Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill

Transcription

1 Wednesday, 16 April 2014, 10.20am Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Oral Submission to the Health Select Committee Tēnā koutou kātoa. My name is Sonya Rimene. I am General Manager, Māori Health at the Royal New Zealand Plunket Society. Plunket speaks in support of this bill s intention to legislate for tobacco to be plain packaged with bold health warnings. I would like to introduce the team: 1. Elaine Gordon, one of Plunket s clinical advisors. Elaine will speak about what Plunket nurses do in this public health area, and the risks of smoke exposure to children s health, as well as highlighting concerning Plunket statistics that show which groups of children are most likely to be exposed to these serious health risks. 2. Clair Trainor, policy analyst, will speak about children s exposure to cigarette advertising in the home, particularly at a stage in their lives when they are highly sensitive to symbols and branding, timing of the Bill s commencement and small quantities of tobacco being directly regulated in the primary legislation. 3. Falenaoti Mokalagi Tamapeau, Plunket s Pacific Services Development Manager, will speak about some experiences of Pacific children and their families. 4. And I will conclude by speaking about the public health opportunity this bill presents and the need for urgent action. Elaine Gordon: I will explain a little about Plunket s work to support smoking cessation, Children s health risks and Plunket statistics. Plunket supports the Government goal of a Smokefree Aotearoa by 2025 and supports all initiatives needed to achieve this. Oral Submission: Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Page 1

2 Plunket completes over 620,000 contacts with parents and whanau annually through a combination of home visits (48%), clinic visits (38%), mobile clinics, and family centres and is regularly in the homes of our children and families. All Plunket Nurses are educated and trained to deliver timely cessation support (ABC) at all client contacts, and also Nicotine Replacement Therapy as indicated. Plunket has developed strong collaborative relationships with cessation services such as Quitline (Txt2Quit referral), and local Aukati Kai Paipa a kanohi ki te kanohi (face to face cessation services) both of which Plunket people refer to regularly. A significant body of reputable research informs Plunket that children who are raised and grow up living and breathing in a smokefree home and environment have a healthier and a better future. Ministry of Health data estimates that thousands of New Zealanders die every year from the effects of smoking, including hundreds of deaths from exposure to second hand smoke. Exposure to second hand smoke, in utero and after birth is a known risk factor for Sudden Unexpected Death in an infant. (SUDI). Exposure to second hand smoke also results in high rates of infection and hospital admission for the under two s with bronchiolitis and pneumonia and long terms health problems associated with recurrent respiratory infection. Exposure to second hand smoke exacerbates asthma and respiratory problems such as coughing and wheezing that require frequent visits to the GP. Exposure to second hand smoke also increases the risk of developing glue ear that requires treatment and often surgery to resolve. Exposure to second hand smoke also increases a risk of developing meningococcal disease. All of these illnesses result in an increasing amount of time out of early childhood education; this also requires parents to take time out of work, further burdening these families and their communities. Children are vulnerable to all forms of tobacco exposure, second/third hand and brand exposure, as my colleague will refer to. Plunket data informs us that Māori and Pacific children living in high levels of deprivation or need are up to 3-4 times more likely to have one or more smokers living in the household than those in the middle and low deprivation bands. Plunket data reveals that in the homes of 0-5 year olds, over the past 12 months, in Counties Manakau: 63% of all smokers are Maori, 16% Others: Gisborne 59% Māori - 18% Other: Hawkes Bay 60% Māori - 22% Other: Wairarapa 40% Māori - 10% Other: Auckland City 40% Māori - 8% Other. Cigarette and tobacco packages are present in the homes of these children; they are regularly exposed to them. Oral Submission: Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Page 2

3 Plunket supports the introduction of plain packaging as simply common sense. Plunket acknowledges that there is not any one policy that will reduce smoking but rather a raft of measures of which plain packaging is one. Clair Trainor: I will speak about children and tobacco advertising in the home, timing the Bill s commencement and regulating small quantities of tobacco. Today, the majority of New Zealand children have almost no exposure to tobacco advertising. Yet thousands of New Zealand children are not so fortunate. As a State Party to the United Nations Convention on the Rights of the Child, the New Zealand government has undertaken to ensure that children s best interests are paramount when legislative decisions are made. 1 In addition Article 36 of the Convention requires State Parties to protect the child against all forms of exploitation prejudicial to any aspects of the child's welfare. In our view, advertising tobacco via packages in homes exploits children, who are sensitive to brand status, symbols and imagery, and particularly vulnerable to messages about social norms. This Bill represents an opportunity to put children first by enacting a law that contributes to the health of future generations. The General Social Survey 2 considered risk factors in households with children. In , 21% of children from this survey lived in a household with a current cigarette smoker. This was the most common risk factor (of all the factors that could adversely affect children's health and wellbeing). These children are subjected to second-hand smoke, to subliminal messages that smoking increases a person s social capital, and readily available cigarettes. These factors create a public health risk for those children, who, should they become smokers, can expect a reduced quality of life. Successful smoking cessation mitigates the risks to children s health. There is evidence that plain packaging supports decisions to quit smoking. 3 Whenever an adult in a household with children quits, those children stand to make health gains, both immediately and into the future, through reduced risk of starting to smoke. 1 Article 3, United Nations Convention on the Rights of the Child (ratified by New Zealand in 1993). 2 General Social Survey (retrieved 24 March 2014). 3 Plain Packaging of tobacco products: A Review of the Evidence, May 2011, Cancer Council Australia ReEnd_FINAL_May27.pdf (retrieved 26 March 2014). The paper covers two decades of research across five countries, in addition to results of 24 published experimental studies examining the likely impact of plain packaging on young people and current smokers. Summaries of research into industry views on the impact of international law and trade agreements on domestic smoke-free legislation are also presented. Oral Submission: Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Page 3

