Smokefree Oceania From Vision to Reality Auckland, Sept 2007

1. Smokefree OceaniaFrom Vision to RealityAuckland, Sept 2007 Colin Tukuitonga Ministry of Pacific Island Affairs

2. Outline • Tobacco use by Pacific Peoples • Tobacco and health inequalities in NZ • Smoking in the Pacific region • Current/recent interventions • From Vision to Reality • NZ actions to support Pacific initiatives

3. Key Messages • Tobacco use one of the largest preventable contributors to health inequalities in NZ; mainly CVD and cancer • Recent/current interventions in NZ largely ineffective? • Solution is better focus; research and resources, community ownership • NZ actions needed to assist PICs

4. Tobacco Use in the Pacific Region • Improving information about tobacco use, WHO STEPS Surveys • Major public health challenge • Recent review showed all PIC male populations reported higher rates of smoking than NZ and Australia (except Palau) • Male smoking prevalence ranges 22-57%

5. Tobacco Use in the Pacific Region • Nauru, Tokelau, French Polynesia, New Caledonia and Kiribati showed higher prevalence of smoking among women • Prevalence ranges from 1-51% in women • High prevalence of youth smoking in several PICs (3-68%); gaps in data • Potential for better exchange of experiences with NZ

7. Smoking Prevalence by Ethnic Group and Gender, NZ 2006.

8. Smoking Prevalence (%) by Ethnic Group and Gender; Alcohol & Drug Survey 2003

9. Prevalence of Current Smoking (15-19 years) by Ethnic Group and Gender, 2006

10. Exposure to Second-hand smoke • No change in Year 10 students reporting living in a home with at least one parent smoking (50% in 2001 and 49% in 2005) • Census 1996 showed 49.5% children under 15 years of age living in a household with at least one smoker • Socioeconomic gradient

11. Maternal Smoking • PIF Study – 1365 mothers of 1398 infants born in Middlemore Hospital 2000 interviewed at 6 weeks • Approx. 25% smoked during pregnancy; ¾ continued smoking; little change during pregnancy Butler et al NZ Med J 2004 26;117

12. Smoking Cessation • 3% of calls to Quitline 2001-2003; lower than expected • Half of all callers in 20-34 year age group; equal gender distribution • Significant improvement needed

13. MOH Review of Evidence 2007 • Recent review of major population-level tobacco control interventions showed that we know little about what works for Pacific Peoples • E.g. impact of increasing unit price of tobacco unknown • Mass media campaigns possibly effective

14. Inequalities in Health • 8% of deaths in women and 19% in men could be avoided if smoking was eliminated • “Smoking-related deaths and illnesses are the most easily preventable in Pacific communities” Cancer Society of NZ: Health Effects of Smoking 2003.

15. Tracking Disparities 2007 • Lowest all-cause mortality rate decline in NZ (14% males, 10% females) between 1981-84 and 2001-04 • Much of the decline due to reduction in CVD incidence and case fatality rates (lowest among Pacific Peoples; 19% for males and 38% for females) • CVD explains about 1/3 mortality gap and ¼ cancer, especially among females

16. Tobacco Use Among Pacific Peoples in Aotearoa/NZ has remained largely unchanged since 1996

17. 1996 Census • 32% adults 15 years plus daily smokers; 35% males and 27% females • Tokelauans, Niueans and Cook Islanders highest prevalence and Fijians lowest prevalence of smoking

18. Clearing the Smoke • 5-year tobacco control plan (2004-2009) • Objectives 1. Prevent initiation; high youth smoking 2. Promote cessation; 3% Quitline calls 3. Prevent harm from second-hand smoke; no change in Pacific households? 4. Improve monitoring, surveillance and evaluation 5. Improve infra-structure support and coordination

19. National Drug Policy 2007-2012 • Government policy on tobacco, alcohol, illegal and other drugs in one framework • ‘Whole of Government’ approach • Better focus on Pacific Peoples • Reducing inequalities is a feature • Action Plans provision

20. Drug Policy – Pacific Focus • Improve ethnicity data collection; ethnic-specific information • Improved treatment services

21. From Vision to Reality Research, Resource, Re-group

22. Strategy for Eliminating Tobacco Use among Pacific Peoples in NZ • Better focussed research • Resources to match burden • Ownership by Pacific communities • Delivery by Pacific providers • Learn from Maori experiences

23. NZ Role in Curbing Tobacco Use in the Region • Continuing support for FCTC • Limits on trade - $5 million annual trade in tobacco with 12 small island states • Exclude tobacco from free trade agreements • Regional approach to limits on sponsorship and marketing tobacco products in the region

24. Summary • Tobacco use is major preventable cause of premature death and illness among Pacific Peoples in Aotearoa • Recent and current efforts remain ineffective; bold actions are needed • Focused research on what works for Pacific Peoples urgently needed

25. Summary • Make tobacco use unacceptable, unsociable in Pacific communities • Better service coordination • Resources to Pacific communities worth considering