Speech: World Congress of Cardiology

Ka mihi atu au ki te tangata whenua, te hau kāinga, nāu te reo karanga ki a mātou.

I firstly greet the traditional owners of this land, the Wurundjeri people.

Thank you for the invitation to speak today. A particular thank you goes to the Cardiac Society of Australia and New Zealand who are hosting this conference.

Just down the road from my tribal home at Whangaehu, we have our family cemetery, what we call our urupā.   As you walk down the rows and look upon the headstones of my family members, one thing stands out – so many of my cousins, aunties, uncles have died before they were 55.

It is a painful visual record of the genogram for tobacco related harm.

The genogram helps to plot out across the generations, the influences, the histories, the adverse impacts of tobacco - and that can make it easier to understand what is needed, in order to focus on outcomes.  

I have seen it used really effectively with one of our providers at home, to provide a pictorial understanding of the inter-generational story about tobacco addiction.

Both my family urupā– and the genogram model – are a stark reminder that we lose 5000 New Zealanders a year to tobacco.  In simple terms, one in every five people over the age of fifteen continue to put their lives at significant risk.

We have come a long way in reducing the burden of heart disease in New Zealand but too many people in our country still die as a result of smoking related cardiovascular disease.

But I come here not to depress you with this reality – but instead to share some of the approaches we are taking which truly inspire me and lead me to believe we can have a smoke-free future.

And so it is that three years ago in March 2011 the New Zealand Government adopted the goal to be essentially a smoke-free nation by 2025.

It was a goal driven by an amazing team of activists and advocates who have thought creatively about how to place tobacco reform on the agenda.

And there was a political pressure as well – one of the key milestones in the Relationship Accord signed between the Māori Party and the National Party was to advance tobacco reform, including the introduction of plain packaging.

The 2025 goal was strengthened by the recommendations of a landmark parliamentary inquiry into tobacco by the Māori Affairs Committee.

When all these influences were brought together, we were able to negotiate a commitment to being Smoke-free 2025.  The focus of the goal is heavily targeted towards reducing smoking prevalence and tobacco availability to minimal levels.

Mid-term targets have been quantified by the Ministry of Health—daily adult smoking prevalence down to 10 percent by 2018, and at least halving the stubbornly high rates among Māori and Pasifika peoples.

This set of mid-term targets also aligns New Zealand with the 2018 smoking targets adopted at both state and federal level in Australia.

We’ve started to see some return for our vision – in the 2013 Census, 15% of New Zealand adults smoke (463,000 people) – a massive drop from 598,000 at the last census in 2006.

Even more encouraging is the fact that smoking prevalence among Māori has dropped from 42.2% in the 2006 Census to 32.7% in 2013. .

We are doing even better for our young people. The 2013 Action on Smoking and Health Year 10 smoking survey of revealed that the rate for 14 and 15 year olds who smoke at least once a day has dropped from 4.1% in 2012, to 3.2%.

This is great news. I am proud that our rangatahi are making conscious positive decisions for their futures by choosing not to smoke. I am particularly pleased that smoking amongst Māori in Year 10 is also continuing to show a rapid decline.  Daily smoking amongst Māori in Year 10 has declined to 8.5% in 2013 -  a massive reduction from the 30.3% rate in 1999.

Putting the rates and percentage marks aside, I think we should be proud of the people who are making brave choices to be smoke-free. 

It’s about attitude, it’s about aspiration, it’s about a basic belief in the value of life.

One of the priorities for me in changing our patterns around smoking has been the Pathway to Smoke-free 2025 Innovation Fund.   This was a $5 million fund per annum to invest in the design, development, promotion and delivery of innovative efforts to reduce the harm and wider costs of smoking. 

We targeted those groups that we considered most vulnerable in terms of high smoking prevalence that is Māori, Pacific people, pregnant women and young people.

Of course, even with the strongest will in the world, individuals can be vulnerable – and a key plank in our tobacco reform plan has been lifting the tobacco excise tax.

Since 2010 the Government has significantly lifted the tobacco excise tax with a series of annual increases.   By 2016 tobacco excise tax will have more than doubled since 2010.  While the final retail price is set by the market, it is expected to rise to over $1 per cigarette in 2016, which is likely to be a significant psychological price point.

Total taxes, including 15 percent GST, now amount to over $13 per pack of 20—one of the highest rates in the world.  The tax level has now reached over 75 percent of the retail price—and over 80 percent of the retail price of the main budget brands.

I’m not always popular for having introduced these increases; but I am proud that we are starting to see the difference I referred to earlier.

Alongside the excise increases, we have initiated support driven out of the health target, Better help for smokers to quit.   Stopping smoking is the best thing a person can do for their health. We have moved to make smoking a medical issue that is addressed by all healthcare professionals.

The target requires 95 percent of all hospital patients who smoke to be given brief advice to quit and offered cessation support.

The target has since been extended to primary care as well, where at least 90 percent of smokers seen in general practice should receive the same intervention (with a special focus on women who are pregnant).

Without a doubt, one of the more controversial aspects of our strategy, has been the introduction of plain packaging.

It has now been close to a year and a half since Australia’s tobacco plain packaging restrictions came into force.  Sixteen months down the track, all the signs are the policy is working exactly as intended.  There have been numerous reports that smokers are being put off by the plain packs. They now think the exact same cigarettes are lower quality, and they find them less satisfying; and best of all they think more and more about quitting.

In fact I am told that the Australian packs are so off-putting they have even won an international marketing award for how skilfully they have been designed to be a turn-off!

I want to be really clear with you all – and reconfirm that New Zealand is committed to introducing plain packaging as part of our drive to Smoke-free 2025, and we are continuing to progress the legislation and regulations required to make this a reality.

The Tobacco Plain Packaging Bill had its first reading in Parliament on 11 February this year and was referred to the Health Select Committee with just one opposing vote.   The select committee is currently hearing the oral submissions from across the country. Following this stage, the bill will be reported back to Parliament, ready for its final readings and passing into law.

We still have several stages to pass through.  Even after the legislation is passed, we need to develop regulations to bring all the detailed requirements into force and that will take some time.

I am however, eternally confident that New Zealand will be the next country in the world to introduce plain packaging of tobacco products.  If Ireland, England and other countries join us in a bunch sprint finish for second place, so much the better. In the meantime, with our eyes firmly on the finish line, New Zealand continues to make the running.

There’s one other thing I would raise which I might suggest could be successful as a regional initiative, and that is the anomaly of duty-free tobacco.

We have again seen Australia leading the way here by reducing its incoming travellers’ duty-free concession down from 200 cigarettes per person to 50.   I am working with my colleague the Minister of Customs to address this issue in New Zealand. It is quite foreseeable that one day soon we could have no duty-free tobacco available for people traveling across Oceania.

Finally, I want to leave you with the words of one of our ancestors, Dr Rangitakuku Metekingi, who said

Ko te pae tawhiti - whaia kia tata,
ko te pae tata - whakamaua kia tina!

In essence, the spirit of his message was that we should pursue the distant pathways of our dreams, the horizons stretching out beyond us, in order that they may become our reality.

This is one of my last opportunities to address an international health conference in my current role as a Minister responsible for tobacco control.  While I leave Parliament at the end of this term, I will continue to share your passion and fight with all my might to eliminate the harm caused by tobacco amongst too many of our families.

I wish you all much courage and determination – and I am absolutely sure that if we work together in a concerted approach, by 2025 we will indeed have a Smoke-free Oceania!