Robert Beaglehole: Flu response lessons can help stub out smoking

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The key lesson from the response to the present influenza pandemic is that Government-led public health interventions are necessary, widely accepted and can work to protect the health of New Zealanders.

The Government must now act in a similar fashion to prevent the tobacco pandemic which is also a global health crisis according to the World Health Organisation.

Everything has been done to prevent, contain and now manage the effects of the rapidly spreading influenza outbreak – right down to instructions to wash hands.

Influenza A has been added to the list of officially notifiable diseases. This means that the compulsory isolation of people who have been in contact with the infection, and the arrest of anyone who leaves their specified place of isolation, are now possible.

The Minister of Health and the public health staff of the Ministry of Health and district health boards are to be congratulated on their actions. These actions have been widely accepted by the community.

The minister has been proactive in communicating the evolving situation and the planned responses. It is not his fault that the New Zealand epidemic appears to be spiralling out of control.

The Government’s leadership on this public health issue has not been questioned; nor has it been accused of “nannying”.

There are now well over 100 confirmed influenza A cases in New Zealand. There may be influenza deaths in the future in people already vulnerable, but so far there have been none.

Compare this with the 20,000 deaths that occur every year in New Zealand from chronic diseases such as heart disease, stroke, and cancer. Most of these are preventable – 5000 alone caused by tobacco use.

Every chronic disease death postponed means, on average, an extra 10-15 years of life – with consequent economic advantages to the country.

But the immediate causes of these diseases – tobacco use, poor eating habits, physical inactivity and excessive alcohol use – still need strong Government leadership.

The key to prevention is to make healthy choices the default options, to nudge people in the healthy direction. The Government has a strong influence on these choices, especially those made by children.

The removal earlier this year of the guideline to schools on the provision of healthy food and drink options was an unfortunate decision by the Minister of Education. It is now easier for children to choose foods higher in sugar, salt and fat at schools. This is exactly the opposite of what the Government should be encouraging.

Tobacco in particular is in urgent need of strong Government action. Although there has been some progress in reducing smoking rates, at the present rate of decline it will take about 70 years to reduce smoking to close to zero.

Over 500,000 New Zealanders still smoke, despite 50 years of evidence on the harmful effects of tobacco. Recent advances include the Smoke-Free Environments Amendment Act of 2003 and the attention to smoking cessation which is now a Government health priority.

But this is not enough to tackle the tobacco pandemic. A few additional key Government actions will have hugely beneficial results and would be acceptable to the vast majority of New Zealanders who are non-smokers.

These include removing the point of sales displays ofmarlboro cigarettes, regularly increasing the tax on tobacco and equalising the tax on roll-your-own tobacco to remove its cost advantage, banning misleading labels, and introducing plain packaging.

The tobacco industry needs be much more firmly regulated in line with the harm it causes; only the Government can do this.

The key lessons from the influenza outbreak are that individuals are not responsible for the infection and strong leadership and comprehensive action is required from the Government to make a real difference. Proactive, justified, and well-communicated preventive actions avoid accusations of “nannying”.

Indeed, such leadership, judging from the influenza epidemic, is welcomed by the community.

These lessons apply equally to the main causes of death and disease in New Zealand and especially to tobacco control.

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