by Sione Tu’itahi, Executive Director, Health
Promotion Forum of New Zealand (HPF)
Auckland University of Technology (AUT),
August 19, 2015
“Helping people and community to be health literate is enabling and empowering people to be confident, informed and engaged in decisions that influence the determinants of their health and wellbeing,” says Sione Tu’itahi, HPF’s executive director.
Mr Tu’itahi says with this month being Health Literacy Month it is the perfect time to highlight the issue of health literacy in New Zealand.
More than 50 per cent of adult New Zealanders have poor health literacy skills according to the Ministry of Health’s report, Kōrero Mārama (2010). which sourced data from the 2006 Adult Literacy and Lifeskills Survey. Māori had poorer health literacy skills compared to non-Māori with 80 per cent of Māori males and 75 per cent of Māori females found to have poor health literacy skills.
According to The Asian Network Inc. – TANI migrants and former refugees also faced more challenges because of the language barrier, lack of understanding of the health system, and different experiences from their home countries. “Therefore, we need to support individuals and communities to give more attention to improve their health literacy level.”
Mr Tu’itahi points out that health literacy is a cornerstone of modern health promotion, especially when it is done together with building healthy public policies, creating supportive environment, community action, and reorienting health services.
“Young people in New Zealand and across the world are advocating for the health of the environment and its effect on their wellbeing because they are environmentally literate. That is the power of health literacy; people move to action when they are in the know,” he said.
HPF’s global partner the International Union for Health Promotion and Education’s Position Statement on Health Literacy: a practical vision for a health literate world calls for global action to improve health literacy in populations.
The Statement positions health literacy as an important and modifiable social determinant of health, that plays a significant role in broadly-based strategies for health promotion and emphasises the necessity of a systems approach to health literacy, underpinned by global, national, regional and local policies.
The theme for Health Literacy Month which is “Be a Health Literacy Hero”. is about taking action and finding ways to improve health communication. Health Literacy Heroes are individuals, teams, or organisations who not only identify health literacy problems but also act to solve them.
Since 1999, organisations around the world have been observing October as Health Literacy Month. It’s a time to bring attention to the importance of making health information easy to understand — and making the health care system easier to navigate.
The Waitemata DHB also celebrates health literacy month and plans to facilitate the 2nd health literacy symposium at the North Shore Hospital on October 31.
HPF’s Executive Director Sione Tu’itahi talks to Hauora about the outcomes, goals and lasting impact of the global Health Promotion Forum conference in Rotorua from April 7-11, 2019
Last April the Health Promotion Forum co-hosted the 23rd International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion in Rotorua. With a timely theme of ‘Hauora: Promoting Planetary Health and Sustainable Development for All’, more than a 1000 delegates and organisations from 73 countries participated.
H: There has been very positive feedback about the conference. Are you happy with the results, and did you achieve the outcomes you set?
ST: Yes, I am happy to say we achieved our three major outcomes, and more. The knowledge that was exchanged was very relevant, crucial and very timely for the needs of health promotion, and the world today. Health promoters and other health workers, as well as those who work in sustainable development enhanced existing networks and formed new ones. And the legacy initiatives of two legacy statements, and initiating the process for a healthy city, were also achieved.
H: Let’s talk more about those outcomes in details. What is some of the relevant knowledge shared?
ST: Among other important features, at least three major areas emerged and moved closer together, offering comprehensive knowledge and practical tools for the delegates to take home and implement on addressing the health of the planet and its peoples. These were the social determinants of health with an equity and social justice approach, planetary health and ecological determinants with an eco-social approach and an inter-generational understanding and goal for health and wellbeing, and indigenous knowledge and health promotion with a clear philosophy and practice that humans are inseparable from the ecology. On another level, the spiritual dimension of wellbeing, and spiritual health promotion also came to the fore during the conference. It was great to see these major areas of health knowledge coming together, offering a profound understanding on planetary health, and relevant, practical tools.
What was significant was that the presenters in all these areas of knowledge were complementary in their addresses, presenting a balanced, and comprehensive big picture of where the health of the planet and its peoples are at, and the comprehensive set of strategies to address those challenges at all levels.
H: What else was significant about the knowledge shared at the conference?
ST: Two other significant contents of the conference were the leading contributions of Maori research, policy, practice and leadership to Indigenous health promotion, and how pronounced climate change and ecological challenges are in our Pacific region. In fact, we decided to host the conference here in order for our New Zealand knowledge and experience to be shared with the world, and for the world to understand our greater Pacific region and its challenges, as well as our collective effort to address those challenges. For example, 20 years after introducing Te Pae Mahutonga as a health promotion model for New Zealand, Sir Mason Durie presented a new model, Matariki, at the conference for Indigenous peoples. Tuhoe Nation Leader Tamati Kruger shared the challenging but progressive and resilient journey of his tribe from the ravages of colonisation to mana motu hake/autonomy today. Delegates were in awe at such profound knowledge and courageous, moral leadership.
