R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Tobacco-Free Aotearoa/NZ 2025

The Policy Context: What are our Major Opportunities?

Professor Chris CunninghamMassey University

The Quit Group

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

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’

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

‘Policy Opportunities’

Leadership

Practical Solutions

Responsiveness

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

‘Policy Opportunities’

Setting and Achieving a Goal

Practical Solutions

Responsiveness

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

‘Policy Opportunities’

Setting and Achieving a Goal

Reduce Exposure/supply

Decrease Initiation

Increase Cessation

Responsiveness

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

‘Burying the Habit’

Setting and Achieving a Goal

Reduce Exposure/supply

Decrease Initiation

Increase Cessation

Enabling Māori Solutions

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Māori Affairs Select Committee

“inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for

Māori.”

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

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

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Plain Packaging

Remove Point of Sale Displa

ys

Extend Smoke

free Environments

Require Informa

tion Disclos

ure

Duty Free and

Excise Taxes

Smokefree

Prisons

1/7/11

Smokefree Aotearoa/NZ 2025

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

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

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

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

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Prevalence by Ethnicity

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Year 10 Females Daily/Weekly/Monthly

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Māori Pattern of Smoking

• Hoha smokers– Smoke other peoples’/social/sometime

• Hard-out smokers– Stronger addiction– Evidence of physiological differences

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

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

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

History of Māori Cessation/Advocacy

1996HSC PHC

1997

ATAK

1999

2000 Aukati Kai Paipa (2000)

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Policy Opportunities

• Leadership– the Big Goal

• Practical Solutions– Cessation providers

• Responsive Policy– Whānau Ora – Māori policy setting

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

• 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 prevalence @ 6 months 2008

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

• Challenges – complementary to other providers (Māori)– policy setting changed from motivation to

mandatory referral– Quit attempts vs Quit

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Whānau Ora

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

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Aspire2025

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

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

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Smokefree Aotearoa NZ 2025

Reduce Exposure

Environments

Plain Packs/PoS

Decrease Initiation

Focus on Rangatahi and Wāhine

Price

Increase Cessation

Facilitate Motivation

Māori solutions

R es e arc h C e n tre fo r M a o r i H ea l th & D e v e lo p m e n tR e se a rch C en tre fo r M ao ri H e a l th & D ev e lo p m e n t

Te Kunenga ki Purehuroa

Tobacco-Free Aotearoa/NZ 2025

The Policy Context: What are our Major Opportunities?

Professor Chris CunninghamMassey University

The Quit Group