Successes and Strategies From Auahi Kore to Tupeka Kore Professor Chris Cunningham Massey University The Quit Group

Conflicts of Interest Not an independent view Maori Health Researcher’s view Maori Development View Trustee of The Quit Group Director Hutt Valley District Health Board Trustee NZ Cancer Control Trust Indigenous and Tobacco-free

What’s the vision for Maori? How do we make the vision real?

The Vision/The Reality Auahi Kore Smoke-free Tupeka Kore Tobacco-free

The Vision/The Reality Auahi Kore Smoke-free Enhancing supported smokefree whanau Reducing initiation Increasing cessation Harm minimisation Tupeka Kore Tobacco-free

The Vision/The Reality Auahi Kore Smoke-free Enhancing supported smokefree whanau Reducing initiation Increasing cessation Harm minimisation Tupeka Kore Tobacco-free Using structural levers in a small jurisdiction

From Reality Check to Reality

Reality Check 1 Te Hoe Nuku Roa Stratified, random, longitudinal, study of Maori households Operated since 1994 with 4 waves of data 600 households; 1800 individuals Through the magic of statistics it gives us a changing picture of Maori in NZ

Reality Check 1 270,000 Māori are smokers Most are women Most are young; rates reduce with age Concerns Affordability; health; negative role models 18 will call the Quitline today 3 will quit and be quit @ 6 months But 15 won’t

Tane; 10 yrs old; Lower Hutt

Tane; 10 yrs old; Lower Hutt smoker

Mother; 28; smoked half her life

Grandfather 49; smoked ¾ life;

Grandfather 49; smoked ¾ life; ¾ thru his life; die at 64

CVD/Cancer will claim 3 Māori today

Tane’s sister is 1; passive smoker

Reality Check 2 We know quite a lot about habits of Māori “Hard out” – strong addiction “Hoha” – bothersome

Reality Check 2 We know quite a lot about habits of Māori “Hard out” – strong addiction “Hoha” – bothersome Concern is that “hoha” smokers are disproportionately counted among those who quit

Reality Check 3 Treaty of Waitangi Imprecise document 1840; Crown:Tangata Whenua Imprecise document Unclear legal status Not written in the language of tobacco control Two versions

Reality Check 3 Treaty of Waitangi Expectations Good government Māori domain over “things-Māori” Equity of all NZers

Reality Check 3 Treaty of Waitangi Expectations MAKE MAORI QUIT Māori domain over “things-Māori” Equity of all NZers

Reality Check 3 Treaty of Waitangi Expectations MAKE MAORI QUIT MAORI OWNERSHIP OF QUITTING Equity of all NZers

Reality Check 3 Treaty of Waitangi Expectations MAKE MAORI QUIT MAORI OWNERSHIP OF QUITTING MORE EFFORTS FOR, WITH, BY MAORI

?numbers? Smoking = Māori ill health Smoking = disparities 270,000 is a finite target 270,000 to 0 is the vision; how?

Successes 1994 HSC PHC 1998 ATAK 1999 2000 Aukati Kai Paipa (2000)

Auahi Kore

Free nationwide phone service Quit Advisors provide support Subsidised NRT Maori targets (exceeded) Same quit rates as non-Maori (~20%) * 32,000 of 6-700,000 *Point prevalence @ 6 months 2005

Challenges – complementary to other providers Innovations Video diaries Texting service Internet/Blogs High visibility of Maori Advisors, Managers, Governors

Strong Maori Advocates Kuia & koroua who have gone before Sue Taylor Shane Kawenata Bradbrook Papaarangi Reid Hone Harawira Marewa Glover Heather Gifford Mary McCulloch Catherine Clark

Smokeless Tobacco Pros Cons Reductions in ETS Health benefits to users Systematic review NZHTA shows benefits Lancet paper (Australia) suggested 14:1 benefit Cons if tobacco companies are interested its bad Swedish culture unique Co-use New, trendy habit especially for Rangatahi

Smokeless Tobacco Need research in NZ context on acceptability, pros and cons Any advantage over medicated nicotine products? Risks involved in introduction in NZ Supply, taxation, restrictions? Crane, Laugesen, Cunningham et al

The Vision/The Reality Auahi Kore Smoke-free Enhancing supported smokefree whanau Reducing initiation (Rangatahi focus) Increasing cessation (More Quit/AKP) Harm minimisation (Medications; Smokeless Tobacco Research) Tupeka Kore Tobacco-free Using structural levers in a small jurisdiction Quotas for cigarettes, reduction in nicotine levels, tobacco-free environments

He aha te mea nui o te Ao? He tangata, he tangata, he tangata

What is the most important thing? He tangata, he tangata, he tangata

What is the most important thing? It is people, people, people

T A N G

T - targets (270,000 to 0) A N G T

T - targets (250,000 to 0) A - advocates N G A T

T - targets (250,000 to 0) A - advocates N - non-governmental agencies G A T

T - targets (250,000 to 0) A - advocates N - non-governmental agencies G - government A T

T - targets (250,000 to 0) A - advocates N - non-governmental agencies G - government A - access (to services/from tobacco) T A

T - targets (250,000 to 0) A - advocates N - non-governmental agencies G - government A - access (to services/from tobacco) T - Tupeka Kore Tobacco-free A

T - targets (250,000 to 0) A - advocates N - non-governmental agencies G - government A - access (to services/from tobacco) T - Tupeka Kore Tobacco-free A - Auahi Kore Smoke-free