Dr George Thomson and Helen Wilson, from the department of public health, Wellington School of Medicine, University of Otago, ask why the Government is lagging on smokefree car laws.
Everyday many of our most vulnerable children travel in smoke-filled cars. They have no say in the matter, and effectively become "smokers".
So it is not surprising to find that many doctors want smokefree car laws to protect children. These groups include the Royal College of Physicians of London, and the Royal Australasian College of Physicians, which includes many doctors in New Zealand.
But closer to home, the New Zealand Medical Association prefers "discouragement" rather than a smokefree car law.
There will be big health gains, here as elsewhere, if a smokefree law means no one has to breathe secondhand smoke in cars. Smoking in a car, even with the windows down, can be worse than a smoky (pre-2004) pub. For children, being in smoky places increases the risk of Sudden Infant Death Syndrome, chest and ear infections, asthma and meningitis.
Why not just use media campaigns? Smokefree car laws help non-smokers to object to smoking around them, and move the norms about smoking when education cannot. Smokefree laws are great for children from poorer backgrounds. This is because they are the ones who are more likely to spend time around smokers, and are least likely to be protected by media campaigns.
The strong evidence of harm, and the desire to protect children, is why at least 11 states and provinces in Australia, the US and Canada ban smoking in cars. So why do some governments seem so reluctant to take a step which can make a real difference to the lives of our most vulnerable citizens?
Our recent research sheds some light on this question. Interviews with over 60 senior officials and politicians showed how they saw policy making on smokefree issues as a difficult "balancing act".
Policymakers often talked about the need for evidence. But, in fact, our study showed that evidence played only a small part, because it was weighed against a number of other powerful influences and concerns. For example, we found that many policymakers were particularly worried about smokefree policy moves because of the perceived risk of political backlash. A common theme was that people would cry "nanny state" if adults were prevented from smoking in their own cars.
No wonder, when the influential NZ Medical Association equates smokefree car legislation with the "nanny state".
Sympathy for smokers was also linked with an unwillingness to extend smokefree policy. Some policymakers felt that smokefree policies would increase hardship for smokers. Knowing that addiction and stress often made quitting particularly difficult for some people strengthened this view.
But what about children? Sympathy for smokers appears at times to outweigh other concerns, such as children's health. It also ignores the benefit of smokefree laws for smokers and their families, when laws help smokers quit.
In spite of their concern for children, we found that policymakers often forgot about children as soon as they thought about adult smokers. This ability to overlook children was captured in a public statement by Prime Minister John Key, in late 2008:
"I'm not opposed to banning smoking in bars, because other New Zealanders are there and people work there, but if you want to smoke in your own car, don't be looking for a National Government to pass a law to tell you can't do it in the next three years."
In contrast to the low priority given to smokefree cars for children, a number of policymakers in our research found their own contact with smokers annoying, particularly when walking past cafés and bus stops. These personal experiences influenced their attitudes towards smoking.
Some considered laws to improve the situation for non-smoking adults, while opposing smokefree car policies. However, other recent research would suggest that policymakers could afford to be bolder. Over 90 per cent of even smokers agree with smokefree car laws to protect children. Perhaps politicians could even gain votes by putting children first!
