Maori, News, Policy

HPF has welcomed Government’s plans to revamp and strengthen the healthcare system to provide more equitable and better health care for all New Zealanders.

NZ’s Health Minister Andrew Little who unveiled the major changes yesterday (May 21) said ensuring fairer access for all New Zealanders and putting a greater emphasis on primary healthcare were two of the main drivers of the reforms.

“The reforms will mean that for the first time, we will have a truly national health system, and the kind of treatment people get will no longer be determined by where they live.

“By making these changes we can start giving true effect to Tiro Rangatiranga and our obligations under the Treaty of Waitangi,” said Mr Little.

The main changes include the setting up of a new and truly independent Māori Health Authority, aimed at overcoming the huge health disparities for Māori as a whole, and the replacement of the 20 DHBs by one new body Health NZ.  A new Public Health agency will also be created within the Ministry of Health.

HPF’s Executive Director Sione Tu’itahi said HPF was pleased to see the creation of a Māori Health Authority (MHA) which would help not only to address the inequities, but also to acknowledging the rights of Tangata Whenua as the other partner in Te Tiriti o Waitangi, the founding document of our nation, and one of the two founding documents of health promotion in our country.

Mr Tu’itahi said however that by not including environmental determinants in the reframing was a missed opportunity.

“Let’s hope that the new Public Health Agency, and the MHA will pick this up. The health sector and all other sectors should seriously note that the planet is broken, as mentioned by the UN Secretary-General recently. We cannot achieve human health without a healthy planet.

“Overall, the reform is a move in the right direction, but let’s wait for the details, especially the distribution of power and the allocation of resources.”

Associate Health Minister (Māori Health) Peeni Henare said while New Zealand’s health system performs well overall against most international comparisons, it has significant issues delivering for Māori who continue to lag behind in key health status indicators.

“Māori health has suffered under the current system for too long,” Mr Henare said.

“We will legislate for a new independent voice – the Māori Health Authority – to drive hauora Māori and lead the system to make real change.

“It will have joint decision-making rights to agree national strategies, policies and plans that affect Māori at all levels of the system and it will work in partnership with Health New Zealand to ensure that service plans and the commissioning of health services drives improvement,” Mr Henare added.

Click HERE for full documents about the reforms.

