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Health Promotion Forum of New Zealand Runanga Whakapiki Ake i te Hauora o Aotearoa
Experts, News, Pacific

Without a doubt, a stand out figure from the global health, health promotion and public health sectors is Colin Tukuitonga.  Speaking from Noumea, Colin shared some thoughts with us on his current work as Director-General of The Pacific Community (SPC).

 

Thank you for your time this afternoon Colin. Firstly, what proportion of SPC work would you identify as health promotion?

Given the broad scope of my organisation’s mandate in food security, fisheries management & education, agriculture, public health, human rights and geoscience, this is difficult to answer however all of these things at one level or another are health promoting in their outcomes. We have a separate public health programme that has a large health promotion component and we work in 26 countries.

 

What are the biggest public health issues in the Pacific nations?

Most definitely non-communicable diseases (NCDs). Obesity affects three out of every four adults. We also have the increasing issue of childhood obesity. All islands were part of developing the Pacific NCD roadmap with specific recommended actions. One of these was to introduce a tax on sugary drinks. Another was an increase in tax on tobacco.  The Pacific NCD roadmap is essentially a blueprint for the islands to follow. Some are active on this. Others less so. However, we expect all islands to implement a sugary drink tax.

Communicable diseases can affect some islands for example tuberculosis in Papua New Guinea.

 

What do you see  as the role of health promotion in addressing these issues?

Without a doubt this (taking a health promotion approach) is where we need to be overall but resourcing places constraints on this. Many islands are doing their best to help but again, more often than not, hospital and treatment services take up the lion’s share of funding. We do what we can at SPC to encourage island nations to invest in core public health functions but it is challenging.

 

You have signalled SPC’s strong support for the 2019 World IUHPE conference to be held in NZ. What do you see as SPC’s role at the conference?

We have three roles. Firstly, general support for the hui. It is just fantastic that we get to have this event in this part of the world. Secondly, we are planning to provide some financial support. Thirdly, and most importantly, our role is to facilitate an opportunity at this global event for small islands to  share concerns and then work together, to take strength and to think about a way forward as an organisation of small islands. That is what we would hope to achieve.

 

Climate change is a major issue facing the peoples of the Pacific. What actions do you think are necessary to address this global environmental issue?

We made significant gains with the Paris Agreement, the United Nations Framework Convention on Climate Change.  Now with United States of America withdrawing from that, it may take us back to before the agreement so trying to maintain momentum is really difficult. We need political support from many to honour the Paris Agreement. Without this we will be going backwards. Pacific nations have put a lot of energy into the agreement particularly the recommendations to limit emissions and enable funds for good work. Right now we are at risk of inertia with the US not agreeing to continue.

 

How do you see public health and health promotion developing over the years?

Well when I started people talked about more traditional quarantine measures, or the role of legislation to regulate behaviours or control diseases. We’ve come a long way since then. The watershed moment for me was the emergence of the Ottawa Charter. This changed things from a conventional public health approach to one of empowerment of communities and of developing healthy public policy.

For me it is about continuing this Ottawa Charter type approach and supporting nations to invest more in health promotion practices. To undertake things like health impact assessment and environmental impact assessment when large development projects are on the table. We have a range of tools to choose from but in general these are not always applied consistently.

 

Having worked in both New Zealand and the Pacific, how would you characterise the relationship between the two?

In some areas it is going well however I would say there seems to be a general lack of awareness in New Zealand about what is happening in the Pacific regions. I do note though that there is more and more interaction taking place.

We could learn a lot from the health promotion models and ideas in New Zealand. Smoking continues to be a significant problem in the islands.  We have been impressed with New Zealand’s smoke free work over many years.

 

Are there any other pointers from your recent work we could learn from?

Recently I was part of the World Health Organisation Global Commission on Ending Childhood Obesity as a commissioner. From that we produced a final report with a set of recommendations and cost-effective measures for ending childhood obesity. New Zealand and Pacific nations have been slow to pick these up. One would hope governments provide leadership and look seriously at the recommendations of this report.

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Case Studies, Pacific

Health Promotion Forum works with organisations at all levels of health promotion and social development.  It is forging close working relationships with leaders in the field, to strengthen the health promotion movement.

The Fono is working to address health and inequality in communities across Auckland and Northland. Jo Lawrence-King talked to its Chief Executive Tevita Funaki; who recently joined HPF’s board.

