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The Government’s Goal for a Smokefree New
Zealand by 2025: more decisions, and more detail, are urgently
needed
In their Response to the Report from the Māori Affairs
Select Committee (MASC) Inquiry,1 the New
Zealand Government has articulated the goal of a smokefree nation by
2025.2 This is a wise and visionary move, which
is critical to protect the health of all New Zealanders in the face of the
ongoing tobacco epidemic. It is also consistent with strong public (and often
majority smoker) support for progress with tobacco
control.3–8 Nevertheless, a close reading
of the Response to the MASC Report suggests that the Government has avoided
decisions it could make now, and there are many areas of the Response that
urgently need further detail.
The Table below briefly summarises some of these
areas.
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Issues
requiring decisions and/or detail
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Additional
comment
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Detail on
the goal
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The goal in the Government’s Response is defined as:
“reducing smoking prevalence and tobacco availability to minimal levels,
thereby making New Zealand essentially a smoke-free nation by 2025”.
However, such an important goal deserves to be more clearly defined. Doing so
will make progress measurable. For example, the goal could be “a daily
smoking prevalence of <0.5% of the adult population with an interim milestone
of <10% by 2018”. Or the goal could be “a complete ban on the
sales of tobacco in 2025” (with the few residual smokers having to grow
their own tobacco). The latter option has many advantages as it communicates an
unambiguous message: (i) to the tobacco industry that its time in this country
is up; and (ii) to youth and current smokers that there is no long-term future
in smoking (and thus every reason not to start, or to quit now).
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A timetable
and plan
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In a previous NZ Medical Journal
editorial9 some of us stated that detailed and
urgent implementation planning is required. The Government’s Response
promises “further detailed work” to set “mid-term
targets”, but avoids saying when those targets will be set. Instead of
noting that: “The Government is considering ...”, the Response would
have achieved more if it provided details on the process by which a
more detailed plan will be formed (e.g., a task force), and the timeline
this will follow. The Response states that the “Government already
has a comprehensive action plan”, but the last such plan was for the 2004
to 2009 period. A new Ministry of Health plan for tobacco control has been
urgently needed since 2009.10 In particular,
critical decisions need to be made now about which of the following four major
mechanisms will be pursued: (i) an annual “sinking lid” on tobacco
sales down to a sales ban11-13; (ii) an ongoing
system for regular tobacco tax increases until a sales
ban12; (iii) a system for phasing down nicotine
levels in tobacco12 14; and (iv) using
alternative nicotine delivery products during the tobacco phase-out
period.15
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The details
around why proposed new legislation is not more comprehensive
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The proposed legislation that will eliminate tobacco displays at point-of-sale to which the Response refers, appears to be a highly desirable step towards the goal. However, there is also an opportunity for proposed law changes to ensure NZ maintains parity with other developed countries, many of which have adopted more far-reaching tobacco control policies. Examples include banning smoking in cars with children and expanding smokefree areas (e.g., the outdoor areas at hospitality venues16). Other opportunities including updating the current sets of graphic health warnings17 and declaring an intention to introduce plain packaging with Australia.18 |
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Outlining
bipartisan support for the goal
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We note that the “2025” date is five electoral cycles away. Responding to the tobacco epidemic requires major political parties to forge substantial common ground, as has already occurred in some policy domains in NZ (e.g., superannuation, nuclear-free policy, and putting a price on carbon emissions). Developing (and committing to) a shared tobacco control agenda will be pivotal to bringing about the tobacco endgame – and moves to achieve this cooperation need to outlined by the Government. |
Many other issues require attention if rapid progress
towards the goal is to be made. Key examples include:
- Benchmarking
New Zealand policies against international best practice, behind which New
Zealand currently sometimes lags (e.g., smokefree cars with
children19 and expanded smokefree
areas16). Further aligning tobacco control
policies internally to reduce policy
incoherence20 is also desirable.
- Enhancing
capacity of the Ministry of Health tobacco control team, especially if a Tobacco
Control Agency is not to be implemented. At present there are only a small
number of staff dedicated to tobacco control, offering limited capacity to deal
with the large body of work required to achieve the goal.
- Reducing
the overall level of fragmentation of the tobacco control sector in New Zealand
and enhancing the extent of knowledge transfer between different DHB districts
and between organisations.
- Ensuring
that progress for Māori is as rapid as for non-Māori in the path
towards the tobacco endgame. This will require a mix of national and local
policies, led by iwi (tribes) or undertaken in close partnership with iwi, local
health agencies and non-governmental agencies.
In
summary, the goal of a smokefree nation is an important step forward, but
achieving this will only be possible if it is supported by sustained leadership
across major political parties, by the necessary work on the major mechanisms,
and appropriate timetabling and resourcing. If these are achieved it will be a
major advance for the health of the population and an important way to reduce
the still substantial health gaps between Māori and non-Māori New
Zealanders.
