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Karine Gallopel-Morvan
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New Zealand: the first tobacco-free generation?

Karine Gallopel-Morvan, Professor in Social Marketing at EHESP and member of the Haut conseil de santé publique

Will New Zealand become the first smoke-free nation by 2025? To achieve this goal – and avoid the pre­ma­ture deaths of 4,500 New Zealan­ders each year – the coun­try could soon pro­pose a num­ber of ground-break­ing mea­sures, includ­ing a ban on the sale of tobac­co to any­one born after 2004. The lat­est WHO fig­ures, from May 2020, show that there are more than 1.3 bil­lion smok­ers in the world, and 80% of them are in low- and mid­dle-income coun­tries1. The same data also shows that smok­ing kills 8 mil­lion peo­ple around the world each year.

The ban pro­posed by New Zealand Prime Min­is­ter Jacin­da Ardern’s gov­ern­ment has yet to be proven as effec­tive and suf­fi­cient. Also, whether it could even­tu­al­ly be import­ed into oth­er coun­tries. We put these ques­tions to Karine Gal­lopel-Mor­van, a mem­ber of the French High Coun­cil for Pub­lic Health (HCSP) and of the sci­en­tif­ic boards of San­té publique France. 

Will New Zealand be able to com­plete­ly abol­ish smoking?

New Zealand has a long his­to­ry of dis­ua­sive cam­paigns to reduce smok­ing, and they have been suc­cess­ful. Today, about 10% of non-Maori New Zealan­ders (and about 30% of Maori) smoke. This is extreme­ly low com­pared to France or Ger­many, where between 30 and 32% of the over-15s smoke occa­sion­al­ly and more than 25% dai­ly2. Over­all, 29% of adults in Europe are reg­u­lar smokers. 

But New Zealand is not the only coun­try to envis­age a world with­out tobac­co – referred to as tobac­co endgame. It is also being con­sid­ered in Aus­tralia, Fin­land and Nor­way; coun­tries where smok­ing preva­lence is also very low (~12–15% of smok­ers). These coun­tries have adopt­ed the many mea­sures rec­om­mend­ed by the WHO, with­in the frame­work of the Con­ven­tion on Tobac­co Con­trol and have suc­ceed­ed in sig­nif­i­cant­ly reduc­ing the pro­por­tion of under­age smok­ers, to around 5% today. New Zealand wants to go fur­ther, and in 2021 pro­posed a plan to go smoke-free by 20253.

How could New Zealand become smoke-free in 2025?

Var­i­ous mea­sures are pro­posed. Among the key pro­pos­als is the reduc­tion of nico­tine in tobac­co prod­ucts. This will have the dual pur­pose of reduc­ing the depen­den­cy of smok­ers (and there­fore mak­ing it eas­i­er to quit) and reduc­ing speed at which young peo­ple start­ing to smoke become addicted.

Anoth­er key mea­sure is the reduc­tion in the num­ber of tobac­co out­lets, of which there are between 6,000 and 8,000 in New Zealand, since any shop can sell this prod­uct. This means that many out­lets are locat­ed in areas where the pop­u­la­tions most like­ly to smoke, such as Maori and the poor­est, reside. Reduc­ing the num­ber of out­lets, par­tic­u­lar­ly around sec­ondary schools, will reduce access to tobac­co, pre­vent youth ini­ti­a­tion and facil­i­tate cessation.

The last key mea­sure is to ban the sale of tobac­co to young peo­ple born after 2004 by 2025. The aim here is of course to cre­ate the first smoke-free gen­er­a­tion. Oth­er mea­sures are also pro­posed to achieve the desired objec­tive: rais­ing prices, ban­ning fil­ters (which are very pol­lut­ing for the envi­ron­ment), increas­ing the num­ber of social mar­ket­ing cam­paigns (such as the “No Smok­ing Month” in France), and reduc­ing the attrac­tive­ness of cig­a­rette shapes (in par­tic­u­lar by ban­ning cig­a­rettes with flavoured capsules).

Do you have any exam­ples of pub­lic poli­cies that have demon­strat­ed their effec­tive­ness on tobac­co marketing?

Yes, for exam­ple, I worked for sev­er­al years on the neu­tral cig­a­rette pack, which was intro­duced in France in 2017 and has now been adopt­ed by many coun­tries (includ­ing New Zealand). It has no adver­tis­ing signs; the brand name is writ­ten in a stan­dard­ised way and the colour is as unat­trac­tive as pos­si­ble (dark green for France). 

One of the aims of the neu­tral pack­et is to elim­i­nate the mar­ket­ing func­tion of the pack­ag­ing – a par­tic­u­lar­ly essen­tial func­tion in attract­ing young peo­ple to smoke. Cer­tain inno­v­a­tive and attrac­tive pack­ag­ing designs were sold on the French mar­ket up until 2017: “phos­phatase”, whose char­ac­ter­is­tic was to light up at night and make health warn­ings dis­ap­pear; the pack­et bear­ing the effi­gy of Che to evoke rebel­lion; the tac­tile “high-tech/­cap­sule” pack, which reminds us that the cig­a­rettes it con­tains change flavour accord­ing to the smok­er’s desires, etc. 

