It's not Ok to kill your customers

The next stage in New Zealand’s tobacco control battle needs a greater focus on where the heart of the blame lies. It’s time to tackle the industry, argues Ben Youdan.

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There are few things more destructive than smoking. If worldwide smoking rates continue, the World Health Organization estimates cigarettes will kill 1 billion people in the 21st century. That’s four times the number killed last century in wars, man-made famine, genocide and political oppression, yet a multi-billion dollar industry that peddles poison is permitted to operate as a legitimate business.

If we are to get really serious about eliminating harm from cigarettes, we need to think about how we control the product and its manufacturers. Tobacco control policies have a long history of concentrating on the smoker. We have successfully controlled second-hand smoke and where people can smoke through workplace bans. Huge sums are spent advertising smoking’s risks via pack warnings and multimedia campaigns. Tobacco tax increases have created disincentives to spend cash on smoking and we have some of the world’s best quit smoking services.

All this has contributed to declining smoking rates, yet we continue to make life difficult for ourselves by competing for the smoker’s attention with an industry that is more market savvy and better resourced and co-ordinated than public health. Blame and accountability for tobacco damage need to shift to these companies and their freedom as a legitimate business must be restricted.

Contrary to the claims of the tobacco industry, tobacco in New Zealand remains relatively unregulated. There is very little control over product contents and where tobacco can be sold. Bizarrely, we have greater regulation over how clothes are made than we do over cigarettes. For example, the smoke from an average cigarette yields almost double the amount of formaldehyde legally acceptable for children’s clothing. There is public outrage and product recalls if a clothing company exceeds a certain level, yet we never see a recall on tobacco.

One line of attack is to target the product. Cigarettes are carefully designed and manufactured to addict. The Royal College of Physicians in London ranked the addictiveness of nicotine in cigarettes above both cocaine and heroin. Although nicotine itself does not pose any major risk, cigarette manufacturers have spent many years refining incredibly efficient ways of delivering it to the brain via the cigarette. It reaches a smoker’s brain within seven seconds, providing fast relief from withdrawal symptoms. The drawback is that the smoke in which the nicotine is delivered is incredibly dangerous to the body.

There are other safer ways to get nicotine such as medicinal nicotine replacement therapies (NRT) like patches and gum. There are also safer ‘recreational’ forms such as oral tobacco pouches called snus and electronic cigarettes that deliver nicotine without the harmful smoke. While our ultimate goal is for people to quit, if we are serious about reducing tobacco-related harm, we must accept that some people are content to be addicted, and we can help them to be so far more safely.

However, in New Zealand there is a paradoxical regulatory system whereby the most harmful form of nicotine (the cigarette) is the least controlled, while the safest form (medicinal quit treatments) are subject to the most stringent safety tests and regulation.

For example, it took a year for an already Medsafe-approved NRT to go through the regulatory process of changing the brand name. In contrast, a tobacco company can introduce a new cigarette product tomorrow without any regulatory control. As for the other recreational nicotine products, nobody can quite decide what to do with them, so they are either banned or a blind eye is turned.

Tobacco policy needs a more sensible approach to nicotine. The current situation of harm maximisation, where the most dangerous form of nicotine delivery is the most accessible, needs to be replaced with an approach that penalises the most harmful and favours the safest.

We need to have greater control over how the tobacco industry operates. This so-called ‘legitimate business’ derives its profit by addicting people to a product it knows will kill half its consumers. These companies are responsible for the tobacco epidemic and more work is needed to hold them accountable.

The Australians are far better than us at doing this. When ‘light and mild’ descriptors were banned there, the industry was forced to pay $5m towards educating the public about harm. Here, the pathetic response was a slightly stern letter from the Commerce Commission telling them they might get in trouble. When tobacco widow Janice Pou’s case against British American Tobacco failed, the public had little sympathy for her cause.

Progress in controlling the industry has been slow. For example, banning the retail display of tobacco is taking years even though we know the ban will work. Why else are tobacco companies sinking large sums of money into groups such as the New Zealand Association of Convenience Stores to front campaigns to keep New Zealand’s deadliest drug advertised like any ‘normal’ product in 10,000 stores nationwide. It’s astonishing that, nearly two decades after tobacco advertising was banned, we still allow it to be promoted alongside the confectionery!

Policies that break tobacco companies’ relationship with the consumer are vital. Retail display bans and plain packaging are important ways this can be achieved. Making the industry pay the costs of implementing such policies sends a strong message that they are to blame.

Other options include capping the number of retail outlets for tobacco, reducing quotas for the amount of product that can be sold, excluding tobacco from free trade agreements and tightly controlling how it reaches the market.

Policy makers need to realise that the tobacco industry can never be a good corporate citizen. It needs to be treated with extreme prejudice for engineering and marketing a product that is unique in the rampant level of harm it causes.

We can be proud of New Zealand’s progress to date in tackling smoking. It’s now time to turn a corner and take the industry on.

• Ben Youdan is the Director of Action on Smoking and Health (ASH) New Zealand. www.ash.org.nz