BANNER PHOTO by Matheus Ferrero on Unsplash


Experts, Global, Policy, What is HP
Health Promotion Forum was fortunate to get some time with Emeritus Professor John Raeburn recently, to ask him about his more than 40 years as a health promotion advocate.   As one of two NZ delegates at the WHO’s first International Conference on Health Promotion, from which the Ottawa Charter emerged, Professor Raeburn made a small but significant contribution to the content of the document; the inclusion of a sentence emphasising the importance of empowerment.  This was the only time the word appeared in the Charter.  He has upheld the principles of community and health promotion ever since.   Invited to attend the 1986 Conference in Ottawa by the Ministry of Health, Prof Raeburn had recently returned from a sabbatical in Canada from his teaching role at the University of Auckland Medical School.  There he had been working alongside Ron Draper; head of the Health Promotion Directorate at Health Canada.  He considered this the ‘Mecca’ of health promotion and Ron Draper one of his heroes. “Canada actually invented health promotion in the 1970s,” says Prof Raeburn.  Little did he know that his year’s sabbatical would see him caught up in the preparations for the seminal Conference at which he was to later play such a significant role.   The other New Zealand delegate to the Conference was a Canadian man called Larry Peters, who was asked to go in his capacity as the first director of the Health Promotion Forum (Larry later went back to Canada and worked in the Health Promotion Directorate).   What was the experience of participating in the conference like? It was a mixed experience, and I wrote an article about it for a public health magazine in New Zealand when I got back, which was essentially a critique. I’ll start with the negative aspects.  It was mainly organised by WHO, who did things in a very grand style with multiple flags and so on, much formality, and participants invited from all around the world. (It wasn’t open to everyone – governments were asked to send representatives). The conference process was awful.    First of all, it was organised out of Europe, and the organisers succeeded in somehow alienating most of the developing world, with the result that most of the attendees were European, white and from industrialised countries.(Only 46 countries were represented).     Second, it was conducted in a very disempowering and top-down way – the opposite of “real” health promotion!  They went through the motions of having a participatory workshop format, but the European bureaucrats had already decided the outcomes beforehand.   Third, they didn’t tell us until almost the end of the several-day conference that they had a charter in mind, and it was clear that it had already been pre-written by them. So we were basically there to rubberstamp it.  Well, the anger that surged around the huge room when the hundreds of delegates realized what had happened was spectacular.     WHO then had to back down somewhat, and then said they’d accept some of the workshop material. They also said that, although the Charter was ready to be printed, if people wanted to scribble something down and hand them into the printing room, they would be considered for inclusion as well.    I hurriedly wrote a sentence down on the back of an envelope (literally) and handed it in. You can imagine how delighted I was to find that whole sentence in the final Charter.  My passion has always been the community dimension of health promotion, and the empowerment of ordinary people, and I’m happy to say that the only time that the term “empowerment” appears in the Charter is in that sentence. It’s in the community action stream (of course!) and says: “At the heart of this process [of community action] is the empowerment of communities, their ownership and control of their own endeavours and destinies”.  The sentiments expressed in the sentence are as important to me now, 30 years later, as they were then, and sums up for me the very essence of the health promotion enterprise.   And also on the positive side, on a wider level, thanks to the various changes done at the last moment, the world got a health promotion charter that still remains a brilliant document.  And I have to say, that when the conference participants heard what WHO had finally came up with after they had incorporating the workshop materials, there was thunderous applause.  What a transformation!  By some miracle, WHO had got it right.  Once again, it’s proof of how important it is to have full-scale participation.   Did you realise at the time how seminal the conference and charter would be?  Yes I think we were all aware that we were at a history-making event.  When Larry and I got back to New Zealand, we spent the next year going around the country promoting the Charter, with the result that New Zealand had arguably the biggest uptake of the Charter of any country in the world, including Canada.   You talk about health promotion moving away from the focus of changing lifestyles and behaviours to one of policy ‘changing society so that people and communities can more easily live healthy lives’.  How far do you think NZ (and global) society has come?     This question is a slightly tricky one for me. I have over the last few years presented in various settings a critique of the Ottawa Charter,  including one memorable occasion in Canada when I was invited to do a keynote on this topic at a conference to mark the 25th anniversary on the Charter.  I was nervous, because the Ottawa Charter is like a sacred document in Canada. Happily it went down well.    Part of my critique is that the movement of health promotion away from the older style of health promotion which emphasised changing lifestyle, behaviour and community, threw the baby out with the bathwater. It’s not by chance that the first action stream in the Charter is to do with policy – that was definitely the main interest of WHO.  However, my main interest, and clearly that of most of the participants at the conference, was in people.  In the late 90s, I published a book co-authored with Canadian grandfather of health promotion, Irving Rootman, called “People-Centred Health Promotion”, which makes just this point.    My argument is that the focal point of health promotion should be community, a stance that enables one both to look “up” to the larger picture of policy and environment, and “down” to the more intimate and personal level of personal skills and family life.  Community is where people do their lives, and is the great meeting point of those two perspectives.   My fear has always been that health promotion would increasingly become preoccupied with policy – with statistics and abstract documents – and as far as most academic health promotion is  concerned, that’s definitely the case.  The result has been, I believe, a major gap between grassroots practitioners of health promotion and communities, and academics and policymakers.  And largely, the public likes a lifestyle/community approach, and is turned off by policy approach.  I’m not saying we shouldn’t have policy in health promotion – of course we should.  But we equally need the community and people level.    My favourite image, which I’ve shown in multiple PowerPoint presentations, is a picture of a gannet in the sky with its wings spread, with one wing labelled “policy”, and the other “people”.  This balanced approach is the one I strongly advocate.    So as to the question about how far NZ and global society has come in regard to these issues, I see that health promotion is probably going backwards, and has lost its broad public constituency, mainly because it has got lost in the arid desert of too much policy.    Community development is your passion.  In an increasingly populous and multi-cultural society how do you think we are progressing with this area of health promotion?   I don’t think we are progressing at all well. In short, I feel health promotion has gone too far in the policy direction, and needs to go back to its heartland, which is community.    There was a time in the ‘70s and ‘80s when there was fantastic progress, with all sorts of great community initiatives around.  One of the best contributions of government here was something called CHIFS; the Community Health Initiatives Funding Scheme, which supported communities coming up with their own empowering projects.   What changed all that was the arrival around 1985 of “Rogernomics”, followed by “Ruthanasia” in the ‘90s, which is to say that both Labour and National governments swung far to the right by adopting wholeheartedly the fashionable new economic policies of neoliberalism. These were first introduced by Maggie Thatcher in the UK, who was famous for a statement that “there’s is no such thing as society”. Rather, she said, there are ony individuals, and unequal ones at that.   Such a philosophy is harmful to community and empowerment of ordinary people, and we still largely live under this system globally and In New Zealand today. So community remains an unpopular concept. But at least now many are more aware of how damaging to society this approach is, and how it favours corporates and the wealthy, and makes the already miserable life of the poor and disempowered even more miserable.   On the other hand, this is offset in Aotearoa by the bicultural and multicultural nature of our society, where Māori and Pacific people in particular see society very much in “true” community terms.  This is a perspective where people are indeed the most important thing in life, and where life is about cooperation, whanau, aroha and connectedness with others.  So definitely, the saving grace in Aotearoa is the health promotion approach of these populations, and also in other cultural populations.   So it’s a mixed bag here.  Because government policy is not generally supportive of community and the less well off, it’s an uphill battle. At the same time, we in this country have a deeply embedded belief in the value of community, which for health promoters applies to health and wellbeing in particular.  A well-connected and well-liked local community means healthy and happy people.  (There’s lots of research to back that statement up).  However, for the present time, in spite of positive aspects, at a general level, the community approach to health promotion is currently on the back foot, and has been so for at least two decades.   Talking about your Public Health Champion award 2015, you are quoted as saying that health promotion is the area of public health with which that you identify most.  What are your thoughts behind seeing health promotion as a subset of public health?     This is a fascinating question, and when I was working at the University of Auckland’s School of Population Health, I was continually aware of it; surrounded as I was by public health people such as epidemiologists.   Because it has its roots in disease prevention and medical approaches to health, mainstream public health has always had an uneasy relationship with the ‘upstart’ called health promotion, which is largely a non-medical enterprise, and operates out of an entirely different model.    I’ve worked hard over the years to make the point that public health is a combination of three components – protection, prevention and promotion – and it’s important to distinguish the three of them.    One of the other things that has put health promotion on the back foot for decades is the fact that it frequently gets confused with prevention, and therefore is based on concepts of disease rather than concepts of health and well-being. And, while I definitely think that health promotion is part of public health, it has yet to carve out its full identity within that context.  I constantly see health promotion being seduced off in the direction of disease-oriented prevention, largely because it doesn’t have a strong kaupapa to the contrary   At the same time, I also think that health promotion goes well beyond what is conventionally regarded as public health. All sorts of things affect our wellbeing outside what’s conventionally regarded as public health. For example, at the simplest level, going to Weight Watchers, playing rugby, being on a marae, or having a good time with friends, all contribute to health and wellbeing in their various ways (again supported by research evidence).  In a way, the whole of life can be either health promoting or health destroying.    So yes, while public health has an arm called “health promotion”, I really think that it’s only one expression of health promotion, which is much wider than that. But I can’t say that seems to be a popular view either. Of recent years, I have become enamoured of the concept of wellbeing promotion rather than health promotion, and I think this represents a more inclusive type of health promotion than the public health version currently provides.   You were recently involved in the publication of the Manifesto of Planetary Health.  Can you tell us more about this paper and the project? Well, this question relates directly to what I was just talking about – I see planetary health as also a great new inclusive concept that will benefit both health promotion and public health, and could well be the future.   I was lucky to be involved in this project through my friendship with Robert Beaglehole and Ruth Bonita, who were asked by the Lancet to participate in the authorship of the trailblazing one page article that is the Planetary Health Manifesto.  When I saw the first drafts, I thought it was very light on community, and too heavy on policy and government action.  So me being me, I pulled out all the stops and kept inserting references to community in the document.  And if you now read that document, it almost looks as though community is the number one consideration, so naturally I’m very pleased with all that.   And what is planetary health? It’s a concept designed to revolutionise public health, which is seen as having lost ground both professionally and in terms of public engagement.  It’s quite clear that the greatest threats to health and well-being in the future are quite different from what they were 30 years ago, or even 10 years ago.  Global warming, terrorism, globalisation, ferocious inequity , ever-growing populations, food and water shortages, new and damaging addictions like gambling and designer drugs, robotization and fewer jobs, are just some of the factors that are going to deeply affect everyone’s health in the future.  This manifesto is designed to bring public health kicking and struggling into the 21st century.  But its goals won’t be achieved, in my view, simply by government policy being developed in a top-down way, and dumped onto populations.  Without community participation, and indeed community leadership rather than just “consultation”, we won’t get anywhere.  The only way to change the world, in my view, is by local people working with the things that concern them most, in their own settings and culture, in partnership with government.   How do you see the manifesto impacting on New Zealand health and Health Promotion? Well so far it’s not very advanced.  The manifesto was only published in 2014, and it’s not very well known here yet.  I and others have given a few workshops and presentations on it, and I must say there’s been a very positive response to it at those.  So definitely, there’s a huge potential for public-health people and other people of good will to become passionately involved in this enterprise.  But we’ve got a long way to go yet.   I understand you are writing a book about spirituality.  Can you tell us more about this? Have you got all day?  Briefly, ten years ago when I was leaving the University of Auckland, I wanted to spend more time meditating and doing “spiritual” things, given that I had a strong interest in Zen and Taoism.  I have a property in the wilds of Great Barrier, and had the romantic vision of spending lots of time there in the bush in the pursuit of – whatever it is one pursues in such a setting. But when the time came, I got cold feet, and wondered whether spirituality was simply a psychological entity dreamed up by humans to provide us with hope and happiness in a stressful world. (My background is as a psychologist). I then got to thinking that there were large numbers of people in the 21st century labelling themselves spiritual, and many declare themselve “spiritual but not religious.”  I decided I wanted to know what they meant. What is this thing called spirituality? It’s definitely not religion, although religion has elements of it of course. So what is it?   It’s taken me all those years to figure it out , and I’ll give just a clue as to what that might be.  I believe it’s in our genes, the result of millions of years of evolutionary development at both the prehuman and human level, and it serves very important survival and well-being purposes.  Unsurprisingly, I believe it also has a very strong community dimension in it’s background.  But at this point I’ll say no more, partly because I’m still working on it, but also partly because once I start on this topic, it could take all day!   And does it relate to health promotion?  Yes indeed it does, and also to planetary health.  For several years at the University of Auckland, I used to teach a postgraduate course called Spirituality and Health, and it had a strong health promotion bias.  It used to attract students from every kind of background, from atheist to fundamenalist, and all cultures, and this enabled me to develop a concept of spirituality as it related to health promotion.  But don’t get me started on that either!     We thank Professor Raeburn for his valuable time, warmth and considered replies.   March 2016 Jo Lawrence-King – See more at:[/vc_column_text][/vc_column][/vc_row]

