2023 Session 4 Seminars

Alongside an historic plan to create a smokefree generation, the UK Prime Minister has announced an 8-week public consultation to consider actions to crack down on youth vaping and ensure the law is enforced.  The consultation will run until 12 December and will consult on several options to deliver the most appropriate and impactful steps.  In this session Deborah Arnott will share a comprehensive analysis of the ASH response to the consultation including reasoning and considerations behind their recommendations.

Regular adult smoking rates in New Zealand have declined almost 40% between 2019 and 2022 to only 9% of adults, tripling the rate of decline achieved over the previous 10 years. These dramatic declines have been accompanied by a rapid rise in vaping, and there are now more people who vape in New Zealand than smoke; the vast majority are former smokers.

In 2022, the New Zealand parliament voted for smoking endgame policies, including all cigarettes to be very low nicotine by 2025, to reduce cigarette sales outlets by 90% in 2024, and introduce a smokefree generation policy. Easy access to safer alternatives played a key role in giving lawmakers the confidence to end smoked tobacco and minimise the risk to people who still smoke.

With the smoking endgame now policy, vaping has become a hot political issue. Public reaction to youth vaping and aggressive policy against vaping in Australia are driving tensions, with youth vaping being framed as a ‘crisis’ and creating a ‘generation hooked on nicotine’.

The debate has become a battle between youth prevention and reducing adult smoking. This talk will examine the impact vaping has had on smoking in New Zealand, and why we can’t afford a culture war on vaping that hurts both young people and adults, and risks undoing harm reduction efforts as policymakers scramble to respond to public concerns.

The WHO/FCTC defines tobacco control as resting on three pillars: tobacco demand reduction, tobacco supply reduction and tobacco harm reduction (THR). While the treaty amply covers the first two (with articles and guidelines for their implementation), it is silent on the third, THR. This has created a vacuum that the tobacco industry has opportunistically exploited, claiming ownership of THR and turning it into a marketing and public relations tool, using it to divide the tobacco control community. The speaker will analyse this phenomenon and offer his views on how to remedy the situation, with a view to giving back THR the place it should always have had in tobacco control.

Many Southeast Asian countries continue to struggle with the epidemic of smoking. While evidence for tobacco harm reduction (THR) interventions are compelling, they have not been effectively and widely adopted by the countries in the region for a variety of reasons. At the policy level, some countries have banned THR products outright while others have implemented a range of policies often lacking in consistency and rationale, while the use of these products continues to rise in many countries. Complex economic, political and ideological factors come into play in the policy responses but opportunities are on the horizon to mitigate the largely negative attitude towards THR in the region.

"If you don't know where you are going, any road will get you there" (Lewis Carroll). This strategy advice given by Alice to the Cheshire Cat should be inscribed on every tobacco law, policy document, and activist pamphlet. The emergence of the 'endgame' strategies begs the question, the end of what? And what does that look like? Is it the end of smoking and smoking-related disease? Or is it the end of nicotine? Or is the former just a milestone in the pursuit of the latter? How do youth vaping and banning flavours fit into an endgame logic? We'll take a hard look at the endgame, where it all might end up, and what could possibly go wrong (and right).

Public health professionals care about tobacco use because it is so harmful to health. It is our job to discover ways to achieve reduce it to the lowest possible level, ideally zero, in ways that are acceptable to the public and policymakers. In my view it is not our job to be guardians of public morality. Neither is it our job to tell the public what it should think. There are considerable risks attached to confusing moral and health objectives in public health, not the least of which is that if the public see us as preaching to them, they lose trust in us when we make scientifically sound statements about health harms and propose policies and interventions to combat these. Arguably, in discourse about e-cigarettes, moral views about what people should and should not enjoy have led to misleading claims from some highly influential public health professionals and health organisations. We are at yet another crossroad in policy choices about e-cigarettes and public health professionals must be self-reflective and humble in pronouncements about the potential harms and benefits of particular policies – always doing our best to use modern ‘systems thinking’ to estimate the impacts of different policy choices taking into consideration the political and commercial landscape.

• How does supporting THR impact the image of the tobacco industry?
• Can THR be successfully incorporated into global tobacco control?
• Will the desire and demand for nicotine always outstrip the ability of countries to enforce bans?