The messy realities of smokefree policymaking to protect children

OPINION: Politicians are leaving kids exposed to smoking, write Helen Wilson and George Thomson.

Smoking kills you, fizzy drinks make you fat, binge drinking is bad for you, and fatty foods cause heart disease. What many public health messages have in common is the expectation that people will make rational decisions, informed by evidence, about how to stay healthy.

New Zealand governments prefer to use public health education rather than legislation, and rely on the assumption that choices about health behaviour will be rational.

But how rational are the policy decisions made by governments when it comes to public health? Our research at Otago University into the New Zealand policy process to reduce smoking around children sheds some light on this. We found that, instead of decision-making being a logical process based on evidence, it was a muddled and messy activity.

This is not to say that the policy process is irrational, but rather that it involves other factors, including evidence, which are weighed up and balanced by policymakers as they make their decisions.

We found the biggest worry for policymakers (politicians and senior officials) was what people would think about smokefree policy decisions. They were particularly concerned that there would be complaints about the "nanny state" prying into people's lives.

Sometimes, personal experiences changed policymakers' minds, and this could influence their stances. For example, walking past smokers outside cafes and at bus stops annoyed some of them. Not surprisingly, they were keen to see smokefree policies extended to some outdoor places. For others, experiences with giving up smoking coloured opinions on addiction and quitting.

Some policymakers were aware that many smokers are from disadvantaged backgrounds. They also knew how addictive smoking can be. This meant some didn't want to increase smokefree areas, even when children were at risk. And they are at risk, despite education campaigns. For instance, in 2008, more than 25 per cent of year 10 students reported being exposed to smoking in cars (46 per cent for Maori and 35 per cent for Pacific pupils). Children are far more likely to start smoking if they see it as normal.

SO EVEN in the face of strong evidence of the health risks to children, most policymakers in the study preferred to rely on education, not legislation, to protect children. But, like policymakers, we also weigh up factors when we make personal health decisions. We are influenced by family and friends' opinions and the media, as well as our social and economic circumstances. So what is the solution when it comes to making smokefree policy, for areas where education doesn't protect children effectively?

Policymakers could look at the experience of smokefree bars. Despite dire warnings, the sky did not fall, and approval of the law reached 74 per cent within 18 months of its implementation. Policymakers can also look at overwhelming evidence that the public supports legislation for smokefree cars and council playgrounds.

Making it easier to say no to smoking, by shifting the norms through legislation, helps protect those least able to protect themselves. The evidence of strong public support is an indication people are open to the Government taking the lead on this.

Even better, policymakers could come to terms with the idea of the end of commercial tobacco in New Zealand. Already half of the public agree that tobacco products should not be sold in 10 years, and over 44 per cent of smokers agree that "If effective nicotine substitutes that are not smoked became available, the Government should then set a date to ban cigarette sales in 10 years' time". If policymakers made this their aim, New Zealand could work towards a future in which children had tobacco-free lives. So let's get on with it.

Helen Wilson and George Thomson are from the department of public health, Wellington School of Medicine, Otago University.

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Stew   #1   08:33 am Apr 23 2010

I'm a smoker I have tried a couple of times to give it up. I wish the govt would just make it illegal altogether. Then I would have no choice.

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