Submission on behalf of: Cancer Society of New Zealand. Claire Austin Chief Executive. Contact person Shayne Nahu Health Promotion and Campaigns Manager PO Box 12700, Thorndon, Wellington, 6144 Email: shayne@cancer.org.nz Phone (day): (04) 494 7192 For the attention of Committee Secretariat Finance and Expenditure Select Committee Parliament Buildings Date of submission: 29 th January 2016
Introduction to Cancer Society of New Zealand The Cancer Society of New Zealand (CSNZ) is a non-profit organisation which is committed to helping reduce the incidence and impact of cancer on the community. Cancer affects many of us and is a major cause of disease, disability and death in New Zealand, with 21,814 new registrations and 8,905 deaths in 2012 (1). To lessen this impact, we work to reduce the number of people who die from cancer and improve the quality of life of those who are diagnosed. The Cancer Society: provides supportive care and information to people affected by cancer, their families/whanau and carers encourages, organises, supports and funds research within New Zealand into the prevention, treatment and cure of cancer delivers health promotion programmes focusing on cancer prevention leads advocacy across the cancer continuum promotes education about cancer for health professionals and publicises progress made in research and treatment. works collaboratively with other organisations who share similar goals to the Cancer Society. At a local level, Cancer Society staff also participate in Regional Cancer Networks, which were set up by the Ministry of Health in 2008. These networks have District Health Boards (DHB s), Primary Care, Non-Government Organisations (NGO s) and Consumer representatives. Purpose of submission The Cancer Society of New Zealand strongly recommends the continuation of a New Zealand tobacco tax increase schedule, at a minimum of 20% from 2017 and beyond. To address the preliminary questions, we do not have any direct or indirect links to the tobacco industry, and we give our permission for our details to be released under the Official Information Act 1982. We welcome the opportunity to give an oral submission to the Committee. 1 (MoH, 2015) 2
Background The Cancer Society s vision is to be the leading organisation dedicated to reducing the incidence of cancer and ensuring the best cancer care for everyone in New Zealand. The first goal of the New Zealand Cancer Control Strategy is to reduce the incidence of cancer. As almost all incidence of lung cancer is attributable to smoking, CSNZ strongly supports evidence-based approaches to reducing smoking incidence and prevalence. Lung cancer is the leading cause of New Zealand cancer-related deaths. Smoking is the leading cause of lung cancer, which accounts for 18.9 per cent of all New Zealand cancer deaths. Between 2009-2011, there were 4925 lung cancer deaths 2, and between 2012-2014 there were 6223 new lung cancer registrations 3. A 2014 World Health Organisation (WHO) report has shown that tobacco tax increases are the most effective tobacco control option in all regions of the world 4. They are a prevention measure to: Support current smokers to quit Reduce youth uptake of smoking To be effective for those at most risk and with greatest need Current situation: Smoking remains a significant threat to our public health. Smoking tobacco is addictive, causes disease and is lethal to half of its long-term users 5. Smoking tobacco deprives 4,500-5,000 New Zealanders of life every year 6 through smoking related causes. Smoking prevalence continues to be higher in Māori, Pacific and low income groups and these groups also bear a disproportional share of the impact that smoking has on their health, compounding health inequalities 7. 2 (MoH, 2014), 3 (MoH, 2015) 4 (Shibuya, 2003) 5 (Wald, 1996) 6 (Petro, 1996) 7 (WHO, 2014) 3
Reducing smoking prevalence in high risk groups through a variety of measures will contribute towards reducing inequalities in health. Young Māori are initiating smoking at an average age of 11.5 years old, with non- Māori initiating at 12.7 years of age 8. Smoking is the number one preventable cause of cancer, causing almost all cases of lung cancer. Smoking also increases cancers of the upper airways, stomach, mouth, tongue, liver, cervix and bladder 9. There has been a 23% reduction in tobacco consumption per adult 10 in New Zealand since the series of tobacco tax increases between 2010 and 2014. During this time, smoking rates also declined for all major population groups 11. One of the most effective measures to decrease consumption of tobacco is to increase the price 12. In a New Zealand survey, undertaken by the University of Otago as part of the International Tobacco