Legitimacy of stakeholder voices in tobacco control in Aotearoa New Zealand.

Abstract

Introduction: Achieving equitable and effective tobacco control policy in Aotearoa New Zealand requires an understanding of the broader policy system in which such policies are developed. This study applied a critical systems lens, using boundary critique, to explore how certain perspectives and actors become legitimised or excluded in the tobacco policy space. In Critical Systems Heuristics (CSH), a 'boundary' refers to the practical line that determines what and who are considered inside the system, such as which goals, actors and knowledge are included and what is positioned outside it. Using this lens, we examined how legitimacy is constructed and contested within the tobacco control system.

Methods: The research employed CSH to guide two sets of qualitative interviews: one with Indigenous Māori participants (n=10) and another with non-Māori participants (n=14). Thematic analysis was conducted separately for each group focusing on the four domains of CSH, knowledge, motivation, legitimacy and power followed by a comparative analysis to identify areas of overlap and divergence in perspectives. This paper focuses on the legitimacy domain as findings in this area were central to participant discussions and echoed in the other domains.

Results: Three key legitimacy boundary issues emerged from the analysis: (1) whether tobacco control policy should prioritise a tobacco-free versus addiction-free narrative; (2) the tension between biomedical and holistic health paradigms and (3) whether individual rights or collective rights should be the foundation of policy direction. These boundary issues influenced who was seen as a legitimate actor in policy development and how policy processes were shaped.

Conclusions: Understanding and navigating these boundary issues is crucial for progressing tobacco control policy that is both equitable and effective. Greater critical awareness of how perspectives are legitimised or marginalised can support more inclusive and transformative policy approaches in Aotearoa.