The connection between HPF and The Fono is clear.  HPF’s own definition of the profession emphasises its focus on “empowering people and communities to take control of their health and wellbeing.”

“At the Fono we value the significant importance of Health Promotion,” agrees Tevita.  “We work closely with families to address their health needs. We provide health education and social support; ensuring both economic and social needs are addressed.  We work with churches to develop their health activities to support a healthy environment both for their homes and churches.”

 

 

The Fono: a model of Pacific health promotion

The Fono is a health service committed to reducing health inequalities in the communities in which it operates.  It finds innovative ways to deliver culturally appropriate services across all its locations.

The Fono works to foster well, safe, vibrant communities and has a commitment to meeting the cultural needs of the people in these communities.  These include its original area of West Auckland (based in Henderson) as well as:

  • Central Auckland (the CBD)
  • South Auckland (Manurewa)
  • West Central Auckland (Blockhouse Bay)
  • Northland (Kaikohe)

The Fono operates a comprehensive model of care, with a full range of affordable health services to people who need it most.  Its services include medical, dental, pharmacy, health promotion, social services, education and Whanau Ora.  It has a focus on reaching Pacific Peoples with its stop smoking programme.

Pacific people have been identified as being hard to reach by conventional stop smoking efforts[1]. With its community-led scope of services, its expertise and geographic spread, The Fono delivers stop-smoking services to Pacific peoples across the metropolitan Auckland region.  This region represents 65% of all Pacific smokers in New Zealand according to needs data[2] (26,523 of the national total of 41,139).

From its beginnings 25 years ago, as a West Auckland community-developed GP clinic, The Fono today provides an integrated range of services in five locations across Auckland and Northland.

An experienced leader in Pacific health

In July this year Tevita Funaki celebrated his sixth anniversary as Chief Executive Officer of The Fono.  Backed by an extensive career working with Pacific communities in health and education, and himself of Tongan heritage, Tevita leads the operational arm of the organisation.

Tevita explained his motivation for accepting the role: “I am passionate about Pacific wellbeing and development. Developing our model of care ensures that our services address the holistic needs of Pacific people and support our family to realise their full potential.”

Tevita was previously the Pacific Health Manager for ProCare Health Ltd and the National Pasifika Liaison Advisor for Massey University. He has also managed an Employment Consultancy and Project Management Services firm and worked in health services for many years.

Despite already being on many influential boards, Tevita accepted his nomination to HPF’s board and took up his role in ……. [month?].  He sees the relationship between The Fono and HPF as mutually beneficial.  “HPF’s success can only be beneficial to organisations like ours; supporting our work and upholding its principles of community-lead health,” he says.

Bringing with him strong governance and business experience, Tevita has an excellent understanding of the health sector, funding environment and the political landscape.

 

We look forward to working more closely with Tevita and the people of The Fono.


[1] Ibid  p.31

[2] Review of Tobacco Control Services – Shore /2014 – MoH – College of Health, Massey University – Smoking number and prevalence (ordered by number of Pacific smokers)

 

 

 

 

October 2016

Jo Lawrence-King

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Community, Diet, Pacific

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.

 

Gardening and Health: Let your garden be your health and your health be your garden

Dr. 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[1].

 

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 [7].[m1] [VP2]

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. 

 

Viliami PULOKA

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.

 

Pesamino TAPUTAI

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.

Nicolas SIMUTOGA

 

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.

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Global, Pacific

The cluster of Zika virus outbreaks and the associated neurological disorders has caused global concern; particularly in tropical and sub-tropical areas.

HPF’s Dr Viliami Puloka offers a perspective for consideration by health promoters working to prevent disease and for the communities under threat.

Communities can be empowered with information on prevention of the spread of disease and on how to remain healthy in order to fight the virus, should they become infected, he says.

 

zika-mosquito

 

On 1 February 2016 the World Health Organisation declared a Public Health Emergency of International Concern (PHEIC) regarding the high incidence of abnormally small brains and other neurological disorders in babies born to mothers infected with the Zika virus.

Much discussion and concern has resulted from the WHO’s decision.

Health promotion will play a key role in minimising the effects of Zika on Pacific peoples.  Being well, being informed and taking precautions to reduce exposure to the disease-carrying mosquito will all contribute to communities’ resistance to the virus and its associated issues, says Health Promotion Forum’s Senior Health Promotion Strategist Dr Viliami Puloka.

