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Progress to Smokefree 2025HEATHER GIFFORD AND ZOE HAWKE
THE 19TH PUBLIC HEALTH SUMMER SCHOOL 2-20 FEBRUARY 2015
Daily Smokers – Maori aged 15+
2006 2007 2008 2009 2010 2011 2012 2013 20145
10
15
20
25
30
35
40
45
CensusNZHS (U)HLS
1
Regular Smoking by ethnicity, 14-15 year olds (daily, weekly or
monthly)
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
5
10
15
20
25
30
35
40
45
50
NZ EuroMaoriPacificAsian
2
Key messages
Gradient for all Māori smoking is in the right direction but its slow
Significant drop in Māori youth smoking but do we understand why
Disparities remain when compared with others Discrepancy in the data depending on what
you look at eg Census vs NZ Health Lifestyle Survey – what figure do we use to convey the public message ?
Projections from modelling suggest that with BAU Māori smoking rates in 2025 will still be almost 20%
3
Challenges
Tupeka Kore Māori kaupapa arising out of Māori Affairs Select Committee Report
Since then loss of multiple Māori leadership Confusion over the strategy for really
achieving 2025 Māori smoking implicated in broader social
and economic reality for many whānau making it even more challenging
Competing priorities for Māori Not enough resource or political will to turn
the goal into a reality
4
What’s the goal?
Abstinence or harm minimization? Not really that clear:
“…reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smoke-free nation by 2025.” (Govt response to Māori Select Committee report)
5
Options we are thinking about
Traditional’ abstinence framework
No ‘safe’ level of tobacco use, No alternatives?
Aligned to Māori aspirations; Addiction not part of culture
• Harm minimisation (of nicotine use)
New technologies possible to actually minimize harm
7
8Options How do we achieve the goal?
First we need to build political support Demand reduction, supply reduction,
or both? At present operating BAU
More demand than supply reduction Strong focus on cessation This will NOT get us to 2025,
particularly for Māori
9TAHO STRATEGY
Te K
aw
a -
Key I
nfl
uen
cers
th
at
help
ed
us a
ch
ieve
the g
oalMāori leadership has engaged
communities on tobacco control strategiesClear, simple kaupapa, focused and strength - based messaging has helped to get communities on boardThere is a united vision across organisations and communities based on tikanga & tobacco not being part of who we are
Leg
isla
tion
& R
eg
ula
tion
, C
essati
on
, P
ub
lic S
up
port Government is fully committed
to 2025Government supports no commercial tobacco salesMāori leaders have influenced the supply of tobacco and are celebrating changeIndigenous cessation models/research have been promoted and are well knownWhānau are quitting through public support gainedThere is an overwhelming appetite for changeThe Māori workforce is unitedWhole communities are selling our message; everyone believes in the story of a smoke free AotearoaSmoking is in our past
2020 GOAL / VISIONWHĀNAU ARE SMOKE FREE | TOBACCO IS NOT OUR TIKANGA
10HOW WE GET TO 2020PATHWAY TO 2020 GOAL/VISION
Putting path finding
policies into place
Communicating with
and mobilising
communities
Collective community
action
2020 Goal/VisionWhānau are smoke free
Tobacco is not our tikanga
Work Streams
11Lows Year One The urgency of the task, wanting to do so much more
but with very limited resources The reality that those with the resources don’t always
understand the complexities of Māori realities and the need for stepping out of the BAU model.
Ideas about Māori leadership being a single person/group model – a contradiction to Māori models of leadership & wellbeing.
Being the constant squeeky wheel challenging the BAU can be wairua draining.
Lack Of Māori champions/ political champions Lack of unity, competitive theme, tension BAU v’s BNU Political neutrality clauses
12Highs Year One
Advisory Board support Having a clear TAHO strategy that really is all
about building political support through Māori community action
Organisations serious about reducing inequalities Having some of the squeeky wheel kōrero
seeping into the sector. A shift in practice. A decrease in Māori smoking rates Relationships with other Māori in the sector National Māori smokefree working group Growing unity Growing Māori community voices
13What we need going forward
Political support built from the ground up Māori need to be part of the process
Local community action – national focus Supporting and building leadership
Urgent need for action Innovative ideas Research keeping pace
Agree on overarching goal and strategy Best allocation of resources Depends on working together