News, Policy
A new charter is a call to action on health and wellbeing at tertiary education centres around the world.  The Okanagan Charter was produced in October 2015 at the 2015 International Conference on Health Promoting Universities.  “Universities and colleges must be exemplars of health-promoting communities,” says Deborah Buszard, Deputy Vice-Chancellor of the host university.  “The Okanagan Charter is a powerful call to action for post-secondary institutions to embed health in our campus policies and services, to create environments which support health and personal development, and to become communities with a culture of well-being.” The Tertiary Wellbeing (Aotearoa New Zealand) – TWANZ – development group is considering a national consultation process to map out ways the Charter can be applied here.  Members of the TWANZ development group were among the 45 countries that contributed to the Charter, which is designed to confront increasingly complex issues about health, wellbeing, and sustainability of people and the planet .“Cumulatively the Okanagan Charter and the NZ tertiary sector’s focus on wellbeing is very encouraging,” says Anna Tonks, project coordinator for the TWANZ development group.  The group is now calling for stories of best practice and for new members to join them. The Okanagan Charter puts higher education at the forefront of the movement. Conference delegates pledged to take the Charter back to their countries and organisations to mobilise health promotion action; both on and off campuses. The Conference was held at the Okanagan campus of the University of British Columbia in Canada. If you have a story to share or are interested in joining the group please contact Anna Tonks.   okanagan-charter-cover

News, Policy, Smoking

campaigns for smokefree cars

  marama-fox-and-chathy-cherrington-source-new-zealand-herald   Northland Health Provider Te Hiku Hauora is leading a campaign to encourage Government to legislate against smoking in cars carrying children under 18 years of age. Cathy Cherrington, manager of Te Hiku Hauora’s health promotion team in Kaitaia presented a 2000 signature petition to co-leader of the Maori party Marama Fox earlier this month.  The petition calls on Government to protect children agains passive smoking in cars.  New rules in Britain now ban smoking in vehicles with children on board. The petition calls for a similar ban here and will be presented to Parliament by Ms Fox. Marama Fox – an ex-smoker and anti smoking campaigner – was delighted to accept the petition.  She said she will accept support for her battle to eliminate smoking in New Zealand by 2025 from wherever it comes.  

