Visionary step on smoking
Young Māori deserve the same healthy future as their Pākehā counterparts, write Richard Edwards, Janet Hoek and Andrew Waa.
The Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill introduced by Associate Health Minister Ayesha Verrall has its origins in the mid-2000s when Māori leaders first advocated for an end to tobacco use and availability in Aotearoa.
The bill asserts the importance of Māori leadership and is centred on Te Tiriti. Its three key measures have received international acclaim and will put Aotearoa on track to reducing smoking prevalence below 5% among all groups by 2025.
Removing nicotine from tobacco products will make them non-addictive. Extensive research shows people provided with denicotinised cigarettes smoke less, are exposed to fewer toxins, and are more likely to become smokefree.
Denicotinised cigarettes will minimise the risk of young people becoming addicted to smoking and smoking long-term. Modelling studies show denicotinisation will substantially and rapidly reduce smoking prevalence, particularly among Māori and Pacific peoples.
Decreasing the number of outlets selling tobacco will further reduce smoking uptake and prompt quitting, particularly in disadvantaged communities, where tobacco retailers are concentrated.
The smokefree generation policy will protect future generations and ensure falls in smoking prevalence after denicotinisation are never reversed. It will enhance equity by ensuring rangatahi Māori have the same smokefree future as non-Māori.
These latter measures signal that tobacco is not a normal consumer product and should no longer be sold as though it were.
Predictably, tobacco companies have opposed all three measures. We outline five reasons why we can confidently reject the tired, ill-informed and illogical claims used to oppose these policies.
First, increased illicit trade has long been an ‘‘argument’’ of last resort, used to oppose policies such as plain packaging and tobacco tax increases, despite evidence to the contrary. Studies of discarded cigarette packs in New Zealand found very similar levels of foreign packs in 2012-13 (5.8%) and 2021-22 (5.4%), suggesting there was no big change in the illicit tobacco market during a period when prices increased markedly and plain packaging was introduced.
The Smokefree 2025 Action Plan proposed greater monitoring of illicit trade and stronger enforcement measures; recent Budget allocations have already provided extra support, and should ensure illicit trade is not a big problem.
Second, claims that creating a smokefree generation is unnecessary because youth are already smokefree overlook survey evidence and the process of smoking uptake. Although adolescent smoking has declined, it has not occurred equitably. In 2021, regular smoking among Māori year 10 boys was 7.7%, and 10.7% among Māori girls. Among young adults, the group where smoking initiation and uptake increasingly occur, current smoking prevalence among 18 to 24-year-olds in 2021 was 11.8%, and 8.1% smoked daily.
Young people can hardly be described as ‘‘smokefree’’ when around one in 10 enters adulthood addicted to smoking. Despite trying to quit, many will remain addicted; and smoking will kill two-thirds of these long-term users prematurely.
Third, describing denicotinisation as prohibition is nonsensical when alternative sources of nicotine, including vaping products, are widely available. Nor is this measure punitive. Surveys of smokers find the vast majority regret starting and wish to quit, and show strong support for denicotinisation. A recent trial found no evidence that denicotinised cigarettes increased stress among smokers who had a current or recent history of anxiety or depression.
Fourth, opposition to the new policies on the grounds that we lack real-world evidence of their impact fails on two grounds. They overlook strong supporting theory and evidence, and imply that policy innovation should never occur. Only tobacco companies stand to benefit from such an approach.
Finally, some critics argue for more focus on encouraging and supporting people to quit. The Action Plan will do just that; recent funding allocations are already strengthening media campaigns and community-based interventions.
However, while these are important, they will not achieve the profound reductions needed to reach the 2025 goal and are no substitute for the bill’s three key measures.
Verrall’s visionary bill will help deliver the profound benefits Māori leaders envisaged, and ensure tamariki and their whānau grow up in a world unblighted by smoking.
Professor Richard Edwards, Professor Janet Hoek and senior research fellow Andrew Waa are co-directors of ASPIRE 2025, the research centre for a tobacco-free Aotearoa at the University of Otago, Wellington.