Here in the Pacific region the rainy season – when mosquitoes are most prevalent – has just begun.  We have recently had new cases of the Zika virus declared in Samoa and Tonga.   One case of Guillain-Barré was identified in Waikato and linked to the Zika virus.  The patient was a man who had recently arrived from Tonga, however, and it was considered to represent no risk of an outbreak here.  This is because the virus is spread via a mosquito that is not found in New Zealand’s colder climate.  Meanwhile the virus has been present in French Polynesia for some time.  There, at least 40 cases of Guillain-Barré syndrome have been associated with the virus.

Zika was first identified in Brazil in May 2015.  Since then babies born to mothers infected with the virus have been found to have a higher incidence of neurological disorders, the main one of which has been abnormally small brains – or microencephaly.  While it has not been proven that the disorders are a direct result of the virus, this is strongly suspected.  In recent days another possible association has been suggested: the use of an antilarval chemical included in the drinking water of the affected residents in Brazil.

Health authorities in New Zealand and the Pacific are putting in place protection measures and public policies to prevent the spread of Zika virus, however Dr Puloka, who is responsible for the HPF’s Pacific portfolio, points out that communities have an equally vital role to play.  Minimising and modifying potential breeding sites is one way in which communities can act to prevent the spread of the Zika, he says. Residents are advised to empty, clean or cover containers that can hold water.  This includes receptacles like buckets, flower pots or tyres.  According to Dr Puloka it is also common practice to have a layer of oil on the top of the water in a septic tank.  This prevents the reproduction of the mosquitoes, whose pupae need oxygen from above the water to survive.

He suspects that immunity to mosquito-borne diseases may offer hope to those Pacific island nations to have recently seen the arrival of the Zika virus.  “The mosquito that carries the Zika virus is the same one that carries dengue fever, chikungunya and yellow fever,” he says.  “People of the Pacific islands have been exposed to these mosquitoes for many years and have developed a level of resistance to those diseases.”  This contrasts starkly with the situation in Brazil, where the people had previously not been exposed to those mosquitoes or their diseases.

Other precautions – where practicable – include using insect repellent, wearing clothes (preferably light-coloured) that cover as much of the body as possible and using physical barriers such as screens, closed doors and windows.

During outbreaks, health authorities may also advise spraying of insecticides.

Dr Puloka’s advice to communities threatened by the Zika virus is that now, more than ever, it is important to be well, be informed and take the necessary precautions to minimise the risk of being bitten by the mosquito that carries the disease.

 

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This paper – by HPF’s Executive Director, Sione Tu’itahi – aims to contribute to the development of Pacific leadership in health, education and other sectors.

Providing insight into the Tongan concepts of matapoto (intelligence and shrewdness) and lotopoto (wisdom and ethics), the paper explores the underlying values of these terms and how they are reflected in the values of many Pacific nations.

King George Tupou IWhen used conjointly, the two terms indicate multi-dimensional intelligence, wisdom and consciousness.  This paper illustrates the dynamic coherence between training the mind and educating the heart and highlights the importance of values as an integral part of knowledge and learning.

 

 

 

Pictured: King George Tupou I

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Equality, News, Pacific

outback-shack-from-freestock

 

“Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system. Keeping people well, it seems, is the much cheaper option.”

Trevor Simpson, Deputy Executive Director,

Health Promotion Forum – Runanga Whakapiki Ake i te Hauora o Aotearoa

 

An article in the 15 December Manawatu Standard, Inequalities stymie health gains for Polynesians, makes a poignant statement and raises important concerns on Māori and Pacific health. Highlighting statistical data gleaned from the New Zealand Health Survey results for 2013 and 2014, the report covered the wide gap in health outcomes between Māori and Pacific and other ethnic groups. A staggering array of both causes and conditions were listed, describing a situation in which certain social groups experience a greater burden of disease than their existing counterparts (see ‘Health promotion, human rights and equity’ on the Health Promotion Forum website).

