Damien O’Connor: Maori smoking cessation hui Christchurch

E nga iwi, e nga mana, e nga karangatanga maha o te motu Tena koutou, tena koutou, tena koutou katoa.

Acknowlegements:

Good morning, it's great to be here in Christchurch to korero with you and to officially open this hui. I would like to begin by passing on to you the greetings of my colleague the Hon Tariana Turia who regrets that she is unable to be present here today.

For those of you who do not know me, I am a West Coaster, and when I am not in Wellington or Auckland or elsewhere, I live in Westport with my wife and four gorgeous daughters ranging from nine through to four. They help me keep in touch with the health system.

I have been in Parliament for nine years and during the last term I was a member of the Health Select Committee. This gave me a very broad picture of the health sector and many of the problems that need to be addressed. I was appointed as Associate Minister of Health six months ago after the last election along with responsibilities in immigration, racing, agriculture, and rural affairs. Quite an interesting mix!

As well as tobacco control, my responsibilities in health cover policy aspects of harm minimisation from alcohol and problem gambling, environmental health, and rural health. So there are many health issues to deal with.

To adequately minimise the harm from tobacco we need an integrated approach which includes taxation, health promotion, legislation and, of course, cessation.

New Zealand has pursued a range of interventions over the last two decades and as a result has made substantial progress with tobacco control. Nevertheless, there is still much scope for accelerating this progress considering the major burden of tobacco-related disease borne by the population, particularly Maori and low-income New Zealanders.

This is an area where Government agencies and MPs such as myself want to work closer with organizations such as yours, so that we can better respond to meet Maori and whanau needs.

I have a goal of seeing tobacco prevalence decrease from around 25% to 20% over the next few years. This would put New Zealand on a par with the lowest rates of smoking among developed countries. And why shouldn't we be?

Smoking has been a major killer of Maori people for decades.

There have been many warnings about the risks. When the Smoke-free Environments Act was passed in 1990, a courageous Maori woman from Ruatoria, dying of lung cancer, allowed her story to be told in a very memorable television documentary called "July's Legacy". Her name was July Minnell and she died that year. Perhaps part of her legacy was the passing of the Smoke-free Environments Act and a new awareness amongst New Zealanders.

Tobacco control is still a major issue for Maori in this country in terms of health, equity, economic status and cultural identity.

I know there is a new generation of Maori, proud and confident in language and tikanga, generally strongly opposed to smoking and into health and fitness. More marae are going smokefree, and Te Wananga of Raukawa has a smokefree campus.

Sadly, the prevalence of smoking continues to be much higher among Maori than across the wider New Zealand population. While the smoking prevalence declined among Maori adults from 56% in 1981 to 46% in 1996, by 2001 the prevalence rate had risen to 51.2% - this is over double the European rate. It is therefore not surprising that 31% of all Maori deaths are attributable to tobacco use.

This is an issue that needs to be addressed. Maori have benefited from mainstream tobacco control programmes, but generally not to the same extent as non-Maori.

There is room for Government to listen more to Maori advisers and to support the programmes recommended ? not just quit campaigns, but "whanau ora" initiatives as well.

I am not one for throwing money at problems to make them go away but I want to point out that the Government has put considerable resources into Maori smoking programmes in the last few years. But there is always more that can be done with more resources. I will be working with Health Minister Annette King to find ways that we can do that. But I have not come here today to promise largesse. We must ensure that the best use is being made of funding that is already there.

I agree with my colleague Associate Health Minister Tariana Turia, that it is important quit campaigns are integrated with other whanau ora strategies, to promote whanau health and whanau control over their own futures.

(pause)

So let's look at what we have got in place.

Government has moved to put in place all the necessary components of a comprehensive Mäori tobacco control programme. This includes:

· Cessation Over the last five years New Zealand has seen a significant increase in the Maori tobacco control workforce for cessation. I'm thinking specifically of the Aukati Kai Paipa programme. Apart form the acknowledged success in terms of helping people to quit, it has also seen a real opportunity for Maori health providers in terms of workforce development. Several small organisations focusing on Maori health have undertaken capacity building and have grown in expertise as resources have been allocated to this important programme. I want to commend all the providers and participants in the Aukati Kai Paipa programme for your dedication to reducing tobacco smoking in New Zealand. In particular I would like to acknowledge those of you from the seven original pilot sites who have been with the project since 1999. I know that those who have come after you have appreciated your the ongoing commitment, guidance and support.

Funding for the original Aukati Kai Paipa programmes has now been made an ongoing commitment by Government which is very supportive of this programme. As well as this, $5 million annually has been provided for additional Maori smoking cessation services. Many of the programmes funded with this resource have adopted the Aukati Kai Paipa model while some have used more traditional approaches, such as Noho Marae.

· Advocacy Each year this Government spends $515,000 on Maori national advocacy and information, which is almost twice what is spent on the mainstream equivalent. In this regard I would like to acknowledge the work of Shane Bradbrooke and his tenacity in the role he has with Apärangi Tautoko Auahi Kore ? the Mäori Smoke-free Coalition.

