Dr Raglan Maddox, Catherine Manning, Prof Raymond Lovett, Assoc Prof Lisa Whop, Selah Hart, Dr Michelle Kennedy, Assoc Prof El-Shadan Tautolo, Shane Kawenata Bradbrook, Prof Tom Calma AO and Anaru Waa
What is Aotearoa/New Zealand doing?
Māori in Aotearoa/New Zealand were among the first to call for a Tupeka Kore (tobacco free) country, moving away from individual blame to the “true source of the problem: commercial tobacco and the Tobacco Industry”. Honoring this, a landmark piece of Smokefree legislation passed in Aotearoa/New Zealand Parliament yesterday. The aim of the legislation is to ensure further progress to a goal of a Smokefree Aotearoa by 2025.
There are four key components to the legislation:
- Making tobacco products less addictive through the use of very low nicotine cigarettes (VLNC) and tobacco products,
- Reducing the ease of access to tobacco through reduced tobacco retail outlets,
- Protecting future generations from ever taking up smoking by implementing a ‘smoke free generation’ (ending the sale of tobacco to anyone born after 31 December 2008), and
- Ensuring key populations, in particular Pacific and Māori are active participants in driving the development, implementation and evaluation of the legislation. This includes the foundational Māori governance component and the commitment to eliminating disparities, building on the strong leadership, engagement and Indigenous governance of tobacco control efforts who have been critical to achieving this law – consistent with Aotearoa’s obligations under the Treaty of Waitangi and the WHO Framework Convention on Tobacco Control.
This legislation can be traced to 2005 when Māori mooted getting rid of tobacco and the launch of Tupeka Kore, and was followed by the 2010 Māori Affairs Select Committee Report that generated an inquiry into the Tobacco Industry in Aotearoa. The inquiry helped establish a new precedent for innovative and comprehensive structural approaches to the nature and supply of commercial tobacco, supporting communities to be free from tobacco related death and disease.
The potential for large declines in tobacco use with nicotine removal from tobacco
An article by Ouakrim et al, highlights the ‘breathtaking’ anticipated health gains from nicotine removal from tobacco. The combined comprehensive package of strategies outlined above, in addition to mass media campaigns, is expected to achieve huge reductions in smoking prevalence and reduced smoking inequities, such as profound changes in inequities from all-cause mortality, particularly for Māori women. Further, this includes reducing adult smoking prevalence from 31.8% to 7.3% between 2022 and 2025 for Māori, and 11.8% to 2.7% for non-Māori. The 5% smoking prevalence target was forecast to be achieved in 2026 and 2027 for Māori males and females respectively, while the Health-Adjusted Life Years (HALYs) gains for the package of strategies over the population’s remaining lifespan was estimated to be 594,000 (95% uncertainty interval: 443,000 to 738,000; 3% discount rate).
These resulting benefits will dramatically improve health outcomes and make unprecedented reductions in longer term health inequities, particularly for Māori women. The measures in this legislation are long-awaited, well researched and provide the opportunity for clear and decisive action on the inequity experienced by Māori.
What is Australia doing: will recently announced tobacco control reforms bring Australia into the 21st century?
In Australia, tobacco use also remains the leading cause of illness and premature death, with tobacco use killing two-thirds of people. Health Minister Butler has recently announced ‘Reignite the fight against tobacco addition’, with the commitment to a comprehensive approach to tobacco regulations providing a substantial step towards ridding Australia from tobacco related harms.
Minister Butler announced the following proposed measures:
- Consolidating Australia’s patchwork tobacco legislation, bringing eight tobacco related laws, regulations and court decisions together,
- Updating and improving health warnings on cigarette packs and individual cigarettes to help people understand the extent, and significance, of the health risks,
- New requirements for pack and pouch sizes to make roll-your-own tobacco less affordable and appealing, particularly to young people,
- Closing loopholes that have allowed the tobacco industry to promote and market their products, and
- Requiring greater transparency from tobacco companies about sales volumes and pricing, product ingredients and emissions along with their advertising, promotion and sponsorship activities.
This is consistent with calls from the tobacco control sector, such as our recent call for eliminating tobacco related harms. We need to implement evidence-based structural change to foster a smoke free future, and move beyond incremental change. This includes self-determining mechanisms to instil agency, self-determination, and sovereignty to be free from nicotine dependence to improve health and wellbeing, including children and future generations.
“Australia needs to reclaim its position as a world leader on tobacco control. Because, quite frankly, lives are at stake.” Minister Butler
More of the same is not enough: Implementation and resourcing
These reforms support the leadership roles of Indigenous peoples in our tobacco and nicotine free journeys. The successes of tobacco control in Aotearoa/New Zealand and Australia will depend on continuing commitment, robust implementation, evaluation and adequate resourcing. Aotearoa/New Zealand have invested heavily in public health compliance and enforcement capabilities with substantial additional funding to establish a tobacco products regulator and to support the implementation of the Smokefree Aotearoa 2025 Action Plan.
“We’ve made sure to have additional support in place for people wanting to quit smoking by increasing the funding and availability of support services. Additionally a new quit campaign will roll out later this year and this Bill will act as the final push toward a smokefree future,” Dr Ayesha Verrall
Measures that fundamentally change the nature and supply of commercial tobacco are vitally important. If we are to bring Australia into the 21st century, resourcing tobacco control reforms are required. After decades of leadership, research, advocacy and calls from communities to end tobacco related death and disease, including eliminating health inequities between Indigenous and non-Indigenous peoples, significant structural changes are in train. If successful, these steps will provide monumental achievements for generations to come, as well as paying homage to the generations of tobacco-control advocates and researchers as we accelerate through conceptualising the idea of eliminating harm fuelled by the Tobacco Industry, into our realities.
Tobacco kills 4,500 people each year in Aotearoa/New Zealand, 20,500 people in Australia, and more than 8 million globally. The question is, how many more Tobacco Industry attributable deaths are you comfortable with?
About the authors
Raglan Maddox
Bagumani (Modewa) Clan, Papua New Guinea.
National Centre for Aboriginal and Torres Strait Islander Wellbeing. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
Catherine Manning
Ngāti Tukorehe, Ngāti Raukawa ki te Tonga.
Takiri mai Te Ata Whanauora Collective. Regional Stop Smoking Service. Seaview Lower Hutt. Wellington. Aotearoa (New Zealand).
Raymond Lovett
Ngiyampaa (Wongaibon), Australia.
National Centre for Aboriginal and Torres Strait Islander Wellbeing. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
Lisa Whop
Wagadagam, Australia.
National Centre for Aboriginal and Torres Strait Islander Wellbeing. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
Selah Hart
Ngāti Kuia, Ngai Tahu, Ngāti Kahungunu ki Wairarapa.
Hāpai Te Hauora – Māori Public Health, Auckland, Aotearoa (New Zealand).
Michelle Kennedy
Wiradjuri, Australia.
School of Health and Medicine, University of Newcastle, Australia.
Hunter Medical Research Institute, Newcastle, Australia.
El-Shadan Tautolo
Samoa/Ngāti Tapuniu.
AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, Aotearoa (New Zealand).
Shane Kawenata Bradbrook
Ngāi Tāmanuhiri, Rongowhakaata, Ngāti Kahungunu. Aotearoa (New Zealand).
Tom Calma AO
Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group
Indigenous tobacco control advocate
Consultant to the Commonwealth Department of Health, Canberra, Australia
Anaru Waa
Ngāti Hine/Ngāpuhi.
Eru Pomare Māori Health Research Unit, University of Otago. Wellington, Aotearoa (New Zealand).