Now is the time to demonstrate that the leadership seen during the pandemic can also be shown to address the other great public health challenges facing Aotearoa, write the University of Otago’s Richard Edwards, Janet Hoek and Andrew Waa

For most people, 2020 was a year of considerable challenges as the Covid-19 pandemic evolved. However, it ends with some optimism, with the virus apparently well-controlled in Aotearoa compared to most other countries.

A defining feature of the Government’s response was how it listened to public health experts in developing its pandemic control strategy. This experience has surely demonstrated the importance of prioritising health, implementing systematic, well-organised and science-led preventive interventions, and communicating clearly to build trust and generate community mobilisation.

Other public health challenges would benefit from a similar approach, with urgent action needed now to reduce the burden of avoidable ill-health and death and huge health inequities caused by diseases like heart disease, stroke and cancer.

The Health Coalition Aotearoa has set out a framework of priority actions, including increasing taxes on alcohol and sugary drinks, restricting the promotion of alcoholic drinks and unhealthy food, removing nicotine from tobacco products, strengthening community input into alcohol licensing, and greatly reducing the supply of tobacco products.

New Zealand is falling behind as these approaches are increasingly introduced elsewhere. For example, the UK has a sugar tax and recently announced it will hugely restrict junk food advertising, including online marketing. Fourteen Pacific Island Countries and Territories have sugary drink taxes. The EU and Canada have banned menthol-flavoured cigarettes. Scotland introduced a minimum alcohol price. The list goes on.

Many people working in health had high hopes that election of a Labour-led Government in 2017 would see greater priority given to preventive interventions, particularly those addressing unacceptable health inequities. Real progress was anticipated in addressing the burden of disease caused by poor diet and obesity, excessive alcohol consumption and tobacco smoking.

Unfortunately, these hopes and expectations were not realised.

The Government implemented almost no population-based measures to address these issues, other than welcome legislation to introduce a regulatory framework for vaping and e-cigarettes, and a long overdue law to prohibit smoking and vaping in cars carrying children. Despite promises in March 2018, and an update in late 2019 advising its ‘imminent’ arrival, an action plan setting out how the world-leading Smokefree Aotearoa 2025 goal would be achieved never materialised.

Coalition politics may have impeded progress and the Government no doubt had to manage competing priorities; yet, despite being faced with an urgent and serious public health problem, policies needed to realise the 2025 goal were not implemented.

However, that was then, and this is now. The new Labour Government has a clear mandate, can govern without the constraints of coalition partners, and public support for action to improve and safeguard population health has never been higher. It is surely time for bold preventive measures that will make a real difference.

Action to achieve the Smokefree Aotearoa goal of minimal smoking prevalence and greatly reduced tobacco availability is urgent. The 2025 deadline is rapidly approaching, yet smoking prevalence is still over 12 percent, with disproportionate harm from smoking and much higher smoking rates among Māori (31 percent) and Pacific peoples (21 percent).

Tobacco products continue to addict and kill thousands every year, yet are still sold at every dairy, convenience store, supermarket and petrol station – making a mockery of the ‘minimal availability’ part of the smokefree goal. The products themselves remain unregulated, leaving tobacco companies free to develop and sell cigarettes and tobacco that are extremely addictive, and use added flavours and sugars to make smoking more appealing to young people.

The pandemic experience has shown that the Government can be bold and decisive when facing a major threat to population health. It is time to show the same resolve to ensure that the Smokefree Aotearoa goal is realised. In particular, we call on the Government to introduce the long-awaited action plan setting out how a Smokefree Aotearoa 2025 will be achieved. Core components should include:

– Major policy interventions that address the continuing causes of high smoking rates. These include progressive reductions in the availability of smoked tobacco products (by limiting sales to a small number of specialist R18 tobacco retailers), reducing the addictiveness of tobacco products (by removing the nicotine) and decreasing smoking’s palatability to young people (by banning flavoured tobacco products and youth-oriented capsule cigarettes).

– Substantial increases in funding for awareness-raising and community-based interventions to prompt and support quitting, reduce smoking uptake among young people, and promote the Smokefree goal.

At a pre-election event organised by the Health Coalition Aotearoa to discuss prevention, nearly all the representatives of the major political parties present agreed that ‘prevention is better than cure’. Given that shared view, the urgent and continuing threat to health equity that smoking poses, and the strong evidence supporting new measures, the Government must surely now act. Now is the time to demonstrate that the leadership seen during the pandemic can also be shown to address the other great public health challenges facing Aotearoa.

Richard Edwards, Janet Hoek and Andrew Waa are all part of the Aspire 2025 research group, based at the University of Otago, Wellington, in our Department of Public Health.

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