Lecture 24: Maori and Tobacco Flashcards
what is the history of tobacco in NZ?
- Maori didn’t have substance use issues prior to colonisation
- tobacco was introduced to Maori by captain cook
- used as an article of trade as European contact increased
- Maori women took up smoking at the same rate as men
- tobacco was distributed to NZ troops during WWI and WWI
- in 1960s the US surgeon report came out showing that smoking linked to heart disease and cancer
how has tobacco control changed overtime?
- in the 1980s it was recognised that tobacco control measures are not as effective for Maori
- Maori men and Maori women had the highest incidence of lung cancer in the world
in the 1990s:
- smoke-free environment act was passed
- establishment of the first Maori national tobacco control programme
- the “Auahi Kore” brand and associated programmes were launched
- Apaarangi Tautoko Auahi Kore/Te Reo Marama established (Maori smoke free coalition - reflected maori voices)
- pilor aukati paipa programme implemented
in 2000s:
- “its about whanau” campaign developed and launched in 2000
- Kaupapa Tupeka Kore in 2006
- government commits to smoke free goal (less than 5%) in 2010/11
- te rea marama was defunded
- vaping proliferates
2015
- tobacco control ‘refresh’ and less money was put toward public health measures and more to individualised measures
what is the cost of smoking?
- causes/exacerbates many diseases including cancer, stroke and heart disease
- leading cause of preventable death and disease
- 4500-5000 deaths per year (1300-1500 Maori)
- 1/4 Maori deaths attributable to smoking
- social, economic and cultural cost
what are common patterns to do with smoking?
High rates not only in maori, it is a common story for many indigenous communities around the world. e.g. aboriginal, first nation, inuit etc
what are smoking patterns in NZ by ethnicity?
Maori have highest smoking rates in NZ. While slight decrease overtime, Maori still consistently have highest rates. There have been interventions since the 1990s, but they haven’t had much of an impact
why do Maori have such high rates of smoking?
Intermediary:
- low SES, smoking in social network/role modeling, tobacco more available in low SES
Basic causes:
- racism, colonisation and economic/legal structures impact social status, surface causes, biological processes and therefore health, well being and health inequities too
what are the current ways of tobacco control and the issues with them?
“Business as usual” tobacco control includes:
- health promotion such as smoke free/auahi kore settings
- support for cessation
- policies such as price, age limits, enforcement
but business as usual approaches can be a cause of inequities
- the structural systems and interventions we have rely on individuals accessing resources themselves and having an agentic approach
- we also have superficial strategies such as campaigns/promotions, but a radical approach such as banning cigarettes entirely might actually make a difference
what have been ways of shifting the discourse around tobacco?
Kaupapa Tupeka Kore (tobacco free)
- in 2006 kaupapa tupeka kore was announced which would eliminate the disparities and end tobacco harm. this moves beyond individual focuses
in 2010/11 there was a Maori Affars select committee inquiry which aimed to reduce smoking prevalence and tobacco availability to minimal levels to make new zealand smokefree by 2025
- but not much happened until 10 years after these events
what are the projections of daily smoking in females if we continue with business as usual interventions?
the goal is to have 5% of the population smoking, but if we continue to do the business as usual interventions, we won’t reach that goals.
non-maori women will get there by 2026, but Maori women won’t reach 5% until 2060 onwards
it’s a good goal, but an unrealistic expectation, especially for Maori considering that the interventions aren’t helping them. we need to move away from the business as usual model
what are some new ways we can shape tobacco control to address disparities?
the population and high risk strategies
- challenges of this: the population strategies are utilitarian and rely on the whole population being on board, but the high risk strategy won’t affect the fundamental causes of tobacco use.
- business as usual strategies focus on individual agency which isn’t very useful
- the population level strategy are amenable to structural and radical strategies
- the most effective intervention is likely to be the ASAP plan
- ACCESS: markedly reducing retail availability
- APPEAL: removing additives, non-addictive nicotine content
- AFFORDABILITY: large increases in tax
- doing these have potential to make the biggest difference
what are the perceptions of Maori who smoke?
Te Ara Auahi Kore study worked with Maori who smoke and asked questions about smoking behaviours and their perceptions of the key measures being suggested in the ASAP plan
- 42% support, 21% ambivalent about the smoke free 2025 goal
- 40% would quit smoking and 14% would only use electronic nicotine devices if very low nicotine cigarettes were introduced
- 19% would quit if tobacco retail reduced by 95%
those who had more quit attempts had a greater support for smoke free 2025 goal
those who had a greater trust in the government and more quit attempts had greater support for very low nicotine cigarettes
those who had a greater sense of control over life had lower support for very low nicotine devices
what are the modelled impacts of very low nicotine cigarettes?
- taking nicotine out of cigarettes has the potential to make a huge impact in reducing smoking. getting smoking rates below 5% can be achieved just after 2025
what are the 2 main ways of looking at tobacco control and the issue that come with it?
tupeka kore vs smokefree
tobacco free vs smoke free
- tobacco free = no nicotine addiction
- smoke free - no cigarettes
Tupeka kore has ideas that align with abstinence. this means there is no safe level of tobacco use and that addiction is not part of Maori culture and a is a symbol of colonisation.
This isn’t entirely realistic for Maori by 2025. It might be better to aim for smoke free by 2025, but minimising nicotine addiction may need more time.
harm minimisation implies that alternative nicotine delivery devices are less harmful.
- this is an ongoing debate which changes the end goal as it is difficult to determine which is better
- the Maori perspective is that all types of addictions are bad, but harm minimisation aims for smokers to change to vapes/electronic cigarettes as they pose less harm.
- reducing harm only makes sense if you are a smoker. but many young non-smokers pick up vaping which is just another form of harm
- the industry has a large influence in the way tobacco is controlled as they want to keep making profits
- in the current context, harm minimisation might be a good start and an achievable goal for 2025, but is not the end goal
what has happened in recent years for tobacco control?
finally we have seen some progress in 2021!
- there has been a goal to reduce smoking to minimal levels and eliminate smoking inequities, influenced by ASAP plan
key measures:
- aims to strengthen the tobacco control system
- reduce access
- make tobacco less addicted and appealing
- less affordable
- enhance existing initiatives
what government actions support the recent tobacco control plans?
- Smoke free Action Plan (2021)
- Smokefree environments and regulated products amendment Bill
- there is a treaty clause that enables independent voices, principles and provisions of the treaty, and aims to protect the future
- there is a big focus on equity
- include very low nicotine cigarettes, reducing retail and aims to create a smoke free generation. rangatahi should be protected and become a nicotine free generation, but this isn’t included in the Bill.
- this is a very important opportunity, but definitely not the end point.