Most of these outcomes can be attributed to social inequities; that is, those unfair, avoidable and unjust factors that impact negatively on the health of social groups. A closer look shows that these outcomes are systemic and relate to what Sir Michael Marmot has described as the social determinants of health (see HPF paper  ‘Health and social inequalities; issues of justice and fairness’)

In the article, interviewee Chrissy Paul touches on a number of key points as to why these disparities may persist. As she accurately points out, these outcomes cannot simply be put down to ethnicity. It can also be shown that they cannot be classed as behavioural or cultural but rather structural i.e. how society is arranged. The entire breadth of a situation must be considered when questioning why any health outcome occurs. For example if Māori and Pacific people are experiencing higher rates of psychological duress then the reasons for this could emanate from a range of social, environmental, political and economic factors.  Chrissy further provided an important clue by referencing the fact that negative health statistics are found in “[Deprivation] Decile 10 areas,”  that is communities that experience higher levels of deprivation.

On this topic it is timely, for proponents of preventative health, that a nationwide discussion has focussed on poverty and the widening gap between the ‘haves’ and ‘have nots’. For example, Bryce Edwards, in his NZ Herald opinion piece on Monday 15th December suggests that  ‘Inequality’ could be the word of the year in New Zealand politics. The correlations between poverty and health outcomes are now very well-known and understood. It is true that poverty exists across all ethnicities but it is hard to overlook the stark contrast between Māori and Pacifica peoples and other groups.

Children are a case in point. The Child Poverty Monitor: 2014 Technical Reportshows that 1 in 3 Māori and Pacifica children live in poverty as compared to 1 in 6 European children. It also states that three out of 5 of these children are likely to live this way for many years. The impact of this on health across the life continuum is obvious, not to mention extremely costly. For example rates of hospitalisations for children living in the most deprived areas (NZDep deciles 9–10) were nearly 3 times higher than for those in areas with the least deprivation (NZDep deciles 1–2). Further the majority of hospital admissions were due to infectious and respiratory diseases among children aged 0–14 years. During 2009–2013, 82% of these admissions were for asthma and wheeze, acute bronchiolitis, acute upper respiratory infections, gastroenteritis, viral infection of unspecified site, skin infections or pneumonia (bacterial, non-viral). In many cases these outcomes were completely preventable.

One simple solution is to reinstate a universal child benefit; to lift not only poor families, but all struggling whānau, above the bread line. Other answers can be found in the Office of the Children’s Commissioners report Choose kids: why investing in children benefits all New Zealanders.

Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system and our communities. Keeping people well, it seems, is the much cheaper option.

16 December 2014

Trevor Simpson

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Equality, News, Pacific
 

“Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system. Keeping people well, it seems, is the much cheaper option.”

Trevor Simpson, Deputy Executive Director,

Health Promotion Forum – Runanga Whakapiki Ake i te Hauora o Aotearoa

 

An article in the 15 December Manawatu Standard, Inequalities stymie health gains for Polynesians, makes a poignant statement and raises important concerns on Māori and Pacific health. Highlighting statistical data gleaned from the New Zealand Health Survey results for 2013 and 2014, the report covered the wide gap in health outcomes between Māori and Pacific and other ethnic groups. A staggering array of both causes and conditions were listed, describing a situation in which certain social groups experience a greater burden of disease than their existing counterparts (see ‘Health promotion, human rights and equity’ on the Health Promotion Forumwebsite).

 

Most of these outcomes can be attributed to social inequities; that is, those unfair, avoidable and unjust factors that impact negatively on the health of social groups. A closer look shows that these outcomes are systemic and relate to what Sir Michael Marmot has described as the social determinants of health (see HPF paper  ‘Health and social inequalities; issues of justice and fairness’)

 

In the article, interviewee Chrissy Paul touches on a number of key points as to why these disparities may persist. As she accurately points out, these outcomes cannot simply be put down to ethnicity. It can also be shown that they cannot be classed as behavioural or cultural but

 

 

rather structural i.e. how society is arranged. The entire breadth of a situation must be considered when questioning why any health outcome occurs. For example if Māori and Pacific people are experiencing higher rates of psychological duress then the reasons for this could emanate from a range of social, environmental, political and economic factors.  Chrissy further provided an important clue by referencing the fact that negative health statistics are found in “[Deprivation] Decile 10 areas,”  that is communities that experience higher levels of deprivation.

 

On this topic it is timely, for proponents of preventative health, that a nationwide discussion has focussed on poverty and the widening gap between the ‘haves’ and ‘have nots’. For example, Bryce Edwards, in his NZ Herald opinion piece on Monday 15th December suggests that  ‘Inequality’ could be the word of the year in New Zealand politics. The correlations between poverty and health outcomes are now very well-known and understood. It is true that poverty exists across all ethnicities but it is hard to overlook the stark contrast between Māori and Pacifica peoples and other groups.