Diet, News, Policy
The majority of New Zealanders now support a tax on sugary drinks.  That is according to public health advisory group FIZZ (Fighting Sugar in Soft-drinks), which published its findings from two large-scale surveys in the 25 September issue of the New Zealand Medical Journal (NZMJ).  According to the authors “a significant shift has occurred in New Zealanders’ appetite for a tax on sugar-sweetened beverages (SSBs), if the funds collected are to be used to prevent obesity.”   coca-cola-obese   There is strong political support, from parties outside government, for action to address SSBs, the paper says. A policy brief by the New Zealand Beverage Guidance Panel has been endorsed by the Green, Labour and Māori parties.  The brief “Options to reduce sugar sweetened beverage consumption in New Zealand” outlines 20 suggested initiatives to address the issue.   New Zealand has the third highest rage of childhood obesity in the developed world1.  In their NZMJ article the authors cite a recent study, which conservatively attributes a high sugary drink intake to 561 deaths in Australasia every year2.  This is equivalent to 40% of the region’s annual road toll.  

 “It seems inevitable […] that an SSB tax will be a major part of reclaiming our chil­dren’s health, considering the growing public support for its implementation,” say the authors of the NZMJ paper. “The only question that remains is when.”

To read the full article, click here.  You will need to subscribe to the NZMJ.   OECD, OECD Obesity Update 2014. 2014. obesity- update.htm Singh G, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D. Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010. Circulation. June 29, 2015.   Jo Lawrence-King

Following her attendance at the Equity at the Centre Conference in Alice Springs (4-5 September 2014), HPF Senior Health Promotion Strategist Karen Hicks reports on some of the presentations made during the two day event. “Austerity kills” – that was the claim of Sharon Friel, Professor of Health Equity at the Australian National University, Canberra in her presentation Power and People: a game plan for health equity in the 21st Century.  “Health promotion is about freedom and empowerment; giving people a voice,” she said.  “What is shaping our everyday living resources is power.”  She characterised budget cuts as ‘structural violence’ that threaten equity and wellbeing.   “Injustices are everywhere and they affect peoples’ health. These injustices can and should be eliminated. …..  How we understand, frame, communicate and engage around matters to do with health equity guides the types of actions that are taken, or not, to improve the lives of all groups in society.” “Health promotion is about freedom and empowerment; giving people a voice,” she said.  “What is shaping our everyday living resources is power.”  She characterised budget cuts as ‘structural violence’ that threaten equity and wellbeing. Asked what health promoters can do in their everyday practice, Prof Friel said  “We need to think about our work with an equity lens on every day; otherwise we are not addressing the social determinants of health.” Prof Friel’s game plan for health promoters consisted of three steps: 1. Keep equity at the centre. Rather than focusing on selective social determinants of health (such as housing or education) we need to keep equity as a whole at the centre of everything we do. 2. Frame your messages to fit your audience. Realpolitik (based on power and on practical factors) rather than ideology is the way to go in the current Australian climate, for example. Data is powerful.  Evidence will support the value of health promotion and initiatives. Social media is a powerful way to create a movement.  It will succeed where traditional media often meet with resistance from the industry that fund them. 3. Release the power. The strength of health promotion lies in its ability to work collaboratively with a range of people and disciplines.  We can release the power of these networks by: Recognising the skills and capacity of our workforce and empower them to make a difference. Foster relationships with a wide range of complementary disciplines to create a team effort.   About Sharon Friel Sharon Friel is Professor of Health Equity, incoming Director of Regulatory Institutions Network (RegNet) and Director of the Menzies Centre for Health Policy, The Australian National University, Canberra She is is from the east end of Glasgow. After leaving Scotland in 1990, she pursued an academic career in public health following a brief stint making carpets in Germany and smelling beer in England. Sharon Friel is currently Professor of Health Equity at the National Centre for Epidemiology and Population Health and Director of the Menzies Centre for Health Policy at the Australian National University. Between 2005 and 2008 she was the head of the Scientific Secretariat, based at University College London, of the World Health Organisation’s global Commission on Social Determinants of Health. In 2010 she was awarded an Australian Research Council Future Fellowship to investigate the interface between health equity, social determinants and climate change (particularly through food systems and urbanisation), based at the National Centre for Epidemiology and Population Health, ANU. Before moving to Australia, she worked for many years in the Department of Health Promotion, National University of Ireland, Galway. She is co-founder of the Global Action for Health Equity Network (HealthGAEN), a global alliance concerned with research, training, policy and advocacy related to action in the social and environmental determinants of health equity, and chairs Asia Pacific-HeathGAEN.         Jo Lawrence-King 10 September 2014

“Inequalities in health exist both within and between countries.  They are both unnecessary and unjust.  They also create a great cost to societies…”  These are the opening words of the latest Eurohealth; the quarterly publication of the WHO-hosted European Observatory on Health Systems and Policies.  Reporting on the 7th European Public Health Conference, this special edition for 2015 focuses on the issues discussed at the November 2014 event in Glasgow, Scotland.  With the theme of the conference being “Mind the Gap: Reducing Inequalities in Health and Health Care”, EuroHealth articles look at:
  • How Roma communities are responding to inequalities;
  • The adaptation of health promotion and disease prevention interventions for migrant and ethnic minority populations;
  • The Glasgow Declaration;
  •  Learning from each other – where health promotion meets infectious diseases;
  • Public health monitoring and reporting;
  • Changing your health behaviour – regulate or not;
  • Developing the public health workforce;
  • Building sustainable and resilient health care systems;
  • Leaving a legacy in Glasgow;
  • Conclusions; and Eurohealth Monitor.
The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, the United Kingdom and the Veneto Region of Italy, the European Commission, the World Bank, UNCAM (French National Union of Health Insurance Funds), London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine. Read more about inequalities and other significant health issues in Eurohealth Number 1, 2015 here.