4 An article published in the British Medical Journal in reported on research that found removing brand imagery and increasing graphic health warning size had a significant effect on the attractiveness of cigarette packaging to young adult smokers and increased the likelihood that they would attempt to cease smoking. As smokers will know, cessation is invariably a process, rather than a discrete event. I have two other matters to speak to before handing over to my colleague, Moka. First, Plunket believes the introduction of plain packaging has sufficient public health importance for the Committee to recommend reducing the period before commencement from 18 months to 12. In our submission, the sooner the new legislation is in force, the sooner we all begin to reap the ongoing rewards for individuals and the health budget. The strongest reason for proceeding expeditiously is that waiting has public health implications, particularly for vulnerable children, as evidenced in the General Social Survey referred to above. Second, Plunket is opposed to Clause 9 of the Bill. This clause repeals Section 30A (Restrictions on sale of certain tobacco products in small quantities) of the primary Act. The rationale for repeal expressed in the Bill s explanatory note is that quantities may be addressed in regulations. Plunket s concern is that sales in small quantities present a particular risk to children. Older siblings wishing to experiment with smoking are inclined to be attracted to small quantities of tobacco because they have little money and it is unobtrusive. Older siblings behaviour is even more likely to influence young children than that of their parents. Plunket urges the Committee to recommend that existing section 30A be retained - or amended if not fit for purpose in its current form - thus ensuring tobacco quantities are subject to primary legislative oversight. I will now hand over to my colleague Mokalagi Mokalagi Tamapeau: I will provide a snapshot of the experience of Pacific children and their families. The tobacco burden for Pacific peoples in New Zealand is huge. As Tolotea Lanumata and George Thomson said in the New Zealand Medical Journal, it is a case of unequal risks and unmet needs. Talofa Lava, Fakaalofa lahi atu, Kia Orana, Ni sa Bula Vinaka, Taloha ni, Malo e lelei, Talofa. I greet you in the 7 languages of the Pacific represented within Aotearoa, and also acknowledge that there are many more Pacific nations who are also present in Aotearoa. Malo le soifua. Mum why do you smoke when it s not good for you? This was the voice of my 5 year old son Lenuasi, to which I responded by your next birthday baby I will stop. It was the only promise I made to any of my 3 children that I did not keep. For the next three of Lenuasi birthdays I remained a liar. 4 Hoek J, Wong C, Gendall P, Louviere J and Cong K. Effects of dissuasive packaging on young adult smokers. Tobacco Control Downloaded from tobaccocontrol.bmj.com on March 25, Published by group.bmj.com Oral Submission: Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Page 4

5 Pacific People spend $72million dollars each year on tobacco products. The only people that benefit are those who make money from tobacco products. Tobacco-related diseases such as heart disease, lung cancer and stroke are some of the largest killers of Pacific People in NZ One in four Pacific People in New Zealand smoke tobacco which is approximately 80,000. We enjoy, as Pacific, high rates of fertility, and bear approximately three children per child bearing woman as at the 2006 census. Approximately 25% of Pacific women smoke during pregnancy. Pacific children access to healthy air is compromised from the earliest stages of their development, and is perpetuated for many of them throughout their childhoods, and for many into their adult lives. We know in the earlier statistics given by Elaine that Pacific and Māori children are most likely to be in households where smokers are present, and a most likely to be residing in areas of highest need. Smoking tobacco, and exposure to second hand, and third hand smoke are well researched, and proof of its deadly impacts irrefutable. We have no choice except to accept that Smokefree Aotearoa is the only way forward for Pacific Peoples, children, and communities 5. Plunket supports the introduction of plain packaging as simple common sense. Plunket acknowledges that there is not any one policy that will reduce smoking but rather a raft of measures of which plain packaging is one. Sonya Rimene: I will now summarize our submission with a focus on the public health opportunity this bill presents and the need for urgent action. Our organisational vision of Together, the best start for every child Mā te mahi ngātahi, e puāwai ai ā tātou tamariki is best met by policies and legislation that put children first and take immediate and long-term benefits for children and therefore society into account. As you are aware, internationally, smoking remains the largest cause of preventable death; it also contributes to profound health and social inequalities in outcomes for Maori and Pasifika peoples. There is no other consumer product that is so widely used and directly poses such a high level of health risk to users, particularly long-term users. 5 accessed 15/4 Pacific Child Health Tolotea Lanumata, George Thomson The NZ Medical Journal Journal of the NZ Medical Association Unequal risks, unmet needs: the tobacco burden for Pacific peoples in New Zealand URL: accessed 15/4] Oral Submission: Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Page 5

6 You have heard from Elaine Gordon on children s health, Plunket s work and our statistics, from Clair Trainor on the impact of advertising and its exploitative effect on children and from Moka Tamapeau on Pacific children s exposure to smoking. The introduction of plain packaging is an investment that this Bill can contribute towards the health of New Zealand children, primarily those children who have other vulnerabilities to deal with (such as income poverty). Plain packaging will support and potentially increase the numbers of parents and caregivers who do not allow smoking in their car at any time, or in their houses, fully cognisant of the threat posed to children. It will contribute to protecting and investing in children and future generations in Aotearoa by giving them a reason not to start. This is truly a case of prevention being better than cure. This Bill demonstrates New Zealand s commitment to investing in children s health; particularly in children most likely to have smokers in their households. Nō reira, kati. That concludes our submission. We urge the Committee to recommend this Bill be enacted with the amendments proposed. Tēna koutou kātoa. Oral Submission: Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill Page 6