H: You mentioned some legacy initiatives. What are they?
ST: There were three legacy initiatives: two legacy statements, and Rotorua to become a healthy city under the WHO (World Health Organization) scheme of the same name. Led by two editorial teams, the conference delegates drafted and approved by acclamation the two statements on the final day. The first statement is the Rotorua Statement which summarises the important themes and knowledge that emerged from the conference, calling for action on those crucial areas for the health and wellbeing of the planet and its peoples. The second statement is the Waiora Indigenous Peoples Statement. It outlines the loss of Indigenous peoples under colonisation around the world, and calls for privileging indigenous knowledge as a right, and articulates how Indigenous health promotion can contribute to addressing the challenges on planetary health. On the healthy initiative, Rotorua’s mayor Steve Chadwick agreed to explore with us how Rotorua can become a ‘healthy city’ under the WHO’s scheme of the same name. Rotorua can be the model for other cities. All social, economic, cultural and ecological challenges, health included, are related, and cities are a manageable setting where these challenges can be addressed in a well-coordinated and effective way. The vision is for our cities to become healthy, liveable and sustainable.
H: So, it was not just a talkfest?
ST: No, certainly not. You can watch the videos of those keynote speakers on the IUHPE and HPF YouTube channels. Maori equity and social justice were articulated by the likes of Sir Michael Marmot and Fran Baum, indigenous health promotion was clearly embedded by the addresses by Sir Mason Durie, Tamati Kruger of Tuhoe Nation, Dame Anne Salmond, and Professor Anthony Capon. Professor Capon and Professor Trevor Hancock also highlighted planetary health, ecological determinants and the eco-social approach.
H: What lessons have you learned as a result of hosting the conference?
ST: Quite a few. One is that our nation’s founding document, Te Tiriti o Waitangi, was very effective as a framework for negotiating the terms of the conference and for co-hosting it with the International Union for Health Promotion and Education. Using Te Tiriti enables us to work as equal partners, sharing our knowledge and experience, and achieving outcomes agreed on, such as the theme of the conference where we highlight Indigenous knowledge, having Te Reo Maori as one of the four languages of the conference.
Health Promotion Forum’s Senior Health Promotion Strategist Dr Viliami Puloka presented his thoughts home grown solutions to the Pacific’s obesity problem at a recent conference in Wallis and Futuna.
Dr. Viliami PULOKA, Senior Health Promotion Strategist, New Zealand Health Promotion Forum
When Hippocrates, the father of medicine some 2,500 years ago said “Let food be thy medicine and medicine be thy food”, I can assure you he was not talking about fast food like Cheese burgers, Fizzy drinks and French fries. He was talking about fresh produce from people’s home gardens. Being the top physician of his time and a leading scientist in the field of medicine, he knew the importance of good healthy food in providing proper fuel for healthy living. Consumption of foods that are highly processed but empty of proper nutrients is one of the key drivers of the obesity and diabetes pandemic the world is facing today, including Wallis and Futuna.
The Wallis & Futuna Chronic Diseases Risk Factor Study in 2009 showed a 17% prevalence of diabetes, and an 87% prevalence of overweight and obesity among the study population. Eating fresh food, locally grown in home gardens is a very good way to prevent and control chronic diseases including diabetes and obesity.
The health benefits of growing your own food are well documented. You are in control and decide what to grow. You are not dependent on food produced by someone you do not know, whose interest is your money not your health. Growing your own garden provides opportunities for physical activity which goes hand in hand with good nutrition giving you good health. One can also enjoy fresh air and sunshine, which is good medicine for the whole person.
Wallis and Futuna are very fortunate to have such fertile soil, and many people still grow food in their own gardens. The challenge is the ever-increasing amount of readily available imported processed food that competes with traditional local cuisines.
I like to suggest that the way forward to good health through home gardening is to ‘return to nature’ and re-claim the socio-cultural and economic value of home gardening and… “Let your garden be your Health and your Health be your garden”.
“If I had the same life expectancy as a Tongan man, I’d only have one year and three months left to live.” Statistics show that life expectancy for men in Tonga is 65 years, mainly due to the rise in NCDs.
A child born in the Pacific today is more likely to die before their grandparents and parents, largely due to the Obesogenic environments. It does not matter whether we are in Samoa, Tonga Vanuatu or Wallis and Futuna our story is one and the same. A healthy baby is born, fully immunized, is well cared for and loved. We invest in their education and they get good qualification, good job and they may earn good money.
