Feedback from the Auckland Regional Public Health Service on the Proposal to Introduce Plain Packaging of Tobacco Products in New Zealand

Transcription

1 1 October 2012 Auckland Regional Public Health Service Cornwall Complex Floor 2, Building 15 Greenlane Clinical Centre Private Bag Symonds Street Auckland 1150 New Zealand Telephone: Facsimile: Plain Packaging Consultation Tobacco Control Programme Ministry of Health PO Box 5013 Wellington 6145 Feedback from the Auckland Regional Public Health Service on the Proposal to Introduce Plain Packaging of Tobacco Products in New Zealand Thank you for the opportunity to provide feedback on the Proposal to Introduce Plain Packaging of Tobacco Products in New Zealand The following feedback represents the views of the Auckland Regional Public Health Service (ARPHS) and does not necessarily reflect the views of the three District Health Boards. Please refer to Appendix 1 for more information on ARPHS. ARPHS understands that all submissions will be available under the Official Information Act 1982, unless grounds set out under the Act apply. ARPHS does not have any direct or indirect links to the tobacco industry. The primary contact point for this submission is: Diana Gomez-Camelo Policy Analyst Auckland Regional Public Health Service Private Bag , Symonds Street, Auckland ext dgomez@adhb.govt.nz Yours sincerely Frank Booth Service Manager Andrew Lindsay Medical Officer of Health

2 A. INTRODUCTION ARPHS AND TOBACCO CONTROL ARPHS is funded by the Ministry of Health to undertake a range of tobacco control activities within the Public Health Framework set by the Nationwide Service Specification. ARPHS undertakes a regulatory role to enforce the Smoke-free Environments Act The Director General appoints Enforcement Officers to carry out the duties prescribed in the Act. In the Auckland region these officers are employed by ARPHS. Activities relevant to the enforcement of the Smoke-free Environments Act 1990 comprise: tobacco display compliance checks, controlled purchase operations and investigations of complaints. ARPHS is also heavily involved in face-to-face tobacco retailer education, the delivery of a Pacific quit smoking service, community and workplace smoke-free health promotion programmes. PLAIN PACKAGING AS A TOBACCO CONTROL STRATEGY As one of the 168 signatories to the World Health Organization s Framework Convention on Tobacco Control, New Zealand recognises the need for a comprehensive approach to reduce the harm caused by tobacco. ARPHS commends the Government for considering the introduction of a plain-packaging regime for tobacco products in New Zealand, following on from increased taxation. Plain packaging is one component of comprehensive and complementary measures which have been shown to be effective in reducing the burden of tobacco-related harm. The introduction of plain packaging is an important next step within a much broader strategy encompassing population-specific cessation services, regulation (e.g. increase in tobacco taxes), increased investment in controlled purchase operations and tobacco display compliance checks. As smoking becomes less socially acceptable, prevalence will continue to fall, particularly amongst young people. If New Zealand is going to reach the goal of being smokefree by 2025, tobacco control strategies will need to be strengthened. There are many health benefits to be gained. 2

3 B. CONSULTATION QUESTIONS Question 1. Overall, do you support or oppose the proposal to introduce plain packaging of tobacco products in New Zealand, as outlined in this consultation document? Yes, we support the proposal ARPHS supports Government s commitment to the goal of Smoke-Free New Zealand by The implementation of strategies such as the introduction of plain packaging of tobacco products will be necessary to achieving this goal. ARPHS also commends Government for actively seeking to implement measures included in the World Health Organization Framework Convention on Tobacco Control (FCTC). This strategy relates to articles 11 and 13 of FCTC: packaging and labelling of tobacco products and tobacco advertising, promotion and sponsorship. As a public health organisation with a mandate to protect the health of the people of Auckland, ARPHS considers that protecting the health of New Zealanders should take priority over commercial concerns. Tobacco is a well-known cause of ill health and death amongst those who use the product and those are subjected to second-hand smoke. ARPHS firmly supports the view that the TRIPS Agreement (Trade Related Aspects of Intellectual Property Rights) does not and should not prevent World Trade Organization (WTO) members from taking measures to protect public health. This is in accordance to Article 8 of TRIPS and to the Doha Declaration on the TRIPS. Likewise, ARPHS supports the Punta del Este Declaration 1 that states that parties may adopt measures to protect public health, including regulating the exercise of intellectual property rights in accordance with national public health policies, provided that such measures are consistent with the TRIPS Agreement. In ARPHS view, introducing plain packaging for tobacco products will also work as a strategy to help reduce health inequalities associated with tobacco harm between different population groups (e.g. existing health inequalities between Māori and non- Māori groups). 1 Punta del Este Declaration (2010) Conference of the Parties to the WHO Framework Convention on Tobacco Control. On: 3

