Is the government's goal for New Zealand to be smokefree by 2025 a pipe dream? Anti-smoking groups want bold action, writes John Gerritsen.
Outside a Wellington office block, Emma Figliola is holding a cup of coffee in one hand and a cigarette in the other.
After 25 years of smoking she said cigarettes were a habit she just cannot quit.
"Obviously it would be great to knock it on the head. I think I'd save about $230 a month, however it's really hard to do that," she said.
Nearby, Chris and Claudia are smoking roll-your-own cigarettes on a bench.
Chris said he was feeling the pinch from the high price of tobacco and though he could still afford to smoke it reminded him he would like to quit. The problem for this smoker of 16 years is that he has tried to give up and it has not worked.
"Tried gum, patches, more recently vaping, nothing that's quite the same as smoking," Chris said.
Claudia said she has tried to quit too.
"Because of the cost. A bit of health issues, you know, finding it harder to breathe and getting older is up there as well."
NZ on track to miss smokefree target
Emma, Chris and Claudia are among an estimated 589,000 New Zealanders who smoke cigarettes every day - people who have stuck with their habit despite increasing prices and anti-smoking measures - and persuading them to quit will be the key to achieving the goal of Smokefree 2025.
The target was set by the National-led government in 2011, with the excise duty on cigarettes increasing by about 10 percent every year making the average price of a pack of twenty cigarettes now about $30.
The target requires the percentage of smokers in the population to drop below 5 percent.
On current trends it will not be met.
The University of Otago's Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme has calculated that under a business-as-usual approach there will be more than 300,000 smokers in 2025, well above the 120,000 needed to meet the goal.
Despite the challenges, Associate Minister of Health Jenny Salesa said the government was committed to trying to reach the goal, though she stressed it was both aspirational and difficult.
"What our scientists are telling us and those who are working in this field is that this will be very challenging," she said.
"But I can tell you this, we are going to give it our best shot. We are very aspirational. For us, it is about saving lives, doing as much as we can to achieve that goal."
Ms Salesa said the government was already moving to ban smoking in cars with children and to regulate vaping with an eye to its role as a smoking-cessation tool, but it was planning more, and it was developing an action plan.
Ms Salesa would not provide details but said further increases in the excise tax on tobacco were being considered, as was an advertising campaign and programmes that encouraged wider lifestyle changes for smokers.
More anti-smoking measures available, not being used - scientist
University of Otago Burden of Disease Epidemiology, Equity and Cost-Effectiveness director Nick Wilson said the goal could be met with a well-funded plan and there were several measures that could make a big difference.
"New Zealand has not really invested seriously in mass media campaigns, for example," Prof Wilson said.
"It could do a lot more about changing the product, getting rid of menthol, sugars and other additives.
"It could invest in looking at how to reduce the level of nicotine to make tobacco less addictive.
"It could also control the number of outlets and phase those down.
"So there's a lot that could be feasibly done that could just get us to the 2025 goal," he said.
Professor Wilson said meeting the target would save lives and money, and it was not as difficult as some of the other health and social challenges facing the government.
"It is actually probably much easier to reduce smoking than it is to reduce, say, overweight and obesity problems.
"So this is where it can make some very major gains in population health and very major savings to the health system so it seems a no-brainer to invest in tobacco control," he said.
Smokefree the new nuclear free?
Ben Youdan from Action for Smokefree 2025 (ASH) said smoking killed 5000 people a year and the government needed a renewed sense of urgency about the target.
"Every year we push out that goal, we're adding more deaths and it's going to take longer and longer before we have got the last person to die in New Zealand from smoking so I think we do need to treat this with urgency, we don't want to push it out, we want the government to be accountable for getting us to Smokefree 2025."
Mr Youdan said the government should make it harder to buy tobacco, treat vaping as a much less harmful alternative to smoking, and back a large-scale advertising campaign.
"Much in the way that New Zealand has got its proud national identity about being nuclear-free or the clean, green, New Zealand, we should be having a national identity about getting to Smokefree 2025 and one that's led from the government," Mr Youdan said.
Smoking the largest health problem facing Māori - health organisation
Māori have the highest smoking rates - 36 percent of Māori women and 29 percent of Māori men are considered to be daily smokers.
Māori health organisation Hapai te Hauora's general manager of tobacco control, Mihi Blair, said smoking was the single biggest health issue facing Māori.
She said efforts targeting Māori women need to do more than provide health advice and a quitting programme.
"We're looking at Māori women who lack education, have housing issues, unemployment issues.
"Unless these stresses are reduced we're going to find it really hard to move Māori wāhine rates down."
Ms Blair said the government also needed to reduce the availability of tobacco in poor neighbourhoods and take a liberal stance on vaping.
"We want vaping to be available for these communities. We're very focused that it's a quit tool, it's a health benefit, we don't want rangitahi to take it up so we've got to have some really important prevention measures as well."
Local councils could help by allowing vaping in locations designated smokefree so that Māori were not shamed about their use of vaping as a replacement for smoking, she said.
The smokefree target was a Māori Party idea introduced by a National-led government and National Party MP Nicky Wagner said it wanted the government to do more to achieve the goal.
She said she did not agree with further restrictions on where tobacco was sold because smokers would simply drive to where it was available. However, she said she was keen to make it easier for people to vape and she has a member's bill to that effect.
"In many cases it's been a very successful way to wean people off cigarettes.
"They might not give up the whole lot on the same day but even if they smoke half the length of time, it's good for them."