Smokefree reversal a shocker

Tax from cigarette sales today trumps the long-term sad and painful healthcare costs

It was weird joining the morning editorial meeting in the week after the coalition agreements were signed, sealed and delivered.

The Health Media has a team of 10 reporters – some are relative newbies to the sector; others have a combined gazillion years of experience in health news and politics. Martin Johnston, for instance, can rattle off the various pieces of legislation by which government in what year. It’s strangely mesmerising and disturbing at the same time.

The meeting was somewhat animated; it’s an understatement to say we were mildly surprised by the proposal to repeal the smokefree legislation amendments. When you write about health sector policy, politics and its people for too many years to mention, you start to get a feel for stuff that works. You become invested in outcomes, not only because you are a taxpayer and a potential patient but because when you are watching people work their butts off, you want it to add up to something.

And now we have a government happy to rip up ground-breaking legislation that would have seen a massive reduction in the health tragedy that is smoking. It certainly would have achieved far more than the many smoking-cessation programmes funded over the years.

I recall a friend, an oncology nurse, telling me about being tasked with meeting a target for smoking cessation advice. When one patient responded with “fuck off”, she mulled for a moment and then ticked the box. Job done.

Now, we have a scenario that reads like a twisted plot from an absurdist comedy. Think the dead parrot sketch from Monty Python’s Flying Circus with the sinister undertones of a Coen Brothers Fargo episode.

Instead of gradually raising the age for cigarette purchases, decreasing nicotine content and limiting outlets – measures that would have curbed demand and reduced ram raids (who wants ciggies without a hit?) – the Coalition Government is taking a new approach. It is fostering the next generation of smokers, predominately Māori and Pacific kids according to demographics, hanging on to the levels of nicotine to ensure they get hooked and keeping the numerous outlets because access to death should be convenient. And the tax take will be cracker.

It’s like health minister Shane Reti has been strong-armed into one of those old cigarette ads featuring happy, white-coated, smoking doctors and a slick message on the health benefits of inhaling tar, nicotine, benzene, carbon monoxide, ammonia, dimethylnitrosamine and formaldehyde, to name a few.

And like those ads, ultimately, it is all about money – the tax taken from cigarette sales today trumps the long-term sad and painful healthcare costs.

The moment the news broke, I could see those tobacco company lobbyists high-fiving, “our work here is done”, then packing their bags and heading across the Tasman to sort out the Aussie Government’s antagonism towards vaping.

As one erudite colleague put it, “You couldn’t make this shit up.”

There’s plenty more for the health sector to process in the 100-day plan, including Te Aka Whai Ora disestablished, over-the-counter pseudoephedrine meds returned, the Therapeutic Products Act 2023 repealed, new health targets, a third medical school in Waikato, the breast screening age extended to 74 and more. Oh, and did I mention the new baddie in town is the World Health Organization?

Beyond the 100-days, each coalition agreement contains further health policy items, including a review of the Māori and Pacific admission schemes for both medical schools, more money and scrutiny for Pharmac and a call from ACT and New Zealand First to broaden the terms of the current COVID inquiry.

That might help shed light on ACT deputy leader Booke van Velden’s comment to delegates at the HealthTech conference in June: “When it came to COVID, we completely blew out what the value of a life was, completely; I’ve never seen such a high value on life.”

What value does ACT, or all three Coalition Government partners, place on a life? The starting point appears to be the tax on a pack of ciggies.

It’s been an odd year by many measures – I’ve summed it up as “messy” for our final cover. Messy in the way of an ice cream on a summer day. You’re hoping for a relaxing moment in the shade. Instead, by the first lick, you already have sticky rivulets running through your fingers, and your slow, satisfying foray becomes a sprint to catch the ice cream before it gets away from you, and you can’t beat the melt. At its worse, the entire scoop plops off onto the ground.

And that was 2023 – workforce, funding, burnout, pay parity, localities and, still in the background, COVID – never clear-cut, always a bit messy.

Thanks for reading us this year. And thanks to everyone who contributed to our newsgathering, opinion pages, a Few Words and Registrar Thinking, and our Educate columns.

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The team here works hard to find the stories – good and bad, happy and sad – that make a difference to your team. Merry Christmas and a happy New Year.