Smoking to be outlawed for future generations – Expert Reaction

The just-launched Smokefree 2025 Action Plan says people aged 14 and under when a new law comes into effect will never be able to legally purchase tobacco, with the age rising each year.

The changes will mean only tobacco products with very low levels of nicotine will be sold, and the number of shops selling tobacco will be limited. A Māori Advisory Taskforce is being created to help achieve better outcomes for Māori. Support measures will also be prioritised to help current smokers quit and to prevent people from lighting up in the first place.

The SMC asked experts to comment on the announcement.

Anaru Waa, Senior Lecturer/Researcher, Eru Pomare Māori Health Research Centre, University of Otago, and co-director of ASPIRE2025, comments:

“Mō tātou, ā, mō kā uri ā muri ake nei

“‘Making a difference for the people today and the generations to follow-us.’

“Smoking is the number one preventable cause of death and illness in Aotearoa. While we have seen steady reductions in smoking prevalence, marked disparities in smoking rates between Māori and non-Māori have persisted.

“This is why in the mid-2000’s Māori leaders such as Hone Harawira and Shane Bradbrook advocated an end to tobacco by focusing on source of the problem – that tobacco is readily available in Aotearoa. Such an approach means we not only have to be innovative, but we also have to change the rules entirely.

“The Government’s announcement does just this. By doing so the government is taking responsibility for addressing harm caused by tobacco and not making it the problem of smokers. This includes measures such as requiring almost all of the nicotine is taken out of tobacco and markedly reducing where tobacco can be brought. Such measures are likely to affect smoking behaviour in a similar way and therefore have good promise to both hugely reduce smoking AND be equitable.

“Measures such as enhancing cessation services will help support those who find it challenging to quit. Importantly the Government’s commitment to ensuring Māori governance throughout the plan’s implementation will ensure Māori ownership as well as that the plan meets Māori needs. Such a plan will reduce the thousands of deaths that might have otherwise been experienced by those who not only smoke today but also among the generations that will follow.”

No conflicts of interest.

Associate Professor Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:

“The Government is to be commended for a strong trend-setting strategy to accelerate the reduction of smoking in Aotearoa/New Zealand. The strategy continues the strong tobacco control traditions building on previous efforts, which has seen excellent progress towards Smokefree Aotearoa. Reduction in smoking among young people in recent times has been impressive and an encouraging trend towards the emergence of a ‘smoke-free’ generation.

“The strategy includes a number of innovations including making tobacco less appealing and addictive, including the nicotine content of tobacco. Further restricting the sale of tobacco by limiting the number of outlets offering the sale of the product will have an important impact. It is important to remain vigilant about vaping and protect young people from this practice.

“It is important that a focus on these efforts should be in neighbourhoods where Māori and Pacific people live. Experience with the Covid-19 vaccination rollout has reminded us of the importance and impact of community-led events. Māori and Pacific communities should be trusted, empowered and resourced to lead the design and delivery of community information and education. A focus on Māori and Pacific smoking would accelerate our progress towards a Smokefree Aotearoa.”

Conflict of interest statement: “No conflicts but I am a Board Member of Action for Smokefree 2025 (ASH) and Chief Advisor Pacific at the National Heart Foundation. No research grants from tobacco industry.”

Professor Janet Hoek, University of Otago, Wellington, and co-Director of ASPIRE2025, comments:

“The Government’s Smokefree Action plan recognises that allowing 4500 people to die each year from diseases caused by smoking is completely unacceptable. As Associate Health Minister Verrall noted, the plan is about people, not profits. The measures outlined draw on robust research evidence and will save thousands of New Zealanders from a painful and premature death.

“The vast majority of people who smoke want to be smokefree; the plan will help these people get rid of the intolerable burden smoking represents and reduce smoking uptake among young people. For the first time since the Smokefree 2025 goal was announced ten years ago, we have a realistic prospect of achieving and sustaining the goal.

“The plan outlines three core proposals: first, greatly reducing the number of outlets selling tobacco sends a clear message that tobacco is not an ordinary product and should not be available alongside bread, milk and ordinary household items.

“Second, removing nicotine from tobacco products so these are no longer addictive is a game changing measure. It will help people quit or switch to less harmful products, and make it much less likely that young people get addicted to nicotine.

“Third, the plan introduces a smokefree generation proposal that will ensure young people grow up free from the harms of smoking and the burden of dependence.

“Importantly, the plan also recognises the importance of strengthening Māori governance of tobacco control, which is crucial to reduce persistent disparities in smoking prevalence.