Control Policy Evaluation Survey, 59% of 1376 smokers surveyed supported tobacco tax increases, if the extra revenue generated was used to promote healthy lifestyles and support quitting 13. The recent policy for annual increases in tobacco tax excise was one measure introduced in 2010 in response to the Māori Select Committee s Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori. The New Zealand Government also set a goal of a Smokefree Aotearoa by 2025. In the 2012 Budget, the Government announced that a tobacco excise rise schedule would be part of their wider programme. The schedule called for a 10% tobacco tax increase every year on 1 st January for the years 2013-2016. The rationale was that increased tobacco prices prevented young people taking up smoking, and encouraged current smokers to quit. The aim was to improve the health of New Zealanders, reduce the long term burden on the health system of smokers and contribute to their goal of a Smokefree Aotearoa by 2025. The last scheduled 10% increase occurred on 1 st January 2016. However, there has been no continuing commitment to maintaining the tobacco tax increase in the Budget Policy Statement 2016, despite the compelling reasons for continuing tobacco tax increases. The Cancer Society recommends a continued schedule of tax increases, at a rate of at least 20%. 8 (MoH, 2013) 9 (Sarfati, 2015) 10 (Laugesen, 2015) 11 (Statistics, 2013) 12 (WHO, 2008) 13 (Wilson N, 2010) 4
NZ research indicates that increased tobacco prices: Create large health gains 6 incentivise smokers to quit reduce youth uptake of smoking, who are more affected by price than adults 7 contribute to reducing health inequities 6 increase health cost savings 14, ($3.8 billion over the lifetime of current NZ population). It should be noted that in order to achieve the best possible health outcomes, tobacco tax increases should also be a part of a comprehensive range of tobacco control strategies that includes plain (standardised) packaging, and strong, easily accessible smoking cessation programmes 15. We note plain packaging legislation is currently before Parliament and the Ministry of Health is undertaking a realignment of cessation services to specifically address the need for a strong cessation sector. Benefits of a continuation to the tobacco tax schedule The World Bank and the World Health Organization Framework Convention on Tobacco Control both prioritise price increases as a key measure to decrease tobacco use. In a 2013 Lancet case study, tobacco control interventions were considered to be a particular priority, given that these can be pro-equity and generally appear to be cost effective 12. Reducing initiation in youth In a systematic review in 2014 of the Equity impact of interventions and policies to reduce smoking in youth by Brown et al, tobacco tax increases were considered to have a positive effect on reducing smoking uptake and therefore prevalence in youth, 14 (Blakely, 2015) 15 (WorldBank, 2011) 5
and tobacco price increases will reduce this group s consumption even further 16. Data from the annual ASH Year 10 Snapshot of 30,000 youth demonstrates the impact of tax increases with the continuing drop in smoking prevalence among 14-15 year olds to record low levels 17. As stated above, tobacco taxation increases are an important measure for reducing tobacco consumption, and there continues to be very strong scientific evidence that they reduce smoking, and smoking uptake by young people 18. Effective for those at most risk and with greatest need- Although these proposed increases could pose a risk of some increased financial hardship for very low-income smokers who do not quit after a tax increase, the harm from continued smoking is far greater than the possible harm from increased tobacco taxation. For those who do not quit, this hardship can be reduced by cutting down daily consumption and co-use of low-cost nicotine replacement therapy patches and gum (to reduce smoking). Other adverse impacts can be minimised through comprehensive targeted cessation support. 19 Research shows that tobacco tax increases impose a greater burden, relative to resources, on the poor than on the rich. They can actually result in greater health gains of lowincome populations due to greater price sensitivity 16. There are a number of reasons for this: the health benefits provided by increased tobacco taxes are greater for those in low socioeconomic groups within low socioeconomic groups, tobacco use is more responsive to price low income households bear a lower share of the tobacco tax increase, high income households pay more 16 (Brown T, 2014) 17 (ASH, 2014) 18 (Chaloupka, 2002) 6
