Around the Motu

Anaru Waa a senior researcher in Department of Public Health; the University of Otago presented at the biennial Oceania  Tobacco Control Conference in Perth Australia. His kaupapa addressed the NZ 2025 goal, the possible pathway options and their impact on te iwi Māori. The kōrero below is written by Anaru Waa.

My presentation provided a Māori perspective on the Tupeka Kore 2025 goal. It recognised how Māori had led the call to get rid of tobacco back in the mid 2000’s, and while we have seen declines in smoking for everyone, these declines have mainly advantaged non-Māori. Māori continue to experience much higher smoking rates than non-Māori. It seems like there are at least two key issues we need to resolve if a) we are to achieve the 2025 goal and b) address smoking disparities. First we need to be clear whether 2025 is about getting rid of all tobacco (abstinence) or just the smoked stuff (harm minimisation). There are pro’s and con’s for each. For example an abstinence approach would well and truly address harm from tobacco products, but we have to really ask ourselves whether this is possible over the next nine years. Bringing about legislative change can take years, bringing about social change to support bold policy can also take years. Alternatively harm minimisation may be a more realistic goal, there are now products that may actually reduce harm. But the challenge is whether we’re OK with (Māori) people who continue to be addicted to nicotine. There may be health costs, there will be a financial cost for whānau, but there is also a cost to our own aspirations of tino rangatiratanga – tobacco was and is a tool of colonisation. So in the harm minimisation scenario we may achieve our goal but there would probably still be work to do. Unfortunately the two perspectives on the 2025 goal probably work at cross purposes to each other. To move forward effectively we must agree on the goal and work together to achieve it.

The second issue that I discussed was about how our tobacco control programme is clearly not working as well for Māori. This has been known for decades but is now being exacerbated by the declines we’re seeing in the non-Māori population. At one level the reasons are complex – Māori are exposed to a myriad of ‘upstream’ factors such as lower incomes and discrimination that place them at greater risk. At another level, at least within the health arena the reasons are a little more straight forward. Much of the current tobacco control programme is focused on reducing demand for tobacco. If these programmes and services do not (or cannot due to what their funding allows them to do) address many of the causes of ‘demand’ (e.g. exposure to triggers to smoke, not having access to the finance or resources to be able to take control of smoking), or are not appropriate then Māori may be at a distinct disadvantage. The alternative to demand side strategies is to reduce supply. This is done through things such as reducing where tobacco can be brought, changing the nature of the product so that it is less appealing, offering alternatives, or just banning tobacco altogether. Supply side strategies reach the whole population in a similar way and therefore levels out the playing field a bit. For such an approach to work Māori would need to be at the table of policy development to ensure that it was not done ‘on’ but with Māori communities. One way of achieving this would be to mobilise our communities to support the kaupapa and support our Māori MPs to take a strong stand.

I also provided some options to think about in terms of what sort of goals (abstinence or harm minimisation) we could pursue and strategies for getting us there.

Nāku iti nei

Anaru Waa