New Zealand: Ground-breaking action plan may help country achieve its Smokefree 2025 goal

Richard Edwards, Janet Hoek and Andrew Waa

On December 9 2021, Associate Health Minister Dr Ayesha Verrall launched the New Zealand (NZ) Government’s action plan to achieve its Smokefree 2025 goal. The Action Plan responded to consultation on a discussion document published in April 2021 that outlined draft proposals.

The NZ government committed to a smokefree goal in 2011, in response to a recommendation from the Māori Affairs Select Committee of the NZ Parliament, which had undertaken a comprehensive Inquiry into the tobacco industry and its effects on Māori (the Indigenous peoples of NZ). Adoption of the Smokefree goal followed sustained advocacy by Māori leaders for a ‘Tupeka Kore’ (tobacco free) goal, which would see tobacco products, introduced to Māori by colonisation, eliminated. The goal aims for minimal availability of tobacco products and minimal smoking prevalence among all population groups. The goal’s strong equity focus recognises that Māori (and Pacific peoples and low SES groups) have much higher smoking prevalence and thus suffer disproportionately from smoking-related diseases and deaths.

The final action plan includes virtually all the draft proposals from the discussion document (the only omission is the proposal to set a minimum price for tobacco products). It sets out a comprehensive strategy to achieve rapid and equitable reductions in smoking, including some ‘endgame’ measures not yet implemented nationally in any other country.

In the foreword to the action plan, Associate Health Minister Verrall describes it as ‘unapologetically bold’ and says it ‘aims to radically change the smoking environment to make it easy for all New Zealanders to live smokefree.”

The action plan includes the following key measures:

First, it has a clear focus on addressing smoking-related inequities. The first stated outcome is to eliminate inequities in smoking rates and smoking-related illnesses. The first of six ‘focus areas’ outlined is to ensure Māori leadership and decision-making at all levels. A Māori-led Smokefree Aotearoa taskforce, which includes among its members former Health Minister Dame Tariana Turia, has already been established to advise on whether the action plan is achieving the smokefree goal for Māori. The rationale for the focus on Māori equity and governance has been discussed elsewhere.

Second, the plan addresses structural factors that create and maintain the smoking epidemic, such as the strong appeal, addictiveness, and easy availability of smoked tobacco products.  Ground-breaking measures addressing these factors include: greatly reducing the retail availability of smoked tobacco products (decreasing the number of stores able to sell these products to around 5% of the current number); mandating removal of virtually all nicotine from smoked tobacco products, so these become non-addictive; and introducing a ‘smoke-free generation’ policy, where it will be illegal to sell tobacco products to people born after a specified date.

Third, the plan includes comprehensive supporting measures such as enhanced smoking cessation services for priority populations, increased funding for mass media campaigns, and support for community mobilisation and community-based interventions to help achieve the smoke free goal. The plan also proposes restricting design features that enhance the appeal and addictiveness of smoked tobacco products including investigating how to best ‘restrict’ filters to minimise their impact on health and the environment.

The plan also commits to a risk-proportionate framework of regulation for nicotine products, with smoked tobacco products more regulated and less available than vaping products. Vaping is acknowledged as a lower cost and less risky alternative to smoking that could contribute to the Smokefree 2025 goal (e.g. via people who smoke switching to vaping). However, the plan also recognises that preventing vaping uptake among children and young people is crucial and proposes enhanced monitoring to ensure an appropriate regulatory balance.

The most recent NZ Health survey revealed substantial reductions in smoking prevalence in 2020/21 compared to 2019/20, albeit with continuing disparities by ethnicity and SES. Daily smoking prevalence dipped below 10% for the first time to 9.4% from 11.9% in the 2019/20 survey. The action plan measures will help maintain or accelerate this accelerating decline in smoking prevalence.

NZ’s ambitious plan has potential global implications. If it sees smoking prevalence fall to minimal levels by 2025, NZ’s action plan could become an endgame template for countries to adapt to suit their environments. NZ’s bold and innovative strategies could set an international precedent and offer an exemplar illustrating how the health loss, inequity and economic burden caused by the tobacco epidemic can finally be ended.

Richard Edwards and Janet Hoek are Professors of Public Health, and Andrew Waa is a Senior Research Fellow and Senior Lecturer in public health at the University of Otago, Wellington, New Zealand. All authors are co-directors of the ASPIRE 2025 Research Centre. The authors declare no conflicts of interest.

 

 

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