The results of a Health Coalition Aotearoa survey of political parties on the priority prevention for tobacco, alcohol, unhealthy food and public health infrastructure has found generally the parties are deeply split along ideological grounds. This is despite the evidence pointing to the savings in lives and health dollars from prevention measures. These three harmful products are responsible for almost a third of Aotearoa New Zealand’s health burden and demand serious, evidence-based policy action.
Ahead of the 2023 Election, Health Coalition Aotearoa (HCA) has developed its top prevention priorities for reducing harm from tobacco, alcohol, and unhealthy food and strengthening public health infrastructure. Our four Expert Panels on those topics identified 12 prevention priorities for the next term of government by scoping the existing literature, tapping into national and international content expertise and experience, and understanding the current policy contexts. These agreed priorities are published in our Prevention Brief 2023.
We surveyed political parties currently in parliament about their level of support for the 12 priority policy areas. The scale we provided for rating was: very supportive; generally supportive; neutral/undecided; generally unsupportive; not supportive at all. In addition, there was space for parties to respond with any comments or other priority actions they have for these priority prevention areas (see Appendix). All parties returned responses, although National failed to answer the survey on alcohol policies despite multiple requests to the health and justice spokespeople.
There was a marked diversity in the level of support for HCA’s priority policy areas from the political parties. The responses fell largely in line with the left/right political spectrum with Te Pāti Māori and the Green party largely being very supportive and ACT being very unsupportive. Labour and National responded with a variety of levels of support.
The summary of results is shown in the table below.
The current Labour Government, under Health Minister Ayesha Verrall, has passed world-leading legislation to reduce the prevalence and inequities in smoking, as well as catch-up legislation to try to halt the explosion of vaping outlets and rapid rise in youth vaping. Tobacco and vaping policies received the broadest support across political parties, apart from ACT which strongly opposed both action areas, but made no comment about how they would tackle these serious harms. National supported even stronger policies and funding for schools and communities to reduce vaping.
Very little alcohol policy has been enacted over many years apart from the recent amendment to the Sale and Supply of Alcohol Act 2012 which gave communities greater say on alcohol access through Local Alcohol Policies. This Government legislation was catalysed by a Member’s Bill from the Green Party. Te Pāti Māori and the Green Party were very supportive of the HCA priority policies and wanted even stronger policies and harm reduction programmes for alcohol. ACT strongly opposed all proposed measures, whereas National failed to respond. Labour will consider further reform, including on marketing and sponsorship, early next year.
Ultraprocessed foods, which are driving the obesity epidemic and many other serious diet-related diseases (eg, diabetes) probably contribute over 40% of the diet of New Zealanders. No substantive policies to address this huge contribution to ill-health and health inequities among children and adults have been implemented for over 15 years. National opposed and ACT strongly opposed all the policy priorities put forward by HCA. Labour remains undecided while Te Pāti Māori is strongly supportive and has called for the free school lunch programme to be made universal, as it is in many other countries.
The first HCA priority in this area was to protect the integrity of public policymaking through a series of measures including legislation on lobbying, managing commercial conflicts of interest, and expanding transparency through reform of the Official Information Act. There was positive or neutral support for this across all parties. Protecting the voice of publicly funded health professionals to advocate for evidence-based improvements to health was supported by all except ACT. In the third policy priority, HCA called for stronger public health systems linking government, NGOs, academia and health unions into a tighter ‘ecosystem’. It also called for protecting the mana and mandate of Te Aka Whai Ora (Māori Health Authority). National and Act opposed this last priority while the other parties strongly supported it.
Tobacco, alcohol and unhealthy food create nearly one-third of the loss of healthy life-years among New Zealanders (>370,000 disability-adjusted life-years lost annually). Despite this enormous harm and strong consensus between the World Health Organization and national experts on priority policy actions to reduce this harm and its inequities, there remains an extraordinarily wide divergence of support among political parties for implementing these policies in Aotearoa New Zealand.
In general, the politically left-leaning parties were supportive or very supportive of the HCA’s prevention policies, whereas the right-leaning parties were unsupportive – from equivocal to strongly unsupportive. This survey has shown how support for strongly evidence-based and expert-agreed policy priorities is heavily over-ridden by political ideologies. The mix of parties which form the next government will likely have substantial impacts on progress in prevention against health-harm products.
Professor Boyd Swinburn, School of Population Health, University of Auckland, and Co-Chair, Health Coalition Aotearoa
Caitlin Haliburton, Project Support Assistant, School of Population Health, The University of Auckland
(Updated on 8 August, 1pm with full party comments)
Other comments provided by the political parties.
National: National introduced SOPs into parliament putting proximity restrictions on new premises and providing support for schools and community facilities to take actions against vaping. Labour voted these down.
Green: The Green Party will regulate vaping products as a harm-reduction measure for established tobacco users, while minimising uptake by new users, including by banning shopfront advertising, and banning disposable vapes. Further, we support the government's proposal to restrict vape sales near schools.
Labour: Our election manifesto has not been released yet. We will have more policy announcements closer to the election.
