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In the third of a three-part online only feature on health in 2025, Dionne Christian looks at risk factors for chronic illnesses. Tuesday: Infectious illnesses we’ll continue to read more about as the year progresses; Yesterday: Climate change, and mental health.
The risk factors for non-communicable diseases (NCDs) are well-known because they tend to feature in every health campaign: Poor diet, physical inactivity, tobacco smoking and alcohol consumption.
We’re often told it’s up to us as individuals to make changes and lower our risk of developing any of these, but while we are all individuals, we’re individuals within communities and societies. It means social factors, often influenced by commercial forces and government policy, can play a role in who succumbs to these conditions.
Professor Chris Bullen, a public health specialist whose main research expertise lies in tobacco control, says this year we’ll hear more about tobacco control because 2025 has been flagged as the year New Zealand becomes “smokefree” - with just 5% still smoking across all population groups.
Bullen is diplomatic when choosing his words about the current government’s stance on tobacco control, which stymied a ban on cigarette sales to anyone born after January 1, 2009, the removal of nicotine from cigarettes and drastically reducing the number of retail outlets.
“The government seems to be taking a perhaps more ‘industry friendly’ approach than the previous government with a very individual approach to tobacco control which leaves it up to individuals to seek treatment for tobacco dependence,” he says. “It is trying to make treatment more widely available and affordable and accessible to populations where smoking prevalence remains high.”
While Bullen acknowledges that’s a good thing, he says it only works as part of a wider range of smoking-cessation strategies and while New Zealand has done well in coming close to having just 5% of the population smoking, it’s still not fast enough to prevent “thousands of future deaths.”
“More needs to be done. We can’t just rest on our laurels.”
Then there’s the issue of vapes and vaping, something Bullen describes as a mixed bag. Vaping might have worked to help some smokers to quit tobacco; unfortunately, though, regulations on its marketing and access were too little and came too late to restrict availability to non-smokers, many of them younger people, he says.
“So, now we have lots and lots of younger people who have never smoked but took up vaping. We’re now trying to mop that up with support for people to quit vaping. There’s very little evidence about what works…”
Some good news, though, from a recent Public Health Communication Centre briefing, that youth vaping rates in New Zealand have declined slightly. However, prevalence remains high, particularly among Māori and Pasifika students, and exceeds rates in Canada, the US and England.
Penalties for selling vapes to minors have increased and from June 17, the sale of disposable vapes will be banned.
There is growing evidence for more warnings about the health risks of alcohol, something we’re also likely to hear more about as the year continues.
In January, the US Surgeon General released an advisory detailing scientific evidence for the causal link between alcohol consumption and increased risk for at least seven different types of cancer: Breast (in women), colorectum, oesophagus, voice box, liver, mouth and throat.
“People generally sit up and take notice when the US Surgeon General comes out with such a definitive statement,” says Bullen. “We need to do more with warnings on alcohol and alcohol marketing, but successive governments have not made the tough calls to get tougher on alcohol marketing.
“The alcohol industry has been very strong at pushing back against restrictions. If you’re looking for any health warning labelling on alcohol, you have to squint hard to see a pregnant woman and any comment about alcohol being harmful during pregnancy. It took years to get those warnings, but with alcohol, I believe we need to head in the same direction as we have with tobacco control.”
Along with (not) smoking and drinking, what we eat is a major influence on non-communicable diseases. Already, our new cut-price school lunch programme has made headlines, with continued questions asked about the quality and nutrition benefits to young New Zealanders.
You can read more about it in No free lunch: The unpalatable politics of the school lunch programme.
The food system is fundamentally based on an economic model, says professor of population nutrition and global health at the University of Auckland’s School of Population Health Boyd Swinburn.
“We’ve designed the food system without intrinsically including environmental, social and health outcomes in it,” says Swinburn. “All systems can work perfectly as designed so this one creates a lot of livelihoods and profits and exports but doesn’t self-correct or take account of all these other negative issues that it creates.”
Swinburn says there’s no easy fix for many of these problems, but governments – local and central – have the power to use regulatory levers.
“We’re doing some work in Auckland looking at food systems at a local level and have found, in terms of healthy food environments, that there’s nothing in the unitary plan that makes allowances for urban agriculture or community gardens,” he says.
“If you look at local alcohol policies, it’s taken about 10 years to get a law change through because the supermarkets and the liquor industry objected and took it to the Supreme Court,” he says.
“We’re hearing the government say it wants communities to have more local control, but there’s legislation going in over the top of that which seems to do the opposite. They actually have no say in how healthy their communities are.”
