“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.
Gardening and Health: Let your garden be your health and your health be your gardenDr. Viliami PULOKA, Senior Health Promotion Strategist, New Zealand Health Promotion Forum Abstract 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:
- Stress relief – A study in the Netherlands indicated that gardening is better at relieving stress than other relaxing leisure activities.
- Brain health – A study that followed people in their 60s and 70s for up to 16 years found that those who gardened regularly had a 36% lower risk of dementia than non-gardeners
- Nutrition – Studies have shown that gardeners eat more fruits and vegetables than other people. The freshest food you can eat is the food you grow,
- Healing – Interacting with nature also helps our bodies heal. A landmark study by Roger S. ULRICH, published in the April 27, 1984, issue of Science magazine, found strong evidence that nature helps heal.
- Immunity – In 2007, University of Colorado neuroscientist Christopher LOWRY, then working at Bristol University in England, made a startling discovery. He found that certain strains of harmless soil-borne Mycobacterium vaccae sharply stimulated the human immune system. It’s quite likely that exposure to soil bacteria plays an important role in developing a strong immune system .[m1] [VP2]
- It actively promotes the use of Taranaki mita (regional language variation), tikanga (cultural practice) and taonga (oral and cultural resources).
- There is critical awareness among leaders of the importance of whānau participation beyond the walls of the centre in the revival of language.
- The initiative maintains a firm stance on active language use and acquisition and has a rigorous whānau selection and induction process.
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 ProgrammeA 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.
- Māori medium early childhood education,
- Business and community partnership roles,
- Managing strategic community engagement and bottom-up leadership movements for health issues such as problem gambling, nutrition and physical activity, tobacco control; alcohol and other drugs.
- Whānau Ora- Māori Community Health Service
- Whānau Ora Mobile Service
- Community Health Promotion
- general health
- education and promotion
- advisory services
- liaison and coordination.
- health education,
- health assessments,
- children under 5 checks
- smokefree cessation and other smokefree activities
- health and social service referrals
- a transport service
- breastfeeding advice
- family violence, alcohol, drugs and problem gambling services.
- Encouraging personal management of diet and nutrition
- community gardening
- a fruit tree planting programme
- education on preserving kai
- a traditional kai gathering programme
- a Rongoa project
- smoking cessation services
- an after school programme.
Operation Eight as a health promotion issueLet’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:
- taha tinana; physical wellbeing
- taha hinengaro; mental and emotional wellbeing
- taha whanau; social wellbeing
- taha wairua; spiritual wellbeing.
- a stable eco-system
- sustainable resources
- social justice and equity.
The role of health promotionAccording 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 speak out about the impact of such injustices on the health of a people;
- to support those who are working to address them and
- to help build a society that has no tolerance for such abuses upon any community.
- Employ Māori health promoters to work in the community to regain self-determination, hauora and a revitalised sense of community.
- Use the health promoting schools framework in the local schools to empower students and their whānau to seek the conditions they need for hauora.
- Have health promoters help with health providers and other services to engage with the residents of the community in a culturally appropriate way to address their trauma.