 

Children are a case in point. The Child Poverty Monitor: 2014 Technical Reportshows that 1 in 3 Māori and Pacifica children live in poverty as compared to 1 in 6 European children. It also states that three out of 5 of these children are likely to live this way for many years. The impact of this on health across the life continuum is obvious, not to mention extremely costly. For example rates of hospitalisations for children living in the most deprived areas (NZDep deciles 9–10) were nearly 3 times higher than for those in areas with the least deprivation (NZDep deciles 1–2). Further the majority of hospital admissions were due to infectious and respiratory diseases among children aged 0–14 years. During 2009–2013, 82% of these admissions were for asthma and wheeze, acute bronchiolitis, acute upper respiratory infections, gastroenteritis, viral infection of unspecified site, skin infections or pneumonia (bacterial, non-viral). In many cases these outcomes were completely preventable.

 

One simple solution is to reinstate a universal child benefit; to lift not only poor families, but all struggling whānau, above the bread line. Other answers can be found in the Office of the Children’s Commissioners report Choose kids: why investing in children benefits all New Zealanders.

 

Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system and our communities. Keeping people well, it seems, is the much cheaper option.

 

 

 

 

 

 

16 December 2014

Trevor Simpson

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HPF’s Senior Health Promotion Strategist in charge of the Pacific portfolio, Dr Viliami Puloka, reports that non-communicable diseases (NCDs) – many of which are preventable – are the overwhelming cause of death in Tonga.  The good news is that Tonga recognises the problem and is prioritising it at a government level.  Dr Puloka believes the situation there is reflected across the Pacific and that we should keep a close eye on the results of the work being done in Tonga to address the problem.

Babies in Tonga have an excellent survival rate, with just 15 out of 1,000 dying before they reach the age of five – a mortality rate of 1.5%.  However this picture changes dramatically once Tongans reach 15, where 25.6 % of males and 35.1% of females die before they reach 60 years of age. [i]  Much of this dramatic increase in mortality is accounted-for by NCDs, of which diabetes and cardiovascular disease are the main culprits.

Tonga top of the obesity league table

According to an article in British newspaper The Guardian in August 2006, more than 90% of Tongans are overweight; making it the world’s fattest nation .[ii]  In 2012 a league table from the London School of Hygiene and Tropical Medicine, supported this figure; putting Micronesia and Tonga at the top of the obesity league table, just ahead of the United States.[iii]

Non-communicable diseases account for approximately 74% of all deaths in the Pacific nation.  Of these the vast majority are preventable diseases such as diabetes and cardiovascular disease. [iv]

It’s not hard to see why NCDs are so prevalent here.  Two research papers, summarised in Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004) found that overall 60.7% of the Tongan population was at high risk of NCDs, with three to five risk factors from the following list:

  • Smoking (46.2% of males  and 16.3% of females aged 15-64 years)
  • Alcohol consumption (22.2% of males and 4.8% of females aged 15-64 years)
  • Low fruit and vegetable intake (approximately 92.8% of Tongans aged 15-64 reported they eat less than the require five servings of fruit and vegetables a day)
  • Low physical activity (54.8% of females and 32.4% of males aged 15-64)
  • Obesity (76.3% of females and 60.7% of males aged 25-64)
  • High blood sugar (16.4% of Tongans aged 25-64 had elevated blood glucose levels)
  • High blood cholesterol (66.1% of men and 34.2% of women aged 25-64 had blood cholesterol levels of more than 5.00 mmol/L)

At an obesity workshop for health workers held in Tonga in May 2013, delegates heard that one in 10 people admitted to hospital –  in Tonga, Vanuatu and Kiribati – were there because of an NCD.  However the money spent on NCDs is disproportionately high, with one in every five dollars spent on treatment being for those with an NCD [v]

 

Tonga is leading the way in tackling NCDs at a policy level

The good news is that Tonga is one of the few countries in the world to be prioritising NCDs.  It is just one of a handful of nations to consider NCDs as a development issue.  They have been identified a key result area in the Tonga National Development Strategy.  Tonga has a multi-sectoral National NCD cabinet committee and sub-committes for NCD prevention and control.

The National Health Promotion Foundation – TongaHealth was set up in 2007 to respond to the nation’s NCD crisis and 20 National NCD nurses have been employed to address NCD prevention.

