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Richard Edwards on smoking in New Zealand
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Richard Edwards on smoking in New Zealand

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Dr Richard Edwards (Senior Lecturer in Epidemiology, University of Otago) argues on ethically grounded research, that we need new approaches to eradicating smoking from our society. This will require ...

Dr Richard Edwards (Senior Lecturer in Epidemiology, University of Otago) argues on ethically grounded research, that we need new approaches to eradicating smoking from our society. This will require a re-framing of the public discourse and pursuing practical public policies geared to achieving clear goals. He advances six ‘radical’ solutions to get there.

http://dosomething.org.nz

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  • But smoking is going down isn’t it? It soon won’t be a problem. Yes it is – but very slowly, and most slowly among those most affected.
  • Smokers would like to stop but are mostly far too optimistic about how quickly they will be able to do it. The chart shows that more than half of all smokers believe they will stop within two years (upper line). However, if recent history is a guide, only about 6% will stop in two years. The lower line shows the proportion of smokers that quit in the last two years looking backwards. [91]
  • NB Previous investigations in Germany, and also in US by Wynder and Graham, 1950
  • In addition to objective measures such as taxable sales and employment and surveys of consumers, surveying restaurant owners is another method for assessing the economic impact of smoke-free regulations. In this NYC newspaper article, many Staten Island (Richmond) restaurant owners claim their business was lower after the NYC regulations took effect. Note, however, that per-capita job growth in Richmond in the years after the law took effect was greatest in Richmond (see slide 18).
  • Countering opinion article in the New York City press highlighting the rights of smokers.

Richard Edwards on smoking in New Zealand Richard Edwards on smoking in New Zealand Presentation Transcript

