The switch from smoking to vaping is helping close NZ’s big health inequalities

A Pākehā boy born in Waikato today can expect to live eight years longer than his Māori neighbour. Pacific infants face mortality rates that have barely shifted in two decades.

These grossly unfair inequalities are set out in Determining Our Future, the first comprehensive Public Health Advisory Committee report on determinants of health and equity since 1998.

The report is wide-ranging, spanning housing, income, education, obesity, diabetes, and mental health. That breadth is necessary; inequalities are complex and deeply rooted. But if we are asking where – or how – government can act immediately to make a measurable difference, one thing stands out: smoking.

Can people who smoke make truly informed choices?
Decades of research show that smoking is the single most preventable contributor to death among Māori and Pasifika. Smoking accounts for almost a third of the Māori–non-Māori life expectancy gap.

If the Government wants to close the gap quickly, smoking is the low-hanging fruit.

The good news is that smoking rates are falling faster than ever. In 2011/12, almost 29 percent of Māori adults smoked daily. By 2023/24, that had halved to 14.7 percent. For the overall population, daily smoking dropped from 16.4 percent to 6.9 percent in the same period. The pace of decline accelerated fourfold after 2018/19. That is not incremental progress. It’s a world-leading success story.

The sharp fall coincided with the rise of vaping. Trials and real-world evidence show that vaping is more effective for quitting smoking than conventional nicotine replacement therapies.

At the population level, the timing is unmistakable: daily vaping increased from under 1 percent in 2015/16 to 11 percent in 2023/24, while smoking prevalence plunged. Correlation is not causation, but the alignment is strong and consistent with international evidence.

People smoke to access nicotine but they die from the smoke not the nicotine. Although vaping is not risk-free, compared with combusted tobacco which delivers thousands of toxins at 800C it is far less harmful. For adults who smoke, vaping offers a practical off-ramp from cigarettes and a path towards being nicotine-free altogether.

The dominance of public debate about young people who vape needs perspective. Daily vaping among 14-15-year-olds (about 7000 children) is concerning, especially among non-smokers. The Government is right to act, by banning disposables, enforcing age-of-sale laws, and curbing youth-appealing products. But these measures should not undermine vaping’s role as a cessation tool for the remaining 300,000 adults who smoke.

Smoking remains concentrated among Māori, Pasifika, those living in deprived communities, people with mental health disorders, and middle-aged and older adults. These are the groups who have reduced life expectancy because of smoking. Targeted and culturally grounded cessation support for these populations offers many more years of life, as well as reduced health system costs.

The Public Health Advisory Committee is right to highlight housing and income as determinants of health. These require intergenerational solutions across government. But alongside that there are immediate steps that would lock in the smoking gains already underway:

• Keep cigarette taxes high, while ensuring less harmful nicotine products – such as vaping and heat-not-burn alternatives – remain affordable and accessible
• Support kaupapa Māori and Pacific-led cessation services, with vaping integrated
• Offer vape starter kits to all people who smoke on discharge from the hospital, with supportive follow-up
• Protect rangatahi by enforcing youth regulations – age-of-sale rules, and curbing youth-appealing products, but without undermining adult harm reduction; and
• Celebrate success – present the collapse in smoking as a national achievement, not just a statistical footnote
  

Kevin Hague, chair of the Public Health Advisory Committee, described the persistent inequalities as a “disaster for all of us”. He is right. But the data also tells a story of hope. Smoking is falling faster than anyone thought possible – ending it will close the gap faster than any other single action available to us today.

By pulling harder on this lever, the Government can deliver gains in life expectancy while continuing the long, hard work on housing, income and other social determinants. Action on smoking is a once-in-a-generation opportunity, and one we can’t afford to miss.