health & science

Our best chance to stamp out smoking

New Zealand is not succeeding in enabling and supporting people to quit smoking at the scale required to achieve Smokefree 2025. ASH's Deborah Hart outlines what we need to do. 

Most parents have experienced the plaintive cries from the back seat, “Are we there yet?” The heart drops. You wonder how on earth you can deal with the situation … again. Or still. You scramble to find a new calming technique. Or perhaps you just stare into the distance and hope like hell that the destination is just around the corner.

It feels much the same way with our aim to be smokefree. And the typical answer seems apt. “We’ll be there soon.” Except with smokefree, on current evidence, we won’t be.

Half a million of us still smoke daily. Thirteen of us die of smoking-related disease each and every day – 4500 each year with one third of these deaths tragically occurring in middle age. That’s more people than those who die of breast cancer. More than the road toll and, to state the topical, way more than the Covid 19 death toll.

Smoking is not new of course. The New Zealand obsession with tobacco arrived with European colonisation. Māori men and women took up smoking with fervour and it quickly became a standard trading item along with muskets, alcohol and blankets. Cigarettes were initially a manly pursuit for Europeans and therefore part of rations in World War I. By World War II, women were taking on male roles and smoking was aggressively marketed to them. Fast forward to today and the dependence is still here, particularly with those who are disadvantaged.

So the question is, why?

In the 1950s, even as Big Tobacco was reassuringly telling us it was fine to smoke, many of us knew smoking was problematic. For one thing, many doctors, who had previously been drawn into the sexy allure of smoking, quit en masse. The first to comprehend the emerging evidence 70 years ago, they knew the consequences looked dire. Today there are very few of us who would challenge the health consequences of smoking.

So for most it will come as a surprise that so many Kiwis are still smoking.

There is the belief that smokers can simply give up. But for smokers, the evidence couldn’t be plainer. As it turns out, smoking creates dependence. Simply, people smoke for the addictive nicotine, but die from the smoke. Added to this, the social dependence is linked to inter-generational use and societal norms within communities.

Most smokers do want to stop smoking and regret they ever started. They typically will make many attempts to quit. They will tell you they have tried cold turkey, patches, gum, support groups, therapy and yet they still smoke. Some will have tried vaping and significant numbers are having success this way, particularly as the behaviours associated with smoking - relaxation, hand to mouth action as well as the nicotine - are replicated with vaping.

Almost 10 years ago, New Zealand first determined it would aim to be smokefree, adopting a goal to achieve it by 2025. Epidemiologist and ASH chair Robert Beaglehole has been working on smokefree initiatives for decades. He says, “We wanted to get to smokefree - less than 5 percent of Kiwis smoking - because smoking is such a huge health problem. It is concerning that after all the work that has been done, we still have so many people smoking.”

And yet New Zealand has been a global poster child for smokefree initiatives. Uniquely, we have enacted all the measures recommended by the World Health Organisation. These included being among the first in the world to ban advertising, heavily taxing cigarettes, implementing plain packaging, and making places of work and public places smokefree. New Zealand has done it all. Before Parliament are two more measures – smokefree cars and a bill to optimise the use of vaping to help smokers quit smoking. Such is the public health imperative, whilst much of the Parliamentary agenda has been in limbo of late, these two items to help get New Zealand to smokefree are still powering through the House.

The suite of measures has been tremendously successful, but only for some sectors of society. The good news is that those aged 18 and under and those over 75 are already meeting the smokefree targets. The largest year-on-year decline in smoking rates for any age group is 18-24-year-olds, suggesting efforts to reduce youth uptake and smoking are being sustained beyond adolescence. Daily smoking for those aged 15-24 has fallen by 40 percent since 2015, the equivalent of 45,000 fewer young smokers.

But the bad news is New Zealand is not succeeding in enabling and supporting people to quit smoking at the scale required to achieve Smokefree 2025. For those in low socio-economic groups, for Māori and Pasifika, we are well off target. At current rates, it will be at least 2060 for Māori to be smokefree and even longer for Pasifika.

Now we need to target public health initiatives for the remaining smokers. We now need a final, strong push to get us to smokefree 2025. Robert Beaglehole says, “it won’t be one thing that gets us there. But community-led initiatives, optimising vaping as a quit smoking tool, a mass media campaign promoting smokefree - particularly relevant for Māori and Pacific, restricting the supply of cigarettes, incentivising smokers to quit, all have the capacity to get us there”. That and a plan. It is surprising that although Smokefree2025 has cross-party support, there is no national plan.

Dr Alex Wodak, Emeritus Consultant, Alcohol and Drug Service, St Vincent's Hospital, Sydney, says “poverty is both an exacerbating factor and a consequence of smoking”. What this means is that the taxation of cigarettes, whilst an important driver to compel smokers to quit and which worked for many, has now done its day. More taxation would simply be punitive and achieve no fewer smokers.

We need to provide the best possible support for quitting. Initiatives that are community-driven are the most promising. One of these, Vape2Save, named because of the savings in health and money, uses community mobilisation and Wahine Māori volunteers to support those trying to quit. The organisation’s founder and public health advocate, Rebecca Ruwhiu-Collins, says, “Māori women have the highest smoking rates of any group in New Zealand – 38 percent and they are a really hard group to get off tobacco. The programme has achieved an 80 percent quit rate.”

Community-led initiatives like Vape2Save should be rolled out nationally. Mass media campaigns and initiatives that decrease the ability of smoking to be pleasurable are our best chance to get us, all of us, to a smokefree future.

Hopefully then, smokefree will be just around the corner and we can truthfully say, “we are nearly there”.

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