The food environment however makes it very easy for us to eat ourselves to death. Young Pacific persons develop diabetes as early as age 30 and many develops complications by age 40 requiring amputation at 50 followed by kidney failure at 55 paving the way for “early preventable death” the plight of Pacifica today.
What a loss! Financial/economic investments as well as social and cultural loss that have direct impacts on families and the country as a whole.
The presentation discusses NCD issues as related to how we look after our health as “a garden for our food security, health is for our everyday living.” Health isn’t everything, but without health, nothing else matters. Your health is the only resource we have to do life and to contribute to life. Doctors and nurses have known for many years now that health deteriorates when people don’t eat healthy food. Everyone knows that as a fact but knowledge is not enough to make us do what we know we should be doing. In the Pacific, NCDs cause up to 40% of sickness and up to 70% of deaths. Over 20% of countries’ budgets are allocated to NCD control in hospitals. Much more resources is needed for prevention and to address the many social cultural determinants outside the hospitals. Some 2500 years ago, Hippocrates said, “Let food be thy medicine and medicine be thy food”. The NCD issue is directly related to what we eat or do not eat. It is therefore important to look at the food we eat with the same respect we give to any medicine we take for any illness.
From the food we eat our body have fuel or energy to carry out daily activities. To be healthy, the energy gain from food we eat should be proportional to the energy required for daily activity.
This is the problem in the Pacific, we eat and gain way too much energy but spent too little doing minimal physical activity. We drives to the supermarket, buy processed energy rich food instead of working in our gardens.
People in the Pacific don’t walk to the hospital, because when they do decide to go, they are too sick to walk.
A 2009 study in Wallis and Futuna revealed high rates of factors causing NCDs. Not enough fruit and vegetables consumed, inadequate physical activity, high rate of high blood pressure and high rates of obesity.
Specifically regarding obesity in Wallis and Futuna, the risk factors are visible as early as age 18. In the 18-24 age group, 51% of men and37 % of women are already obese.
Many people are obese very early in life.
In Wallis and Futuna, diabetes prevalence was three times higher in 2009 than 1986. High blood pressure was twice as prevalent and obesity remained high.
If the various NCD risk factors in Wallis and Futuna and are compared with American Samoa (the Pacific NCD champions), the figures for both territories are quite similar.
With regard to food security, the issue is access to and the availability and use of food. In Wallis and Futuna, these issues do not really apply, as food is available. The problem is related to the choices local people make in terms of food. We eat what we do not grow, we grow what we do not eat.
Geoff Lawton said that all these issues can be solved by gardening. Gardening can really feed both body and mind.
When people garden, they know exactly what they are growing, unlike shop items produced in unknown places by unknown people whose interest is more in our wallets than our good health. So it is best to grow our own food. Gardening should be medically prescribed.
Uvea is a garden with a few houses dotted around it. Most homes have gardens and gardening has many benefits:
Nature is the key to health. We have a certain affinity with nature, because we are part of it and would rather look at a flowery lawn than concrete and steel. We are one with the fenua. Plants and animals must not be simply seen as useful things, but given the same respect we would expect from them.
A big challenge and real issue is the war between economic development and health. More than 60% of food consumed locally in many of the Pacific islands are imported from outside. The driving force is economic growth and often done in the expense of good health. By nature, imported food are not fresh, processed and high in sugar, salt and fat. Wallis and Futuna need healthy economy but it can only happens when people are healthy themselves to grow the economy and to enjoy the benefits it produces.
A discussion followed Dr Puloka’s presentation, comments were made by participants. Here is a summary
Pierre CAMI, nurse in Wallis
A lot has been said about preventing, but little about treating these non-communicable diseases. Too often in the Pacific, we tend to try making methods from mainland France fit our situation when they are not necessarily suited to Pacific-island cultural notions about disease.
With regard to soda, it’s 15% sweeter in the Overseas Territories than Europe. Individual preventive measures have been mentioned, but the political and traditional authorities should also be used to reduce soda consumption. It has been done in New Caledonia for alcohol. Individual initiative is not enough to win the struggle between business and health. The government and traditional authorities should do their duty and at least start a genuine discussion on these issues.
Human beings are very strange creatures. As soon as someone advises us to do something, we decide not to listen. My experience has taught me that Pacific islanders are hard to convince. We don’t like listening to reason. To overcome the problem, we need to speak to Polynesians’ hearts and win them over. Pacific people are “heart people” Speak to the hearts not the minds. “We think with our hearts and feel with our minds”
We tell people they chose to be the way they are, but how many really did have a choice? People’s choices are limited to what they can afford and can easily do. The campaign must be politically driven for healthy lifestyles and to make healthy choices, easy choices.