Dr Puloka advises us to watch the progress in Tonga closely.  “If there can be a favourable result from a regional approach to NCDs it will be in the Kingdom of Tonga,” he says.

 


[i] S. Hufanga et al Mortality Trend in Tonga . Population Health Metric 2012

[ii] The Guardian, Thursday 3 August 2006 http://www.theguardian.com/lifeandstyle/2006/aug/03/healthandwellbeing.health

[iv] WHO  Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004)

 

[v] Doran C.  Pacific Action for Health Project: Economic impact assessmentof noncommunicable diseases on hospital resources in Tonga, Vanuatu and Kiribati. 2003

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Pacific, Policy, What is HP

South West Pacific health promotion leaders have undertaken in March to develop a work plan that includes research, New Zealand representation at global health promotion meetings and to develop a health promotion work plan for the region.

 

swp-map

 

The decisions were taken at a March meeting of the South West Pacific regional committee of the International Union of Health Promotion and Education (IUHPE)

Health promotion work plan for the South West Pacific

The committee is to begin work on a plan for health promotion development for the South West Pacific region. Priority areas for the three-year plan include

  • workforce development
  • research,
  • indigenous health promotion and health issues.

Research

The meeting approved a submission from HPF to investigate some of the challenges that face the discipline of health promotion and its practitioners in the region. These include policy decisions that disadvantage certain sectors of the community, job-losses due to the recession and research on the effectiveness of health promotion.

Indigenous NZ health promotion advances

Two new members were welcomed onto the committee, further strengthening region’s indigenous health promotion work.  Dr Viliami Puloka, a health promotion team leader at the Secretariat for the Pacific Community (SPC), is based in Noumea, New Caledonia.  His appointment is the first from a small Pacific nation in ten years.

Trevor Simpson, Deputy Executive Director at HPF was also co-opted onto the committee, taking advantage of his work as a member of the Regional Indigenous Health Promotion Working Group of IUHPE.

Already in place is Dr Heather Gifford:chair of the SWP regional indigenous health promotion working group and co-chair of the IUHPE global working group for indigenous health promotion.

As a member of the global executive board of the IUHPE, Sione Tu’itahi was tasked with keeping indigenous health promotion on the agenda at all meetings. “This is great news for both Maori and Pacific health promotion,” he said. “Our progress and positive experience with Indigenous health promotion in New Zealand is leading the way at a global level”.

Sione Tu’itahi is executive director of the HPF, vice-president of the South West Pacific region of the IUHPE and a member of its global executive board.

The South West Pacific region of IUHPE includes New Zealand, Australia three countries in South East Asia and all other 22 Pacific small nations and territories. Its regional office is co-hosted by HPF and the Health Promotion and Research and Evaluation Unit of the School of Public Health, University of Otago.

 

30 April 2014

 

By Sione Tu-itahi

Editor: Jo Lawrence-King

 

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Pacific families and communities are taking increased control over their wellbeing and future, with initiatives such as Whanau Ora and Fanau Ola. With this trend comes a corresponding need to better understand the philosophies of these indigenous cultures.

Here HPF Executive Director Sione Tu’itahi explores kautaha: one of the underlying concepts that inspire and inform the Māori and Pacific view of self-sufficiency and self-determination.

Kautaha is a model for working together towards a common goal.  It is underpinned by a set of related and coherent principles that takes a unified approach and focuses on strengths, potential, and solutions rather than on accentuating problems and deficits.  For these reasons the kautaha approach has been highly effective across history and could be successfully adapted to collective endeavours such as Fanau Ola, socio-economic and community development.

Kautaha is a Tongan term and a Pacific concept with several layers of meaning. Its Samoan equivalent is ‘aufa’atasi.  The Māori synonym iskotahitanga.

The concept and practice of kautaha seems to draw on the collective nature of Tongan culture, which is also a common feature of other Pacific cultures.  The approach is strengths-based and complementary rather than being competitive and adversarial.  It promotes striving for excellence and the common good of all. The final outcome is a more equitable distribution of wealth and wellbeing.

In the Tongan context, one definition of kautaha is that of a group of people or parties who agree to work collaboratively in order to achieve their common purpose. In Tonga ‘ufi (yam) farmers in the village would come together and form a collective labour force (kautaha toungaue) that moved around and tended the yam garden of each member. Similarly, the women would form a kautaha toulalanga or koka’anga/kautaha of weavers or tapa makers.

