Tobacco-Free Aotearoa/NZ 2025 The Policy Context: What are our Major Opportunities? Professor Chris Cunningham Massey University The Quit Group

Conflicts of Interest Not an independent view –Māori Health Researcher’s view –Māori Development View Trustee of The Quit Group Trustee NZ Cancer Control Trust Specialist Advisor to Māori Affairs Select Committee Member of ASPIRE 2025 Indigenous and ‘Never-Smoked Non-Smoker’

‘Policy Opportunities’ Leadership Practical Solutions Responsiveness

‘Policy Opportunities’ Setting and Achieving a Goal Practical Solutions Responsiveness

‘Policy Opportunities’ Setting and Achieving a Goal Reduce Exposure/supply Decrease Initiation Increase Cessation Responsiveness

‘Burying the Habit’ Setting and Achieving a Goal Reduce Exposure/supply Decrease Initiation Increase Cessation Enabling Māori Solutions

Māori Affairs Select Committee “inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori.”

Set a Goal for NZ goal of making New Zealand essentially a smoke-free nation by 2025, [and] to aim for tobacco consumption and smoking prevalence to be halved by 2015

Plain Packaging Remove Point of Sale Displays Extend Smokefree Environments Require Information Disclosure Duty Free and Excise Taxes Smokefree Prisons 1/7/11 Smokefree Aotearoa/NZ 2025

Smokefree Prisons Ban on tobacco from 1 July 2011 –Prisoners and staff 75% of Prisoners Smoke (over-estimate) –Also used as currency 50% of Prisoners are Māori Youth Justice Units are already smokefree Offenders offered 8 weeks’ NRT Access to QuitLine

More than 600 Māori die prematurely each year from smoking-related illnesses, and this loss, as well as the preceding addiction, erodes economic, social, and cultural wellbeing, and hinders Māori development aspirations and opportunities

Prevalence by Ethnicity

Year 10 Females Daily/Weekly/Monthly

Māori Pattern of Smoking Hoha smokers –Smoke other peoples’/social/sometime Hard-out smokers –Stronger addiction –Evidence of physiological differences

Successes and Strategies More than half of Māori are tobacco free Māori and mainstream providers Strong and convincing advocates Māori cultural imperative –Smokefree whānau –Smokefree marae –Smokefree kohanga reo/kura

History of Māori Cessation/Advocacy 1996 HSC PHC 1997 ATAK Aukati Kai Paipa (2000)

Policy Opportunities Leadership –the Big Goal Practical Solutions –Cessation providers Responsive Policy –Whānau Ora – Māori policy setting

Free nationwide phone service –Counselling & Subsidised NRT Māori specific targets (exceeded) –Same quit rates as non-Māori (~20%) * –60,000 attempts from > 600,000 smokers Innovations –Video diaries –Texting service –Internet –Blogs and Social Media *Point 6 months 2008

Challenges –complementary to other providers (Māori) –policy setting changed from motivation to mandatory referral –Quit attempts vs Quit

Whānau Ora Whānau Ora – Policy setting for Māori Development –Whānau = customary, extended Māori family

Aspire2025

Whānau Ora Whānau Ora – Policy setting for Māori Development –Whānau = customary, extended Māori family Māori families are bigger, more children, multi- generational Greater exposure (literally) to environmental tobacco smoke, and to peers/elders who smoke Risks cluster, and collective solutions are appropriate AKP/Quit providers addressing Whānau Cessation AKP/Quit providers addressing Whānau Initiation

Smokefree Aotearoa NZ 2025 Reduce Exposure Environments Plain Packs/PoS Decrease Initiation Focus on Rangatahi and Wāhine Price Increase Cessation Facilitate Motivation Māori solutions

Tobacco-Free Aotearoa/NZ 2025 The Policy Context: What are our Major Opportunities? Professor Chris Cunningham Massey University The Quit Group