It is high time to start asking our political leaders and elected representatives a few tough questions. We need to startle people and ring alarm bells, as the doctor said. I’m grateful to the traditional leaders who are here, because they are the ones who need to get the ball rolling by holding village meetings.
In Wallis and Futuna, people sometimes feel that health is something to be ashamed about. The territory’s leaders must set an example. The Catholic mission should also be involved in agricultural, land and health issues. These people still wield some influence and are respected by the community.
We shouldn’t be bashful about being healthy. There’s nothing wrong with walking. It is nothing to be ashamed of.
Banning was mentioned. Smoking is prohibited in public areas. Unfortunately there are advertisements everywhere that tempt people. It’s Big Food that invented these diseases. Politicians are also to blame.
Te Kōpae Piripono is a successful whānau intervention based in Taranaki. Te Pou Tiringa and the National Centre for Lifecourse Research, University of Otago have formed a research partnership to carry out a robust evaluation of the initiative. Research team members are Dr Mihi Ratima, Aroaro Tamati, Hinerangi Korewha, Erana Hond-Flavell, Dr Will Edwards, Dr Moana Theodore, and Professor Richie Poulton. The research programme is ‘Te Kura Mai i Tawhiti’.
About Te Kōpae Piripono
Te Kōpae Piripono was established in Taranaki in 1994 in the form of an early childhood education centre, and its governance body is Te Pou Tiringa. It was recognised in 2008 by the Government as a ‘Centre of Innovation’, with the potential to be implemented in other settings.
The initiative was premised on the accepted wisdom that early connection to culture, practice and language have a long-term effect on indigenous health and well-being. The emphasis on whānau ora has been integral to Te Kōpae since its establishment, with its underlying objective to respond to the social and cultural impact of historical grievance (massive land confiscations and Taranaki wars) and the continued trauma experienced by Taranaki Māori communities trying to restore their cultural and social strength and health and wellbeing.
Te Kōpae Piripono has been able to advance its vision in a way that is consistent with the Government’s Te Whāriki early childhood curriculum framework. The core aspiration of Te Whariki is for children to grow up as competent and confident learners and communicators, healthy in mind, body, and spirit, secure in their sense of belonging. The programme’s early-childhood centre setting allowed for greater self-management and provided a more reliable source of funding that reflected the wide range of activity the initiative hoped to achieve and sustain.
Te Kōpae Piripono aims to revitalise Taranaki Māori language use and cultural practices.
The programme has also developed its own model for positive resolution of issues, called ‘Te Ara Poutama’, which may be used for both children and whānau members. Children learn to advocate for their needs, and to negotiate and find solutions themselves. The process helps isolate the issue from the person, enables constructive dialogue, and fosters trust and confidence to positively resolve issues.
Longitudinal research shows that influences in early life matter greatly in terms of how a person fares later in life across a wide range of domains. It has been demonstrated that high quality early life interventions represent one of the best ‘investments’ a society can make to ensure an optimal start to life – one which will net significant returns over time via long-term benefits for individuals, whānau and society. There is huge potential for intervention in the early years to lead to substantial health gains later in life across a broad range of health issues that disproportionately impact Māori. These include health outcomes related to non-communicable diseases such as diabetes, coronary heart disease, stroke and also mental health issues and disability. While there is clear evidence around early years interventions leading to improved outcomes, what is largely missing are proven interventions that address ethnic inequalities, are effective for Māori and achieve sustainable positive health outcomes across the life-course. The aim of the Te Kura Mai i Tawhiti research is to contribute to generating an evidence base around what constitutes effective early life kaupapa Māori programming for tamariki and whānau that will lead to improved health outcomes later in life for tamariki.
Te Kura Mai i Tawhiti – research programme
Figure 1: Te Kura Mai i Tawhiti Research Programme
A feasibility or Proof of Principle study is under way in 2016 to firstly demonstrate the ability of the team’s research methods to determine change over time in tamariki and whānau on key constructs of interest (e.g. tuakiri, whānauranga, self-control). The Proof of Principle study will focus on whether, over the course of a year, an individual changes over time, taking into account developmental changes.
Findings from the Proof of Principle study will be used to design two future studies. Firstly, a 10-year prospective project to compare same age cohort tamariki in Te Kōpae Piripono, with at least two comparison early years programmes selected from Taranaki or similar regions. This involves conducting a longitudinal study to compare groups across key child behavioural and whānau development measures (i.e. the measures used in the Proof of Principle study). In addition to the prospective study, a retrospective (historic) study will be undertaken (Figure 1 – as a part of Tangi ana te Kawekaweā). This will focus on previous graduates and whānau of Te Kōpae Piripono from the past 20 years (n>150 whanau) with an emphasis on graduate outcomes in health, education, Te Ao Māori and other determinants areas that may have been influenced by the kaupapa Māori child and whānau programming.