On a regional level, a few decades back, some of our great tufunga (nation builders) established a kautaha, now called the Pacific Islands Forum, so that they could talanoa (talk) more freely about our political and socio-economic needs as island nations.

The philosophy 

Unity in diversity is a philosophy that embraces biological and cultural diversity as essential to human existence. Unique differences are seen not only as inherent characteristics and rights but also appreciated as strengths to be respected, celebrated and utilised for the collective good[i].

To illustrate the efficacy of unity in diversity, let us briefly look at two examples. First, all human organs and body parts are of different shape and form and they all have different functions. But they all contribute to one purpose: the wellbeing of the whole human being. Second, cultural and ethnic groups of the world may be different in colour, shape and form, but they all belong to the human race and are dwellers of one planet. They have a choice to share their collective, common, global resource in order to live together, or they continue to squabble over it and, consequently, die together.

Importantly also within the process of kautaha, is the central principle of va(space)[ii].  The maintaining of that relational space (tauhi va) guards the wellbeing and progress of the individuals as well as the collective .

The kautaha approach is effective when its underpinning principles are adhered to, and used to inform the practice.

Some of these principles are: angatonu (integrity), fefaka’apa’apa’aki (mutual respect), lelei fakakatoa (collective good), tukupa (commitment), tu’unga tatau (equality), and tuha mo taau (equity).

The word and its meaning

Analysed linguistically, kautaha is made up of two related but distinct root words.  The first is kau – to belong, to join, to participate, or to become a partner. The second is taha – to collectively unite, to become one, to collaborate.

In one sense, kau reflects an invitation by a caller, and a choice of the called to join, or not to join. Taha implies that the intention of the caller is to collaborate with the invitees, and to work in unity towards a common purpose which will serve the common good.

The invitees are expected to subscribe to the same set of values and goals. In another sense, kautaha means coming together to talanoa[iii] (talk) and then agree to collaborate on common needs and aspirations. There are no callers and there are no called.  While all are equal collaborators, this is not to say that kautaha means unity by conformity or uniformity. Rather, kautaha is about unity in diversity.

 

Kautaha offers us a model of unity and cooperation that empowers and benefits all members of the cooperative. It is a valuable concept of Whanau Ora and can be applied across a wide range of health promotion initiatives.

 


[i] Pacific Islands Forum. (2005) The  Pacific Plan, Pacific Islands Forum, Suva

[ii] Mahina, ‘O. (2004). Reed Book of Tongan Proverbs, Auckland, Reed Publishing (NZ) Ltd

[iii] Manu’atu, L. (2000). Tuli ke Ma’u Hono Ngaahi Malie: Pedagogical possibilities for Tongan students in New Zealand secondary schooling, unpublished Doctoral thesis, University of Auckland, Auckland

 

 

 

April 2014

By:  Sione Tu’itahi

Edited by: Jo Lawrence-King

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Equality, Maori, Pacific

 

Bruce Jesson Lecture 2013

“Assertive, if not aggressive approach” called for by the Right Hon Sir Edmund Thomas

The Rt Hon Sir Edmund Thomas

 

Retired Court Appeal Judge the Right Hon Sir Edmund Thomas (pictured right – from 3 News) called for an “assertive, if not aggressive approach” by communities and community groups; to reverse the extreme inequality that currently exists in Aotearoa New Zealand.  He was speaking to a packed Maidment Theatre in Auckland, late October.

 

HPF Health Strategist Dr Ieti Lima was in the audience and reports on some of Sir Edmund’s key points to support his argument.

 

Call for “sufficient force”

In his powerful, engaging and, at times, challenging lecture, Sir Edmund proposed a focussed campaign to promote substantive human rights.  He further called for “sufficient force” to ensure people claim the minimal social, economic and cultural standards to which they have a right.  Sir Edmund asserted that, if the governing bodies or the courts cannot generate the required assertive approach to support people’s rights, the community must initiate the action needed.  “Discussion and debate will not suffice,” he said.  “This legacy is now too entrenched to be so readily reversed.”

 

Neo-liberalism at the heart of the problem

Sir Edmund was unequivocal in linking the “extreme – even obscene – inequality” that exists in Aotearoa New Zealand to the “traumatic neo-liberal transformation” that has been pursued here.

 

According to the retired judge, the top ten per cent of New Zealand’s population today owns half of the country’s wealth, while the bottom 50 per cent owns just five per cent of the wealth.

