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Tobacco Control NEW ZEALAND HEALTH STRATEGY DHB TOOLKIT Tobacco Control To reduce smoking (and harm from second-hand smoke) 2001 Edition 1: October 2001 Contents Executive summary ...........................................................................................................3 Introduction........................................................................................................................4 Development of the toolkit .............................................................................................4 Key documents ..............................................................................................................4 Linkages.........................................................................................................................6 Policy context.....................................................................................................................7 The rationale for tobacco control in New Zealand .........................................................7 Who smokes in New Zealand? ......................................................................................9 Regional prevalence data ..............................................................................................9 Tobacco control efforts in New Zealand ......................................................................13 Roles and responsibilities for tobacco control .................................................................14 The Ministry of Health..................................................................................................14 District Health Boards ..................................................................................................14 Other providers ............................................................................................................14 Best evidence on interventions........................................................................................16 Effective interventions across the whole population....................................................16 Interventions for Maori .................................................................................................16 Interventions for Pacific peoples..................................................................................17 Interventions for low-income New Zealanders.............................................................17 Interventions for older people ......................................................................................17 Interventions for people with existing chronic illness...................................................17 Interventions for young people ....................................................................................18 Recommended key interventions ................................................................................18 Research strategy............................................................................................................19 Appendix 1: Recommended key interventions: tobacco control.....................................20 Appendix 2: Draft indicators for District Health Boards and other regional providers ....25 Data and information requirements .............................................................................26 Appendix 3: Tobacco-related websites...........................................................................27 New Zealand................................................................................................................27 Australia .......................................................................................................................27 International .................................................................................................................27 Endnotes..........................................................................................................................29 New Zealand Health Strategy • DHB Toolkit: Tobacco Control • Edition 1 2 Executive summary This toolkit is designed to assist District Health Boards (DHBs) to implement the New Zealand Health Strategy priority population health objective of: ‘reducing smoking (and the harm from second-hand smoke)’. This is one of 13 priority areas identified in the New Zealand Health Strategy. The toolkit’s development has been led by the Public Health Directorate of the Ministry of Health, with expert advice from an advisory group of tobacco control experts drawn from the wider health sector. This toolkit has linkages to toolkits in several other priority areas of the New Zealand Health Strategy. Tobacco policy operates within a context of significant tobacco-related death and illness, associated costs to the public health services and to the wider costs to society, and an emphasis on Maori health and wellbeing. Approximately 4,700 New Zealand smokers die from smoking- related illnesses each year. It is estimated that a further 400 people die each year from exposure to second-hand smoke. Those smokers who die from a tobacco-related cause lose, on average, 14 years of life compared with non-smokers. New Zealand’s tobacco control strategy has seen tobacco consumption fall by almost 50 percent from 1990 to 2000. However, the percentage of people smoking, although continuing a downward trend, fell by only about 2–3 percent over that period. The section on Policy Context covers these issues. The challenge is to reduce smoking prevalence by assisting those who wish to quit smoking and, better still, discouraging people from taking up the habit in the first place. The benefits of quitting are considerable in terms of both people’s health and quality of life and the cost savings to the health services and society. For example, within two years of quitting, a former smoker’s risk of heart disease or stroke is similar to that of a non-smoker. The New Zealand Health Strategy emphasises the need for health policy to reduce inequalities for those population groups with the poorest health status, and particularly Maori and Pacific peoples. The section entitled Best Evidence on Intervention points to those interventions for the prevention and cessation of smoking for which strong evidence is available. Research also indicates benefits are forthcoming from interventions that target or adapt services to specific population groups. This section also identifies recommended key interventions, a subject Appendix 1 develops in more detail. In some areas, more research is required to develop a greater understanding of effective interventions and this issue is discussed under the section on Research Strategy. Appendix 3 points to useful tobacco control websites and the Endnotes to the toolkit include references noted in the toolkit text and in the interventions template. Key reference documents, upon which the toolkit relies heavily, are identified at the front of the toolkit. New Zealand Health Strategy • DHB Toolkit: Tobacco Control • Edition 1 3 Introduction Objective: To reduce smoking (and harm from second-hand smoke) The New Zealand Health Strategy has identified 13 priority areas for population health. District Health Boards (DHBs) will be required to report annually on progress towards each of these priority areas. The Minister of Health will then report to Parliament on overall progress in these areas (New Zealand Public Health and Disability Act 2000, section 8(4)). This toolkit addresses the priority of reducing smoking and harm from second-hand smoke. This toolkit: • outlines the burden to health and society resulting from active tobacco use and people’s exposure to second-hand smoke • provides evidence on the best ways to achieve health gain for tobacco users and those exposed to second-hand smoke • identifies priorities for further research on tobacco control • proposes indicators so that progress towards identified targets can be monitored • provides baseline data for indicators. Development of the toolkit This toolkit was developed by the Ministry of Health Public Health Directorate (National Drug Policy Team), in conjunction with an expert advisory group of tobacco control experts from the wider health sector. It was developed with reference to a considerable amount of research on tobacco control issues. Given that Ministry of Health personnel have regular contact with a broad range of tobacco control agencies in New Zealand and internationally (eg, the World Health Organization), this toolkit includes elements of international best practice. This document is, however, still a preliminary toolkit. A more comprehensive version will be available in future years on the Ministry of Health website. This toolkit should be read in conjunction with the Public Health Services Handbook,1 which sets out the tobacco control services that public health services are to provide. Key documents In particular, the toolkit relies heavily on the following documents: WHO-WPRO. 1999. Regional Action Plan on Tobacco or Health 2000–2004. Manila: World Health Organization (Western Pacific Regional Office). Ministry of Health. 1998. National Drug Policy Part 1: Tobacco and Other Drugs Part 2: Illicit and Other Drugs. 1998. Wellington: Ministry of Health. [Online] available at http://www.ndp.govt.nz/policy/ndppolicy.html) Health Funding Authority & Ministry of Health. 2000. Public Health Services Handbook 2000–2001. Wellington: Health Funding Authority and Ministry of Health. Health Funding Authority. 1999. Toward a Tobacco-Free New Zealand: A Five-Year Plan for HFA Funding for
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