Surgical outcomes are consistently poorer for smokers than non-smokers, with patients who smoke experiencing longer recovery times, increased risk of wound infection, and significantly increased risk for myocardial infarction and stroke. Smokers also have a higher post-surgery mortality rate than non-smokers. Smoking cessation is therefore advised to reduce the incidence and severity of diseases linked with tobacco smoking. In many cases there is evidence that smoking cessation prior to surgery also lowers the risk of diseases linked with tobacco smoking. In many cases there is evidence that smoking cessation prior to surgery also lowers the risk of postoperative wound infection, wound healing problems, respiratory complications and admissions to intensive care.  

As your consultation document states, smoking is a leading cause of preventable disease and death in New Zealand, and it continues to have a significant impact on Māori and Pasifika health inequities.

RACS therefore strongly supports the laudable goal of Aotearoa New Zealand being smokefree by 2025, and we support the proposals, outlined in the consultation document, for a Smokefree Aotearoa 2025 Action Plan, in particular:

Strengthening Māori governance of the tobacco control programme

As your consultation document states, Māori smoking rates remain much higher than those for the overall population. Māori women have New Zealand’s highest smoking rates, wth just under one-third smoking daily. It is imperative that Māori women are represented in leadership of the tobacco control programme, that Māori are involved in developing and leading engagement programmes around the benefits of quitting smoking and the support that is available to do this. 

Supporting community action for a Smokefree 2025

RACS congratulates the community agencies and organisations that are working, and providing practical support, to reduce smoking uptake in our communities. We commend, in particular, the efforts of community groups that resulted in the recent legislation banning smoking in motor vehicles that are carrying children. However, there is always more to do and we would support, for example, restrictions around parents who smoke while caring for their children and possible prohibition of smoking inside homes where there are children, to reduce risks from passive inhalation.

Increasing research, evaluation, monitoring and reporting 

RACS agrees with the writers of the consultation that this initiative will improve understanding of smoking populations and the contexts in which people begin to smoke and quit smoking, and that there will be a need for the impacts of the action plan to be monitored and evaluated. 
Equally importantly, we believe there needs to be investment into ongoing research of vaping. RACS has serious concerns about the inconclusive evidence regarding the efficacy and safety of vaping products, their possible long-term health effects and their impact on surgery. For example, the impact of e-cigarettes on different surgical procedures, notably spine surgery and plastic and reconstructive surgical procedures that rely heavily on the vascularity of tissue, is unknown but potentially harmful as it is with cigarette smoking. There is no evidence yet that vaping is safe. Canterbury secondary school principals’ concerns about an emerging vaping ‘epidemic’ among young people was reported in the media just this week.

A survey, conducted in 2019 by researchers from four universities of more than 7700 adolescents (13 – 18 years) in 52 Auckland, Northland and Waikato schools, found that many adolescents who vape are non-smokers, vaping in Year 10 students has increased rapidly since 2015. “These findings call into question that idea that vaping is displacing smoking. The alternative possibility, that vaping is fuelling smoking, must be taken seriously by communities and policy makers. It is imperative that ongoing research, evaluation, monitoring and reporting is carried out to provide evidence of whether vaping is safe, and to enable people to make informed decisions.  

Reducing availability of and access to smoked tobacco products

RACS supports licensing of retailers of smoked tobacco products and reducing the number of retailers in an area based on population size and density. However, we do not support replacing the availability of smoked tobacco products with vaping products, for the reasons mentioned above. Instead of encouraging smokers to switch to vaping, we would prefer they were encouraged and actively supported through a range of existing programmes, to quit smoking outright. 

Introducing a smokefree generation policy  

RACS fully supports this proposal and believes it could be a very effective way of preventing young people from taking up smoking, and therefore greatly reducing the risk of lifelong addiction and future serious adverse health effects. According to several academic staff at the Department of Public Health at the University of Otago, “New Zealand studies modelling the smokefree generation approach found it effective and highly pro-equity (i.e., even more favourable to Māori health vs non-Māori health, given the younger age-structure of the Māori population and the relatively high prevalence of smoking currently among young Māori).

Reducing nicotine in smoked tobacco products 

This initiative is supported by RACS as a way of encouraging smokers to reduce or quit smoking and reducing the likelihood of former smokers taking up smoking again. Research shows that cigarettes with very low levels of nicotine result in limited ‘compensatory’ smoking, which typically lasts only for a few days, if it occurs at all. It is then followed by a reduction in the number of cigarettes smoked.

Enhancing existing initiatives

RACS fully supports this proposal and commends the Ministry of Health and the many organisations and agencies that provide very effective support to people to quit smoking. We wholeheartedly endorse the need for the Ministry to renew its focus on supporting young people to stay smokefree and vapefree, and we would like to see more emphasis, particularly in mass and social media campaigns, on the fact that the long term effects of vaping are not yet known.