If the research generates robust evidence of the success of the Te Kōpae Piripono model, there is potential for the overall approach and/or key elements of the intervention to be scaled up for implementation in other settings (e.g. other ECE and Māori medium) to complement broader approaches to addressing determinants of health and education and in other domains. The research is currently supported by the Health Research Council of New Zealand, the Ministry of Education, the New Zealand Council for Educational Research and the University of Otago.
Zoe Aroha Martin-Hawke is National Manager – Te Ara Ha Ora: Māori Tobacco Control Leadership service at Hapai Te Hauora. Jo Lawrence-King finds out about her work and how it exemplifies the principles of health promotion.
Tupeka kore (tobacco free)
Hapai te Hauora has initiated a number of successful health promotion programmes, not least of which focusses on reclaiming a tupeka kore (tobacco free) Māori identify.
According to Zoe the organisation “strongly promotes a working model that focuses on empowering Māori communities to have a voice on tobacco harm, and to create environments that prevent future harm from a product that leaves our communities ill and dying. “
Hapai te Hauora promotes and provides practical examples on how to provide a platform for Māori communities locally, regionally and nationally to take action. The team also works alongside other local, regional and national organisations who are also showing leadership in these areas.
“We are dedicated to ensuring Māori are strongly represented in local, regional and national policy development opportunities,” explains Zoe. “Iwi prior to European contact were tupeka kore. Māori leading and participating in the development of healthy and culturally affirming public policy, which contributes to reclaiming this identity, is one of our key health promotion strategies.“
By having iwi, hapū and whānau leading change, the Hapai Te Hauora team believe it will see more of a positive impact on intergeneration health outcomes. This, they feel, will contribute more effectively to a sustainably equitable, healthy future for all.
All activities of the initiative have involved a process of evaluating outcomes based on empowering whānau and Māori communities to control their own wellbeing and to influence New Zealand society to ensure that their determinants of health are addressed. More recently Hapai have supported the development of a Rangatahi Māori Tupeka Kore Consumer action group. The group consists of young Māori wahine who currently smoke, but are on a mission to prevent other young Māori from taking the habit up. Their work is focused on changing how the product is sold in their local area. The wahine are informing their local community about rules and regulations regarding the sale of cigarettes and are encouraging communities to monitor local dairies to ensure they are not selling single cigarettes or to people who are under age. They are also to working with merchants; encouraging them to take a stand by becoming smokefree retailers.
Within this work Hapai also provides support for personal health by linking action group members to smoking cessation treatment services; providing them with the expertise they need to successfully stop smoking. Hapai/Te Ara Hā Ora often works to find ways to seamlessly link people with services, whilst also promoting the message that none of us is independent of our physical environment and that change needs to happen at all levels.
Hapai measures both short and long-term olicies, increased numbers of Tupeka Kore hapū, iwi and whānau and reduced rates of smoking initiation. The growing engagement of Māori in tupeka kore work is also an indicator of the success of this initiative.
The quality of the engagement is also measured, including such things as: transparency of the process; relevant, timely, fitting delivery of information and the degree to which the engagement is inclusive and culturally appropriate.
About Zoe Aroa Martin-Hawke
Zoe is a member of HPF’s board. Her broad background includes
Zoe has also been heavily involved in workforce development opportunities and NZQA training programmes. Her focus has been on increasing knowledge and delivery of best practice health promotion initiatives; with an emphasis on engaging Māori in policy development at a local, regional and national level.
About Hapai te Hauora
Hāpai Te Hauora invests in community and whanau wellbeing locally, regionally and nationally. Since 1996 the organisation has supported communities to have a voice on issues that affect them and their whanau so that whole communities can be well. It also provides infrastructural support to the hauora sector to strengthen public health action.
Hapai does this through innovative research, workforce development, public health planning, information technology solutions and policy development. Along with its subcontractors or whanau whanui, the team also delivers on public health issues including tobacco control, problem gambling, alcohol and other drug harm minimisation, wellchild, nutrition and physical activity.
Health Promotion: Enlightenment, engagement and empowerment
View the powerpoint presentations from a workshop with Professor Sir Mason Durie on 17 September 2009.-
Power point presentations
Part 1 discusses the progress to date and looks to the future for Māori health
Part 2 focusses on the key role of whānau in Māori health.
