Damien O'Connor speech to smokefree meeting

National Smokefree Meeting, Wellington

E nga iwi, e nga mana, enga karangatanga maha o te motu Tena koutou, tena koutou, tena koutou katoa.

It is an honour to be invited to open the national Smokefree Conference with the theme "Clearing the Air ? What's Next?". As well as an honour, it is a very fitting and timely opportunity as one of my first duties in the role of Associate Minister for Health with responsibility for tobacco control. My first and a very pleasant task is to thank Amster Reedy for his mihimihi, which set the tone for a very positive conference over the next two days. Kia ora, Amster. I'd also like to welcome Cynthia Hallet and Cathy Segan, our international keynote speakers.

With more than 180 attendees, this is by far the largest turn out ever for a tobacco control conference in New Zealand. Since the last conference two years ago a lot has been accomplished, thanks to the hard work of many of you here today. I think in looking around this room and seeing the faces of our colleagues in tobacco control, we can remind ourselves of how far we've come. From this Government's point of view, five years ago we were spending approximately $12 million a year on tobacco control. Today that figure is closer to $30 million.

CONTEXT Over the last ten years the prevalence of tobacco smoking in the community has decreased by more than 30%, with a more measured decrease over the last five years. Currently we see around 25% of New Zealanders smoking, which compares favourably with many countries. The theme of this conference is "What's next?" so it seems opportune to state that I have a goal of seeing tobacco prevalence decrease further to around 20% over the next few years. This would put New Zealand on a par with the lowest rates of smoking among developed countries.

The recently launched New Zealand Health Monitor will assist all of us in the Government and non-Government sectors to better assess the impact of our programmes in the future. The Health Monitor is a ten-year cycle of surveys which include questions about tobacco consumption and attitudes, among other health-related questions. The surveys are a mix of face-to-face and telephone-based methods and gather age-specific as well as health behaviour data. The ten-year cycle allows for consistent delivery and will allow us to answer questions such as "what are the impacts of New Zealanders' smoking behaviour on their health?" "Is the gap with Australia closing?" and "Is inequality between Maori and non-Maori health outcomes widening or contracting?"

REDUCING INEQUALITIES Sadly, the prevalence of smoking continues to be much higher among Maori and Pacific peoples than across the wider New Zealand population. Issues around the smoking rates of more recent immigrants also need to be addressed. As many of us would be well aware, 31% of all Maori deaths are attributable to tobacco use. Over the last five years New Zealand has seen a significant increase in the Maori tobacco control workforce. I'm thinking specifically of the Aukati Kai Paipa programme, which, apart form the acknowledged success in terms of helping people to quit, has also seen a real opportunity for Maori health providers in terms of workforce development. Several small organisations focusing on Maori health have undertaken capacity building and have grown in expertise and (dare I say it) political influence as resources have been allocated to this important programme.

Maori have benefited from mainstream tobacco control programmes, but generally not to the same extent as non-Maori. Consequently this Government spends $515 000 annually on Maori national advocacy and information, which is almost twice what is spent on the mainstream equivalent. Each year, another $425 000 is spent on Maori cessation training and coordination. As well as these initiatives, the Quitline has Maori as a priority group, uses Maori Quit Advisors and focuses advertising on Maori, such as the "It's About Whanau" campaign.

LEGISLATION Focusing again on the theme "What's next?", I think part of the answer lies in building on that example of community involvement with our tobacco control programmes. The next challenge for us in tobacco control is to bring our respective local communities along with us and get them to share the vision of a smoke-free New Zealand. I'm sure many of us have experienced first-hand the pitfalls of trying to get people to change their behaviour before they are ready. I'm thinking for example of our hard-working regional Smokefree Officers, who have the sometimes unenviable task of enforcing the current Smoke-fee Environments Act.

This is where I see the Amendment Bill to the Act coming in. As you would all be well aware, the Amendments currently before the Health Select Committee would have a range of effects, including reducing the number of workplaces in which people are exposed to second-hand smoke. Of course what will ultimately be recommended to Parliament is in the capable hands of Steve Chadwick and other colleagues on the Select Committee. However the point I want to make today is that limiting the places where it's acceptable to smoke sends a strong message that smoking is not a normal or common part of life in New Zealand.

The effect of the amendments would not just be to improve health outcomes in the short term for people who are affected by second-hand smoke in a bar or restaurant, but to change attitudes to smoking in the long term so it becomes no longer chic, but instead rather sad. My resolve in this direction was strengthened recently on hearing of a survey of Maori women who had quit smoking. On being asked what were the main reasons they had finally decided to quit, one of the most popular reasons was "not wanting to have to go outside for a cigarette". This shows how insisting on a smoke-free indoor environment can have real health gains even for smokers. Their consumption is reduced in the short term and in the long term they may even choose to give up, not from being scolded but because it's more convenient. This is what bringing our communities along with us means to me.

Another aspect of the Amendments to the Smoke-free Environments Act that gives me encouragement for the future is the issue of vending machines. The Amendments propose restrictions on cigarette vending machines so that not only must they be on licensed premises, they must also be only accessible by a staff member. This is designed to prevent the common practice of young people accessing vending machines by ducking in the doorway of their local pub, perhaps unseen by staff, and helping themselves to tobacco products. As many of you may know, several public submissions to the Health Select Committee have encouraged the Committee to ban vending machines altogether. Whatever the Committee recommends, reducing access to vending machines would make it harder for youngsters to purchase cigarettes. It has been argued that such measures just lead to adults making purchases on behalf of under-eighteens. I would respond that even if it just places one more hurdle in the way of under-age purchase, it's better than turning a blind eye as teenagers help themselves. Again, it's part of changing attitudes to underage smoking in the long term.

CESSATION Perhaps the most ground-breaking part of this Government's cessation initiatives is the Subsidised Nicotine Patches and Gum programme. The programme is delivered by the Quit Group and by independent health providers including GPs. Subsidised NRT is part of the services provided under Aukati Kai Paipa, under the Quit for Our Kids programme (which targets parents and care-givers who have children admitted to hospital with second-hand smoke related illness) and under the smoking cessation for pregnant women programme. Apart from the significant successes we have gained in terms of helping individual smokers to quit, New Zealand is the first country to implement the idea of subsiding nicotine replacement therapies. This means that the results of this programme are keenly anticipated by overseas researchers and policy-makers. New Zealand is at the cutting edge of policy in this area and has a significant responsibility to ensure our programme is rigorously evaluated. To this end, this Government has contracted an independent research group to assess the quit rate and outcomes for the Subsidised Nicotine Patches and Gum programme. The evaluation will be based on a twelve month cohort study of participants, which is already underway. The cohort is of 2000 people, of whom 1000 are Maori. This substantial sample has been selected to give us the statistical power to assess how well subsidised NRT works for people with different smoking histories, of different ages and of different ethnicities. So, in terms of "What's next?", I look forward to the results of that cohort study with some excitement. CLOSING My warm thanks go to the National Smokefree Conference organising group for making it possible for me to speak to you today. I understand that this address and those of our keynote speakers are being relayed in real time via the Ministry of Health website. I hope this gives an opportunity for those who wanted to be here but couldn't to hear some of the proceedings. I look forward with interest to hearing your views as the conference proceeds, and to representing them as best as I am able in my new role as Associate Minister of Health.

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