Should Australia follow New Zealand’s lead on smoking?

Last month the New Zealand Government launched its Smokefree Aotearoa 2025 Action Plan. The plan maps out the intent of the health authorities to halve the number of people who smoke, and how they plan to do it.
 
The goal is to reduce the proportion of New Zealanders who smoke to just 5% of the adult population by 2025. While the goal may seem lofty, the country’s smoking rate is already low at just over 10% and could prove more obtainable for that nation than many others.
 
It aims to increase investment in health promotion and smoking cessation programs as well as cut the amount of nicotine in tobacco products, reduce their availability in retail outlets and increase enforcement of its tobacco laws.
 
One of the plan’s most eye-catching and widely reported details is the intent to nurture a smoke-free younger generation by making it illegal for tobacco ever to be sold to anyone born after 2008. That legislation is expected to pass at the end of this year.
 
In Australia, huge inroads have already been made into reducing smoking rate. In 1995 close to a quarter (23.5%) of the adult population smoked, whereas the latest figures suggest that rate now sits at 14.7%, with daily smokers at 11.6%.
 
However, the rate of decline has plateaued in recent years and the number of mortalities linked to smoking remains high. In its 2019 report, ‘The Burden of Tobacco use in Australia’, the AIHW reported that more than one in every eight deaths that occurred in 2015 was linked to smoking.
 
Such sobering a statistic begs the question – could it be time for Australia to look at a more radical approach?
 
For Dr Hester Wilson, the Chair of RACGP Specific Interests Addiction Medicine, the New Zealand plan will be one to watch very carefully.
 
‘From a health point of view, it’s absolutely brilliant,’ Dr Wilson told newsGP.
 
‘Smoking is one of our leading causes of death, here and in New Zealand and around the world.
 
‘Making it much harder to obtain cigarettes is going to make a difference to the number of young people trying it.’
 
However, she also expresses some reservations, including the potential impact on consumer choices, specifically the sale of heated tobacco and e-Cigarettes.
 
‘Where does this then put e-Cigarettes? We are seeing young people taking up e-Cigarettes because they’re “cool”,’ Dr Wilson said.
 
‘And yes, it probably is less harmful. But there are concerns about what [the New Zealand proposals] do around the choices that people make.’
 
Associate Professor Rowena Ivers of the University of Wollongong is a GP who was involved in compiling the RACGP’s smoking cessation guidelines for health professionals.
 
While she believes Australia has set a high standard with its approach to tobacco, she also has noted the slowing decline of smoking rates.
 
‘Australia has actually led the world in terms of tobacco programs,’ Associate Professor Ivers told newsGP. ‘And we have seen smoking rates drop.
 
‘[But] to some extent it seems to have plateaued, where there is a hardcore of continuing smokers. I think that we need to consider the options [from the New Zealand Plan].’
 
At-risk groups
The New Zealand plan has a particular focus on reducing levels of smoking in the Maori community. While there is a significant disparity – the rate of smoking among Maoris is more than double those of European background – the gap in Australia is much starker.
 
In 1994, more than half of Aboriginal and Torres Strait Islanders aged over 18 were recorded as current smokers. And even thought that had declined to 43.4% by 2018–19, the proportion remains almost three times higher than for non-Indigenous Australians.
 
Associate Professor Ivers says any change in approach needs to ensure Aboriginal smokers are not unfairly targeted as a result.
 
‘There are risks on introducing a rule such as this,’ she said.
 
‘It certainly would reduce smoking uptake, [but] I guess there are a few challenges in terms of the enforcement.
 
‘I think that really still means we need to focus on our stop smoking programs.’
 
Dr Wilson also recognises the much higher rates of smoking in Indigenous communities as an acute source of concern.
 
‘If you’re looking at particular groups, you’ve got to really think about how you get those communities on board, the elders of those communities with specific and targeted and culturally appropriate engagement,’ she said.
 
Black market concerns
One of the concerns raised in New Zealand is that a harder line on the retail of cigarettes could fuel the black market – a point that both Dr Wilson and Associate Professor Ivers also raise.
 
‘We know that there’s a very active black-market trade for tobacco in Australia already,’ Associate Professor Ivers said.
 
‘It’s a complex picture, but I think it’d be great to wait and watch what happens in New Zealand.’
 
Dr Wilson agrees and says if the New Zealand plan proves to have a positive impact, then its successes should be replicated in Australia.
 
‘I really hope that we would be looking at similar legislation in Australia that protects our young people,’ she said.
 
‘The bottom line is tobacco has no nutritional value.
 
‘It is highly addictive, and we have been conned for years and years by tobacco companies who make money out of it.
 
‘Let’s be clear. They are taking advantage of the fact that people develop a chronic relapsing medical condition called nicotine addiction.’
 
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