Plunket’s Asian strategy is expected to be implemented in July 2015. The strategy addresses all levels of the organisation, including the staff, volunteer groups and Plunket Line; aiming to increase customers’ access to-, use of-, and satisfaction with Plunket’s services.
Plunket is developing culturally appropriate professional services, and encouraging ongoing feedback from service users about their work. They will set and update yearly goals; ensuring the inclusion of the Asian service-user’s voice in their business planning and strategies.
The new strategy follows extensive research commissioned by Plunket in 2013. Conducted among their service users, staff and stakeholders; the research investigated Asian mothers’ experience of access to health care. It included interviews, consultations and focus groups held with Chinese, Korean and Burmese mothers as well as members of The Asian Network Incorporated (TANI), and Plunket’s internal staff. The results indicated that Asian mothers were not proactively seeking help, despite the superficial appearance that access to the services was good. At the time only 4% of the Plunket staff were of Asian ethnicity, while 15% of babies among the service users were of Asian descent. Mothers spoke of access barriers to service, including language barriers and lack of understanding of available services.
It found that Asian mothers mainly accessed Plunket information via the internet and from their GP and concluded that it was important to provide more information about the culturally appropriate services available from Plunket.
For more information, please contact Vivian Cheung on 021 246 3398 firstname.lastname@example.org
ActiveAsian aims to improve access to physical activity information and opportunities for Chinese children and their parents on Auckland’s North Shore. To date it has included events such as a Chinese Sport Forum volunteering programme for Asian youth in the community, tramping, bike training, and leadership development through sports.
The project also offers an Asian community engagement model and toolkit and a wealth of resources and contacts for the Asian (Chinese and Korean in particular) communities.
ActivAsian was established by Harbour Sports in 2009 in response to the need to focus on the health needs of the growing Asian population on Auckland’s North Shore. It was the result of extensive research and ground work with the Asian community in the years preceding its initiation. Sprouting from this ground work included several important decisions and documents.
Contact ActivAsian’s project coordinator Jenny Lim email@example.com and DDI: 09 415 4654 for more information.
John Wong, the Chair of Chinese Positive Ageing Charitable Trust (CPA), talked to the Eldernet Gazette in July 2014 about what ageing in New Zealand means to elderly Chinese, and about the services provided by CPA.
Formed by a group of volunteers, CPA aims to promote quality of life for the Chinese elderly residing in New Zealand. John Wong explains the considerations that an older Chinese person might take into account when considering aged care. He also gives examples of culturally appropriate services that might be useful for aged care services when providing care to the Chinese elderly.
A pilot sexual health training programme for Asian youth workers in 2012 provided invaluable insight into the best ways to reach Chinese youth with important sexual health messages.
Concerned by the high rate of pregnancy terminations occurring in the young Asian women of their community, The Chinese Women’s Wellness Community Group devised a sexual health training programme that provided culturally appropriate ways of reaching them with health information.
Fifteen to 20 volunteer youth trainers attended a one-day training session with experts from the Family Planning Association (FPA), Primary Health Organizations (PHOs) and sexual health providers. The Group also provided ongoing support and mentoring to the volunteers.
As well as training youth workers, the Group developed resource packs for distribution to citizens’ advice bureaux (CABs) and local high schools across Papakura, Manukau, Auckland City and Waitakere.
It is estimated that the volunteers went on to directly reached an estimated 200 young Asian women with their newfound skills and information, while the printed resource packs reached countless more.
In a recent Health and Social Needs report prepared by Litmus Ltd for the Ministry of Health the Chatham Island community was described as having a strong sense of whānau connection, resilience and nurturing (Smith et al, 2013). Our Deputy Executive Director, Trevor Simpson recently had the opportunity to witness these strengths for himself, when he visited Chatham Island in late March to present a series of workshops.
Some great work being done by the Ha o Te Ora o Wharekauri Trust- Māori Community Services (MCS) on Chatham Island is a great example of a “wrap-around” health promotion service in action within a small community. It was encouraging to see the important role played by health promotion in an integrated approach to health and wellbeing on the Island.
Established to improve the health status of Māori, MCS’ three areas of focus are:
The Whānau Ora – Māori Community Health Service is underpinned by the notion of Hauora Wananga (health and wellbeing development from a Māori perspective and world view). It works within and across a range of activities, including:
The service draws on the four mainstay philosophical aspects of Te Whare Tapa Whā and utilises whānau health plans and face to face sessions to both identify whānau needs and to develop effective strategies for them.
The scope of the Whānau Ora Mobile Service is vast. Two full time kaiawhina; one a community health worker, the other an enrolled nurse; work to improve prevention and self-care by empowering whānau to both manage their own health and develop health literacy.
