Current challenges that governments face in smoking control – the New Zealand case

September 21, 2022

New Zealand is considered a success story in smoking control. Implemented in 1990, its comprehensive Smoke-Free Environments Act was very progressive and fully embraced a harm reduction approach to smoking. However, the Vaping Regulation, that was passed in 2020, signaled a shift from harm reduction to prohibition. Marewa Glover presented the New Zealand approach and framework, its achievements, and goals.

David T. Sweanor J.D., Chair, presented the keynote speaker Marewa Glover, Director of the Centre of Research Excellence: Indigenous Sovereignty & Smoking, New Zealand, as a person who challenges the status quo and who focuses on understanding, helping and empowering the most disadvantaged people, along her efforts for smoking control. He invited her to talk about the New Zealand experience, raising the following question: has New Zealand reached where we need to get or are they just a little bit better than the rest of the world?

New Zealand has become a model for other countries, said Mrs. Marewa Glover, but its current position in smoking control is the result of many decades of anti-smoking efforts and preventive measures, that started in 1945. These included public education, restrictions in industry marketing and advertising, tobacco product advertising banning on TV and radio, and introduction of tax on tobacco, until finally New Zealand was the first country in the world to implement a comprehensive Smoke-Free Environments Act in 1990; subsiding routine replacement therapy was not funded until 2006. The road was long, and smoking reduction took place at a glacial pace.

Smoking prevalence has diminished in New Zealand from 27% in 1992 to 18.4% in 2011-12 and then to 10.9% in 2020-21, one of the lowest in the world. Yet, smoking prevalence varies greatly according to income level and it remains higher among the poorest and the most disadvantaged. This shows that interventions to reduce smoking must see to reduce such inequities; it is particularly important that these inequities are eliminated before thinking about imposing criminalizing policies that could worsen socioeconomic disparities.

People begun vaping in New Zealand in about 2011 and this trend soon spread. The Vaping Regulation, which was passed in May 2020 and came into force in August 2021, signaled a shift from harm reduction focus to prohibition―from a focus on improving health to a morally-based form of social engineering. As Mrs. Glover pointed out, “although looked-up to as progressive and an exemplar for other countries to imitate, I recommend you stick to public health approach”. The law amended the intentions of the original 1990 Smoke-Free Environments Act, its intention being to prevent the normalization of vaping and to insure no one starts or ever returns to smoking, vaping or using heated tobacco products (HTPs).

The latest law change that is now being pushed through Parliament proposes to i) cut the amount of nicotine in smoked tobacco products at a sub-functional level (e.g., <0,05 mg/g yield), ii) reduce the number of tobacco retailers across the country from about 8,000 to about 500-1,000, and iii) increase the legal age of purchase (from today’s 18, the age will start to raise by 1 year every year). According to Mrs. Glover, this prohibition is not consistent with harm reduction; it is top-down and not person-centered, it is punitive and not compassionate, and it will likely cause harm due to a) the injury/criminalization associated with black market activity, b) a worsened mental health, c) an increased marginalization, and d) a shift to higher-risk substances.

Therefore, the countries that want to reduce smoking-related harm will face the following challenges: i) a campaign of disinformation about relative risk of nicotine, ii) loss of academic freedom, iii) rise of “liberal paternalism”, and d) diminishment of human right to autonomy, dignity & right to consent, e.g., to medical intervention.

Mrs. Glover concluded that other countries should not forget the historical context (it took New Zealand a generation to get where they are today) and the different social context & disparities per country. Times and products have changed. There is now a practical strategy, acceptable to the consumer, that could albeit eliminate smoking across the world. She cautioned these other countries to beware of the lies & propaganda campaigns demanding prohibition and of the policies for which there is no real-life scientific trials that record their adverse effects and consequences.