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Richard Edwards, Nick Wilson, George Thomson
We congratulate the authors of the new smoking cessation guidelines for New Zealand, which are summarised in this issue of the Journal by McRobbie and colleagues (http://www.nzma.org.nz/journal/121-1276/3117).
It is heartening to see guidelines developed through a rigorous, evidence-based approach; and which provide practical advice clearly and succinctly for all those engaged in smoking cessation support in New Zealand.
But, and there is always a but, the publication of the guidelines also underlines the need for public health decision-makers to adopt a determined, similarly rigorous, and evidence-based approach to the development and implementation of population-based tobacco control policies. The publication should also focus the minds of all organisations with an interest in health and social justice to support and participate in advocacy for effective tobacco control policies. This should, of course, include organisations which represent the medical profession and specialities.
We need to keep in mind the extent of the public health problem that tobacco represents for the people of New Zealand. In 2006, over 50 years after it became clear that tobacco smoking is a deadly carcinogen, almost a quarter (23.5%1) of the New Zealand population were still regular smokers, and over 4000 New Zealanders died from smoking-related diseases.
The rate of decline in the proportion of adults smoking regularly in the last two decades in this country has been very low, although evidence from the 2006/7 New Zealand Health Survey was more promising.2 Other countries such as Canada and Sweden have achieved much greater reductions in prevalence.3 Furthermore, the continuing very high prevalence of smoking and the resulting harm from tobacco to the health of Maori and Pacific peoples', and its contribution to health inequalities in New Zealand is a particular concern.4
Fortunately there has been some recent progress. There has been a successful new smokefree environments law 5 (Smoke-free Environments Amendment Act 2003), continuing development of the Quitline, and some innovative mass media campaigns. The introduction of graphic health warnings on tobacco products is underway. But the slow reduction in adult smoking prevalence suggests that much more is needed to make substantial progress.
First, health service policy needs to ensure that the new smoking cessation guidelines are fully implemented at every level of the health system. This...