Dr Wodak is a physician and was the Director of the Alcohol and Drug Service, at St Vincent's Hospital, in Sydney, Australia from 1982 to 2012. He began advocating for drug law reform in 1987. Wodak is President of the Australian Drug Law Reform Foundation and was President of the International Harm Reduction Association. Wodak also helped open Australia's first needle exchange programme and Australia’s first medically supervised injecting centre in Kings Cross. In the 2010 Queen's Birthday Honours, he was made a Member of the Order of Australia for "service to medicine and public health, particularly in the area of drug and alcohol dependency treatment, through legislative reform, and to medical education". You might have seen Dr Wodak on TV1 Breakfast show this month as we spoke about the Hāpai/ ASH/Tala Pasifika Vaping policy launch which he presented at.
Tēnā tātou katoa
Ko Blue Mountains te Maunga
Ko Sydney Harbour te Awa
Ko Ngāti Hūrai (Jewish) te Iwi
Ko Helen rāua ko Eric ōku mātua.
Ko Alexander David Wodak tōku ingoa.
Nō reira, tēnā koutou, tēnā koutou, tēnā tātou katoa
In putting together this interview, I read a lot of impressive quotes and statements made about you online- particularly regarding the immense contribution you’ve made to the Australian medical and public health community. But how might your whānau describe you?
All my work has always been with others. It’s very hard, if not impossible, to make any significant contribution in public health working alone. I have a wife, 4 children and 3 grandchildren. I think my family would describe me as fairly driven. I worry greatly about the climate of the world my children will live in as they get older.
When we met last week, you shared some personal thoughts with me on the inequalities in the Australian health system for indigenous. The historical contributions to that inequality are also well documented. We are grappling with similar challenges in our country but more of us need to understand why some seem to be less well-served by our health system than others in different demographics around the country. How do you personally work to be an agent of systemic change?
In many countries the health and wellbeing of indigenous people is inferior to that of the majority population. This is especially true in the New World countries of Canada, US, New Zealand and Australia but the gap in health, social and economic status between indigenous and majority populations is far greater in Australia than in the other New World countries. This has been the case for a long time. This gap is not shrinking. About a quarter of the gap in life expectancy is due to the higher smoking rates in Aboriginal and Torres Strait Islander people. Smoking rates are declining in both indigenous and majority populations but the gap in these rates is not shrinking. Many Australians believe that New Zealand has handled many issues, including indigenous matters, much better than Australia has.
Last week, you presented to members of our government around the topic of harm reduction which is a bit of a buzz word at the moment in the smoke free sector. I liked the analogy you gave about your son and his motorbike to explain it- could you share this?
Twenty years ago my son, then in his late teens, told my wife and I that he had decided to buy a motor bike with money he had earned working in a supermarket. He anticipated (correctly) that we would strenuously object but told us that his decision was final. I spent weeks trying to change his mind but realised that nothing would change his mind. So I offered to buy and pay for all the equipment he would need, including helmet and gloves, provided that he would always wear what I bought. He agreed to this offer. So at the shop I asked the salesman to sell us the safest of everything regardless of the price.
The salesman commented that of all the many father-son combinations he had served, none had taken this approach. About a year later my son was knocked off his motor bike by a swerving car. He was wearing all the protective equipment I had bought him and escaped injury. As he got up he decided to sell his motor bike.
This was another victory in my opinion for harm reduction. As parents, we cannot stop our children from doing risky things but we must never stop trying to reduce their chance of injury. This also applies to smoking. Up to two of every three smokers will die from a tobacco related cause. Most smokers want to quit and will try to quit many times without success. Many smokers are happy to switch to vaping which is much less risky than conventional cigarettes. Smokers also find it easier to quit vaping than to quit smoking. Rich countries generally make it easy to switch but Australia has a de facto ban on vaping. All countries should adopt tobacco harm reduction. People smoke for the nicotine but die from the tar. So we should let smokers use all the nicotine they want but without the tars and smoke. That’s what vaping does.
How do you think this concept of “harm reduction” could contribute to our country’s smokefree 2025 goal, and what should we be prioritising to achieve this?
Smoking rates in recent years are falling faster than ever in countries which make it easy for smokers to switch to tobacco harm reduction options like vaping, (Swedish) snus or heated tobacco products. But smoking rates in Australia have been almost flat since 2013. The New Zealand Ministry of Health is considering how tobacco harm reduction will be regulated. It is very important, especially for Māori, that regulations for tobacco harm reduction are proportional to risk rather than resembling regulations used for cigarettes. How New Zealand regulates tobacco harm reduction is important for New Zealand but it is also important for the rest of the world. New Zealand has another opportunity to show the world better ways of doing things.