Damien O'Connor speech to smokefree meeting
National Smokefree Meeting, Wellington
E nga iwi, e nga mana, enga karangatanga maha o te motu Tena koutou, tena koutou, tena koutou katoa.
It is an honour to be invited to open the national Smokefree Conference with the theme "Clearing the Air ? What's
Next?". As well as an honour, it is a very fitting and timely opportunity as one of my first duties in the role of
Associate Minister for Health with responsibility for tobacco control. My first and a very pleasant task is to thank
Amster Reedy for his mihimihi, which set the tone for a very positive conference over the next two days. Kia ora,
Amster. I'd also like to welcome Cynthia Hallet and Cathy Segan, our international keynote speakers.
With more than 180 attendees, this is by far the largest turn out ever for a tobacco control conference in New Zealand.
Since the last conference two years ago a lot has been accomplished, thanks to the hard work of many of you here today.
I think in looking around this room and seeing the faces of our colleagues in tobacco control, we can remind ourselves
of how far we've come. From this Government's point of view, five years ago we were spending approximately $12 million a
year on tobacco control. Today that figure is closer to $30 million.
CONTEXT Over the last ten years the prevalence of tobacco smoking in the community has decreased by more than 30%, with
a more measured decrease over the last five years. Currently we see around 25% of New Zealanders smoking, which compares
favourably with many countries. The theme of this conference is "What's next?" so it seems opportune to state that I
have a goal of seeing tobacco prevalence decrease further to around 20% over the next few years. This would put New
Zealand on a par with the lowest rates of smoking among developed countries.
The recently launched New Zealand Health Monitor will assist all of us in the Government and non-Government sectors to
better assess the impact of our programmes in the future. The Health Monitor is a ten-year cycle of surveys which
include questions about tobacco consumption and attitudes, among other health-related questions. The surveys are a mix
of face-to-face and telephone-based methods and gather age-specific as well as health behaviour data. The ten-year cycle
allows for consistent delivery and will allow us to answer questions such as "what are the impacts of New Zealanders'
smoking behaviour on their health?" "Is the gap with Australia closing?" and "Is inequality between Maori and non-Maori
health outcomes widening or contracting?"
REDUCING INEQUALITIES Sadly, the prevalence of smoking continues to be much higher among Maori and Pacific peoples than
across the wider New Zealand population. Issues around the smoking rates of more recent immigrants also need to be
addressed. As many of us would be well aware, 31% of all Maori deaths are attributable to tobacco use. Over the last
five years New Zealand has seen a significant increase in the Maori tobacco control workforce. I'm thinking specifically
of the Aukati Kai Paipa programme, which, apart form the acknowledged success in terms of helping people to quit, has
also seen a real opportunity for Maori health providers in terms of workforce development. Several small organisations
focusing on Maori health have undertaken capacity building and have grown in expertise and (dare I say it) political
influence as resources have been allocated to this important programme.
Maori have benefited from mainstream tobacco control programmes, but generally not to the same extent as non-Maori.
Consequently this Government spends $515 000 annually on Maori national advocacy and information, which is almost twice
what is spent on the mainstream equivalent. Each year, another $425 000 is spent on Maori cessation training and
coordination. As well as these initiatives, the Quitline has Maori as a priority group, uses Maori Quit Advisors and
focuses advertising on Maori, such as the "It's About Whanau" campaign.
LEGISLATION Focusing again on the theme "What's next?", I think part of the answer lies in building on that example of
community involvement with our tobacco control programmes. The next challenge for us in tobacco control is to bring our
respective local communities along with us and get them to share the vision of a smoke-free New Zealand. I'm sure many
of us have experienced first-hand the pitfalls of trying to get people to change their behaviour before they are ready.
I'm thinking for example of our hard-working regional Smokefree Officers, who have the sometimes unenviable task of
enforcing the current Smoke-fee Environments Act.
This is where I see the Amendment Bill to the Act coming in. As you would all be well aware, the Amendments currently
before the Health Select Committee would have a range of effects, including reducing the number of workplaces in which
people are exposed to second-hand smoke. Of course what will ultimately be recommended to Parliament is in the capable
hands of Steve Chadwick and other colleagues on the Select Committee. However the point I want to make today is that
limiting the places where it's acceptable to smoke sends a strong message that smoking is not a normal or common part of
life in New Zealand.
The effect of the amendments would not just be to improve health outcomes in the short term for people who are affected
by second-hand smoke in a bar or restaurant, but to change attitudes to smoking in the long term so it becomes no longer
chic, but instead rather sad. My resolve in this direction was strengthened recently on hearing of a survey of Maori
women who had quit smoking. On being asked what were the main reasons they had finally decided to quit, one of the most
popular reasons was "not wanting to have to go outside for a cigarette". This shows how insisting on a smoke-free indoor
environment can have real health gains even for smokers. Their consumption is reduced in the short term and in the long
term they may even choose to give up, not from being scolded but because it's more convenient. This is what bringing our
communities along with us means to me.
Another aspect of the Amendments to the Smoke-free Environments Act that gives me encouragement for the future is the
issue of vending machines. The Amendments propose restrictions on cigarette vending machines so that not only must they
be on licensed premises, they must also be only accessible by a staff member. This is designed to prevent the common
practice of young people accessing vending machines by ducking in the doorway of their local pub, perhaps unseen by
staff, and helping themselves to tobacco products. As many of you may know, several public submissions to the Health
Select Committee have encouraged the Committee to ban vending machines altogether. Whatever the Committee recommends,
reducing access to vending machines would make it harder for youngsters to purchase cigarettes. It has been argued that
such measures just lead to adults making purchases on behalf of under-eighteens. I would respond that even if it just
places one more hurdle in the way of under-age purchase, it's better than turning a blind eye as teenagers help
themselves. Again, it's part of changing attitudes to underage smoking in the long term.
CESSATION Perhaps the most ground-breaking part of this Government's cessation initiatives is the Subsidised Nicotine
Patches and Gum programme. The programme is delivered by the Quit Group and by independent health providers including
GPs. Subsidised NRT is part of the services provided under Aukati Kai Paipa, under the Quit for Our Kids programme
(which targets parents and care-givers who have children admitted to hospital with second-hand smoke related illness)
and under the smoking cessation for pregnant women programme. Apart from the significant successes we have gained in
terms of helping individual smokers to quit, New Zealand is the first country to implement the idea of subsiding
nicotine replacement therapies. This means that the results of this programme are keenly anticipated by overseas
researchers and policy-makers. New Zealand is at the cutting edge of policy in this area and has a significant
responsibility to ensure our programme is rigorously evaluated. To this end, this Government has contracted an
independent research group to assess the quit rate and outcomes for the Subsidised Nicotine Patches and Gum programme.
The evaluation will be based on a twelve month cohort study of participants, which is already underway. The cohort is of
2000 people, of whom 1000 are Maori. This substantial sample has been selected to give us the statistical power to
assess how well subsidised NRT works for people with different smoking histories, of different ages and of different
ethnicities. So, in terms of "What's next?", I look forward to the results of that cohort study with some excitement.
CLOSING My warm thanks go to the National Smokefree Conference organising group for making it possible for me to speak
to you today. I understand that this address and those of our keynote speakers are being relayed in real time via the
Ministry of Health website. I hope this gives an opportunity for those who wanted to be here but couldn't to hear some
of the proceedings. I look forward with interest to hearing your views as the conference proceeds, and to representing
them as best as I am able in my new role as Associate Minister of Health.