Robert Beaglehole and Richard Edwards: Let's get fired up to stamp out cigs

Goal of being smokefree by 2025 needs an urgent plan, write Robert Beaglehole and Richard Edwards

The Government is committed to the Smokefree 2025 goal - a very low smoking rate of less than 5 per cent. This is achievable; already among some professional groups and communities the smoking rate is under 5 per cent. Reaching this goal will do more to improve the health of all New Zealanders than any other government policy.

What will New Zealand look like in 2025 when we have achieved the 5 per cent goal? Smoking will no longer be a "normal" activity. Children will never use tobacco products and smoking will be rarely seen.

Tobacco products will be legally available, but access will be restricted to a small number of licensed tobacco shops. By 2025, the price of cigarettes will be high, well over $40 for a pack of 20, and will be sold in drab, standardised packs with powerful graphic warnings. The cigarettes sold will have greatly reduced nicotine content to decrease their addictiveness.

The presence of the tobacco industry will be greatly reduced in New Zealand, if it remains at all. The current tobacco workforce will be happily engaged in other more health-promoting industries.

Most importantly, all New Zealanders will be living longer and healthier lives. Deaths and diseases caused by the tobacco industry, especially heart disease, stroke, cancer and chronic lung diseases, will be falling rapidly and there will be major savings for the health budget.

The smoking rate in adults is now about 17 per cent - a long way from the 5 per cent goal. If we are to reach the Smokefree 2025 goal in just 12 years, business as usual won't do. The rate of decline is far too slow, particularly in Maori and Pacific people.

Associate Minister of Health Tariana Turia has confirmed plain (standardised) packaging legislation for tobacco products will be introduced to Parliament before the end of this year. She is working with the Minister of Customs to remove, or at least cut back, duty-free tobacco allowances. The Health Promotion Agency will lead a campaign to protect children from tobacco smoke in cars.

These are important steps. However, they are not sufficient. We need more than some very welcome, but piecemeal, actions to succeed. As a matter of urgency, New Zealand needs a comprehensive plan setting out a series of actions from now to 2025 designed to achieve the smokefree goal.

The key steps in the journey include continually increasing the price of tobacco products - it's the most effective way to reduce smoking and stop initiation. We need really large tax increases of at least 20 per cent each year - much higher than the ongoing 10 per cent increases - beginning with the next budget.

We also need to do much more to support the 640,000 current smokers, a third of whom are Maori and Pacific people, to quit. The Government will raise about $1.3 billion in tobacco tax this year but spend only about $52 million on tobacco control. This imbalance must be redressed; much more should be spent on encouraging and supporting successful quit attempts. Even smokers say they will accept higher prices if more is ploughed back into helping people quit.

Researchers at Otago Medical School in Wellington estimate 20 per cent of Maori and Pacific smokers and 10 per cent of Pakeha smokers will need to quit each year between now and 2025 to achieve the goal. These quit rates can only be reached with more resources for Quitline and other services. We need to support all people trying to stop, particularly in Maori and Pacific communities and pregnant women.

If the 50,000 health professionals in New Zealand managed to get just one smoker a year to quit smoking, we would get close to the goal. The simple ABC programme (Ask about smoking, offer Brief advice, support Cessation attempts) is surprisingly successful and working well in hospitals. It needs to be made to work in primary care, and extended to other settings such as Winz offices and communities.

Mass media campaigns have been shown to encourage smokers to try quitting, reinforce quit attempts and reduce the attractiveness of smoking to young people. Yet, the amount spent on mass media has fallen recently. The messages need to be hard-hitting with strong emotional appeal. We should draw attention to the horrible realities of smoking as well as exposing the obstructive actions of the tobacco industry. Social media are being used by the tobacco industry - we need to take the lead in this forum.

Other measures may also be needed, such as ready availability of lightly regulated, quality e-cigarettes or similar devices to aid quitting. But not their promotion by the tobacco industry. Removing flavourings from tobacco and cutting nicotine content will reduce the addictive power of tobacco. Reducing tobacco availability is another supporting measure. Depending on progress in the next few years, we may need legislation, like the landmark 1990 Smokefree Environments Act, to put in place all the measures needed to reach the goal.

New Zealand is leading the world with its Smokefree 2025 goal and other countries are following. Achieving a society free from the devastating effects of the tobacco industry will be a fantastic health achievement to make all New Zealanders proud. But it won't happen without a clear road map to Smokefree 2025. We must start to develop and implement it now. We owe it to our children, and their children.

Robert Beaglehole, Emeritus Professor at University of Auckland.
• Richard Edwards, Department of Public Health, University of Otago, Wellington.

- NZ Herald

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