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Ngā mihi ki a koutou katoa,  

What a privilege to edit the 100th edition of the policy spot!  Despite winter wets and blues, the membership is in good heart, and I'm delighted this provides a platform to present the work of others.

It is a time of change and opportunity for public health in New Zealand. Covid has reminded us all how vital our work is in the infectious disease space. Now we need to get the messages out that our work also includes addressing all the social determinants of health: poverty, racism, poor housing, food impoverishment and health literacy to name but a few. 

Advocating for climate change action, tackling tobacco, alcohol, gambling and violence harms, and reducing inequality in every facet of society, IS public health work. 

As ever, please continue to contribute to the debates, showcase your public health specialism or passion, and get involved with YOUR association.

Mauri ora!

Ngā mihi mahana 
Leonie Walker 
PHANZ HQ Wellington 

Keep in touch by emailing grant@pha.org.nzleah@pha.org.nz, leonie@phaorg.nz

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In this week's PolicySpot:
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Each fortnight, we will highlight hot policy topics, blogs or publications related to public health in Aotearoa. Our aim will be to summarise the issues and stimulate debate and facilitate sharing of viewpoints from across the wide and diverse public health spectrum.

We particularly welcome contributions from our public health student members. Around 500 words, please. Editor's reserve the right to balance content  (two "guest spots" per edition) across different policy spots!

To suggest topics for inclusion, or to respond to the issues raised, please contact leonie@pha.org.nz 

 
Policy debate. Rebuttals welcome! 
Teen Vaping: two contrasting policy approaches

The evidence is clear that vaping is substantially less harmful than smoking. There is also good evidence that it can be an effective way for current smokers to quit, and to beat addiction to nicotine.  There is a place for vaping products as quit aids to be widely and affordably available. However:  

Nicotine e-cigarettes have a high addiction potential. Of particular concern, is the attractiveness of these products to adolescents, and the recent rapid increase in their use by adolescents. Adolescents and youth are vulnerable and particularly susceptible to nicotine addiction. An Irish HRB report concluded that adolescents using e-cigarettes are between three to five times more at risk of future initiation of cigarette smoking when compared to those who have never smoked e-cigarettes. While the long-term effects of e-cigarette use are still unclear, there is emerging evidence for long-term adverse health effects on the respiratory and cardiovascular system.

In New Zealand, and in response to the emerging international evidence, and worrying trends of never-smoking teens becoming addicted to nicotine and evidence of aggressive /subversive marketing to teens, a new Vaping Amendment Act, comes into force in November. The law aims to make e-cigarettes less appealing and available to teens, by banning advertising, toughening up the R18 sales limit and restricting flavours sold outside specialist vape shops – such as at dairies and supermarkets – to tobacco, menthol and mint.

Our laws will still be more permissive of vaping than in Australia where recent international evidence has been cited by the Australian Advisory Committee on Medicines and Chemicals in support of a change coming into law there on the 1st of October 2021. Despite vociferous industry lobbying, effectively, nicotine-containing vape products will be available only by prescription, and be firmly for the purpose of smoking cessation support. https://www.tga.gov.au/scheduling-decision-final/notice-final-decision-amend-current-poisons-standard-nicotine

The Australian decision was based on a number of significant systematic reviews. In particular the 2016 report of the US Surgeon General, which concluded that youth use of nicotine in any form, including e-cigarettes, is unsafe. The Australian National University review concurred. The findings of the Irish HRB reports were also consistent with the European SCHEER report, which concluded that there is strong evidence that e-cigarettes are a gateway to smoking for young people. Similar conclusions were reached in the ANU report, which found that, across multiple settings, non-smokers who use e-cigarettes are consistently more likely than non-e-cigarettes users to initiate cigarette smoking.

The question of whether nicotine e-cigarettes are an effective aid to smoking cessation is still contested. However, while some individual smokers have successfully used nicotine e-cigarettes to quit smoking, evidence at a population level is lacking. The Cochrane Review suggested that nicotine e-cigarettes may be more effective than nicotine replacement therapy. The Australian legislator found that the use of nicotine e-cigarettes should be considered in the context of a smoking cessation tool for short-term use and under medical supervision.

