Oral Presentation to Maori Affairs inquiry into
tobacco
14th May 2010, 11.30 am
Kia ora members of the committee. My name is Philip Pattemore, Associate
Professor of Paediatrics at the Christchurch School of Medicine, University of
Otago. I represent the Paediatric Society of New Zealand, including the doctors,
nurses and other health professionals that look after children throughout the
country. I also represent indirectly the children that these professionals look
after.
Every day of my working life as a paediatrician, I see the effects of smoking on
children and on families, just like the children have just presented to you. I look
after children with respiratory diseases.
I would like to make three points to the committee.
1. The disastrous effects of tobacco smoking by adults on the wellbeing and
health of children who have no choice in the matter.
2. Why addressing tobacco control in terms of adult choice of a legal drug
and discouraging teenagers from smoking will not succeed, on its own.
3. Why tobacco control must be multi-faceted.
Effects of adult smoking on child health.
1. Tobacco smoke exposure causes harm to the unborn infant, to children
and to young people. The fetus and young child have no choice about this
exposure.
2. Tobacco smoke exposure causes fetal death, prematurity, poor growth
and impaired growth of airways in the fetus. (15,000 exposed)
3. Tobacco smoke exposure causes a 1.5 - 4-fold increase in infections of the
nose, ears, sinuses, throat, airways and lungs in young children as well as
an increased risk of meningitis. It increases the likelihood and severity of
wheeze and asthma. (200,000 exposed)
4. Tobacco smoke exposure decreases fitness and increases blood pressure
in school-aged children.
5. Smoking increases the disruption and grief of whanau, through death of
parents and older family members, as you have just seen presented by the
children.
6. Smoking by parents and other adults is the biggest risk factor for young
people trying and experimenting with smoking.
7. Maori adults including pregnant women, parents, and Maori teenagers
have a higher prevalence of smoking than other groups.
Why smoking is not just a matter of adult choice and
discouraging teenagers from smoking
Prevention is better than cure. It may seem superficially that tobacco control
should focus primarily on preventing the uptake of smoking by teenagers and
young people. But this is not the case.
1. Children have no choice in regards to exposure to adult smoking. Adult
choices must be restricted in order to protect the health and future
choices of our children.
2. Adults who are addicted to smoke cannot be said to have full choice in
their smoking.
a. I had an example of this when a mother brought her child to my
clinic for wheezing, which I felt was significantly due to smoke
exposure. When I discussed this with her she thumped her fist on
the table and said: “If you get rid of my child’s wheezing then I’ll
give up smoking.” But the shoe was on the wrong foot. This
demonstrates that smoking is an addiction which robs adults of
insight and choice. Many parents are not aware of the effects their
smoking is having on their own children.
3. Our nation as a whole is addicted to the influence of the tobacco industry
through monetary and retail connections.
4. Very importantly, I would like to stress that teenagers do not buy into
strategies where they are the target and adults continue to smoke.
a. This was illustrated in the case of alcohol on the Close-Up program
last night when a teenager being interviewed said: “Why should
we give up alcohol when that’s how we see adults enjoying
themselves?” The same applies to tobacco.
5. Children and teenagers smoke to emulate adult behaviour. Smoking has
become a right of passage into adulthood for many young people.
6. The first emphasis must therefore be to tackle adult smoking in order to
limit the damage to the fetus and child; adult smoking must be eliminated
to remove the attractiveness of smoking to children and teenagers.
7. “There is ample evidence that framing tobacco control in terms of adult
choice, whether or not restrictions are put in place on youth access has
the overall effect of increasing the desirability of smoking amongst young
people. Tobacco control must be primarily directed to eliminate adult
smoking, which directly impacts the fetus and child, and maintains the
acceptability and uptake of smoking amongst youth. Young people will
continue to take up smoking while smoking is seen as an adult choice.”
I would commend to the committee the WHO Western Pacific Region report:
“Seeing beneath the surface: The truth about the tobacco
industry's youth smoking prevention programmes. “ WHO (2002). I will leave a
copy with the committee.
