What works to get Māori women to quit

With Winston Peters condemning the Smokefree 2025 initiative and calling to lower the excise tax on tobacco, ASH health promoter Boyd Broughton questions whether lower prices would reduce tobacco-related crime and looks at the initiatives that have worked for our most vulnerable, Māori women, in the past. 

Wāhine Māori are, and always have been, acknowledged as vital to the survival of te ao Māori, te reo Māori me ōna tini tikanga ātaahua and our whakapapa, often more so than land.

Nā te whenua, nā te wahine, ka mate te tangata
(Because of the land, because of women, people will die)

While it is impossible to translate the wairua of this whakataukī accurately in te reo Pākehā, it rightfully asserts that people will die to ensure the healthy longevity of both women and land due to that importance to our survival.

It’s a sentiment that has sadly not been historically or contemporarily reflected in government policy and we must make and take opportunities to do better. Starting with one of this country’s most insidious killers, tobacco.

Shockingly about two out of three people will die prematurely from using tobacco as it is intended to be used. No other legally sold product or activity is as destructive to whakapapa Māori as tobacco.

Māori were among the first women to smoke combustible tobacco at a time when it was solely the domain of men, and wasn’t deemed ‘lady-like’ – a social convention they took much pleasure in flaunting.

Māori women’s current smoking rates are around 34%, having only slightly decreased from 39% since 2010 when, led at the time by the outstanding political leadership of Dame Tariana Turia, the Māori Affairs Select Committee (MASC) toured the country gathering evidence, stories and the aspirations of our people to determine a Smokefree life for our tamariki and mokopuna into the future. Within the ensuing 2011 report were a raft of recommendations including setting an aspirational goal of achieving an essentially smokefree New Zealand (<5% smoking prevalence) by 2025. That same report also rightfully determined wāhine Māori as a priority. Since then over 45,000 New Zealanders will have died prematurely to preventable tobacco-related causes.

Since that report a number of recommendations and strategies within have been piloted, trialled, realigned, re-imagined and discontinued, with varying degrees of success for the general population, declining from about 20% prevalence in 2011 to 16% in 2017 (current smokers). Daily smoking prevalence is down to about 13% for the general population.

We have hidden the packets, we have taxed the packets, we have standardised the packets, we have printed pictorial health warnings on the packets and we have realigned all the smoking services throughout Aotearoa. These have been some of the recommendations from the MASC that have arguably been hampered by the government of the day choosing not to implement the recommendations as a staged comprehensive suite of strategies simultaneously, as recommended, and instead cherry-picking strategies that are politically palatable and less controversial. However, there has been very little success in supporting Māori women of child-bearing age to stop smoking. Alarmingly high rates of smoking during pregnancy have remained high (37%) and of those who do manage to stop smoking during the pregnancy, a fair percentage return to smoking once they have given birth to their pēpi (32%).

There have been two notable successes recently that I wish to share.

The Counties Manukau Smokefree Pregnancy Incentives Pilot, facilitated by the Counties-Manukau District Health Board, involved incentivising pregnant mothers to stop smoking and rewarding them for their perseverance to break free from an incredibly addictive product that has the massive financial backing of an industry able to employ some of the most scientific minds, the most legally educated brains and the most expert social marketing and promotional intelligence globally. Incentivising people to stop smoking is understandably not politically popular and easily made controversial by opposition parties, so despite consistent and outstanding success rates with women stopping smoking (over 60%), it has thus far not received further support to be implemented nationally.

Another recent success for Māori women specifically has been with an innovative approach called Vape2Save, an initiative by Māori women, for Māori women and their whānau. It has incorporated the use of newer technologies and alternatives but maintained a focus on financial wellbeing, of which stopping smoking tobacco is an integral part. The results for this have been outstanding not just for the individual, but for their whānau, loved ones and their community.

Vape2Save’s results support the notion that Aotearoa must ensure a well informed and intelligent utilisation of safer alternatives including vaping, which are proven to be 95% safer than, and successfully able to shift people away from, smoking combustible tobacco which still kills over 5,000 New Zealanders every year and over 800 Māori. Currently, despite being able to legally be supplied and sold in New Zealand following a court case ruling earlier in March 2018, vaping remains less accessible to the smoking population than a packet of ciggies available at most local dairies. The most harmful product remains the most accessible.

Where to from here? Lowering excise taxes to prevent tobacco-related crime is a double-edged sword.

Tax increases have been a deterrent for young people to not start smoking and it has had a positive impact internationally and for us earlier on. But it was never intended to be implemented on its own, it was proposed as part of the suite of strategies that included increased media spend to take advantage of the dissonance between smokers and their cigarettes as a result of increased price, directing them to cessation support services and also reinvestment into effective services and safer alternatives that treat people with respect and mana. 

Lowering the price again will have a negative impact on smoking prevalence, making it more affordable to mainly young, poor, brown communities. Tobacco pricing is not the sole driver and determinant of crime. We also need reliable crime data from our police who have only recently started collecting data on tobacco-related crime. 

The whole tax and blackmarket argument is perfect for the tobacco industry as it distracts from the fact their legally sold product, which they continue to profit from, kills New Zealanders.

This government has an opportunity to disrupt the normal business practice of tobacco industries by developing a robust, brave and aspirational Government Plan with focused strategies, time-framed goals and measured government accountability that prioritise Māori women, Māori and Pacific people in order to begin to address the existing inequities that by and large people have become desensitised to hearing and reading about.

It has been proven that wahine Māori bear an unequal burden of responsibility for the financial, emotional and day-to-day running of whānau Māori. Anecdotally, cigarette smoking has been referred to as a ‘time-out’, ‘loyal friend’, ‘an escape’ and many other positive associations for Māori women who smoke. Giving those associations up will require more than a medicine and more than a hobby. It also places Māori women as the burden to the health and wellbeing of the whānau. That stigma is wrong, unhelpful and undeserved. More of the burden and responsibility needs to be placed upon the tobacco industry and the government as opposed to the current situation which places all the responsibility on the individual to stop smoking. Especially when you consider the tobacco industry have fared very well since the MASC report, with one group almost tripling their profits in from 2011 ($16 million) to 2017 ($40 million). We need to see a reinvestment of funds to ensure access to effective support services and alternatives that support our people to live their lives smokefree.

Wāhine Māori remain as fundamental to the success of te ao Māori as they have been throughout our history. They have fought fiercely for and lovingly nurtured our whakapapa, our stories, our reo and its many beautiful tikanga for centuries before colonisation and have continued to lead in every resurgence for all te ao Māori since.

Let’s repay the debt.

Boyd Broughton is a health promoter for Action on Smoking and Health (ASH).

 

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