4 Question 2. Do you agree that plain packaging of tobacco products has the potential to: reduce the appeal of tobacco products? increase the effectiveness of health warnings on tobacco packaging? reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking? influence the attitudes and behaviours of children and young people? Yes ARPHS considers that major gains to population health can be made by using wellresearched strategies. Based on the existing evidence 2,3 ARPHS does agree that plain packaging of tobacco products has the potential to: Reduce the appeal of packaging or product Increase the salience and effectiveness of health warnings Minimise the perception of product strength and harm A myriad of national and international evidence demonstrating the efficacy of a plainpackaging regime to change people s attitudes towards tobacco and health warnings has been presented and summarised by the Ministry of Health in the proposal and in the Regulatory Impact Statement. The evidence from research is clear that the introduction of plain packaging will help address the impacts of tobacco industry marketing on attractiveness, smokers behaviours, perceived harmfulness of tobacco and perceived impact on health of tobacco. 4 This is further supported by a study published in April 2012 investigating New Zealand youth (14-16 years of age) opinions on the impacts of graphic warning labels on plain cigarette packs. Participants believed that plain packets increased the salience and impact of the warning labels, increased perceptions of the harm caused by smoking, and reduced the social appeal of smoking. 5 2 Moodie C, Stead M, Bauld L, McNeill A (2011) Plain Tobacco Packaging: A Systematic Review. In: Consortium PHR, editor. 3 WHO (2008) Guidelines for implementation of Article 11 of the WHO Framework Convention on Tobacco Control - Packaging and labelling of tobacco products. 4 Moodie C, Stead M, Bauld L, McNeill A (2011) Plain Tobacco Packaging: A Systematic Review. In: Consortium PHR, editor. 5 McCool J, Webb L, Cameron, L.D & Hoek J (2012). Graphic warning labels on plain cigarette packs: Will they make a difference to adolescents? Social Science & Medicine, Volume 74, Issue 8,

5 Question 3. Do you agree that plain packaging of tobacco products would help to: discourage young people from taking up smoking? encourage people to give up smoking? help stop people who have quit smoking from relapse? contribute to a reduction in smoking prevalence in New Zealand and reduce people s exposure to second-hand smoke? Yes Reducing the harm caused by tobacco at a population level requires a complex intervention that is built up from a number of components, which may act both independently and inter-dependently. 6 Plain packaging would be one component of a complex intervention. Although there is not direct link between a plain packaging regime and the reduction in smoking rates, when used in conjunction with other strategies (e.g. increased taxation), plain packaging will help to reduce smoking prevalence by reducing the appeal of tobacco products and thus impacting on the promotion of tobacco products. A plain packaging regime has significant potential to positively influence quit attempts and to reduce initiation of smoking amongst young people who will no longer associate smoking with glamour, wealth, holidays on the beach, and being cool. It is well known that businesses compete to sell their products and that brand promotion is a very effective way for a business to grow overall demand of the product. To promote their products, tobacco companies invest in gathering comprehensive insights into smokers preferences and buying behaviour ( ) then invest in developments across the marketing mix. 7 A cigarette package is unique because the consumer carries it around with him all day...it's a part of a smoker's clothing 8 6 Medical Research Council.(2000) A framework for the development and evaluation of randomised controlled trials for complex interventions to improve health. London: MRC. 7 British American Tobacco website. On: 3mnfen.nsf/vwPagesWebLive/DO78BDW6?opendocument&SKN=1 8 Wakefield M, Morley C, Horan K, Cummings K (2002) The cigarette pack as image: new evidence from tobacco industry documents. Tob Control2002;11:73-80 Issue suppl 1 5

