Global tobacco control report – Expert Reaction

A new global report from the World Health Organization says many governments are making good progress in the fight against tobacco, but greater action is needed to help people quit.

The WHO Report on the Global Tobacco Epidemic 2019 labels New Zealand a ‘best practice’ country, since initiatives like plain packaging and increased taxes on tobacco have taken effect since the last report in 2017.

The Bloomberg-funded report says tobacco use has declined proportionately in most countries, but population growth means the number of smokers remains high – though 80 per cent of them live in low- and middle-income countries.

Unlike our Ministry of Health, the report says the WHO does not endorse e-cigarettes as a tool to help people quit smoking.

The SMC asked experts to comment on the report.

Professor Janet Hoek, Professor Richard Edwards, and senior research fellow Anaru Waa, co-directors of ASPIRE 2025, University of Otago, Wellington comment:

“The WHO report shows New Zealand performs well in several areas of the FCTC [Framework Convention on Tobacco Control] treaty; key achievements include introducing standardised (plain) packaging, mandating smoke-free settings, and increasing the excise tax applied to tobacco products.  However, as a country that has set a tobacco endgame goal – the Smokefree 2025 goal – New Zealand needs to do much more to achieve the Smokefree Aotearoa goal of reducing smoking prevalence to below five percent (and as close to zero as possible) among all population groups.

“Innovative new measures are needed to greatly reduce the availability of tobacco, which continues to be sold at thousands of outlets that also sell staple items such as bread and milk. Outlets are concentrated in the most deprived areas, thus perpetuating higher smoking prevalence among groups already experiencing disadvantage. We urgently need measures that recognise tobacco is no ordinary product, restrict the number of outlets selling tobacco, limit sales to R18 stores, and prevent sales near schools or places where young people gather.

“Other measures could make tobacco products less appealing and less addictive. For example, New Zealand could adopt FDA suggestions and reduce the nicotine in cigarettes to non-addictive levels. It could also remove additives that make smoking a more palatable experience, particularly for new users, and prevent innovations such as flavour capsules, which appear designed to attract young people to smoking.

“The Associate Minister of Health’s announcement that she is preparing an Action Plan to 2025 gives the first hope in a decade that these and other measures could be introduced and see New Zealand provide international health leadership.”

Conflict of interest statement: We have received funding from the Health Research Council of New Zealand and the Royal Society Marsden Fund to investigate smokefree research topics.

Emeritus Professor Robert Beaglehole, Chair, ASH (Action for Smokefree 2025), comments:

“Global progress on tobacco control has been disappointingly slow. We are not on track to achieve the WHO target of a 30% reduction in adult current smoking prevalence by 2025.

“New Zealand is one of the best performing countries in the world, and we owe this success to serious and comprehensive government led policy measures, all supported by public opinion. Despite having implemented all the recommended WHO measures to the highest level, even in NZ we are not on track to achieve the Smokefree 2025 goal of an adult daily smoking prevalence of less than 5%.

“In particular, we have serious and persistent social and ethnic inequities in smoking rates, with the most disadvantaged people in New Zealand smoking at least four times the rate of the most advantaged. The inequities have not been reduced over the last decade. The Smokefree goal will only be achieved by helping many more smokers to quit.

“This WHO Report subtitled “Offer help to quit tobacco products” is not helpful. In fact, it is extremely disappointing: it promotes a medical model of cessation services which we know from the New Zealand experience, cannot be brought to sufficient scale to help large numbers of people who want to quit.

“The WHO report does not recognise that new technological innovations have encouraged a consumer-led movement for tobacco harm reduction – a movement we should be encouraging as the only way to reach the Smokefree 2025 goal.

“The Report rejects the most important and disruptive intervention in the history of tobacco control – vaping (e-cigarettes). Vaping is effective in cessation, much safer and much cheaper than cigarettes. The WHO review of the vaping evidence is incomplete and alarmist. The proposed regulations will privilege the established tobacco industry and entrench cigarettes as the major form of tobacco use.”

No conflict of interest. Note: Robert worked for the WHO between 2000-2007 in a range of public health roles, including director of the Department of Chronic Disease and Health Promotion.

Nick Wilson, Professor of Public Health, University of Otago, Wellington comments:

“This new major report provides good news on the progress to reduce the health burden from smoking globally. New Zealand ranks fairly well on progress compared to most other high-income countries and it has been one of the lead countries in using high tobacco taxes and in requiring plain packaging with health warnings on tobacco packs.

“But New Zealand still has higher smoking levels than some: e.g, New Zealand at 14% smoking prevalence in 2017 among adults vs: Australia (13%), Canada (10%), Iceland (11%), Norway (13%), Singapore (13%) and Sweden (10%). Also this report does not detail how New Zealand is actually way off track for meeting the Government’s own Smokefree 2025 Goal. This is particularly the case for reducing the burden of tobacco on Māori. Some indicators that this current government and previous governments don’t have their eyes on the ball include:

  • There is still no Government plan on how to reach the Smokefree 2025 Goal.
  • There are still no regulations around e-cigarettes (to maximise their potential benefits and to minimise the risks of youth uptake).
  • There are no Government plans to phase down the number of tobacco retail outlets (despite other jurisdictions internationally making progress with this).
  • There are no plans to require that cigarettes are made less addictive eg, by phasing down the nicotine levels.

“The lack of progress in these areas is particularly problematic given that the tobacco burden contributes to so much preventable health loss and also contributes to child poverty and health inequalities. Also there is the very high costs of smoking-related disease to the New Zealand health system. For example, previous modelling work at our university indicated that a sinking lid on tobacco supply would save NZ$5.4 billion in health costs over the remaining lifetimes of the current New Zealand population. For all these reasons, New Zealand governments should be focusing way more on progressing tobacco control.”

No conflict of interest.