“The World Health Organization has estimated that smoking will cause a billion deaths this century. New Zealand’s plan will have global implications that change this trajectory and make ending the smoking pandemic a realistic prospect.”

Conflict of interest statement: “Professor Hoek receives funding from the Health Research Council of New Zealand and the Royal Society Marsden Fund to support research into smokefree policies and their effects.”

Dr Natalie Walker, Associate Professor in Population Health, Director of the Centre for Addiction Research, Faculty of Medical and Health Sciences, University of Auckland, comments:

“New Zealand once again leads the world – this time with a cutting-edge smokefree 2025 implementation plan– it’s truly a game changer.

“We know from experience that utlising a combination of policy interventions will have the biggest impact on tobacco use in New Zealand, particularly in those populations with higher smoking rates than the general population. The proposed combination of policies is perfect.

“Reducing access to tobacco is vital, and the new smokefree 2025 implementation plan aims to do this through a reduction in the number of retailers selling tobacco. I would strongly recommend the government take a more holistic approach and look to apply the same process to retailers who sell alcohol. Tobacco and alcohol are the leading risk factors for heart disease and cancer, plus alcohol is a key risk factor for falls, drownings, poor mental health, miscarriage, Foetal Alcohol Spectrum Disorder, motor vehicle accidents and social harm (such as domestic violence). Imagine the additional health and societal benefits if access to both of these dangerous consumptions became harder through a reduction in the number of retailers.

“Nicotine has been able to be removed from tobacco since the 1930’s. The planned nicotine reduction strategy builds on New Zealand and international research showing that if you take the nicotine out of tobacco there is no longer any point to smoking, particularly when ‘cleaner’ forms of nicotine are available through vaping and nicotine replacement therapy.”

Conflict of interest statement: “No conflicts of interest, although I have undertaken research on reduced nicotine tobacco (and purchased tobacco from tobacco companies to do this research).”

Professor Chris Bullen, Professor of Public Health, the University of Auckland, comments:

“All I wanted for Christmas this year was evidence of a serious commitment from government to tackle our tobacco smoking problem.

“As a doctor, tobacco control researcher and advocate for many years, I was hoping to see a plan that would have the best chance of getting rid of the harm and misery caused by tobacco smoking, for all people in Aotearoa.

“The plan I wanted to see would include some world-leading, game-changing approaches to make smoking far less attractive and less available while making support for quitting even more available and effective for people.

“All my wishes have come true with the launch today of the Smokefree Aotearoa 2025 Action Plan by Associate Minister of Health Dr Ayesha Verrall.

“Among the six focus areas in the Smokefree Aotearoa 2025 Action Plan, the first, crucially, is a central role for Māori leadership and decision-making at all levels of the plan. The plan includes establishing the Smokefree Aotearoa 2025 Taskforce, an all-Māori group chaired by Dame Tariana Turia, that will hold the Ministry of Health, the government, and the tobacco control sector accountable to Māori for delivering on the plans.

“There will be a greater investment in local community action and targeted support for smokers, especially Māori and Pacific, to help them on their difficult journey to quitting. The smoking cessation workforce will be boosted.

“The next area is a world-first. The government will introduce an amendment Bill to allow only very low nicotine levels (ideally, below the level that causes addiction) in smoked tobacco products and introduce product assurance systems to support compliance with these requirements. It will also seek to restrict product design trickery, such as techniques like flavour capsules and additives the tobacco industry uses to maintain or enhance the appeal and addictiveness of smoked tobacco products.

“Staying with tobacco products, the plan includes investigating how to eliminate cigarette filters from the market. As well as misleading smokers into thinking they make smoking safer, filters are full of microplastics and are a blight on our environment. They should go.

“Reducing the number of shops selling tobacco especially in low-income areas will help to reduce youth smoking and restrict availability. Retailers will have to be ‘authorised’ to sell tobacco and won’t be able to be concentrated in the areas of highest deprivation.

“But perhaps the next most bold idea is to introduce an amendment Bill to prohibit the sale and supply of cigarettes to people born after a certain date, thus creating a ‘smokefree generation.’

“The sixth focus area seeks to shut down the booming illegal trade in tobacco through better enforcement and monitoring.

“The Action Plan is very good news: if implemented as outlined, it could just be the single most significant step we take as a nation to reducing preventable death and disease and reducing health inequities in the next few years.”

Conflict of interest statement: Full-time employee of the University of Auckland. No affiliation with the tobacco industry! Member of Health Coalition Aotearoa. President, Society for Research on Nicotine and Tobacco-Oceania. Recipient of numerous public-good grants for health research from Health Research Council and other funders; and contracts for research and consultancy from the Ministry of Health.