Drinking and smoking in the land of the long white cloud.

Abstract

Turning my back on two long chains of purple mountains, the Richmond and Arthur ranges, and walking out of the sun, the brightest in the world, into a dark, cold bar in Motueka, New Zealand, I was reminded immediately of a bar in the Maryhill Road, Glasgow. Three short, toothless, drunk men, who looked 50 but were probably 35, and who may have been working but were more likely unemployed, sat at a table covered in empty bottles and full ashtrays, pointing fingers at each other and discussing the state of Kiwi rugby. Outside might have been scenery that has travel agents reaching for the thesaurus but inside it was just like an inner-Glaswegian scene of excessive drinking, heavy smoking, and premature aging. New Zealand, Godzone as the Australians like to sarcastic? ally call it, has alcohol and smoking problems that rank alongside those of Scotland, a country notorious for such problems. About 4000 New Zealanders a year die because of their smoking (the population is just over 3m), and Maori women have one of the highest incidences of lung cancer in the world.1 (Despite this the New Zealand government is helping build a cigarette factory in Samoa.) New Zealanders drink a little more alcohol than the Scottish and have just as many alcohol-associated problems. I worked for a year in New Zealand in 1978 after having worked in Scotland: alcoholic cardiomyopathy, liver failure from alcoholic cirrhosis, and other physical complications of alcohol abuse all seemed much commoner in New Zealand than Scotland. The tuberculosis unit in which I worked contained almost exclusively Pacific Islanders, Maoris, and pakeha (Euro? pean) alcoholics, and the piano would not play in tune because it was full of empty bottles. Less subjective studies confirm that New Zealand has formidable alcohol-related problems,1 2 and alcohol seems to account for a higher percentage of road traffic accidents than in any other country in the world (W A Parkins in a paper presented to the Australia and New Zealand Associa? tion for the Advancement of Science conference, in Auckland, 1979). What is different between Scotland and New Zealand, however, is that New Zealand has been slow to take initiatives to deal with smoking and alcohol problems. This is surprising as New Zealand is not slow in most medical and social matters: it has had a free health service for as long as Britain; spends a higher percentage of its gross national product on health care; is a world leader in various medical specialties?for example, cardio thoracic surgery; and has pioneered important social welfare schemes?for example, no-fault accident compensation. Yet the Australasian Royal Medical Colleges have never produced reports on the danger of smoking and drinking; there is no equivalent of the Health Education Council or the Scottish Health Education Group; belated attempts to found a New Zealand equivalent of the British Action on Smoking and Health (ASH) have met difficulties; and although there is a statutory body for dealing with alcohol problems?the Alcoholic Liquor Advisory Council (ALAC)?its organisation makes it difficult for it to be effective. Although they have agreed that shifting health resources towards preventive measures is important, most developed countries have been slow to do so. But why should New Zealand, with its considerable problems, be even slower than most Is it because a country where the pioneers are not long in their graves is unenthusiastic about measures that interfere with a man's freedom to drink and smoke ? (Unlikely, as wearing seat belts has long been a legal requirement.) Is it because the medical profession is that bit more conservative in New Zealand and has been slow to take a lead? Is it just because everything happens more slowly in New Zealand? (Although various people suggested this almost facetiously as a reason, in fact many innovations happen faster in New Zealand than Britain? for example, the introduction of a no-fault accident compensation system.) Or is it just the long reign of right-wing politicians When I was in New Zealand recently I spent some time looking at smoking and drinking problems in New Zealand and what is and what is not being done about them.