Scottish MPs (MSPs) have called for a multi-agency approach to tackle inequalities.  This follows the publication of the Report on Health Inequalitiesafter a two year inquiry, which identified the ongoing health gap between the rich and poor in Scotland.     The gap, they say, has endured; despite political will and investment in public health campaigns on smoking, nutrition and exercise.  In fact the inquiry identified that such campaigns had the potential to increase inequalities.  This is for two reasons:   1. Such campaigns do not address the primary causes of inequalities such as poverty and deprivation and 2. There is greater likelihood that the approaches would be taken up by the more literate and financially-able middle classes than those living in poverty.   It concluded that effective narrowing of the gap will require a multi-agency, multi-initiatives approach.   The MSPs pointed out that the primary causes of health inequalities; social and economic problems; lie outside of the health sector.  The National Health Service (NHS) alone cannot these issues. They identified three approaches to tackle inequalities:   Measures through the taxation and benefits system; Agencies collaborating to work effectively on related policies such as housing and education; NHS to provide better access to primary health services for the poorest and most vulnerable.   While the life expectancy gap in New Zealand is not as great as that in Scotland, there remain significant differences between different sectors of the population, with Māori and Pacific people faring poorly in health outcomes.   “It is particularly important to address this inequity; not only as a moral issue but as a societal one: inequities are linked to poor health outcomes, reduced opportunity, poor economic growth, lack of social cohesion and increased health care costs.,” says HPF Senior Health Promotion Strategist Karen Hicks.  “HPF will watch the development of this initiative in Scotland with interest.”     Karen Hicks and Jo Lawrence-King  

The Alma-Ata Declaration is considered by many to be the founding framework for health promotion internationally.  It came from an International Conference on Primary Health Care, in Alma-Ata, USSR, 1978. “The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world ….. “

World Health Report 2008 – Primary Health Care – Now More than Ever “Globalization is putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should. People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in ways that correspond to their expectations. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.”  The 2008 WHO report Now More Than Ever outlines Primary Healthcare (PHC) reforms to mee the health challenges of today’s world.

Family and child, Policy
The first 1000 days of a child’s life are critical to their long term development. One thousand days is also approximately the duration of one term of parliament. So either way we have about 1000 days to get it right. The future of New Zealand depends on it.”   Getting it right in those first thousand days means today’s young children are given every opportunity to develop their full potential as healthy, emotionally mature, socially engaged and well-educated, productive adults.”   Read the 2011 report from Every Child Counts.

The 2014 Child Poverty Monitor released this month shows that reducing child poverty will require bold and sustained commitment from government. Child Poverty Action Group welcomes the latest Child Poverty Monitor and congratulates the Office of the Children’s Commissioner, the JR McKenzie Trust and the University of Otago’s NZ Child and Youth Epidemiology Service on their commitment to measuring and monitoring child poverty. The Monitor brings together all the known statistics about child poverty in Aotearoa New Zealand with current statistics on health outcomes. CPAG health spokesperson Dr Nikki Turner says, “The 2014 Child Poverty Monitor shows there has been little change over the past year and far too many New Zealand children still live in poverty.  This problem is too difficult to be addressed by piecemeal measures – substantial commitment is needed to improve incomes and housing for families with children.” Nikki Turner says, “We know childhood poverty has life-long consequences for people’s health and well-being.  For children to stay healthy, families need enough money for affordable, decent and stable housing, nutritious food, doctor’s visits and prescription fees.  They need cooking and laundry facilities, access to hot water, soap, clean towels, clothing, shoes, bedding and basic first aid.   Income adequacy is pivotal and insufficient money continues to affect children’s health, as the statistics in the Child Poverty Monitor show.  There are a range of issues to be tackled and some progress is being made, such as the reduction in costs for GP visits, but income adequacy is an urgent need, particularly for our most vulnerable children.” Child Poverty Action Groups calls on the government to lead a cross-party agreement on an action plan to reduce child poverty, including: •    Treating all low-income children equally. •    Improving incomes significantly for low income families and access to affordable housing and healthcare for all children •    Ensuring an accelerated rate of poverty reduction for Mäori and Pasifika, so they achieve equity with other children. •    Introducing child poverty legislation to ensure proper, regular measurement of child poverty on a range of measures. In addition, targets and timelines for child poverty reduction should be set with annual reporting to Parliament on progress towards these targets by the responsible Minister.  

Economics, News, Policy
Health professionals are calling for a comprehensive health impact assessment of the Trans-Pacific Partnership (TPP) agreement to protect the health of New Zealanders. According to leaked information, international big business – such as the tobacco or alcohol industries – could sue the New Zealand government if the country’s health-based policies threaten their profits. Clauses designed to protect the intellectual property rights of the pharmaceutical industry would apparently prevent PHARMAC purchasing cheaper generic drugs; making medicines more expensive in New Zealand. health-review-of-tpp-image “The negotiations are all being carried out in secret, and the little that has leaked out is very worrying,” says Dr Joshua Freeman, a spokesperson for the ten health organisations involved. “New Zealand should have the sovereign right to make laws and policies for the wellbeing of its people without interference. Under the TPP it appears that New Zealand could find itself in the international trade tribunal if it brings in new policy around, for example, tobacco, alcohol, unhealthy food, or environmental regulation.” Read the full media release.   28 October 2014 Jo Lawrence-King  

A briefing by the New Zealand College of Public Health Medicine (NZPCHM) for the incoming Health Minister focuses his attention on seven key issues:
  • health equity
  • child poverty and child health
  • climate change
  • housing
  • nutrition and physical activity
  • smoking
  • alchohol.
Prescription for a Healthier New Zealand” describes the key health and social issues affecting the health and wellbeing of New Zealanders.  