Prevention is better than cure. But the prevention needed is the
removal of smoking as a desirable and normal adult behaviour.
Why any approach to tobacco control must be
multi-faceted.
1. The tobacco industry maintains its grip on New Zealand through two
major factors. One is the addictiveness of nicotine;the other is the
corporate, legal and monetary power of the industry, affecting many
workers and retail businesses.
a. Are the people in the industry responsible for the 5000 deaths
including 600 Maori, due to tobacco smoking in New Zealand each
year? They are individuals like you and me. They have to decide
and I would request, if I may, that the Committee ask their
representatives at the hearing if they have any control over the use
of tobacco in New Zealand or not. If they have control they must
accept responsibility for the 5000 deaths, 600 of them Maori each
year due to tobacco. It is then their moral responsibility to stop
selling and distributing tobacco. If they do not have control over it
then that is a clear mandate that the government must take control
by regulating the industry and its products to eliminate these
preventable deaths.
2. The industry has a history of exploiting any and every loophole in tobacco
control. A multi-faceted approach is essential.
3. People who are addicted to smoking must be shown that the government
is serious about eliminating smoking through a transparent and
thoroughgoing process operating on multiple levels.
4. Therefore tobacco control must include
a. A regular scheduled increase in excise tax on manufactured
cigarettes and roll-your-own tobacco
b. Use of tobacco excise to fuel smoking cessation and tobacco
control programs. The public will support taxation that is targeted
to help the people that are taxed. It is a matter of transparency
and honesty to smokers that the revenue they are charged is
linked directly to assistance to them to stop smoking and for
tobacco control.
c. “Tobacco retail display should be illegal. It influences choices, and
it keeps tobacco products seen as desirable by children, who watch
their parents shop for it amidst their normal shopping practices,”
Professor Pattemore said.
d. Regulation of the product including nicotine, toxic ingredients, and
flame-retardants. Progressive nicotine reduction will help
smokers withdraw and make it easier to give up, while parallel
reduction in toxins and increase in tax will avoid harm through
compensatory increase in smoking. Removal of flame-retardants
will reduce the fire-causing propensity of tobacco products. (HSC
and Quitline)
e. Graphic advertising through TV and printed media to smokers
about the risk of smoking to adult and child health, and the
possibility of giving up.
f. Plain packaging for cigarettes, with removal of branding colours.
g. Pressure on, or regulation of ,the film industry to prevent tobacco
product placement in movies and TV.
h. Further provision for inspection and penalties for those who
display tobacco or sell to people under 18 years.
i. Education of children from a young age about the harm due to
tobacco smoking, and why strenuous efforts are being made to
reduce it. (Smokefree Schools leadership)
j. Consistent education, advice and assistance to quit from the
medical profession in all encounters. This is now happening and
all our paediatric health professionals are being trained to advise
parents and teenagers about tobacco cessation.
k. Removal of the right to smoke from vehicles. Tobacco control in
areas where children frequent - parks, reserves and playgrounds –
should be addressed through policy development within local
bodies.
l. Increased subsidised access to smoking cessation programs for the
people who find it difficult to quit through nicotine replacement
and brief counselling alone.
New Zealand society as a whole, must withdraw from its
addictive affair with tobacco in order to protect those
without choice.
Thank you very much.
Questions: What is the best way to help mother’s in pregnancy give up smoking?
Answer: Smokechange programmes in pregnancy are being applied around the
country and are becoming more consistent in their approach. They have shown
efficacy. However we see many mothers who give up smoking in pregnancy and
start smoking again after birth, they say because of the stress of the baby. This is
an area that needs urgent attention.
Smoking in pregnancy needs addressing in the context of a multi-faceted
approach where society and the government come to accept that tobacco use is
not something that should be tolerated. In that way smoking mothers, older
adults who smoke, teenagers and children will all get the message that smoking
is not a normal acceptable choice.