Figure 1. Annual cigarette deaths, New
Zealand, 1955-2000
Source:
Peto et al. Mortality
from smoking in developed countries 1950-2000. www.ctsu.ox.ac.uk
The necessary
legislation to control this epidemic is likely to require two bills five to
ten years apart.
A first-stage Choices bill which provides
increased freedom of choice for smokers wishing to quit
A second Phase-out bill, some five to ten
years later, which finally enacts a ban on cigarette sales, and thus put
cigarettes out of the reach of children.
Suggested Target dates (See
Figure 2)
|
Consultation and recruitment of support for the concept among
doctors and health professionals
|
2006
|
|
Adoption of the Smokers
Choices Bill as a private members’ bill:
|
2007
|
|
Enactment of the Smokers Choices Bill
|
2008
|
|
Enactment of the Cigarette Phase out Bill
|
2015
|
|
Implementation of the Cigarette Phase out Bill, ending the sale
of cigarettes and smoking tobacco
|
2016
|
·
Bills in
parliament set the agenda for public debate. Laws shape society, and
educate the public along the way.
·
Historically,
the purpose of public health law in New Zealand is to control epidemics. The Smokefree Environments Act 1990 however, restricted
tobacco advertising and smoking, but was not designed to end the tobacco
mortality epidemic.
·
The
Smoke-free Environments Act 1990 now needs to be rewritten to make it
strong enough to control the current tobacco mortality epidemic, without
interfering with smokers’ desire to stay addicted to smokeless
nicotine. As smoking declines, the lethal trade in cigarettes can be phased
out.
The Smokers Choices Bill www.smokeless.org.nz/choicesbill.htm
would
include:
·
Strengthening
of the purpose of the Smoke-free Environments Act
·
Partial
reduction of the nicotine content of cigarettes
·
Lifting
of the ban on the sale of less harmful smokeless oral tobacco products
Phasing-out of
Cigarettes Bill www.smokeless.org.nz/phaseoutbill.htm
The Choices Bill will increase the pace of quitting, and smoking
prevalence will decrease more rapidly. When smoking prevalence has fallen
substantially, it will be time to phase out cigarette sales. As with the smokefree bars bill, cigarette sales could be timed to end a year after
the bill’s enactment.
_______________________________________________________________
Figure 2. The interaction of
legislation and smoking prevalence reduction 2006-2021
|
|
From 2006 to say 2008 when the Smokers Choices Bill became law,
the expected reduction in adults smoking prevalence is 0.3% per year.
Once the Bill makes quitting easier, a reduction of 1.2 %
points per year is expected, resulting in smoking prevalence of 10%
within 10 years, at which point the Cigarette Phase Out Bill should be
enacted, with effect say one to five years later.
|
Rationale for the Bill as a
whole
Various approaches need to be
used simultaneously:
A. The public-health-law
approach– ‘Control the cigarette smoking mortality
epidemic’.
Since 1990, government policy, government publicity, and law
changes have been the main driver lowering smoking, and latterly, in
reducing second hand smoking. But the smoking death toll has only decreased
slightly. (Figure. 1)
·
Further law changes can once again be the driver to lower smoking, a focus for
strengthening the government’s comprehensive programme to control the
cigarette smoking mortality epidemic.
B ‘Treat the
Addiction’ approaches.
B. 1. Replacement of smoke
nicotine with clean nicotine. Improving
the supply of pure nicotine to smokers
·
Nicotine
gum and later patches sold through pharmacies (from 1985).
·
Lowering
the price by subsidising nicotine patches and gum
(from 2000 through the Quit Group)
·
Nicotine
patches and gum widely available (on general sale through supermarkets)
·
Using
nicotine patch and gum simultaneously to give a higher dose of nicotine.
(gaining acceptance since 2005)
B. 2. Reduce the reliance on smoke
nicotine by limiting nicotine content in all cigarettes sold
·
Further law changes can make it easier for
smokers to quit by lowering the nicotine content of cigarettes.
C. Enlisting cigarette retailers
to switch their customers to less dangerous forms of tobacco or nicotine
·
The excise rate levied on tobacco products
should be proportionate to the death risk of each class of product. This
will decrease the relative price of less dangerous smokeless tobacco.
The tobacco deaths epidemic is a
problem too big for the health system alone to fix.
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