News, Policy, Racism
All but one of all the political parties of New Zealand have responded to last month’s invitation, by the Institutional Racism Special Interest Group (IRSIG), to state their position on addressing institutional racism in Aotearoa New Zealand. racism_thematic   Responses were as wide-ranging as the political parties.  A brief paragraph from the Act party suggested the issue centres on preferential treatment of Māori, while the Green Party issued an in-depth statement acknowledging that health and wellbeing is a basic human right and needs to be upheld for all New Zealanders, regardless of their ethnicity. The New Zealand Labour Party was the only party to decline to respond Institutional racism is defined as “an entrenched pattern of differential access to material resources and power determined by race, which advantages one sector of the population while disadvantaging another”[1].  Present-day examples of institutional racism can be seen in Waitangi Tribunal claims and lead to inequities in health, education, employment and criminal justice outcomes for Māori [and other ethnic minorities?]. The IRSIG is a tripartite group, with members from the Health Promotion Forum of New Zealand – Runanga Whakapiki Ake i te Hauora o Aotearoa, the Public Health Association and the Māori Public Health Leaders Alumni. Read the ISRIG’s report on the parties’ responses.  

Maori, News, Policy
Outgoing co-leader of the Maori Party, the Honourable Tariana Turia, signalled her support for public health and health promotion this week.  In a heartfelt speech, delivered on her behalf to the Public Health Association Maori Caucus Hui, Mrs Turia emphasised the holistic definition of health.  She proposed the use of the phrase mauri ora (life force) to better describe it and expressed her desire to see a relentless effort to achieve equity of health outcomes for all. Minister Turia’s speech ended with encouragement to continue our work: “keep asking the curly questions; demand answers that are sourced in our own solutions.   We must leave no stone unturned until we can change the circumstances for the health of all our whanau, and enable all our families to flourish.”   guestspeakerhontarianaturia   “Health is not merely the absence of illness or disease; a medical condition, a pinpoint on a chart,” read Mrs Turia’s speech. “It must be found in the sense that one’s life is rich and vibrant; the capacity to take action; to purposely make life better.”  Mrs Turia referred to the World Health Organisation’s assertion that health is a ‘positive concept emphasising personal and social resources, as well as physical, mental and spiritual capacities’. “We must organise to do whatever it takes to improve, promote and protect the health of the whole population.  We must mobilise on many fronts – participating in public policy processes; sharing information; building our workforce.” “It was hugely encouraging to receive the endorsement of such a respected member of our community,” said HPF deputy executive director Trevor Simpson.  “Minister Turia’s words closely match our mahi (work) and will spur us on to continue contributing to public policy, building the health promotion workforce and offering support and leadership to health promoters across New Zealand and the world.” Mrs Turia went on to propose a new definition for health – mauri ora – which, she says, “is about whanau flourishing – about vitality, integrity and energy.   We find mauri ora through positive relationships in the wider environment…” And she expressed a wish to see an organisation created – dubbed the Relentless Institute – that ensured every person on the planet has equity of access and opportunity to health outcomes. Mrs Turia planned to attend the hui, despite it being just ten days out from her valedictory speech in parliament.  Unfortunately fog kept her plane on the ground in Wellington, so her speech was delivered on her behalf by Adrian Te Patu, Public Health Consultant and facilitator for the hui. 15 July 2014 Written by: Jo Lawrence-King  

Global, News, Policy
An in-depth paper published in The Lancet this February urges policy makers to recognise and address global political determinants of health inequity.  “Grave health inequity is morally unacceptable,” the authors say; it is a “global political responsibility” to ensure “transnational activity does not hinder people from attaining their full health potential.”   global-governance-for-health   The paper, produced by the Commission on Global Governance for Health challenges the ‘biological’ argument for health inequalities and places the main responsibility for them firmly at the feet of national governments around the world; calling on them to redress the imbalance of fairness and justice that currently exist.  “Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven,” say the paper’s authors. “Health equity should be a cross-sectoral political concern, since the health sector cannot address these challenges alone”. The Commission recognises the crucial role of the health sector in addressing health inequalities it points out that the sectors efforts  “often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.” “This is a timely development for the discourse about our health and the wellbeing of our planet,” says HPF Executive Director Sione Tu’itahi. “What happens at the international level impacts directly on the local level, whether we like it or not: take global warming and trade, for example. Worldwide political determinants are rising fast but our governance and policy framework are still largely focused on local and national interests at the expense of our collective wellbeing. As a global family, we can no longer afford to focus on the room that we occupy when the whole house is battered by the storm.”   The political origins of health inequity: prospects for change The Lancet, Volume 383, Issue 9917, Pages 630 – 667, 15 February 2014 Access the article online at The Lancet here (you will need to register, but it is free)   1 May 2014 By: Sione Tu’itahi Edited: Jo Lawrence-King  

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  

The World Health Organisation (WHO) has published five new policy guides for addressing health inequity.  The guides have been produced by New Zealand Doctor Belinda Loring, a past Fellow of Health Promotion Forum with a strong interest in health equity and action on the social determinants of health.  While she was still in New Zealand Dr Loring worked on health equity and public health at local, regional and national government levels, with a strong focus on Māori health inequities.   The equity action spectrum: taking a comprehensive approach Alcohol and inequities Injuries and inequities Obesity and inequities Tobacco and inequities  

Economics, News, Policy
    In a consultation draft published this month, the Ministry of Health (MoH) has renewed its commitment to health promotion as one of five core functions for public health.  It is inviting submissions on the service specification by 16 May.   In the Public Health Service Health Promotion Tier Two Service Specification, published by the National Health Board Business Unit, the MoH emphasised the importance of tackling the factors that determine health:  “Because of the focus on determinants of health, there should be less focus on the activities in personal knowledge and skills section, and a move toward approaches such as health in all policies,” it says.   The Health Promotion Forum of New Zealand (HPF) welcomed this new emphasis.  “It is encouraging to see the Ministry recognise the foundations of health promotion in the social factors that determine the hauora of an individual, community or population,” says HPF Executive Director Sione Tu’itahi.  “We will certainly be putting forward a submission to the Ministry to encourage this crucial approach to hauora and would encourage all organisations in health promotion to do the same.”   As the National leaders in health promotion, HPF has 25 years’ experience in the area; providing training and capacity-building to thousands of individuals and organisations. Tu’itahi continues:  “Health promotion is most effective when all five strands of the Ottawa charter are applied in an integrated way.  HPF would love to work alongside the Ministry to help it gain the best outcome from this crucial work here in Aotearoa New Zealand.”   As part of the Ministry’s greater focus on the health inequity and the social determinants of health, Health Minister Hon Tony Ryall recently announced a proposed new initiative Healthy Families New Zealand.  See our news article about the initiative here.   The consultation document is part of a review of public health service specifications.     Jo Lawrence-King 18 March 2014  

