After the new law for smokefree cars for Kiwi kids, what next?

This blog discusses the passing of the Smoke-free Environments (Prohibiting Smoking in Motor Vehicles Carrying Children) Amendment Act last week. We briefly review some lessons from this legislation’s long journey and explore future smokefree possibilities in Aotearoa / New Zealand.

A law providing smokefree cars for children is a matter for delight. Many have worked hard and long for this, community workers, advocates, researchers, officials and policymakers. As we celebrate the passing of legislation which will require cars carrying those under 18 years to be smokefree, what can we learn from the process for smokefree and wider health matters?

Why was the policy process for the law so long? It is over 45 years since the first smokefree places law in the world,¹ over 35 years after there was clear evidence that secondhand smoke kills,² 30 years since the first smokefree places law in NZ, 14 years after the first Australian state announced it would require smokefree cars for children,³ 13 years since a survey of NZ smokers showing high support for smokefree cars with children.⁴ Only now do we get a NZ law for protecting the most vulnerable, in the most confined of smoky spaces.

We know that many NZ officials and politicians have assumed that adult ‘rights’ were politically dominant over child protection, did not know about public and smoker support, and were unaware of the progress elsewhere on such laws.⁵ We know that much of the public policy process is messy and irrational.⁶ In NZ, the Health Select Committee in 2016 recommended legislation for smokefree cars, but the then Government said that ‘present initiatives [were] sufficient to deter smoking in cars carrying children under the age of 18 Years’.⁷ NZ Government responsibilities to children under the United Nations Convention on the Rights of the Child⁸ were ignored, part of the systemic lack of priority for children in the NZ policy-making process.⁹

So what can we do about progress for other smokefree policies? Some things work – advocacy, changing social norms, and informing policymakers.³ A major requirement for progress in NZ is the rebuilding of official and non-government health advocacy capacity.

The haphazard nature of politics means that windows of opportunity need to be sought, recognised and acted on. There may be current windows globally arising from the COVID-19 pandemic upheaval because of: (a) politicians may be less likely to prioritise ‘individual rights’ over collective action, allowing the introduction of policies that increase the collective public good;¹⁰ (b) the apparent increased risks for smokers from COVID-19^{11 12} may help shake loose the tobacco control logjam; and c) the pandemic may increase the political priority and acceptability of measures to safeguard public health. Privileging ‘individual rights’ over collective action has long hindered protective policy making, with catastrophic consequences. Following the pandemic, we have a unique opportunity to change some NZ policy priorities.

What are some of the changes for NZ that might happen in that breaking of the logjam? Smokefree outdoor areas of hospitality venues is an example of the type of policy that has been stuck between the fears of some vocal hospitality owners, and the needs of both those wanting to quit¹³ and wanting protection from secondhand smoke. More radical moves on controlling the tobacco industry, regulating tobacco products and reducing supply may be possible.¹⁴¹⁵ And to make the whole Smokefree 2025 aim a reality, we need a coherent plan with teeth. The Government promised a plan in March 2018, over two years ago.¹⁶ We need it now.

Finally, we must learn more from our health interventions. While there is clear evidence that smokefree car laws work (eg, from Canada,¹⁷¹⁸ California,¹⁹ and England ²⁰), it is critical that we know how the intervention package is working in NZ. What are the outcomes from the whole bundle of the law, media coverage, paid media campaigns, and police training and enforcement? NZ Governments have failed to properly evaluate major tobacco control interventions since 2008 – including the introduction of pictorial health warnings, the point-of-sale display ban for tobacco, and standardised packs with enhanced pictorial health warnings. We need a comprehensive evaluation for this law and its implementation, particularly to ensure that it benefits Māori and Pacific children.