It will be interesting to note the impact of these divergent policy settings in New Zealand and Australia. It is to be fervently hoped that a new generation of nicotine addicts (and smokers) are not created.

Dr Leonie Walker
Adjunct Professor, School of Health Sciences, Massey University

 

Member blog spotlight: 
Smokefree Action Plan

Professor Richard Edwards


New Zealand: Government proposes world-leading action plan to achieve Smokefree 2025 goal

 
In April 2021 the New Zealand (NZ) government published a discussion document with a proposed action plan for Smokefree 2025. The sponsor is Associate Minister Dr Ayesha Verrall, a physician and newly elected member of Parliament.
 
The NZ government’s commitment to a smokefree goal in 2011 was a response to a recommendation from the Māori Affairs Select Committee of the NZ Parliament. It followed sustained advocacy by Māori (the Indigenous peoples) leaders for the ‘Tupeka Kore’ goal for the elimination of tobacco products, which were introduced to Māori by colonisation, from NZ.
 
Smokefree 2025 was defined as minimal prevalence of smoking and minimal availability of tobacco products. However, progress has been slow, and under its ‘business as usual’ approach, New Zealand was on track to miss the goal by a wide margin, particularly for Māori, Pacific and low-SES populations which have much higher smoking prevalence.
 
The discussion document sets out a comprehensive strategy to achieve rapid and equitable reductions in smoking. The proposed plan also includes structural changes to strengthen the tobacco control system – most importantly to strengthen Māori governance of the smokefree programme. It includes several world-leading measures, including two ‘endgame’ measures that could drive the profound reductions in smoking prevalence that are required.
 
First, the discussion document proposes greatly reducing the retail availability of smoked tobacco products and gradually phasing out sales altogether. Strategies include markedly decreasing the number of stores able to sell these products (to around 5% of the current number), requiring tobacco retailers to have a licence and restricting tobacco sales to specialist stores or community pharmacies. It also puts forward a ‘smoke-free generation’ policy, where the legal age of purchase for smoked tobacco products would increase by one year every year, effectively meaning that future generations will never be able to legally purchase tobacco products and sales would eventually cease.
 
Second, it proposes removing virtually all the nicotine from cigarettes and tobacco, so these become much less addictive.
 
Additional measures include banning product design innovations that may appeal to young people, such as flavour ‘crushballs’ in cigarettes; and banning filters to prevent filters misleading people who smoke about health risks and to greatly reduce the environmental harm caused by cigarettes. The plan also proposes enhancing ‘business as usual’ approaches such as mass media and social media promotions to promote quitting and deter smoking uptake, increased smoking cessation support for priority populations, and community-based smokefree interventions.
 
Other proposed changes include improved research, monitoring and evaluation; and strengthened enforcement and compliance-enhancing activities.
 
The plan is notable for its comprehensive and ambitious approach, and has attracted global attention due to the inclusion of several innovative policies not yet introduced at country level anywhere else in the world. If implemented in full, it appears to provide a realistic roadmap to Smokefree 2025, which will protect the health of current and future generations of young people by greatly increasing quitting among people who smoke and by minimising the risk that young people will experiment with, and become addicted to, smoking. New Zealand’s experience could provide crucial evidence for other jurisdictions wanting to eliminate the health loss, inequity and economic burden caused by the tobacco epidemic.
 
An initial consultation on the action plan closed on 31 May 2021. Key NGOs and public health organisations in New Zealand have warmly welcomed the plan, as have many international health researchers and public health experts. Local experts, in collaboration with international colleagues, have published a series of blogs commenting on the plan and its specific proposals.
 
However, not everyone has been so supportive. Indeed, the newly ‘transformed’ tobacco industry has opposed the plan with their principal argument being that it will boost illicit trade. British American Tobacco has been caught out orchestrating retailer opposition. Philip Morris International (PMI), which has loudly proclaimed its desire to achieve a smokefree world, has been conspicuously silent on a plan that provides a potential roadmap to do just that (PMI NZ does not appear on the list of submitters to the consultation process).
 