In a consultation draft published in 2013, the Ministry of Health (MoH) renewed its commitment to health promotion as one of five core functions for public health.  It is inviting submissions on the service specification by 16 May. In the Public Health Service Health Promotion Tier Two Service Specification, published by the National Health Board Business Unit, the MoH emphasised the importance of tackling the factors that determine health:  “Because of the focus on determinants of health, there should be less focus on the activities in personal knowledge and skills section, and a move toward approaches such as health in all policies,” it says. The Health Promotion Forum of New Zealand (HPF) welcomed this new emphasis.  “It is encouraging to see the Ministry recognise the foundations of health promotion in the social factors that determine the hauora of an individual, community or population,” says HPF Executive Director Sione Tu’itahi.  “We will certainly be putting forward a submission to the Ministry to encourage this crucial approach to hauora and would encourage all organisations in health promotion to do the same.” As the National leaders in health promotion, HPF has 25 years’ experience in the area; providing training and capacity-building to thousands of individuals and organisations. Tu’itahi continues:  “Health promotion is most effective when all five strands of the Ottawa charter are applied in an integrated way.  HPF would love to work alongside the Ministry to help it gain the best outcome from this crucial work here in Aotearoa New Zealand.” As part of the Ministry’s greater focus on the health inequity and the social determinants of health, Health Minister Hon Tony Ryall recently announced a proposed new initiative Healthy Families New Zealand.  See our news articleabout the initiative here. The consultation document is part of a review of public health service specifications.       Jo Lawrence-King 18 March 2014

Global, Policy
iuhpe-executives-inc-st   Health Promotion Forum (HPF) Executive Director Sione Tu’itahi is calling on health promoters at all levels to join forces and make a difference to hauora here and around the world.  “They say think globally, act locally, but these days we must think and act on all levels,” says Sione .   Sione returned last Friday from Paris, France, where he attended a two-day meeting of the GlobalExecutive Board of the International Union for Health Promotion and Education (IUHPE).  At the meeting the Board put together a work plan to contribute to solving global health challenges and ensuring the long-term sustainability of the IUHPE.  One of the key resolutions was to redouble efforts to unify and energise the health promotion movement and Sione hit the ground running when he arrived back in Aotearoa New Zealand.   “The world is but one global village and challenges impacting on the international level influence the national and local levels as well,” said Sione.  “Take the economic recession or global warming, for instance. Both challenges affect everyone at every level, whether you are in Paris, Auckland, or Ha’ano, [Sione’s home Island in Tonga].  “We must work together or we will all be affected by these common challenges, many of which are human-made and, therefore, can be resolved.”   Sione is the first Indigenous person from the Pacific region to hold an official post with the IUHPE.  He is a member of the global board in his role as Vice-President of IUHPE, South West Pacific Region, which covers New Zealand, Australia, all small Pacific island nations and some countries in Asia.   IUHPE is a global umbrella organisation for health promotion professionals and organisations of the world.  Its headquarters are in Paris.  For the next three years (2013-2016) its South West Pacific Region office is co-hosted by the Health Promotion Forum and the Health Promotion and Research and Evaluation Unit (HePPRU) of Otago University’s School of Public Health. HePPRU’s Director, Associate Professor Louise Signal, is also the Director of IUHPE for the South West Pacific Region.   The HPF is a national umbrella organisation for health promotion organisations and teams in New Zealand. While its primary focus is on the national level, HPF has both a global reach and a local impact.   Sione issued a personal invitation to health promoters around the country: “If you wish to be part of the solution on all levels, join a global movement and a national organisation.”   Join IUHPE and HPF by contacting Emma at HPF” Read about the benefits of HPF membership.   Pictured above are (from left): IUHPE President, Professor Michael Sparks, of the Australian National University, Ms Marie-Claude Lamarre, Executive Director of IUHPE, and Sione Tu’itahi, HPF Executive Director and Regional Vice-President of IUHPE, at the meeting held at the Paris Global Centre of Columbia University.   Story published: 13 December 2013 By: Sione Tu’itahi Edited:  Jo Lawrence-King  

Community, Economics, News, Policy
tony-ryall-crown-copyright   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.”   Subscribe to NZ Doctor   Article adapted from NZ Doctor article by Karen Hicks Edited by Jo Lawrence King Published: 2 December 2013 Photo: Crown copyright  

Maori, Policy
image-for-maori-public-health-hui-story   Three key project areas were agreed at a recent hui taumata (summit) of Māori Public Health Leaders at Te Ohāki Marae in Huntly. The three agreed areas of focus are to:   1. provide support infrastructure like communications, a clearing house, agenda setting and a mobilisation plan (dubbed He Mahi Kaitiaki). 2.promote action around institutional racism 3.foster wider social and political change.   All three of the projects will be interconnected: aiming to increase participation in Public Health dialogue, increase a sense of collective responsibility to make change and challenge the current political arrangements in health to do better.   The project ideas will seek further support and mandate at the national annual hui being held at Turangawaewae Marae this 14-15th November.   The hui drew on the knowledge of Māori public health Leadership programme graduates to develop a plan of action for Māori public health.  Led by Tania Hodges of Digital Ltd and Grant Berghan, Public Health Consultant hui asked the question “If there was just one thing we could do as leaders…?” The agreed focus areas were arrived-at following two days of intense and challenging discussion, with debate focussed on improving health for Māori communities and whānau.   There are nearly 500 graduate members of the programme, with membership of the alumni  covering the length and breadth of the Aotearoa New Zealand and involves people from a wide gamut of Public Health.  There was much discussion around the importance of mobilising this expertise to improve Māori health outcomes.   Te Ohāki Marae itself was a significant venue for the summit, with historical references to Te Kirihaehae Te Puea Herangi who famously placed a stake in the ground where the marae and wharenui was to be situated. For the attendees at the hui the stake was seen to symbolise the point from which stronger Māori public health action would be advanced.   Further information: The Health Promotion Forum offers training in several areas specific to Māori health.  Click here to find out more about our workshops and other training opportunities. Read about Māori health models here. Click here to find out about the Maori Public Health Leadership course.   Wordle created by Papatuanuku Nahi Article created: 15 October 2013  