Delivered across multiple settings including schools, kohanga reo, marae and provider clinics, the service provides:
The Community Health Promotion work form the basis of cross generational knowledge sharing and interaction where kaumātua and rangatahi work together, sharing energy, resources and time. The main focus is on increasing physical activity and healthy eating.
A 24/7 fully equipped gym, together with a qualified personal trainer, are available to all members of the community for a nominal $50 annual membership fee. Classes offered at the gym include yoga, circuit training and line dancing.
Healthy eating is encouraged through:
The Service also offers a programme of social activities aimed at reducing the burden of isolation and increasing connectedness within the community.
Underpinning all these services is a free GP clinic and pharmacy based at the hospital and 24/7 for emergency service.
The approach to wide cross-community involvement is evident in all areas of work. The service’s flexibility also makes it possible to include other social and health projects as they emerge.
Barby Joyce, manager of the Māori Community Centre says that, despite the vast array of existing services in place, the service will continue to “branch out” and take on board some of the innovative ideas of the local young people who she says “have much to offer to the community and to the development of the service.”
Although infectiously positive, Barby was honest in her appraisal of outstanding issues that need to be addressed. Housing standards, mental health, alcohol and drugs and family violence were still a concern: “The service is working hard to find effective solutions to these issues,” she said.
Judging by the great work being done in this small community, there is a good chance solutions will be found: this service has shown itself to possess patience and perseverance; focusing on creating a strong, adaptive and healthy community.
Established in 2003, Ha o Te Ora o Wharekauri Trust- Māori Community Services are contracted to and funded by the Hawke’s Bay DHB and also Te Puni Kokiri to deliver services to all the residents of the Chatham Islands.
Although available to the wider community, the service has been tasked with targeting and making inroads into the Māori and Moriori populations. In the 2006 census 64.2% of the total population of the Island identified themselves as belonging to the Māori ethnic group. However the all-encompassing approach to the work means that all community members are valued and seen as important. On observation this has created a positive and warm environment and increasingly a place for many in the community to gravitate to.
With an underpinning philosophical approach of nurturance and a deep affection for the people and the land, Te Ha o Te Ora will remain a vital support mechanism for the Chatham Islands and all who live there.
Trevor’s workshops were held at Te Ha o Te Ora o Wharekauri Trust Centre in the small western settlement of Waitangi. Supported by staff of the Māori Community Service, these workshops provided a first time opportunity for a member of HPF to contribute in a small way to the workforce development needs of this isolated South Pacific Island. Along with MCS staff, a number of participants from various service providers together with individual community members attended.
Smith, L., Duckworth, S (2013) Wharekauri, Rekohu, Chatham Islands Health and Social Needs Report. Ministry of Health and Litmus Ltd 2013.
By Trevor Simpson
Edited by Jo Lawrence-King
An article published in the 20 November edition of NZ Doctor suggests the Government may be considering funding a community based health promotion programme in Aotearoa New Zealand.
Follow a visit to the “Healthy Together Victoria” obesity prevention programme in Australia, Health Minister Tony Ryall has acknowledged the value of implementing preventative health at a community, grass roots level here. “This actually works,” says Ryall; “and if it can work in Australia, it can work in New Zealand.”
The programme’s success is attributed to an approach that values contribution and buy in from the local community, leaders and groups. “Healthy Together Victoria” uses local councils to coordinate a team of health promoters, who work with local community groups. “It’s being evaluated, it works and it’s based on evidence,” says Ryall, who told NZ Doctor his officials have been looking at the Victorial model for several months.
The Victorian State Government provides communities with four or five year contracts. Ryall believes the contract length is fundamental: allowing capacity-building at the local level.
The Minister stopped short of committing to the programme, but said “… I’m sure we could afford to do something.”
Article adapted from NZ Doctor article by Karen Hicks
Edited by Jo Lawrence King
Published: 2 December 2013
Photo: Crown copyright
Why are the raids of Ruātoki in Uruwera a health promotion issue? What can our profession do to help all those involved, as well as prevent such traumatic effects in the future? Hauora editor Jo Lawrence-King investigates.
In October of this year, the unlawful Uruwera raids of the small community of Ruātoki were once again brought into the public eye. An episode of TV One’s Marae Investigates, marked the sixth anniversary of the event and the feature was followed a few days later by a speech in Parliament by Te Ururoa Flavell MP.
Why is this distressing chapter in our recent history a health promotion issue? And how might we, as health promoters help address it? Answering the first question is relatively straightforward: we need only go back to the determinants of health and the four essential ingredients to Māori of hauora (wellbeing). The second is perhaps a more complex conundrum, but Deputy Executive Director of HPF Trevor Simpson has some ideas.