6 Since the promotion of brand through packaging is an essential component of tobacco companies marketing strategies 9, removing brand promotion through standardising packaging, would definitely support the Government s goal of smoke-free New Zealand by Question 4. If New Zealand does go ahead with plain packaging, is there any reason why a significantly different scheme might be necessary or desirable for New Zealand, compared to the scheme that has been introduced in Australia? Yes ARPHS supports the implementation of a standardised approach aligned to the Australian scheme. Such alignment would, primarily, reinforce the international consensus about protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. 10 From a health perspective, this would result in very similar labelling and health warning regulations with the underlying shared aspiration of reducing the harm caused by tobacco. An aligned scheme would also support the unique Closer Economic Relations between New Zealand and Australia. It would demonstrate in practice that the two countries walk a very similar path in pursuit of shared aspirations and that it is only right that politicians on both sides of the Tasman ( ) reflect that reality. 11 An aligned scheme would also lower barriers to agreements such as the Tasman Mutual Recognition Arrangement (TTMRA), hence, the two countries can join forces to leverage these trade agreements for maximum benefit 12. ARPHS supports the Government: Backing Australia 100 percent 13 on its defence of the law change to introduce plain packaging in the WTO and praising the Australian High Court for ruling in favor of this initiative Ibid 10 WHO Framework Convention on Tobacco Control (2003) World Health Organization. On: 11 Address to Australian Parliament (2011) John Key, Primer Minister. On 12 Ibid 6

7 Recognising the need not to create any impediment to Australia's plain packaging law as a result of the TTMRA and the desirability of alignment. 15 Question 5. If adopted, do you think plain packaging of tobacco products might have any unintended or undesirable consequences, such as: unacceptable implications for consumers (eg, limitations on consumer choice)? legal implications (eg, implications for freedom of expression under the Bill of Rights Act)? adverse implications for competition or trade? unduly adverse impacts on tobacco manufacturers and exporters in developing countries? Yes For many years social scientists and economists have identified the importance of the Law of Unintended Consequences 16 of policy interventions. ARPHS recognises that the Law is at work always and everywhere (e.g. limits to consumer choice), however, we consider that the consequences of the proposal are minimal when compared with the profound harm caused by tobacco. Unintended consequences are not necessarily undesirable. For instance, arguments that the proposal limits consumer choice do not recognise the addictiveness of tobacco products (nicotine) and the dependence on smoking. The addictive nature of tobacco products erodes free choice and autonomy of the consumers. That is, in the face of addiction and from a health perspective, reducing the consumer s choice for addictive products is not undesirable given that the habitual use of tobacco is not longer an expression of consumer choice. In relation to other unintended consequences, it is our view that the health and wellbeing of all New Zealanders should be prioritised over commercial interest, here in New Zealand and overseas. 13 Trade Minister Tim Groser. On: News Website. On: 15 Cabinet Social Policy Committee (2011), Office of the Associate Minister of Health (Hon Tariana Turia). 16 Merton R (1936) The Unanticipated Consequences of Purposive Social Action. American Sociological Review Vol. 1,. 6) pp

8 We acknowledge that when it comes to tobacco control, reconciling the state's international public health obligations with those on trade and investment will be as much a political matter as a legal one 17 However, as a public health unit, ARPHS is in alignment with article 5 of the WHO FCTC that states that: in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law 18. The independent report Labelling Logic commissioned by the Australia and New Zealand Food Regulation Ministerial Council developed a hierarchy for policy interventions on food labelling based on the assessment of risk for consumers. In ARPHS view, this model can be applied to tobacco control strategies: The report highlights that when intervening via regulation, Government should take into account that: the greater level of risk to public health the greater the need should be for Government regulation ( ) This approach is consistent with the position of the Taskforce on Industry Self-Regulation that self-regulation should [only] be considered where there is no strong public interest concern, [there are] no major public health and safety concern [and] the problem is a low risk event of low impact/significance. 19 When an issue poses high risks to health and there is strong public concern there is a need for a high level of Government intervention via regulation regardless of the potential unintended consequences there might be to commercial interest. Tobacco companies have emphasised that the current Australian law on plain packaging is a bad piece of law that would have serious unintended consequences. 20 However, the Law itself and the diverse source of unintended consequences are two of the traditional arguments that are used to criticise government programmes. Therefore, ARPHS considers that the introduction of a plain packaging regime aimed to restrict the promotion of tobacco use is an appropriate governmental intervention and that, from a health view point, unintended consequences might not necessarily be undesirable 17 Kelsey J (2012) Trade and investment law issues relating to proposed tobacco control policies to achieve an effectively smokefree New Zealand by Tobacco Control Research Turanga 18 WHO Framework Convention on Tobacco Control (2003) World Health Organization. On: 19 Labelling Logic - The Final Report Of The Review Of Food Labelling Law And Policy (2011) Accessible through: 20 New Zealand s Rhema Website: 8