Labour is fully committed to protecting the health and wellbeing of New Zealanders. Last year, we passed The Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act. This legislation will create an entire smokefree generation and will save thousands of lives. The three main changes are reducing the amount of nicotine that is allowed in smoked tobacco products, decreasing the numbers of retailers that sell tobacco and making sure tobacco isn’t sold at all to anyone born on or after 1 January 2009. We are proud to lead the world in tobacco control, and we will defend this legislation from Tobacco company litigation.
Too many young people are vaping, which is why Labour is making a number of moves to stop that happening. From August this year, all vaping devices sold in New Zealand will need to have removeable or replaceable batteries. This limits the sale of cheap disposable vapes that are popular among young people. We also want vapes as far from the minds and reach of children and young people as possible, so any locations within 300 metres of schools and marae will be off-limits for new shops. Vapes will need child safety mechanisms, and potentially enticing names like ‘cotton candy’ which accompany far too many products will be prohibited. These new regulations build on protections the Labour Government introduced in 2020, including banning sales to under-18s and prohibiting vape advertising and sponsorship. Vaping use and evidence around its effects are changing rapidly. We will keep the science and regulations under review, and if we need to do more, we will.
Te Pāti Māori: Ban serving alcohol in public institutions
National: These policies lie with the Justice spokesperson not health.
Green: Increase health and rehabilitation support for people who are seeking to reduce their use of drugs and alcohol, through kaupapa Māori, Rainbow, youth, and harm reduction programmes.
Labour: Labour is fixing alcohol legislation to ensure the voices of our communities are at the heart of alcohol licensing decision making. The Sale and Supply of Alcohol (Community Participation) Amendment Bill is currently at second reading. This bill responds to persistent issues with alcohol licensing processes in the Sale and Supply of Alcohol Act 2012. Firstly, it supports territorial authorities to adopt local alcohol policies to better guide licensing decisions in their area. Secondly, the bill allows almost anyone to object to alcohol licence applications to ensure licensing remains squarely focused on harm reduction. Third, the bill makes licensing hearings more accessible and fairer for everybody taking part. Early next year, the Government will consider the second phase of alcohol reform, including relating to sponsorship and marketing.
Te Pāti Māori: We are going to make Ka ora ka ako universal
Labour: Healthy food makes a difference to learning in the classroom and provides the nourishment ākonga need for their development. Labour will continue Ka Ora, Ka Ako - Healthy School Lunch Programme to the end of 2024. Ensuring children who experience the greatest socioeconomic barriers to education are fed is a top priority. Ka Ora, Ka Ako has helped reduce food insecurity for children and young people since 2020, by providing daily school lunches to approximately 220,000 students at 987 schools. This programme has been estimated to save a family with two students, on average, $60 per week.
Green: The Green Party will:
- Ensure public healthcare services are timely, accessible, and meet the needs of everyone in Aotearoa – including progressively expanding the health services offered through the public system.
- Empower and resource the Te Aka Whai Ora (the Māori Health Authority) to work in an equal partnership together with the Ministry of Health and Te Whatu Ora (Health New
Zealand) to improve outcomes for whānau, hapū, iwi and hapori.
Labour: The Labour Government has delivered a nationwide health system that will ensure better outcomes for all New Zealanders with the establishment of Te Whatu Ora - Health New Zealand, and Te Aka Whai Ora - the Māori Health Authority. Our health system had become complex and fragmented - 20 different district health boards meant the healthcare you got depended on where you lived. It was a postcode lottery and a true nationwide health service changes that. This new health system is about improving access to healthcare on the basis of need for all New Zealanders, no matter who they are, their ethnicity or gender, or whether they’re urban or rural.
The reformed system has strengthened public health functions, with a public health agency in the Ministry of Health focused on public health policy, strategy and intelligence. Within Te Whatu Ora a National Public Health System joins up our public health units to minimise regional variation. Covid illustrated that infrastructure to support public health functions like contact tracing and case management were underdeveloped in small public health units. We’ve changed that and invested heavily in information systems to support vaccination and screening. The Pae Ora legislation also includes a source of independent public health advice to the Minister of Health via the Public Health Advisory Committee. This committee is chaired by Kevin Hague and is working on innovative approaches to improving food environments.
Te Aka Whai Ora - the Māori Health Authority was set up to put hauora Maōri at the centre and make health outcomes for Maōri a priority. These are by Māori for Māori solutions to ensure the groups we’ve identified as needing more support through the health system will be getting the help they need. Te Aka Whai Ora is an equal partner at the heart of the new health system. It is able to co-commission and plan services across the system with Te Whatu Ora - Health New Zealand as well as commission its own kaupapa Māori services. Iwi Māori Partnership Boards ensure whānau have a real voice in developing of services are tailored to better reflect those who need and use them. Te Aka Whai Ora is critical to driving the health system to meet its Treaty obligations, and to turning around longstanding inequities. Te Aka Whai Ora has the potential to make a profound public health impact if it is given the chance. Progress towards a more equitable health system is at risk with a change of government.
The next step in the health reforms will be a greater focus on population health and primary care, including the development of localities. Localities will be a vehicle for work with the community to address health service needs and collaborate with NGOs, providers and other agencies to act on the social determinants of health.
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