Nick Wilson* 1, Tony
Blakely 1, Janet
Hoek 2, Heather
Gifford 3, Richard
Edwards 1, George
Thomson 1
1 Department of Public Health, University
of Otago, Wellington 2 Department of
Marketing, University of Otago, Dunedin 3
Whakauae Research Services, Whanganui *nick.wilson@otago.ac.nz References:
- NZ
Parliament. Inquiry into the tobacco industry in Aotearoa and the consequences
of tobacco use for Māori, Report of the Māori Affairs Committee.
Wellington: New Zealand (NZ) Parliament, 2010.
- NZ
Parliament. Government Response to the Report of the Māori Affairs
Committee on its Inquiry into the tobacco industry in Aotearoa and the
consequences of tobacco use for Māori (Final Response). Wellington: New
Zealand (NZ) Parliament, 2011. http://www.parliament.nz/NR/rdonlyres/3AAA09C2-AD68-4253-85AE-BCE90128C1A0/187795/DBHOH_PAP_21175_GovernmentFinalResponsetoReportoft.pdf
- Trappitt
R, Li J, Newcombe R. Public support for the End Game: HSC’s Health and
Lifestyles Survey [Presentation]. Tobacco-free Aotearoa Conference 2010,
Auckland: Health Sponsorship Council, 2010.
- Thomson
G, Wilson N, Edwards R. Kiwi support for the end of tobacco sales: New Zealand
governments lag behind public support for advanced tobacco control policies. N Z
Med J 2010;123(1308):106-111.
- Edwards
R, Wilson N, Thomson G, et al. Majority support by Māori and non-Māori
smokers for many aspects of increased tobacco control regulation: national
survey data. N Z Med J 2009;122(1307):115-118.
- Wilson
N, Weerasekera D, Edwards R, et al. Characteristics of smoker support for
increasing a dedicated tobacco tax: National survey data from New Zealand.
Nicotine Tob Res 2010;12:168-73.
- Wilson
N, Blakely T, Edwards R, et al. Support by New Zealand smokers for new types of
smokefree areas: national survey data. N Z Med J 2009;122(1303):80-9.
- Edwards
R, Wilson N, Weerasekera D, et al. Occasional Report: Attitudes towards the
tobacco industry and support for tobacco regulation in New Zealand: National
survey data. Wellington: Department of Public Health, University of Otago.
http://www.wnmeds.ac.nz/academic/dph/research/HIRP/Tobacco/itcproject.html,
2010.
- Blakely
T, Thomson G, Wilson N, et al. The Māori Affairs Select Committee Inquiry
and the road to a smokefree Aotearoa. N Z Med J 2010;123(1326):7-18.
- Ministry
of Health. Clearing the Smoke: A five-year plan for tobacco control in New
Zealand (2004-2009). Wellington: Ministry of Health, 2004.
- Thomson
G, Wilson N, Blakely T, et al. Ending appreciable tobacco use in a nation: using
a sinking lid on supply. Tob Control 2010;19:431-5.
- Laugesen
M, Glover M, Fraser T, et al. Four policies to end the sale of cigarettes and
smoking tobacco in New Zealand by 2020. N Z Med J 2010;123(1314):55-65.
- Blakely
T, Carter K, Wilson N, et al. If nobody smoked tobacco in New Zealand from 2020
onwards, what effect would this have on ethnic inequalities in life expectancy?
N Z Med J 2010;123(1320):26-36.
- Cavana
R, Tobias M. Integrative system dynamics: analysis of policy options for tobacco
control in New Zealand. Syst Res Behav Sci 2008;25:675-94.
- Wilson
N, Borland R, Weerasekera D, et al. Smoker interest in lower harm alternatives
to cigarettes: national survey data. Nicotine Tob Res 2009;11:1467-73.
- Wilson
N, Edwards R, Parry R. A persisting second-hand smoke hazard in urban public
places: Results from fine particulate (PM2.5) air
sampling. N Z Med J 2011;24(1330):34-37.
- Hoek
J, Wilson N, Allen M, et al. Lessons from New Zealand's introduction of
pictorial health warnings on tobacco packaging. Bull World Health Organ
2010;88:861-6.
- Hoek
J, Wong C, Gendall P, et al. Effects of dissuasive packaging on young adult
smokers. Tob Control 2010;[E-publication 21 October].
- Thomson
G, Wilson N. Public attitudes to laws for smoke-free private vehicles: a brief
review. Tob Control 2009;18:256-61.
- Wilson
N, Thomson G, Blakely T, et al. A new opportunity to eliminate policy
incoherence in tobacco control in New Zealand. N Z Med J
2010;123(1311):89-92.
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