Achieving Smokefree in our backyards - What will your organisation do? Richard Hoskins

Richard Hoskins
Achieving Smokefree   Medical Officer of Health
  in our backyards    Waikato Public Health Unit

    What will your
   organisation do?

Achieving Smokefree – National / Regional / Local
• Smokefree (

Health can’t do it alone
• You already know that about 70% of health outcome
  is not due to actions of the health sector, right?
• We actively try to get local government (and others)
  doing all sorts of things that improve and protect the
  health of their populations – road safety, active
  transport, changing our alcohol culture, reducing
  contamination, mitigating climate change, etc etc…
  and smokefree policies and bylaws 
• We want to see these expanded and extended –
  buildings, parks, sports grounds, communal areas…

Principles relating to local government…

Remember that in the LGA 2002 (as amended) at
r14(h):
  In taking a sustainable development approach, a
  local authority should take into account –
  (i) The social, economic, and cultural interests of
        people and communities; and
  (ii) The need to maintain and enhance the quality of
        the environment; and
  (iii) The reasonably foreseeable needs of future
        generations.

Smokefree Options
for Councils

NZ’s Current Tobacco Landscape

• ~5000 dairy's selling tobacco at ≥$25.00 per pack (20s)
• No national database or licensing system
• Retail outlet density is highest in most deprived areas

•   17% of adults still smoking, 15% are daily smokers.
•   Māori 38.6%
•   Pasifika 25.5%
•   European/other 14.5%

• Lack of Smokefree outdoor areas across the Waikato region

• National Government focusing on tax increases and plain
  packaging to deter smoking behaviour

Which of these does not need a license?

Licensing Tobacco Retailers in Australia

1. License required (‘Positive licensing’): Tobacco retailers
   need to obtain an annual license at their own cost.

2. None: Any retail outlet can sell tobacco without licensing
   requirements (except temporary outlets).

3. Requirement to list (‘Negative licensing’): Any retailer can
   sell tobacco but needs to list their details with the state
   government.

SF2025 – How can your council contribute?

• Smokefree outdoor area policies pertaining to CBD’s,
  parks, playgrounds, reserves, sports grounds, bus stops,
  buildings, entrance ways, etc.
• Policies that make all events on council land or venues
  Smokefree
• Support National Government to make SF outdoor
  dining compulsory, being led by LGNZ.
• Consider leasing options applicable to outdoor dining
      - Wellington City Council waiving license fee to
      incentivise cafes and restaurants to have smokefree
      outdoor dining areas.

Case Study: Wellington

• 2015 - Public opinion survey conducted with 1,329
  respondents:
-   84% supported Wellington to be smokefree
-   75% supported using bylaws over ‘educational’ policies for SFO areas.

• 2016 – 2 year action plan was developed:
-   Creating new SF areas, extending prior SF areas and SF events
-   Signage to designate SF areas
-   Leadership and advocacy
-   SF promotion and community engagement, cessation support.

Communication plan:

• Evidence suggests a strong communication plan is a
  key success factor for implementing Smokefree
  policies and creating Smokefree environments

• Positive marketing messages work more effectively
  than ‘traditional’ negative SF marketing

Wellington’s positive marketing:

Case Study: Palmerston North

• 2013 – Smokefree Outdoor Areas Policy
• 2014/15 – Community Engagement
• 2015 – Signs and Use of Public Places Bylaw
• 2015 – Amendments to Smokefree Outdoor Areas
  Policy, with the following performance measures:
-   Number of smokefree areas increasing (survey)
-   Increased awareness and public support (email survey)
-   Smoking population decreases (2018 census)
-   Proportion of people smoking in public places decreases (observational
    study)

Palmerston North’s Smokefree CBD

Waikato DHB
Smokefree Policy
  support for

Patients &
Staff

Which addictive substance contributes
most to preventable death and disability?

   smoking is the elephant in the room!

The Problem                  is …..

The deliberate inhalation of smoke from combusted
substance at any level is harmful to the person inhaling
and those around them

Smoking is an addiction - a          chronic relapsing
disease.

Over half of all people who smoke
cannot quit without help

5000 people die every year in NZ
from smoking. (12 per day)

This includes 300 who don’t smoke!

The damage is mainly derived from the
smoke inhaled   .

Cancers
27% of all cancers DNA link to tumour

Chronic Respiratory Disease
  85% of all COPD
    Thoracic Society of Australia and NZ

CHD, Stroke and PVD
Associated with a two-to-four fold
increase in risk
Hay DR, Cardiovascular Disease in NZ 2004,
Technical Report No. 82, Oct 2004

People want to stop smoking
• 69% of smokers tried to quit in last 5 years

• 44% smokers tried to quit at least once in last year

• 72% of 15 to 19 year old smokers would not smoke if they
  had their life again

• Māori, Pacific and young smokers just as likely to have tried
  to quit

and there are effective interventions, but…

Most people try to quit without support

Waikato DHB Smokefree Policy - staff

• No smoking or electronic cigarette use in paid breaks;
  includes buildings, grounds, car parks, cars or gardens
• If chose to smoke in unpaid meal break must leave grounds
  and not be identifiable as Waikato DHB employee
• Staff will be supported and encouraged to work towards
  being smokefree while at work
• Can get free nicotine and support from Health & Safety

Waikato DHB Smokefree Policy - Patients ABC

We ask that patients and visitors respect our smokefree policy

• Patients’ smoke status documented on every admission
     Current, Ex over 4 weeks, Never, Exposed.
• Patients who smoke offered interventions – advice and
  recommendation to stop smoking and nicotine replacement
  therapy

• Opt off referral to community stop smoking services

• All interventions are documented

Our Patients deserve better help

Treatment for our Patients

Smokefree promotion and regulation

Priority Groups
Pregnant women      Mental Health and Addiction
                           Services users

Waikato DHBs comprehensive equity focused approach to maternal smoking

           almost 50% of pregnant Maori women smoke

          only 2% quit from booking to 2 weeks postnatal