9 Question 6. Are you concerned that a plain-packaging regime might lead to an increase in illicit tobacco trade and related black market or criminal activity? If so, can you provide any evidence to support your concern? For example: what difference would plain packaging make to the incentives or opportunity for the supply of counterfeit or contraband (ie, smuggled or non-duty paid) cigarettes? do you have any views as to the adequacy of measures contained in the Australian plain-packaging regime to avoid illicit trade? do you have any views as to the role the tobacco supply industry itself should play in preventing illicit tobacco trade? Yes Tobacco companies have traditionally argued that control strategies (e.g. tobacco retail displays 21, increase the excise tax 22 or plain packaging 23 ) may increase the risk of crossborder smuggling or illegal sale of tobacco products in New Zealand. However, New Zealand has one of the lowest estimates of illicit tobacco consumption in the world. 24 It has been estimated that illicit tobacco consumption in New Zealand is around percent. 25 New Zealand s location, population size and limited demand for tobacco, makes cross-border smuggling and illicit trade harder than countries such as the UK, Canada and the US. 26,27 Additionally, Customs has stated that no significant seizures of cigarettes have been made in the past years 28 despite industry assertions that tightening tobacco control, e.g. tax increases, will foster an illicit market. In ARPHS view, the back market argument should not divert the attention from the harm caused by legally available tobacco (over 97 percent of the market). New Zealand has 21 Ministry of Health (2010) Analysis of Submissions on: Proposal to ban tobacco retail displays in New Zealand. Prepared by Quigley and Watts Ltd 22 Illegal tobacco market set to rise. Press release: Imperial Tobacco: 23 One News. Tobacco black market warning over plain packaging Action on Smoking and Health ASH- (2010) Illicit Tobacco Trade: monitoring and mitigation risk in New Zealand. On: 25 Ibid 26 Ibid 27 Wilson n, Paynter J, Thomson G, Blakely, Edwards R (2012) Phasing out tobacco sales via a sinking lid on supply: additional detail to address potential concerns, particularly around illicit activities. Otago University. On: 28 NZ herald. Black market tobacco claim unfounded, says Customs. August 28,

10 relatively high-quality border control operations 29 and in the event of any increase in the black market for tobacco, there are ways to address such concerns effectively Wilson n, Paynter J, Thomson G, Blakely, Edwards R (2012) Phasing out tobacco sales via a sinking lid on supply: additional detail to address potential concerns, particularly around illicit activities. Otago University. On: 30 Ibid. 10

11 APPENDIX 1 - AUCKLAND REGIONAL PUBLIC HEALTH SERVICE Auckland Regional Public Health Service (ARPHS) provides public health services for the three district health boards (DHBs) in the Auckland region (Auckland, Counties Manukau and Waitemata District Health Boards), with the primary governance mechanism for the Service resting with Auckland District Health Board. ARPHS has a statutory obligation under the New Zealand Public Health and Disability Act 2000 to improve, promote and protect the health of people and communities in the Auckland region. The Medical Officer of Health has an enforcement and regulatory role under the Health Act 1956 and other legislative designations to protect the health of the community. ARPHS primary role is to improve population health. It actively seeks to influence any initiatives or proposals that may affect population health in the Auckland region to maximise their positive impact and minimise possible negative effects on population health. The Auckland region faces a number of public health challenges through changing demographics, increasingly diverse communities, increasing incidence of lifestyle-related health conditions such as obesity and type 2 diabetes, outstanding infrastructure needs, the balancing of transport needs, and the reconciliation of urban design and urban intensification issues. 11