Research car­ried out in France, and that of researchers in oth­er coun­tries, shows that neu­tral pack­ag­ing influ­ences smok­ers’ behav­iour and per­cep­tions. Fur­ther­more, the plain pack­et does not make teenagers want to buy it and reduces their desire to start smok­ing. The plain pack­et also pre­vents con­sumers from being mis­led about the real dan­ger of the prod­uct it con­tains: a prod­uct that kills one out of two reg­u­lar con­sumers. Final­ly, the neu­tral pack­et increas­es the effec­tive­ness of the health warn­ings on the pack­ag­ing. They are more vis­i­ble, bet­ter remem­bered, and con­sid­ered more cred­i­ble and serious. 

But to defend this com­mu­ni­ca­tion space that is pack­ag­ing, the tobac­co indus­try went so far as to sue Aus­tralia in 2012 when the coun­try decid­ed to impose it. They lost their case and were over­ruled by the Syd­ney High Court.

Will it ever be pos­si­ble to ban smok­ing in coun­tries where smok­ing preva­lence is above 30%, such as France or Germany?

Noth­ing is impos­si­ble. It is impor­tant to bear in mind that today a prod­uct like cig­a­rettes would nev­er have been accept­ed for sale in Europe, sim­ply because it kills 50% of its reg­u­lar users. Smok­ing preva­lence is high in Europe, but it has been decreas­ing since 2016 (except in 2020, a year made spe­cial by Covid-19), because there has been a real polit­i­cal will to achieve this objec­tive with the imple­men­ta­tion of effec­tive mea­sures (price increase, social mar­ket­ing cam­paigns, neu­tral pack­age, reim­burse­ment of nico­tine substitutes…).

If the next gov­ern­ments con­tin­ue in this vein, the per­cent­age of smok­ers could fall very quick­ly. In Great Britain, for exam­ple, the adop­tion over the last fif­teen years of very effec­tive mea­sures (price increas­es, mas­sive social mar­ket­ing cam­paigns, ban on adver­tis­ing and sales to minors, plain pack­ets, assis­tance deployed through­out the coun­try to help smok­ers quit, etc.) has had sig­nif­i­cant effects: the British have gone from around 30% of smok­ers to less than 15% today. If nec­es­sary, it might be pos­si­ble to move to a smoke-free France or Ger­many by 2030.

Wouldn’t a sales ban lead to an increase in black-mar­ket tobac­co sales?

As stat­ed in the pre­vi­ous ques­tion, there is no ques­tion of ban­ning tobac­co sales in France when preva­lence is close to 30%. How­ev­er, once it is close to 5%, a ban will become fea­si­ble with­out gen­er­at­ing large-scale illic­it traf­fick­ing, since few peo­ple will be inter­est­ed in the prod­uct. In this case, it will of course be essen­tial to help the remain­ing smok­ers to man­age their nico­tine depen­dence, for exam­ple with med­ica­tion and nico­tine substitutes.

Interview by Juliette Parmentier
1https://​www​.who​.int/​n​e​w​s​-​r​o​o​m​/​f​a​c​t​-​s​h​e​e​t​s​/​d​e​t​a​i​l​/​t​o​bacco
2https://​www​.euro​.who​.int/​_​_​d​a​t​a​/​a​s​s​e​t​s​/​p​d​f​_​f​i​l​e​/​0​0​0​9​/​4​0​2​7​7​7​/​T​o​b​a​c​c​o​-​T​r​e​n​d​s​-​R​e​p​o​r​t​-​E​N​G​-​W​E​B.pdf
3https://​www​.health​.govt​.nz/​o​u​r​-​w​o​r​k​/​p​r​e​v​e​n​t​a​t​i​v​e​-​h​e​a​l​t​h​-​w​e​l​l​n​e​s​s​/​t​o​b​a​c​c​o​-​c​o​n​t​r​o​l​/​s​m​o​k​e​f​r​e​e​-​a​o​t​e​a​r​o​a​-​2​0​2​5​#​a​c​h​i​e​v​i​n​g​s​f2025

Contributors

Karine Gallopel-Morvan
Karine Gallopel-Morvan
Professor in Social Marketing at EHESP and member of the Haut conseil de santé publique

Professor in Social Marketing at the École des Hautes études en santé publique (EHESP), Honorary Professor at the University of Stirling (Scotland) and member of the Haut Conseil de Santé Publique Karine Gallopel-Morvan's research activities focus on the prevention of smoking and drinking behaviors. More specifically, her work focuses on the analysis of the marketing and lobbying strategies of the tobacco and alcohol industries and the consideration of these commercial strategies to establish more effective prevention programs.