The Ministry of Health has an extensive collection of publications about child health in New Zealand These include the 1998 Child HealthStrategy. Child health publications

Influences in Childhood on the Development of Cardiovascular Disease and Type 2 Diabetes in Adulthood: An Occasional Paper (2005)

This paper examines the medical literature on the childhood determinants which correlate to adulthood diabetes and cardiovascular disease in an effort to inform policy decisions and program implementation in the health sector. It also provides important information for health practitioners who are striving reduce the chronic disease trends for adults in NZ. Influences in Childhood

Health Eating Healthy Action: Strategic Framework (2003)

This strategy calls for a more integrated and multi-sectoral approach to addressing nutrition, physical activity and obesity, and highlights the importance of both individual behaviour and our environment. Strategic Framework

Family and child, Policy
Children and Young People: Indicators of Wellbeing in New Zealand 2008
This the second indicator report published by MSD highlighting indicators of social well-being of children and young people, how these have changed and the status of health for different child and youth groups in the current population. MSD has utilized the findings from this report to advise the UNCROC report to be submitted to the United Nations. Summary of findings Full Report  
Raising Children in New Zealand: The Influence of Parental Income on Children’s Outcomes
This report examines the impact parental income has on many child outcomes including health and well-being. By focusing on the correlation between net family income and child outcomes this report contributes in advising public policy on income support. Influence of Parental Income  
The Social Report 2010: Indicators of Social Well-being in New Zealand
This site provides in-depth information on the social health and well-being status of New Zealand society, through the use of indicators to monitor trends over time and to make global comparisons. The site also contains the full 2008 Social report and areas dedicated to the different indicators. The Social Report 2010

Milestones in Health Promotion. Published by World Health Organisation (WHO) in 2009, this is a collection of global statements in one booklet. Or you can access individual statements below: Adelaide Statement on Health in all Policies -Report from the International Meeting on Health in All Policies, Adelaide 2010. The purpose of this report was to engage leaders and policy-makers at all levels of government – local, regional, national and international. It emphasizes that government objectives are best achieved when all sectors include health and well-being as a key component of policy development. This is because the causes of health and well-being lie outside the health sector and are socially and economically formed. Although many sectors already contribute to better health, significant gaps still exist.

WHO Global Conferences on Health Promotion

The Eighth Global Conference on Health Promotion: Health in all Policies. Helsinki, Finland 10-14 June 2013. Two items were produced from this conference: the Helsinki Statement and a Framework for Country action. Thestatement asserts that “health inequities between and within countries are politically, socially and economically unacceptable, as well as unfair and avoidable. Policies made in all sectors can have a profound effect on population health and health equity.” It called on governments to fulfil their obligations to their peoples’ health and wellbeing. Both the Statement and the Framework for Country Action can be found here. The Seventh Global Conference on Health Promotion, Nairobi, Kenya 26-30 October 2009, produced a Call to Action, whichidentified key strategies and commitments urgently required for closing the implementation gap in health and development through health promotion. The sixth Global Conference on Health Promotion – Thailand; 7-11 August 2005 – produced theBangkok Charter (above) The Fifth Global Conference on Health Promotion: Bridging the Equity Gap, Mexico City, June 5th, 2000. Signed by Ministers of Health, the brief 8-pointMexico Ministerial Statement for the Promotion of Health: From Ideas to Action acknowledges the duty and responsibility of governments to the promotion of health and social development. The Fourth International Conference on Health Promotion: New Players for a New Era- Leading Health Promotion into the 21st Century, meeting in Jakarta from 21 to 25 July 1997, came at a critical moment in the development of international strategies for health. It was the first to be held in a developing country and the first to involve the private sector in supporting health promotion. The Jakarta Declaration on Leading Health Promotion into the 21st Century identified the directions and strategies needed to address the challenges of promoting health in the 21st century. The Third International Conference on Health Promotion, Sundsvall, Sweden 9-15 June 1991: Supportive Environments for Health. This conference called upon people in all parts of the world to actively engage in making environments more supportive to health. Examining today’s health and environmental issues together, the Conference points out that millions of people are living in extreme poverty and deprivation in an increasingly degraded environment that threatens their health, making the goal of Health For All by the Year 2000 extremely hard to achieve. The way forward lies in making the environment – the physical environment, the social and economic environment, and the political environment – supportive to health rather than damaging to it. The Sundsvall Statement on Supportive Environments for Healthis a call to action, directed towards policy-makers and decision-makers in all relevant sectors and at all levels. The Second International Conference on Health Promotion in Adelaide, South Australia, 5-9 April 1988, continued in the direction set at Alma-Ata and Ottawa, and built on their momentum. Two hundred and twenty participants from forty-two countries shared experiences in formulating and implementing healthy public policy. The resulting Adelaide Recommendations on Healthy Public Policyreflect the consensus achieved at the Conference. The first International Conference for Health Promotion in Ottawa, Canada 21 November 1986 produced the Ottawa charter (above) The WHO has links to all its past conferences on health promotion.

“This position statement uses the term equity in preference to equality because it better recognises that people differ in their capacity for health and their ability to attain or maintain health. Consequently, equitable outcomes in health may require different (i.e. unequal) inputs to achieve the same result. This is the concept of vertical equity (unequal, or preferential, treatment for unequals) in contrast to horizontal equity (equal treatment for equals).”