  • Do something! Tobacco smoking in New Zealand – where are we now and where should we be going? Richard Edwards Health Promotion and Policy Research Unit (HePPRU) Department of Public Health, University of Otago, Wellington
  • Outline
    • The case for societal action and public policy
    • Current activities
    • Why so slow?
    • What should we be doing?
    • How do we get there?
  • Outline
    • The case for societal action and public policy
    • Current activities
    • Why so slow?
    • What should we be doing?
    • How do we get there?
  • Background
    • Tobacco smoking as key public health problem in New Zealand
    • Slow decline in smoking prevalence and persisting disparities
  • Percentage smoking by ethnicity, 1991-2008
  • Per-Capita Tobacco Consumption in New Zealand, 1970-2008 Data: Stats NZ
  • So why is that society’s problem? Smokers bring it on themselves.
  • The Moral Case for Intervention
    • Smoking is a uniquely hazardous consumer product
    • Most smokers start young
    • Hardly anyone starts smoking as a mature adult
    • Most smokers want to quit
    • Smoking is highly addictive
    • Stopping smoking is very difficult (and the methods to help are not very effective)
    • Almost all smokers regret starting
    • Virtually all smokers don’t want their children to start smoking
    • Smoking causes and exacerbates health inequalities and poverty
    • Secondhand smoke harms non-smokers, including children
  • The delusion gap
  • Tobacco industry and secondhand smoke/smoke free public places “ The anti-smoking forces’ latest tack … on the passive smoking issue … is quite a different matter. What the smoker does to himself may be his business, but what the smoker does to the non-smokers is quite a different matter …. This we see as the most dangerous development to the viability of the tobacco industry that has yet occurred” Tobacco Institute, 1978 Secondhand smoke is “probably the single most important challenge we face.” Vice Chair of Phillip Morris (W Murray), 1989
  • Many international professional bodies have concluded that SHS is harmful
    • US Surgeon General 1986
    • US Environmental Protection Agency 1992
    • Australian National Health & MRC 1997
    • UK Department of Health 1998
    • World Health Organisation 1999
    • International Agency for Research on Cancer 2002
  • Smoking prevalence among 20-24 year olds, 1996 and 2006 censuses
    • 1996 – 32.2%
    • 2006 – 29.8%
    • In 2006, 50% Māori and 39% Pacific Islander 20-24 year olds smoked
  • 1950 Epidemiologic Evidence Richard Doll & A. Bradford Hill ( British Medical Journal UK) Smoking and Carcinoma of the Lung; Preliminary Report “ We therefore conclude that smoking is a factor, and an important factor , in the production of carcinoma of the lung.”
  • Outline
    • The case for societal action and public policy
    • Current activities
    • Why so slow?
    • What should we be doing?
    • How do we get there?
  • Tobacco control policies in NZ
    • Progressive increases in duty and taxation
    • Action vs smuggling
    • Progressive restrictions on advertising/promotion cumulating in total ban
    • Strong counter advertising (mass media campaigns etc)
    • Systematic provision of smoking cessation support
    • Smoke-free public places
    Weak since 2001 N/A Almost complete ban since 1990, still occurs through Point of Sale and pack Mass media campaigns, Graphic Health Warnings 2008, but could do more Comprehensive legislation since December 2004 National quitline, increasing NRT subsidy, provider coverage patchy
  • Tobacco taxation (NZ)
    • Tobacco Control Strategy (2004-09)
    • “ This (increase tobacco taxation) is probably the most important single intervention to reduce smoking initiation”
    • “ Strong scientific evidence supports the effectiveness of increasing the unit price for tobacco products.”
    • [Potential output] “Excise tax policy is integrated with other interventions such as mass media campaigns to increase effectiveness.”
    • But no specific commitment to real increases in tobacco taxation in the strategy
  • Tobacco taxation (cont)
    • High taxation levels and cig prices (large rises in 1985, 1988-89, 1991, 1998 and 2000)
    • But:
    • No real increase in tobacco taxation since 2001, no drop in per capita consumption since 2003
    • No ear-marking of $1 billion in tobacco related revenues to tobacco control
    • Tax is not presented as a public health strategy nor implemented to maximise public health impact e.g. no linkage of tobacco increases with mass media campaigns
    • Control of tobacco taxation remains outside of health sphere, and increases presumably deemed too politically risky
  •  
  • Outline
    • The case for societal action and public policy
    • Current activities
    • Why so slow?
    • What should we be doing?
    • How do we get there?
  • Why so slow?
    • Lack of public support?
    • Lack of political will?
    • The usual suspects?
  • Lack of public support?
    • Support for interventions among smokers
      • Ban on point of sale displays (60%)
      • Support for increase in tobacco tax if revenue ear-marked for supporting smokers to quit (59%)
      • Support for bans on smoking in cars with pre-school children (96%)
      • Support for bans on smoking in council playgrounds (68%)
      • Support for additional tobacco industry and product regulation (65%)
      • Source: NZ ITC Project
    • ‘ I saw some research … saying … it was a good idea that the government should be banning smoking in cars.  I've gotta tell you, that’s not gonna be happening, because it will take years, it will distract the parliament and in the end you know we're a party of sort of reasonable choice, I'm not opposed to banning smoking in bars, because other New Zealanders are there and people work there, but if you want to smoke in your own car don’t be looking for a National government to pass a law to tell you can't do it in the next three years.’
    • John Key – December 2008
    Lack of political will?
  • US EPA Air Quality Index
  • Windows closed Do we protect children from SHS in cars?
  • The Usual Suspects
  • Tobacco industry tactics
    • “ Philip Morris presented to the UK industry their global strategy on environmental tobacco smoke. In every major international area they are proposing in key countries to set up a team of scientists organised by one national co-ordinating scientist and American lawyers to review the scientific literature or carry out research to keep the controversy alive . They are spending vast amounts of money to do so.” [Dr Sharon Boyce, BAT internal memo 1988]
    • It is understandable that people may have concerns about being exposed to ETS. We support reasonable and comfortable accommodations for non-smokers who are concerned about exposure to ETS. Likewise, we support reasonable accommodations for people who wish to smoke. We believe that through common courtesy and common sense , the interests of both smokers and non-smokers can be accommodated in a way that is acceptable to both.
    • Brown and Williamson website – accessed 29 February 2004, http://www.brownandwilliamson.com
  • What is missing?
  •  
  •  
  •  
  • Outline
    • The case for societal action and public policy
    • Current activities
    • Why so slow?
    • What should we be doing?
    • How do we get there?
  • Three options
    • More of the same – faster
    • + More radical measures
    • + Change the market/regulatory framework
  • Three options
    • More of the same – faster
    • + More radical measures
    • + Change the market/regulatory framework
  • More of the same - faster
    • Increase tax and duties
    • Better and more comprehensive quit support
    • Better and more mass media campaigns
    • ……… . Etc etc
  • Three options
    • More of the same – faster
    • + More radical measures
    • + Change the market/regulatory framework
  • Ban Point of Sale Displays
  • Plain packaging
  • Extend smokefree legislation - SmokefreeParks in New Zealand
  • Supply side measures
    • Licensing for retailers
    • Reduce density
    • Reduce proximity to key sites (e.g. schools)
    • Mandate quit support and cessation aids where sold
  • Product modification
    • Ban all additives
    • Reduce toxicant and carcinogen levels
    • Fire-safe cigarettes
    • Reduce nicotine content
  • Three options
    • More of the same – faster
    • + More radical measures
    • + Change the market/regulatory framework
  • New structures
    • Tobacco control authority
    • Monopoly purchaser + distributor (not for profit)
    • Reducing import quota
    • Register of users who can buy tobacco products
    • Prescription only tobacco products
  • Outline
    • The case for societal action and public policy
    • Current activities
    • Why so slow?
    • What should we be doing?
    • How do we get there?
  • How do we get there?
    • Communication and framing
      • the continued urgency and importance of the tobacco issue
      • a credible vision for a tobacco free future
      • framing of tobacco products as poisons
      • ‘ Tobacco resistance’ not tobacco control
      • Tobacco smoking as a development and social justice issue
  • ‘ Maori Murder’ and ‘Endangered species’ Campaigns
  • Paradigms Evidence of success Evidence required for intervention Intervention Types of evidence Public/policy-maker view Type Frame ‘ Pro-smoking’ influences e.g. PoS displays Asbestos/dioxin Exposure
  • Protection, precautionary principle Paradigms Removal of exposure Evidence of success Presence of exposure Evidence required for intervention Remove Intervention Toxicological, epidemiological Types of evidence Any exposure = unacceptable Public/policy-maker view Environmental toxin Type Poison Frame ‘ Pro-smoking’ influences e.g. PoS displays Asbestos/dioxin Exposure
  • Cautionary principle, balanced, evidence-based Protection, precautionary principle Paradigms Reduced uptake, increased quitting, reduced prevalence, no/minimal adverse effects Removal of exposure Evidence of success Exp/outcome, intervention effectiveness, lack of adverse effects Presence of exposure Evidence required for intervention Policy measures e.g. PoS regulations, PoS ban Remove Intervention Epidemiological – exp/outcome (strong), intervention/outcome (probable but incomplete) Toxicological, epidemiological (NB v. weak for low exposure) Types of evidence Possible cause of uptake (what’s the evidence?) Any exposure = unacceptable Public/policy-maker view Potential influence on behaviour Environmental toxin Type Risk factor Poison Frame ‘ Pro-smoking’ influences e.g. PoS displays Asbestos/dioxin Exposure
  • Remember the human suffering behind the smoking statistics
    • Thank you
    • Further information:
    • [email_address]
    • www.wnmeds.ac.nz/academic/dph/research/heppru