E‐cigarette policies in Aotearoa (New Zealand): An Indigenous perspective

Similar to commercial tobacco, e-cigarettes are likely to disproportionately affect Indigenous peoples in countries with colonial histories. This is partly due to exploitation by e-cigarette industries and a dominance of Western perspectives about what tobacco harm is. There is a need for greater inclusion of Indigenous voices in e-cigarette policy development. Berridge et al. [1] provide insights into how e-cigarette policies have evolved in England, Australia and the United States. Australia and Aotearoa (New Zealand) share similar colonial histories, geographical proximity and close political ties. However, the e-cigarette policy environment in Aotearoa has evolved very differently to Australia. In 2018, the government of Aotearoa lost a legal case against Philip Morris's sale of IQOS products [2]. This led to a relatively deregulated e-cigarette and heat-not-burn market that has only been partially reined in with legislation. Particular concern has been raised in Aotearoa over the development and marketing of e-cigarettes that specifically appeal to younger people [3]. The result has been a rapid increase in vaping over the past 5 years with 9.7% of the population of Aotearoa vaping daily in 2023 [4]. Daily vaping rates among Māori (the Indigenous peoples of Aotearoa) are almost three times higher than people of European decent (Māori: 23.5%; European: 8.3%). Similar trends are observed among Year 10 students with 10% vaping daily overall, but of these 22.3% of Māori youth use e-cigarettes daily compared to 7.5% of European descent students [5]. E-cigarette use far exceeds smoking (daily smoking Māori: 2.9%; European: 0.7%) in this age group suggesting a substantial proportion of students in Aotearoa who use e-cigarettes have never smoked. Berridge et al. [1] highlight policy tensions between providing less harmful alternatives for people who smoke while protecting young people and people who have never smoked from becoming addicted to nicotine. An emerging area of concern is seen as the appropriation of the term 'harm reduction' [6] by the e-cigarette industry. Cohen [6] comments e-cigarette companies (often owned by big tobacco) have been promoting their products as tobacco harm reduction tools while simultaneously marketing them as lifestyle accessories. Cohen [6] notes that an important distinction between how 'harm reduction' is advocated in public health compared to the e-cigarette industry is that the former's goal is health and wellbeing while for the latter it is profit. This profit model is exploitative because it is built upon the highly addictive properties of nicotine and regardless of whether people smoke, vape as an alternative to smoking or vape as a recreational activity, the industry stands to make money. Mayer [7] notes that exploitation is harmful because, in the case of those who use e-cigarettes, the benefit's they receive (e.g. alleviation of nicotine withdrawal) is disproportionate compared to the benefits accrued by the e-cigarette industry (often substantial profits). For Māori and other Indigenous peoples exploitation does not stop at being a consumer market, it has also involved attempts by the industry to recruit them as allies to promote their products and influence policy [8-10]. 'Harm reduction' in the context of tobacco control is usually confined to biomedical interpretations that focus on impacts of smoked tobacco on the physical health of people who smoke. These impacts are undoubtedly catastrophic and compared to e-cigarettes physical harm may be of much greater magnitude [11]. However, the interpretation of harm reduction within tobacco control is inconsistent with other fields [12] where a broader definition of harm is often adopted, such as including social and legal harms. For Māori, the concept of tobacco harm goes much deeper than physical health. Māori were an addiction free culture prior to European colonisation [13]. Tobacco was introduced by Europeans as an article of trade. As a result, high rates of nicotine addiction among Māori are intimately connected with coloniality and in addition to other harms represent an ongoing reminder of colonisation as well as a physical barrier to self-determination. Māori have raised their concerns about e-cigarette related harm based on more holistic interpretations grounded in Māori worldviews [14]. However, these concerns have not been acted upon in government policies and vaping rates remain high for Māori. This is despite high rates of use among Māori, Māori making up 17% of Aotearoa's population and a Treaty signed in 1840 obligating government to protect the interests of Māori. The new Aotearoa government that came into power in 2023 has already repealed what was world leading commercial tobacco endgame legislation. It has also signalled that it is committed to tobacco harm reduction [15], but in a flavour that seems to favour the e-cigarette and the wider alternative nicotine device industry. In their paper Berridge et al. [1] note that the 'intersection' of evidence and values in each country has resulted in very different policy approaches to e-cigarettes. Each of the countries included in their study have actively colonised Indigenous nations. The degree that Indigenous peoples voices are heard in the development of e-cigarette policies reflect the value governments place on Indigenous perspectives. At present e-cigarette policies reflect Western values and interests, suggesting there is some way to go before these policies meet the needs of Indigenous peoples. Andrew Waa: Conceptualization (lead); writing — original draft (lead); writing — review and editing (lead). Open access publishing facilitated by University of Otago, as part of the Wiley - University of Otago agreement via the Council of Australian University Librarians. None. Data sharing not applicable - no new data generated.