacific, we need to learn from our experience in tackling inequalities in New Zealand, take advantage of the global tools that are now available to all countries through the WHO Framework Convention on Tobacco Control (FCTC), and support the innovative solutions that arise from the Pacific states themselves.

Recent New Zealand experience has shown the comprehensive legislation, such as the Smokefree Environments Amendment Act 2003 that eliminated tobacco smoke exposure in indoor workplaces and public places, is successful at reducing inequalities between groups.

Once the legislation came into force, the exposure of Māori workers to secondhand smoke in indoor workplaces dropped from 27% (2003) to 9% (2006), and for non-Māori from 19% to 8% over the same period.4 At the same time, the cumulative effects of an increasingly smokefree environment is having a positive impact on smoking initiation, with a marked and ongoing reduction in smoking initiation by young teenagers in all ethnic and socioeconomic groups.5

While there was no significant decline in the proportion of young people whose parents smoked between 2001 and 2006, the proportion of Pacific 14 to 15 year olds exposed to smoking in their homes declined significantly from 34.6% in 2001 to 27.4% in 2006.5 This demonstrates the power of broad environmental approaches to making progress in non-communicable disease control. In addition, widespread environmental ‘prompts’ to smokers to quit and increased availability of smoking cessation services will both increase the number of quit attempts and the likelihood that they will be successful.

New Zealand played a major role in the development of the FCTC (a world first as a global convention to curb a non-communicable disease), and continues to take a leading role in its implementation.6 Interestingly, the convention has been extremely popular, with 149 ratifying countries at last count, making it one of the most widely affirmed Treaties in the UN system. New Zealand is already compliant with most of the mandatory provisions of the FCTC, but there are large gaps in the tobacco control policies and programmes of most Pacific states.

The FCTC will greatly assist tobacco control efforts in Pacific states. The Treaty effectively creates a globally agreed blueprint for tobacco control available to all countries, enabling them to leapfrog several developmental steps in their control programmes and move quickly to what is internationally accepted as best practice. The existence of a global consensus provides firm backing for states that will inevitably be challenged by tobacco industry interests.

The value of the FCTC in this respect can be seen in the experience of Canada where lengthy legal challenges by the tobacco industry to national tobacco control legislation were recently rejected, partly because of the mandate now conferred by the FCTC on ratifying parties.7

NZAID, the overseas development arm of the New Zealand Government, is funding a programme to develop capacity in the Pacific to develop tobacco control programmes and implement the FCTC.8 The overall goal for the Tobacco Control in the Pacific (TCIP) programme is to support the efforts of Pacific states in countering the adverse health, social and economic impacts of tobacco use.

This initiative has involved two stages: Stage 1 took place from 2003-2004 in Tonga and the Cook Islands, with Stage 2 being implemented over 2005-2007 in Samoa, Solomon Islands, Vanuatu, and Tuvalu.

An additional strength for Pacific states is their history of developing uniquely Pacific approaches specific to their size and cultural context. Examples of this include the “Healthy Islands” Policy,9 and the developing response to the obesity epidemic; for example, both Fiji and Samoa have acted at a national level to restrict the availability of fatty foods.10,11 Approaches to tobacco will benefit from similarly inspired local solutions that small states can apply.

The stakes for effective non-communicable disease (NCD) control in the Pacific are high, as the disease burden associated with it will impact and overwhelm local health responses, as well as potentially strain those of neighbouring countries such as New Zealand and Australia. Altruism and self interest combine to make this a priority. Our ability to share experience and directly assist approaches that work will be important for tobacco control, but even more so for other drivers of NCDs such as obesity and alcohol related harm where the evidence for effective interventions has not been as well researched and evaluated.

Author information: Don Matheson, Director International Relations; Ashley Bloomfield, Chief Advisor Public Health and Acting Manager, Tobacco Policy and Implementation; Debbie Ryan, Chief Advisor Pacific Health;
Ministry of Health, Wellington

Correspondence: Don Matheson, Director International Relations, Ministry of Health, PO Box 5013, Wellington, New Zealand. Fax: +64 (0)4 816 2340; email: don_matheson@moh.govt.nz