The country with arguably the toughest anti-smoking laws in the world is calling for an abrupt about-face.
In December 2022, New Zealand passed pioneering legislation to cut down on smoking: limiting the amount of nicotine in cigarettes to non-addictive levels, slashing the number of retailers that sell cigarettes by 90% and banning anyone born after 2008 from ever buying cigarettes in the country.
For the indigenous Māori and Pasifika populations of about 1.3 million, which have smoking rates of 18% to 20%, three times higher than the European population, the smokefree bill was "a cause for celebration," says Teresa Butler, who is Māori and a member of the Ngāti Porou and Te Arawa tribes — and a former smoker of 28 years. "We were ecstatic, so, so happy."
Prior to colonization, New Zealand's indigenous population had never smoked, according to the government's Encyclopedia of New Zealand. Now, 4,000 Māori and 2,000 Pasifika die every year in New Zealand, and according to research in the New Zealand Medical Journal, cigarettes are responsible for 15% to 25% of these deaths. With cigarettes festering in the country since the 1700s, the legislation promised to help stamp out this scourge.
But now the newly elected conservative government, which took power in November, has announced plans to scrap the bill, offering as a rationale that it violates freedom of choice, fuels crime and exacerbates a cigarette black market. They hope to accomplish this repeal within their first 100 days in power, putting it to a vote in Parliament before March 2024.
In an interview with Radio New Zealand, Prime Minister Christopher Luxon focused on the bill's 90% reduction in the number of tobacco retailers, saying that "concentrating the distribution of cigarettes in one store in one small town is going to be a massive magnet for crime." Likewise, Deputy Prime Minister Winston Peters has described cigarette smoking as a "freedom of choice issue." Perhaps most notably, on November 25th, Finance Minister Nicola Willis told Newshub Nation they were scrapping the smokefree bill to fund a billion dollars in tax cuts.
"Money's more powerful than lives," Butler says bitterly. "They don't give a s*** about our communities and our well-being; they don't care about Māori. They have made that very clear."
Even though Māori and Pasifika had some criticisms about the smokefree bill — notably that it lacked enough support and consideration for indigenous communities — they were eager to move forward to a smokeless future.
Now, that future is in jeopardy, as well as New Zealand's health equity efforts more broadly, given news that the government also plans to abolish the Māori Health Authority, an independent government body that sets Māori health policies and oversees care delivery.
In the wake of the new government stand, I interviewed several New Zealand public health leaders and over a half-dozen Māori and Pasifika. Their consensus: These dual proposals — to abolish the smokefree bill and the Māori Health Authority — will lead to more tobacco-related deaths and entrench health inequity by making it more difficult for indigenous people to quit smoking and to access high-quality health care.
Leitu Tufuga, who is Pasifika and leads tobacco control advocacy for Māori Public Health, put it simply: "The well-being of our people is at stake, and that blood will be on the government's hands."
Worrying about indigenous youth and cigarettes
What was remarkable about New Zealand's smokefree legislation is the mountain of evidence behind the bill, including randomized trials, modeling, epidemiological investigations and systematic reviews of how these policies would affect health outcomes, says Andrew Waa, an associate professor of public health at the University of Otago who is Māori and a member of the Ngāti Hine tribe. As Waa wrote in a 2023 study in Tobacco Control, the smokefree bill was estimated to, over the next 20 years, save New Zealand $1.4 billion in social costs and reduce the mortality gap between Māori and non-Māori by 10% in males and 23% in females.
If the bill is officially repealed, New Zealand's goal to slash its smoking rate to 5% by 2025 will become impossible for Māori and Pasifika, says Ben Youdan, director of the Action for Smokefree 2025 advocacy group. Public education and awareness campaigns have been effective in New Zealand, but the smokefree policies were designed to "really get those last few people to switch [to vaping] or to stop smoking," Youdan says. Vaping is much less harmful than smoking, as well as one of New Zealand's primary tools to help people quit cigarettes.
Vivienne Bould is one of those smokers who'd like to quit, having started smoking when she was 12 years old. Now the 64-year-old office administrator says that "quitting smoking is in my head every day," even though she admits it feels impossible to do. (On average, it takes smokers 14 attempts to quit successfully, according to the New Zealand Ministry of Health.) For Bould, who is Māori and a member of the Ngāti Porou and Ngāti Raukawa ki te Tonga tribes, it's hard to say whether the smokefree laws would have helped her quit — maybe she's too far gone — but she nonetheless thinks it's "crazy not to put any barriers on when they can stop selling cigarettes, on whom they sell it to."