The next steps are that the submissions will be analysed and considered and the Minister will prepare a final version to take to Cabinet. Smokefree advocates are hoping that implementation of some of the key measures will begin in 2022.
 
Richard Edwards and members of the ASPIRE 2025 Research Centre
richard.edwards@otago.ac.nz
 
An earlier version of this article with links and author information was published
on the Tobacco Control website at: https://blogs.bmj.com/tc/2021/05/05/new-zealand-government-proposes-world-leading-action-plan-to-achieve-smokefree-2025-goal/


 
Member paper spotlight: 
Expansion of a national Covid-19 alert level system to improve population health and uphold the values of Indigenous peoples

Authors: Amanda Kvalsvig, Nick Wilson, Cheryl Davies, Carmen Timu-Parata, Virginia Signal, Michael G. Baker


Summary: The Alert Level system is well-positioned to become an enduring legacy of the Covid-19 pandemic. With some revision, this system could provide a flexible infection control framework to manage the next phase of the pandemic and to address NZ’s longstanding burden of infectious disease incidence and inequities by building in prevention synergies with other endemic, epidemic, and pandemic diseases. There is also potential for benchmarking infection control to support mutual travel agreements with other countries, particularly in the Western Pacific. The past year has amply demonstrated the value of Indigenous models of health for responding to public health emergencies. This new version aims to be explicitly equity-promoting and to uphold Te Tiriti o Waitangi/the Treaty of Waitangi, the founding document of NZ’s constitution.
Key aspects of the Alert Level revision 
 
  • Upholding Te Tiriti and implementing a more equitable response: The current system has made several assumptions that do not necessarily hold for Māori for example, that ‘households’ are small nuclear families. In many regards, the current system is rules-focused rather than building on the known effectiveness of a strengths-based, mana-enhancing (self-empowering) approach. Māori knowledge and capability can ensure that the system is more responsive to populations at risk and more effective at protecting community wellbeing in a public health emergency.
  • Better calibrating controls to the level of risk:
  • Responding to new knowledge:
  • Signaling improvements and innovation:
  • Supporting harmonisation with Australia (and the wider world):
  • Establishing protective measures for a safer future:

 
Recent Submissions and 
Consultations open:

 Joint Venture Family Violence Sexual Violence Consultation  Submitted 29 June 2021


Resource Management Act 

Natural and Built Environments Bill  :

A high-level overview of the key differences between the RMA and the proposed NBA (and Spatial Planning and Climate Change Adaptation Acts) is available on the Ministry for the Environment’s website.

Our understanding is that the Exposure Draft will include drafting of some, but not all, of the key provisions of Part 2 of the new NBA. We understand that the Exposure Draft is likely to set out:

  • The purpose of the NBA, including a Te Tiriti o Waitangi clause and supporting provisions
  • Implementation principles
  • National Planning Framework (i.e. national direction) (some key clauses, but not all)
  • Natural and Built Environment Plans (some key clauses, but not all)

When the Select Committee process will commence is yet to be confirmed. 

[RMA Consultation with Tangata Whenua guidance]

 
PHA@AUT:Critical te Tiriti analysis:
A tool to strengthen te Tiriti compliance workshops - NEW DATE!
(Photo credit Leah Bain)

Critical te Tiriti analysis: A tool to strengthen te Tiriti compliance August 16th 2021 

Critical te Tiriti analysis: A tool to strengthen te Tiriti compliance interactive workshops led by Assoc Prof Jacquie Kidd and Dr Heather Came have been wildly popular selling out in record times. A second workshop was then offered which has also sold out in quick succession. 

We are proud the highlight both these workshops and the CTA tool developed by Prof Tim McCreanor and Dr Heather Came to inform the development of policy, review policy/curriculum/competencies, analysis qualitative research data to check te Tiriti compliance. Ka mau te wehi!
Have an event to share? Send the details through to leah@pha.org.nz and we'll feature it here. 






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