Progress to Smokefree 2025 HEATHER GIFFORD AND ZOE HAWKE THE 19 TH PUBLIC HEALTH SUMMER SCHOOL 2-20 FEBRUARY 2015

Daily Smokers – Maori aged 15+ 1

Regular Smoking by ethnicity, year olds (daily, weekly or monthly ) 2

Key messages  Gradient for all Māori smoking is in the right direction but its slow  Significant drop in Māori youth smoking but do we understand why  Disparities remain when compared with others  Discrepancy in the data depending on what you look at eg Census vs NZ Health Lifestyle Survey – what figure do we use to convey the public message ?  Projections from modelling suggest that with BAU Māori smoking rates in 2025 will still be almost 20% 3

Challenges  Tupeka Kore Māori kaupapa arising out of Māori Affairs Select Committee Report  Since then loss of multiple Māori leadership  Confusion over the strategy for really achieving 2025  Māori smoking implicated in broader social and economic reality for many whānau making it even more challenging  Competing priorities for Māori  Not enough resource or political will to turn the goal into a reality 4

What’s the goal?  Abstinence or harm minimization ?  Not really that clear: “…reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smoke-free nation by 2025.” (Govt response to Māori Select Committee report) 5

Options we are thinking about  Traditional’ abstinence framework No ‘safe’ level of tobacco use, No alternatives? Aligned to Māori aspirations; Addiction not part of culture Harm minimisation (of nicotine use) New technologies possible to actually minimize harm 7

Options How do we achieve the goal? First we need to build political support  Demand reduction, supply reduction, or both?  At present operating BAU  More demand than supply reduction  Strong focus on cessation  This will NOT get us to 2025, particularly for Māori 8

TAHO STRATEGY 9 Te Kawa - Key Influencers that helped us achieve the goal M ā ori leadership has engaged communities on tobacco control strategies Clear, simple kaupapa, focused and strength - based messaging has helped to get communities on board There is a united vision across organisations and communities based on tikanga & tobacco not being part of who we are Legislation & Regulation, Cessation, Public Support Government is fully committed to 2025 Government supports no commercial tobacco sales Māori leaders have influenced the supply of tobacco and are celebrating change Indigenous cessation models/research have been promoted and are well known Whānau are quitting through public support gained There is an overwhelming appetite for change The Māori workforce is united Whole communities are selling our message; everyone believes in the story of a smoke free Aotearoa Smoking is in our past 2020 GOAL / VISION WHĀNAU ARE SMOKE FREE | TOBACCO IS NOT OUR TIKANGA

HOW WE GET TO 2020 PATHWAY TO 2020 GOAL/VISION 10 Putting path finding policies into place Communica ting with and mobilising communities Collective community action 2020 Goal/Vision Whānau are smoke free Tobacco is not our tikanga Work Streams

Lows Year One  The urgency of the task, wanting to do so much more but with very limited resources  The reality that those with the resources don’t always understand the complexities of Māori realities and the need for stepping out of the BAU model.  Ideas about Māori leadership being a single person/group model – a contradiction to Māori models of leadership & wellbeing.  Being the constant squeeky wheel challenging the BAU can be wairua draining.  Lack Of Māori champions/ political champions  Lack of unity, competitive theme, tension BAU v’s BNU  Political neutrality clauses 11

Highs Year One  Advisory Board support  Having a clear TAHO strategy that really is all about building political support through Māori community action  Organisations serious about reducing inequalities  Having some of the squeeky wheel kōrero seeping into the sector. A shift in practice.  A decrease in Māori smoking rates  Relationships with other Māori in the sector  National Māori smokefree working group  Growing unity  Growing Māori community voices 12

What we need going forward  Political support built from the ground up  Māori need to be part of the process  Local community action – national focus  Supporting and building leadership  Urgent need for action  Innovative ideas  Research keeping pace  Agree on overarching goal and strategy  Best allocation of resources  Depends on working together 13