GPs and the Smokefree Aotearoa 2025 Goal

25 May 2022

By Professor Robert Beaglehole 
Emeritus Professor, University of Auckland; Chair, ASH – Action for Smokefree2025 

My first patient as a medical student in Dunedin was a middle-aged man coughing blood as he died from lung cancer. In the same year, my father died from smoking-caused vascular disease. Back then, cigarette smoking was very common. About half of adult men smoked, and they smoked heavily. The links between smoking and deaths from heart disease and cancer were only just becoming evident.   

It’s no surprise that as an epidemiologist and public health professional, I’ve spent much of the last fifty years combating the impact of tobacco on health both here and at the WHO in Geneva as Director of Chronic Disease and Health Promotion.  

All countries are endeavouring to curb the harmful effects of cigarette smoking. Aotearoa New Zealand is leading the pack, setting, in 2011, the Smokefree 2025 goal: to achieve a very low smoking rate of under 5 percent in the adult population. The goal means at least 95 percent of the entire population would be smokefree, and the number of people killed by tobacco each year, around 5,000, would begin to fall with billions of dollars in savings to the health system. 

GPs have a central role in helping Aotearoa New Zealand reach the Smokefree 2025 goal by encouraging and supporting patients who smoke to quit or transition from cigarettes to less harmful nicotine products. The job is not over - there are still 380,000 people who smoke cigarettes daily.   

People smoke because they are dependent on the nicotine in cigarettes; they die because of the toxins in the smoke from burning tobacco.  

We have used many tools to help people quit, including nicotine patches and gum, and behavioural support. Vaping is a recent option for delivering nicotine more safely, a tool that did not exist when I first started work helping smokers quit cigarettes. Vaping (electronic cigarettes) helps the transition away from cigarettes more efficiently than alternative nicotine delivery devices. It has many of the same social and behavioural features as cigarette smoking and, most importantly, provides nicotine without deadly toxins.   

There is now little doubt that the uptake of vaping has contributed significantly to the recent unprecedented fall in smoking rates: approximately 100,000 fewer people were smoking in 2021 than in the previous year. Although vaping may not be completely harmless, the best estimates suggest that it is at least 95 percent less harmful than cigarettes. It’s a disruptive technological advance over the uniquely harmful cigarettes, which have for so long maintained a monopoly.  

Further, vaping is much cheaper than cigarettes. On average, switching to vaping would save a smoker about $5,000 every year, an important consideration given the link between smoking and poverty.  

No one wants young people to take up vaping unless they are using it to shift away from cigarettes. Much of the debate around vaping has been focused on youth vaping, which is mainly experimental, rather than the significant benefits of vaping for people dependent on smoked cigarettes. The critical public health challenge is to help 50,000 adult smokers quit each year.  

The Government released the Smokefree Aotearoa 2025 Action Plan earlier this year. We now have unprecedented government support and commitment; the environment has never been better for GPs to help their patients to quit smoking. Each GP has on average, about 80 people who smoke on their books, and they are all known to the practice. 

If each of you - the 5,500 GPs in Aotearoa New Zealand - could support just 12 people to quit cigarettes every year – one a month - the 2025 Smokefree goal will be met. 

Some tips when talking to your patients about smoking: 

  • ask the smokers if they’re interested in quitting 
  • let them know that quitting will improve their health and bank balance 
  • stress that the aim is to be smokefree, not nicotine-free, at least in the first instance 
  • remind them that the reason for shifting away from cigarettes to reduced harm nicotine products is that the smoke from tobacco kills, not nicotine.  

Talking about vaping: 

  • tell smokers about the range of options now available, including that they may find it easier to quit with vaping 
  • if the first type of vape does not work, encourage them to persevere; there are many different devices and e-liquids with various strengths and flavours 
  • encourage them to get advice from a specialist vape shop and find the vape that is best for them. 

Cigarette smoking is the most readily preventable cause of death and disease; supporting a patient to stop smoking is probably the best thing a GP can do.  

Reaching the Smokefree 2025 goal will improve the health of all New Zealanders, and I encourage all GPs to take up this challenge, and to take it up now.