New Zealand’s decision to scrap anti-smoking legislation will do immeasurable harm
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2956 (Published 18 December 2023) Cite this as: BMJ 2023;383:p2956
- Amohia Boulton, research centre director
In Aotearoa (New Zealand), a country of just over five million people,1 13 people die every day because of smoking or second hand smoke exposure.2 That’s roughly 5000 people a year. For Māori, the Indigenous people of Aotearoa, the effects of smoking are felt even more profoundly. Data from 2020-21 show that almost 20% of all Māori,3 and 26% of Māori adults, smoked.4 Although these numbers are lower than they have been in previous decades, Māori adult smoking rates are still almost three times higher than the rates for adults of European descent,4 putting Māori at greater risk of morbidity and death from cancer, respiratory and cardiovascular disease, diabetes, or a combination of these.567
In addition to generally bearing a greater burden of disease and ill health than non-Māori people of Aotearoa,89 Māori are more likely to have multimorbidities,10 experience inferior healthcare treatment and service,1112 and die younger.13 The consequences of legalised tobacco addiction are a key part of this broader picture of health inequalities.
In the face of such overwhelming evidence of the harms caused by smoking to the population as a whole and to Māori in particular, the recent decision by the government in Aotearoa to repeal new anti-smoking legislations is reprehensible.14
The new coalition government announced the change as part of an action plan that reverses a raft of policies aimed at reducing inequities between Māori and non-Māori people and strengthening opportunities for Māori to drive decisions that directly affect them. The anti-smoking legislation had included three pivotal steps in Aotearoa’s journey to becoming a truly auahi kore (smoke-free) nation: firstly, reducing the number of retail outlets allowed to sell smoked tobacco products; secondly, introducing a requirement to denicotinise smoked tobacco products so they are no longer addictive; and lastly, creating a smoke-free generation by ending the sale of tobacco to anyone born after 1 January 2009.
I will always remember exactly where I was when I first learnt that this internationally lauded and groundbreaking legislation was to be repealed. I read the announcement at a tribal council meeting for Ngāti Hauiti, the tribe for whom I work as the director of their health research centre. Our centre is unique, being the only tribally owned Māori health research centre in Aotearoa. The very first piece of research our centre ever embarked on was a study designed to understand how to reduce smoking uptake among the tamariki (children) and rangatahi (youth) of Ngāti Hauiti.15 It was a shocking and truly devastating moment to read of the repeal on the very whenua (land) where, 20 years earlier, the tribe had committed to reducing the harm of cigarette smoking among its youth.
Putting public health efforts back decades
The combined policy package that would have been introduced by the smoke-free legislation has been widely reported as having the potential to avoid around 8150 deaths by the year 2040.16 Importantly, it is estimated that a third of these prevented deaths would have been in wahine Māori (Māori women).16 In repealing the legislation, the new government has managed, in a single stroke, to stymie long term efforts to reduce inequities in Māori mortality. This policy U turn will do immeasurable harm to tangata whenua (the Indigenous people) and undo 20 years of work by Māori leaders, public health advocates, health researchers, Māori community owned and operated health providers, and tangata Māori (Māori people) to rid our nation of this insidious practice.17
The new government has said that it is still committed to reducing smoking rates,18 but its repeal has single handedly undone the best chance of achieving this.18 It also fails to recognise that Māori want more than simply a smoke-free Aotearoa. We want Aotearoa to once again be a completely tupeka kore (tobacco-free) nation. This bigger, bolder, and arguably more audacious goal is aimed at protecting the health and wellbeing of future generations: our tamariki (children), mokopuna (grandchildren), and the many generations yet to be born. Of course, we must support adults to quit smoking, but we think it’s even more important that our children never have the opportunity to inhale nicotine in the first place. And that is one of the key flaws that Māori recognise in this policy reversal.
The smoke-free legislation would have required the gradual phasing out of nicotine from smoked tobacco and ensured that those born after 2009 could not access any smoked tobacco products. But the new government has stated that smoke-free efforts will now focus on vaping as the primary tool for reducing smoking rates.18 Although the damaging effects of smoking tobacco are undeniable, the long term harms of electronic cigarette use remain unknown.1920 Data reported in May this year confirm the increasing popularity of vaping among rangatahi (youth): daily vaping among 14-15 year old Māori girls increased from around 5% in 2019 to 25% in 2022.21 This trend, and the age at which young people are starting to vape, is cause for concern.
We know that stopping smoking is the single change we can make to improve our health and wellbeing. Furthermore, we know that vaping is not the solution to the goal of a smoke-free Aotearoa, let alone tupeka kore Aotearoa. Our rangatahi have the right to be protected from tobacco products that we know will kill up to two thirds of the people who use them long term.22 Māori want to ensure that we never lose another generation of our rangatahi to the damaging effects of nicotine, irrespective of the method of delivery. If we seek more for our tamariki (children) than sickness and early death, this government must perform its stewardship role, reverse its decision to repeal the act, and give our children the gift of life.
Footnotes
Competing interests: AB is the research centre director of Whakauae Research Services, a tribally owned health research centre, and the principal investigator on several Health Research Council of New Zealand funded grants and on the Governance Group Kahui Māori for the Healthier Lives National Science Challenge. She is also an adjunct professor in the Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, and at the Health Services Research Centre, Faculty of Health, Victoria University of Wellington.
Provenance and peer review: Commissioned; not externally peer reviewed.