 

He pointed to Maori health statistics as appalling, and declared that he finds “the neglect of a people socially and culturally offensive.”

 

So how has this gross inequality been tolerated in a country that once prided itself on its egalitarian culture and sense of social justice?  Sir Edmund’s explanation was blunt; it has been fostered and sustained by the rich and powerful, to perpetuate their own wealth and privilege.  Sir Edmund argued that the term ‘equality’ is today more often than not defined in terms of equality of opportunity.  By suggesting that all people have the same opportunity, the term obscures the true extent of inequality within the community.  If this definition remains, it simply provides the opportunity for those in an advantaged position to further advance their superiority and privilege.

 

“This perspective of equality in turn impairs social mobility,” he said. “The disadvantaged are stuck with being disadvantaged. … It becomes a vicious circle”.

 

Neo-liberalism – according to Sir Edmund – is a theory that insists human well-being can best be advanced by ensuring strong property rights, free enterprise, free market and free trade.  He identified eight features of the neo-liberal legacy:

 

  1. Values directed by economic order
  2. Exploitation
  3. Equality
  4. Governmental intervention
  5. Unemployment
  6. Taxation
  7. Trade unions
  8. Social justice

Assertive action by community groups

Sir Edmund challenged his audience to consider who will speak for “losers” in a capitalistic society? How can they be guaranteed their basic economic, social and cultural human rights?  He proposed that a first step in any campaign to achieve a more equal and just society is to identify and challenge the damaging features of neoliberalism. Ultimately the aim is to arrest and reverse them.

 

In the absence of legal options to redress the inequalities, Sir Edmund called on a focussed campaign by community groups.  “They [must] possess sufficient force for people to claim that the minimum social, economic and cultural standards they reflect are theirs as of right”.

 

Sir Edmund was the speaker at the annual Bruce Jesson 2013 at the Maidment Theatre, University of Auckland.  He is a retired Court of Appeal Judge and former acting judge of the Supreme Court.  His lecture was made to a mainly academic audience.

 

 

Author: Dr Ieti Lima

Editor: Jo Lawrence-King

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Pacific, What is HP

A new paper, published today, makes a further contribution to the development of Pacific leadership in health, education and other sectors.

Providing insight into the Tongan concepts of matapoto (intelligence and shrewdness) and lotopoto (wisdom and ethics), the paper explores the underlying values of these terms and how they are reflected in the values of many Pacific nations.

 

170px-george_tupou_i_c-_1880s

 

When used conjointly, the two terms indicate multi-dimensional intelligence, wisdom and consciousness.  This paper illustrates the dynamic coherence between training the mind and educating the heart and highlights the importance of values as an integral part of knowledge and learning.

Matapoto pea Lotopoto – Exploring intelligence and wisdom from a Tongan perspective for enhancing Pacific leadership in health, education and other sector – is by HPF’s Executive Director, Sione Tu’itahi.  It is published as part of the HPF’s Occasional Papers series.

Visit our Pacific health promotion pages.

 

 

Pictured: King George Tupou I

 

Published: 5 May 2013

By: Jo Lawrence-King

 

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Pacific

“Seitapu – sei is a flower worn in your hair, tapu is the sacred position of the flower on the head, put together it is a strong force of beauty, spirituality and power.” Fuimaono Karl Pulotu-Endemann

Seitapu consists of a framework of cultural competencies covering core and essential skills. The framework is not restricted to the workforce alone. Instead, the framework focusses on broader interactions with people, covering key theme areas of working with families, language, tapu considerations and organisations. Seitapu framework

 

suicide-prevention-overview

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Workshop held at the Wellington campus Massey University, 7 September 2009. The presenters were Ieti Lima, Sione Tuitahi, both of the HPF, and Fuimaono Karl Pulotu-Endemann, a Pacific health consultant. Ieti gave an overview as to why we need Pacific health promotion models. Fuimaono presented on Fonofale, a model that he led its development in the 1980s. Sione presented on Fonua, a model that he developed and introduced into the public health sector in 2007.

Overview of Pacific Health Promotion – Ieti Lima
Fonofale Model – to be read in conjuction with the Explanation – Fuimaono Karl Pulotu-Endemann
Fonua Model – Sione Tuitahi

Participants at the Pacific Health Promotion Models Workshop
Christchurch May 2010


Sione Tu’itahimiddle, Fuimaono Karl Pulotu-Endemann right

 

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