Let’s look at why Operation Eight is an issue for health promoters. Firstly we need to look at the Māori concept of hauora. Professor Sir Mason Durie describes the four crucial factors of hauora as the four walls of a whare:
For the whānau of Ruātoki all four of these factors were taken from them on 15 October 2007. Indeed, in an interview on TV One’s Marae Investigates, highly respected paediatrician Professor Innes Asher* referred to the incident’s effect on the children of the community as “one of the worst cases of child abuse by state authority figures in modern time.”
It is reported that people were detained at five properties in Ruātoki by armed police, dressed in combat gear wearing masks and carrying guns. They were denied food and drink for up to nine hours. They even had to ask to use a toilet. Other children were taken from their parents or grandparents and held in prison, while their caregivers were arrested. “They would have been terrified,” says Professor Asher. A road block by similarly clad and armed police intimidated the occupants of cars passing into and out of Ruātoki. According to one report the officers even came onto a school bus; frightening the children on board. The people caught up in this operation – which was later found to have been unlawful – described their experience as terrifying.
For most of the people caught up in the raids, three of the four factors of hauora may well elude them to this day; those of taha hinengaro (mental and emotional wellbeing) taha whanau (social wellbeing) and taha wairua; (spiritual wellbeing). Six years on, the trauma suffered by these people (and particularly their tamariki and mokopuna) has had little acknowledgement; apology or attempt at helping those affected. “They have been abandoned by the state that abused them,” states Professor Asher. The raids continue to have a terrible effect on the people of the community.
As well as the four principles of hauora, we can look at the fundamental conditions of health as defined by the Ottawa Charter for Health Promotion (World Health Organisation, 2013) and how they are impacted by this event. They are:
Again, it’s clear to see that the people of Ruātoki were denied a number of these fundamental conditions on 15 October 2007, by some of the very people whose role it is to protect them. It can be argued that those traumatised by the events of that day may still not feel they have peace. They almost certainly do not feel they have social justice and equity.
In a speech to parliament on Wednesday 23 October, Te Ururoa Flavell called for action to acknowledge the events of six years ago. “I do not understand how we can receive that sort of information and we can hear the horrific experiences our State forced upon children and not feel motivated to change or to act,” he said. “This is beyond party politics. It is beyond bureaucracy. This is about our children.”
In a later statement Flavell deplored the “ridiculous delays” by the Human Rights Commission in releasing their report on the incident: “… are the human rights of Tuhoe people not important to the Commission? Is the Commission hoping the issue will just go away? The only other explanation would seem to be serious incompetence by the Commission, or political concerns about releasing an embarrassing report.”
According to HPF’s Deputy Executive Director Trevor Simpson (himself Tūhoe) there is a lot health promoters can do; both to help address the raids’ effects on the community, and to prevent such effects in the future. The work falls into three categories;
To address the effects of the raids on the people of Ruātoki, Trevor suggests the community might:
Perhaps even more significantly, Trevor believes health promotion has a key role in preventing such devastating effects on wellbeing in the future. “We must use the experience gained in Ruātoki to inform policies and actions; to equip communities with better information and empowerment and to seek support and measures to redress the harm caused,” he says.
He suggests health promoters might work alongside the authorities concerned to help them identify appropriate ways of redressing the injustices. “If we can help them see the effects their actions have had, we might be able to help them identify the best ways to address them.”
And in the future Trevor envisages a time when all authorities – indeed all organisations – are required to conduct health impact assessments on their proposed initiatives; this will help to mitigate the devastating effects of bad policy imposed on both individuals and communities. Without this measure we will continue to run the risk of potentially harming people.
The Operation Eight story illustrates the breadth of our responsibility in health promotion. Hauora is affected by a huge array of factors. Freedom to live without fear is one of the most fundamental of these. The experience of the people of Ruātoki – and particularly their tamariki – serves as a reminder of the work that still needs to be done to achieve hauora for all citizens of Aotearoa New Zealand.
The Health Promotion Forum of New Zealand (HPF) – Runanga Whakapiki Ake i te Hauora o Aotearoa – is the industry leader in health promotion. It is founded on the principles of Te Tiriti o Waitangi, and the Ottawa Charter for Health Promotion.
*Professor Asher is head of the department of paediatrics at Auckland University
He Mara Kai (the food garden) is an initiative focusing on good nutrition and physical activity by supporting Kohanga Reo (Māori speaking early childhood centres) to grow vegetables. It was originally created as part of the Labour Government’s Healthy Eating, Healthy Action (HEHA) initiative 2004-2010.
Theresa Wharekura, then Manager Te Kupenga Hauora, paints a picture of the initiative, its origins and its plans for the future.