11 Nov 2016
The immediate trigger for New Zealand’s goal was the 2010 Mäori Affairs Select Committee (MASC) inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Mäori. The inquiry drew on input from multiple stakeholders, including Mäori communities, wh nau (extended family), hapü (sub-tribe), and iwi (tribes), researchers and clinicians.
The first of the MASC’s 42 recommendations was endorsed by the government in March 2011 in setting a goal of “reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smoke-free nation by 2025.” In doing so it became the first government in the world to set a specific ‘endgame’ goal for the use of smoked tobacco products. This goal goes well beyond the more incremental target of the World Health Organization (WHO): a 30-percent reduction in smoking prevalence, from 22 percent in 2010 to 15 percent in 2025.
New Zealand’s Smokefree 2025 goal has had a highly positive impact. It has created a clarity of purpose and clear timeline that has galvanised the tobacco control sector, media and the public. It has stimulated local Smokefree coalitions, and facilitated the discussion of radical interventions such as mandated very low nicotine cigarettes or radical reductions in supply of tobacco. The goal has overwhelming public support and has ensured that tobacco control remains strongly on the political and policy agenda.
Since the adoption of the goal, some key interventions have been introduced, including:
• Annual, above-inflation, tobacco excise tax increases since 2010
• Introduction of smoke-free prisons in 2011
• Removal of point-of-sale tobacco displays in shops in 2012, and
• Substantial reductions in duty-free allowances for tobacco in 2014.
In September 2016 the bill to introduce standardised packaging (also known as plain packaging) was passed by Parliament; implementation will occur in the next 18 months. The Ministry of Health is currently consulting on permitting the sale of nicotine containing e-cigarettes and e-liquids.
There are however growing concerns about whether the Smokefree 2025 goal will be achieved. The goal is often interpreted as reaching a smoking prevalence of less than 5 percent. Smoking prevalence in 2014-15 in the New Zealand Health Survey was 17 percent. Modelling studies suggest the government’s midpoint target of 10 percent by 2018, and the 5-percent target, are unlikely to be met on current trends. Furthermore, current smoking prevalence of 38 percent for Mäori and 25 percent for Pacific peoples are unacceptably high. Studies suggest that the 5- percent figure for Mäori will not be achieved until beyond 2060.
One of the key MASC recommendations was for the government to establish a tobacco control strategy and action plan with a strong emphasis on Mäorifocused outcomes. No such plan has been developed. It is unclear how the government intends to achieve the Smokefree 2025 goal, and what measures will be taken to reduce the unacceptably high level of smoking among Mäori and Pacific peoples.
Furthermore, although the government has implemented some positive measures since 2011, many more, including several key recommendations in the MASC Inquiry report, remain unaddressed.
For example, the government Smokefree 2025 goal included the aim of reducing tobacco availability to minimal levels by 2025, and also a commitment to investigate options for measures to reduce tobacco supply. However, the ministry of health in a report to the MASC described these measures as ‘low priority’, and there is no evidence of any investigation or implementation of supply-side measures, other than the restriction on duty-free sales introduced in 2014.
Adoption of the Smokefree 2025 goal put New Zealand at the forefront of tobacco control internationally. However, the goal will not be reached without bold and determined political leadership. Interventions cannot be cherrypicked according to what is politically pragmatic.
Achievement of the goal will require the government to develop a strategy and introduce a comprehensive range of effective interventions, developed in partnership with Mäori and Pacific communities and leaders, building on the energy, commitment and innovation to achieve Smokefree 2025 that is being shown by local coalitions across New Zealand.
With such a robust, evidence-based and comprehensive approach, the Smokefree 2025 goal can and should be achieved.
Professor Richard Edwards, Co-Head of Department, Department of Public Health, University of Otago, Wellington; Shayne Nahu, Health Promotion and Campaigns Manager, Cancer Society of New Zealand; Boyd Broughton, Programme Manager, Action on Smoking and Health; Zoe Hawke, General Manager Tobacco Control Advocacy; Häpai Te Hauora, Mäori Public Health; Louisa Ryan, Pacific Health Manager, Heart Foundation