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

2. 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

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

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

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

6. 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

7. From Reality Check to Reality

8. 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

9. 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 6 months
But 15 won’t

10. Tane; 10 yrs old; Lower Hutt

11. Tane; 10 yrs old; Lower Hutt
smoker

12. Mother; 28; smoked half her life

13. Grandfather 49; smoked ¾ life;

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

15. CVD/Cancer will claim
3 Māori today

16. Tane’s sister is 1;
passive smoker

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

18. 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

19. 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

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

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

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

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

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

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

26. Auahi Kore

28. 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 6 months 2005

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

30. 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

31. 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

32. 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

33. 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

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

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

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

37. T A N G

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

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

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

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

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

43. 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

44. 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