For Bould, the impact of the anti-smoking campaign on younger generations is most critical. One of her biggest disappointments was when her daughter started smoking. When she quit a couple of years later, "I couldn't have been more delighted," she said. "No one can tell me more than I can tell myself what a dumb thing it is to do."
Her cousin Fay Selby-Law, a former neonatal nurse, emphasizes, "What Smokefree 2025 meant was that our tamariki [children] and mokopuna [grandchildren] will not be exposed to tobacco, that our communities are free to get on with their health."
The Māori Health Authority also faces extinction
The abolishment of the Māori Health Authority will only further exacerbate health disparities among Māori and Pasifika, Selby-Law predicts. Already, Māori die 7.5 years earlier than New Zealand's European population and Pasifika 5.5 years earlier — partially a function of their higher smoking rates but also the limited access to health care and the quality of care they receive, according to research in the New Zealand Medical Journal by epidemiologist Michael Walsh. The Māori Health Authority was launched in July 2022 to address these disparities, allowing indigenous communities to lead their own health services. Selby-Law argues that solutions to reducing those life expectancy gaps won't be found by eliminating these communities' self-governance.
New Zealand's health minister Shane Reti, regulation minister David Seymour and deputy prime minister Winston Peters did not respond to multiple requests for comment from NPR. However, in previous statements, Peters has suggested that abolishment of the Māori Health Authority is critical to eliminate "separatism" and "secret social engineering." For his part, Reti has argued against a "two-tiered funding system based on race" and wants to return to a single integrated system. "It will be with gentle hands and with consideration as we disestablish the Māori Health Authority," Reti said.
But the ten New Zealanders I spoke with all found these claims fantastical, arguing that it's impossible to say the country shouldn't have race-based health care since New Zealand already does segregate health care by ethnic identity — as the life expectancy gaps make clear.
Butler emphasizes, "This is a colonial, white supremacist system that continuously deprived our whānau [extended family] of good health and well-being." Bringing an end to the systemic discrimination and health disparities Māori and Pasifika face won't come from wishing them away, she says, but by giving indigenous communities the control to deliver more equitable care.
Overturning the smokefree bill and Māori Health Authority will also extinguish a beacon of public health progress for the rest of the world, says Sue Crengle, a professor of Māori health at the University of Otago who is from the Kāti Māmoe, Kāi Tahu and Waitaha tribes. "For public health momentum here in Aotearoa [New Zealand], this just completely stops it," Crengle continues. "We have gone from being world leaders to walking backwards."
Ayesha Verrall, who is the Labour Party's health spokesperson and who developed the smokefree bill as the former health minister, emphasizes these international stakes. "We're very proud of the changes we were making for our people, and we had hoped that others would be able to learn from the progress," she says. "I think that also drew the attention of the global tobacco industry to New Zealand. And that probably meant shutting down our changes was a priority."
Will Māori and Pasifika protests succeed?
Neither the repeal of the smokefree bill nor the Māori Health Authority has yet occurred: The new Health Minister has promised to scrap the Māori Health Authority by Christmas and repeal the smokefree bill before March 2024, per the coalition government's agreement.
Over the coming weeks and months, Māori and Pasifika across New Zealand hope to force the government to reverse course – or to convince politicians from the ruling National, ACT and New Zealand First parties to buck their parties and vote their conscience. "This was a backroom deal done by politicians who got into the coalition government," says Verrall. "Members of Parliament are still free to change their vote."
Tufaga from Māori Public Health helped launch a petition – "Put our People over Profit - Stop the Repeal of the Smokefree Legislation!" – that has received 25,000 signatures in a week, from November 27 to December 4. "The new government is more worried about the profit you can make off tobacco than our lives," she says. "It's the tone of colonization coming back into the fold again."
Protests across New Zealand have also already started. The first ones on Tuesday were organized by Te Pāti Māori — New Zealand's indigenous political party, which holds six seats in Parliament. At 64 years old, Māori grandmother Selby-Law was told by a friend to "take my walking boots out because we're going to be trampling the streets." Verrall emphasizes that health professionals and the Labour Party will be mobilizing alongside indigenous communities to prevent the repeals. "We're not going to take this lying down."
Butler says pushback is likely to intensify, driven by existential dread over the new government's policies. "We need to pull together as Māori and Pasifika to make our voices heard," Butler says. "If we don't protest now, we're in so much trouble for our future."
Simar Bajaj is an American journalist who has previously written for The Atlantic, TIME, The Guardian, Washington Post and more. He is the recipient of the Foreign Press Association award for Science Story of the Year and the National Academies award for Excellence in Science Communications.
Copyright 2023 NPR. To see more, visit https://www.npr.org.