positive net financial impact for low income households can be achieved when taxes are used to support programmes targeting the poor Recommendations The Cancer Society of New Zealand fully endorses the first goal of the New Zealand Cancer Control Strategy - to reduce the incidence of cancer through primary prevention. We also fully endorse the Government s goal to achieve a Smokefree New Zealand by 2025. Summary of Recommendation: The Cancer Society strongly recommends the continuation of tobacco tax increases at a minimum of 20% per annum from 2017, and beyond. This submission was prepared by analysing and considering the latest national and international research information. The Cancer Society consists of six divisions around the country, 16 centres as well as a national office based in Wellington. In the formation of this submission, consultation with our six divisional offices as well as within our national office took place, with comment and feedback sought from our staff. 7
References: ASH. (2014). Year 10 Snapshot Survey. Retrieved from ASH.org.nz: http://www.ash.org.nz/wp-content/uploads/2015/03/f1-general-topline.pdf Blakely, T. e. (2015). Health, health inequality, and cost impacts of annual increases in tobacco tax: Multistate life table modeling in New Zealand. PLoS Med, 12(7). Brown T, P. S. (2014). Equity impact of interventions and policies to reduce smoking in youth: systematic review. Tob Control 2014. Chaloupka, F. (2014). The Economics of Tobacco Control Lessons Learned from International Experiences. Romania: University of Illinois. Chaloupka, F. C. (2002). Tax, price and cigarette smoking: ecidence from the tobacco documents and implications for tobacco company marketing strategies. Tob Control. Cobiac LJ, I. T. (2015). Modelling the implications of regular increases in tobacco taxation in the tobacco endgame. Tob Control, 154-160. Laugesen, M. (2015). Analysis of Manufacturers Returns on Tobacco. Report to the Ministry of Health for 2014. NZ Ministry of Health. Retrieved from https://www.health.govt.nz/system/files/documents/pages/tobacco-returns- 2014-analysis-report.pdf. MoH. (2013). Māori smoking and tobacco use 2011.. Wellington: MoH. MoH. (2014). Cancer: New registrations and Deaths 2011. Wellington: Ministry Of Health. MoH. (2015). Annual Update of Key Results 12014/15: New Zealand Health Survey. Wellington: Ministry of Health. MoH. (2015). Annual Update of Key Results 2014/15: National Health Survey. Wellington: Ministry of Health. MoH. (2015). Cancer: New Registrations and deaths 2012. Wellington: MoH. Petro, R. e. (1996). Mortality from smoking worldwide. BMJ, 12-21. Sarfati, D. (2015). Retrieved from www.womens-health.org.nz: www.google.co.nz/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=utf- 8#q=diana+sarfati+Smoking+also+increases+cancers+of+the+upper+airways%2C+sto mach%2c+mouth%2c+tongue%2c+liver%2c+cervix+and+bladder+ Shibuya, K. C. (2003). WHO Framework Convention on Tobacco Control. WHO Framework Convention on Tobacco Control: development of an evidence-based global public health treaty. British Medical Journal, 154-157. Statisitcs, N. Z. (2013). 2013 Census cigarette smoking tables. New Zealand Statisitcs. Retrieved from http://www.stats.govt.nz/census/2013-census.aspx van der Deen FS, I. T. (2015). Projecting future smoking prevalence to 2025 and beyond in New Zealand using smoking prevalence data from the 2013 Census. N Z Med J, 71-79. 8
Wald, N. H. (1996). Cigarette smoking: an epidemiological overview. Br Med Bull, 3-11. Retrieved from http://bmb.oxfordjournals.org/cgi/content/abstract/52/1/3?ijkey=e63cb3c6c8939 87945063e42b26623ec0896773b&keytype2=tf_ipsecsha WHO. (2008). Report on the Global Tobacco Epidemic. Geneva: The MPOWER package. Retrieved from WHO: http://www.who.int/tobacco/mpower/publications/en_tfi_mpower_brochure_r.pd f WHO. (2014). Why is tobacco a public health priority? Retrieved from World Health Organisation: http://www.who.int/tobacco/health_priority/en/print.html Wilson N, E. E. (2010). Characteristics of smoker support for increasing a dedicated tobacco tax: National survey data from New Zealand. Nicotine and Tobacco Research. Retrieved from University of Otago: http://www.otago.ac.nz/wellington/otago022867.pdf Wilson, N. (2004). How much downside? Quantifying the relative harm. J Epidemiol Community Health, 451-4. Wilson, N. B. (2013). Would addressing high-priority risk factors from the Global Burden of Disease Study (GBD) 2010 potentially reduce health inequalities? A case study. The Lancet, S147. WorldBank. (2011). World Bank. Retrieved from World Bank: http://web.worldbank.org/wbsite/external/topics/exthealthnutritionandp OPULATION/EXTPH/0,,contentMDK:22760830~menuPK:648591~pagePK:148956~piPK :216618~theSitePK:376663,00.html 9