· Training Each year, another $425,000 is spent on Maori cessation training and coordination. We are seeing the impact of that work here today.

· Mass Media Campaign The Me Mutu ? "It's about whanau" campaign is continuing to reach Maori people with its message of the importance of quiting smoking.

· Quitline Quitline has Maori as a priority group and uses Maori Quit Advisors.

· Health Promotion The Health Sponsorship Council's Auahi Kore programme is aimed at encouraging Maori, especially young Maori to live a Smoke-free lifestyle. Maori also benefit from local "by Maori for Maori" auahi kore services and from regional health promotion services delivered to Maori communities. Also in the mix are co-ordination services at national and regional levels.

I welcome advice on how these can be integrated and coordinated with other whanau ora initiatives.

Over the next few months, there will be much attention at government levels devoted to legislative aspects of tobacco control. As you may know the amendment to the Smoke-free Environments Act was reported back to Parliament on 18 March. It will now proceed to its second reading in the House as a Members Bill in the name of Steve Chadwick. The Select Committee process has resulted in a number of changes to the Bill that was originally proposed and largely takes a stronger line on tobacco measures. I believe it is a very courageous move and will help New Zealand society step further out of the darkness of nicotine addiction.

Many of you will be familiar with the provisions of the Bill and the Supplementary Order Paper which was referred to the Committee for consideration. The Bill extends protection to workers and the public from the dangers of second-hand smoke. Some of you may have presented submissions to the Committee process.

While there is still a good deal of parliamentary debate yet to occur, it might be useful to highlight the main changes that have been recommended by the Select Committee.

At present, as you will know, only office workplaces are required to be Smoke-free in the current Act. The original Bill expanded this but provided for a number of exceptions.

In its report back, the select committee has taken a much stronger position and recommended an expansion to 100% smoke-free indoor workplaces. If we are looking for progress in New Zealand, this is progress. It is progress that benefits New Zealanders everywhere. That would mean all bars, and restaurants, and also to warehouses, factories, all school premises and grounds, and taxis. We are not talking about half measures here. The only exemptions would be limited to temporary accommodation situations such as private clubs, rest homes, hotel rooms and prison cells.

There would be no provision for separately ventilated smoking rooms for bars etc as was proposed in the bill.

There would also be no provision for smoking in parts of workplaces where all workers agree to smoking. The reason for this is that it was considered that there could be considerable peer pressure for workers to agree to smoking against their real wishes.

Also there would be no exemptions for smoking in work cafeterias and passenger lounges. There would therefore be no need for workplaces to have smoke-free policies since they would be required to be smoke-free anyway. So there will be less paperwork and more fresh air.

Early childhood centres, primary and secondary schools would be required to be totally smoke-free inside and out for 24 hours a day, seven days a week. This would apply to all buildings and grounds. Tertiary educational institutions will be smoke-free in the same way as other workplaces.

The select committee has also recommended individual smoking offences where people smoke in smoke-free areas. An infringement fee regime would be applied to individual smokers smoking in prohibited areas. If we want to better the health of New Zealand people we have got to do the "hard yards". No buts about it. Supply, as well as sale to people under 18 year olds, would be banned and access to vending machines would have to be controlled by bar staff.

Other provisions in the Bill cover limits on tobacco product display, bans on co-packaging of tobacco products with other products, tighter disclosure provisions for harmful constituents of cigarettes, and wider enforcement powers.

I understand the current bill exempts marae from provisions of legislation. No doubt this is because tangata whenua see marae as places where they control what goes on. I fully understand that attitude. It is important Maori be empowered to control their own affairs. I look forward to seeing tangata whenua looking at smoking policies as part of their tikanga.

In conclusion, I want to wish you every success for this hui. I understand that you will be focusing on quality and data collection processes, programme evaluation, relapse prevention planning models and strategic planning for the future of the Aukati Kai Paipa programme. As I mentioned funding for this programme is now ongoing. Reports that I have received indicate that the Aukati Kai Paipa programme is not just a different approach but it is a "best practice" model in smoking cessation. I am aware that there are other models for smoking cessation among Maori. In whatever we do, but particularly in this area where lives are at risk, we must continually strive to do better. So your discussions on programme evaluation during this hui will be important.

I want to assure you that I support the efforts you are making to turn around the high levels on smoking by Maori and particularly by young Maori women who seem to be taking up smoking at much greater rates than in the past. For the new generation of Maori, your work is going to be of critical importance. Programmes like Aukati Kai Paipa are helping reduce the inequalities faced by Maori and to preserve the continuity of the whakapapa. We must better with the resources we have got and, where possible, government will look for funding opportunities to address the serious health consequences of smoking.

I wish you a very successful hui and continuing success in your work around New Zealand. As the media campaign says "It's about whanau".

Thank you for inviting me.

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