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The Minister For Smoking Must Resign

Dr Shane Reti, the Minister for Smoking, needs to do the honourable thing. That seems unlikely, given he will shortly co-sign a death warrant for thousands of vulnerable people, but it must be called for: resign.

I can’t think of a more ignoble start to a ministerial career. As Minister of Health, he should be the pre-eminent protector of the nation’s health. He should be nurse, not executioner. What happened to Primum Non Nocere, Hippocrates' injunction to his students: “Above all, do no harm”?

The Coalition, led by Luxon, Peters and Seymour, has breathed new life into the lungs of the tobacco industry by rescinding what was one of the most positive, life-affirming actions a government could take: to end the cancer of smoking, to gently snuff out this toxic habit inflicted on ordinary Kiwis by big business. Ironically, the UK Tories are so impressed by our world-leading legislation they are introducing it next month in Britain. You know things are bad when we make that lot look good!

There is a famous painting of Hippocrates refusing financial gifts offered by the Persian Emperor Artaxerxes in exchange for favours. His head is disdainfully turned from the King of Kings, his arm thrust backwards in a signal of rejection. Chris, Winston and David would no doubt have had their hands out too - but cupped to receive a bit of coin.

Dr Reti may be little more than an order-taker but he is the Minister for Health – and that’s why I call him out. This repeal may be an early insight into how policy will be made under the coalition’s triumvirate. Who should lead health policy? The Minister of Health, obviously. But in this instance, I very much doubt it. The nation’s health and wellbeing was not what drove this decision; it was no doubt made in consultation with the tobacco industry. Were any health researchers consulted? What epidemiological studies, what longitudinal studies, what fact-based research led the Minister of Health to seek the repeal of New Zealand’s revolutionary legislation? Or was it a deal made in a smoky room?

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And what about the economic impact? National, Act and New Zealand First sold themselves as sound and sensible economic rationalists. We’re told taxing smokers will fill the coffers (about $1 billion) to fund tax cuts but these politicians have been sold a dodgy vehicle by men in shiny suits. The money they get from tobacco tax will be swamped by the dollars lost to the economy. Smoking burns through an estimated $2.5 billion of GDP a year as we pay for workers to wheeze at home, slice bits off their tongues, throats and lungs. We pay overworked medical professionals to tend to the victims in wards up and down the country, not to mention have businesses pay people to stand in alleyways having sneaky fags. Smoking – actively or passively - kills 5000 Kiwis a year.

So in one foul act the Coalition has shown itself to be economically illiterate and morally bankrupt.

In contrast, the legislation it will repeal was made in defiance of the merchants of death and their lobbyists.

Drawing on decades of research and major projects like Aotearoa’s International Tobacco Control Project, New Zealand crafted legislation that breathed fresh air into the nation. Operating within the World Health Organisation’s Framework Convention on Tobacco Control, the Otago-led ITC began its groundbreaking research into smoking in 2007.

Through their work we know that over 80% of people who smoke regretted starting, and “contrary to the notion that people continue to smoke as a free and informed choice, virtually all believe that smoking is addictive (99%)”. A clear majority supported measures to end smoking.

The Smokefree Aotearoa 2025 Action Plan was launched in 2021 with the ambitious goal of eliminating inequities in smoking rates and smoking-related illness, creating a smoke free generation, and increasing the number of people who successfully quit smoking. What’s not to like about that? This plan included:

Reducing access to tobacco by slashing the number of available outlets

“Denicotinising” – reducing the nicotine in these products to very low levels

Restricting sale of tobacco to people born before a designated year (the “smokefree generation” idea)

Increasing expenditure on media campaigns to discourage people from starting the habit.

The British Medical Journal reported this week that a modelling study published this year clearly shows that the Smokefree Aotearoa 2025 plan was likely to achieve its aims to rapidly reduce smoking to negligible levels.

Hearing Dr Shane Reti defend the repeal in an interview with Checkpoint’s Lisa Owen made for sad listening. He could offer no evidence-based argumentation for the move. He sounded empty, disbelieving his own words as he mouthed defences of the indefensible. Physician: cure thyself.

All sorts of New Zealanders will suffer. Eight percent of adults are daily smokers. According to Smokefree.org.nz, “adults living in the most deprived areas were 4.3 times as likely as adults in the least deprived areas to be daily smokers”. Easy targets.

As Dr Reti knows, Māori and Pasifika will bear the heaviest burden of this betrayal. One-fifth of Maori are smokers. Maori and Pasifika are three times more likely to smoke than other New Zealanders. Hāpai Te Hauora’s Jason Alexander said the move favours economic interest over whanau.

My father died aged 62 from a heart attack triggered by acute emphysema - the product of decades of smoking. His last years were burdened by its symptoms. His hacking cough, always heard before he entered the house at the end of the working day, still rattles in my ears. He did not have the retirement he dreamed of one day enjoying. I did not get to enjoy his excellent company. Dr Reti no doubt has tended to many such men and women. Bottled oxygen in the corner, distressing throat clearing every couple of minutes, reduced horizons, shortened lives, blighted family life. Some will be pregnant mothers, some parents of young children, themselves passive smokers, others middle-aged parents whose children will be robbed of one or more parents. Teenagers who didn’t need to start what becomes a lifetime addiction. The price of a packet of fags.

What could be more shameful than a Minister of Health knowingly taking the lives of fellow New Zealanders? Primum Non Nocere. The principle of non-maleficence - don’t do more harm than good.

Dr Reti: Is the price worth paying? You’re a successful and accomplished New Zealander. You have received a QSM for public service. You’ve participated in valuable campaigns, including delivering Covid-19 injections in Northland. Wouldn’t it be a far, far better thing than you have ever done, a quite amazing and inspiring thing, at this, the last minute, to say to the triumvirate, “Bugger, that. I’m not signing up for this. Shove it in your own pipe and smoke it.” Otherwise, your reputation, your good name, will go up in smoke.

I read the Coalition's plans this week, including its decision on smoking, its revocation of the National Policy Statement on Freshwater Management and its loosening of support for the economically disadvantaged. Now, as we stand on the bank of time, bracing for the Great Leap Backwards, I’ll share one last quote from the 5th Century BC:

“If you want to learn about the health of a population, look at the air they breathe, the water they drink, and the places where they live.” Hippocrates.

EUGENE DOYLE is a community organiser who lives on Wellington’s South Coast. He received an Absolutely Positively Wellingtonian award in 2023 for community service to coastal communities, environmental action, water quality, emergency resilience and other causes.

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