This Statement from Indigenous participants in the 23 rd IUHPE World Conference on Health Promotion (Rotorua, Aotearoa New Zealand) is a call on the health promotion community and the wider global community to make space for and privilege Indigenous peoples’ voices and Indigenous knowledges in promoting planetary health and sustainable development for the benefit of all. It should be read alongside the Rotorua Statement from all participants in this Conference.
Indigenous peoples are diverse and our worldviews, which have developed over millennia of human experience, are specific to peoples and place. However, there are fundamental commonalities in these worldviews that have provided the basis for Indigenous peoples’ movements that draw us together around our shared interests. Core features of Indigenous
worldviews are the interactive relationship between spiritual and material realms, intergenerational and collective orientations, that Mother Earth is a living being – a ‘person’ with whom we have special relationships that are a foundation for identity, and the interconnectedness and interdependence between all that exists, which locates humanity as part of Mother Earth’s ecosystems alongside our relations in the natural world.
Understanding our place in the natural world in relational ways leads us to consider how access to the natural environment shapes human health and wellbeing, the impacts of our activities on the environment, and our inalienable collective responsibilities of stewardship which will benefit future generations.
Within Indigenous worldviews our relationship with the natural world is characterised by reverence and values that include sustainability, guardianship and love. Planetary health is understood as the health and wellbeing of Mother Earth and of humanity as an inextricable part of natural ecosystems. It should also be noted that Indigenous languages are critical in articulating Indigenous worldviews as they
enable the most full and accurate expression of Indigenous conceptualisations, and should be protected.
The forces of colonisation, capitalism and globalisation have caused massive environmental degradation, climate change, loss of biodiversity and the devastation of Indigenous communities. Further, they have led to intellectual imperialism and the widespread subjugation and exclusion of Indigenous worldviews, bodies of knowledge and voices.
Prevailing Western and other worldviews promote individualism and anthropocentric perspectives that to human peril separate humanity from the natural world. This has encouraged human activity that accelerates the depletion of planetary resources, the destruction of ecosystems, pollution, climate change and increase in the risk of ecological collapse.
Environmental degradation impacts disproportionately on Indigenous peoples because of close relationships with the natural world and our already marginalised circumstances in nation states. The silencing of Indigenous voices and the subjugation of Indigenous bodies of knowledge has been detrimental to all, most evident in our global environmental crisis.
Indigenous health promotion (as opposed to the generic form of health promotion which has largely Western origins) emerged in response to Indigenous peoples’ needs to make space for our own ways of seeing the world and as a vehicle to realise our aspirations to sustain future generations who are healthy, proud and confident as Indigenous peoples. It is an Indigenous-led endeavour with origins that stretch back in time to customary systems to maintain health and wellbeing that emphasised social and ecological connections. At the same time, Indigenous health promotion is open to knowledge generated from within other worldviews where there is alignment. Indigenous health promotion can be understood as the process of increasing Indigenous peoples’ control over the determinants of health and strengthening our identities as Indigenous peoples.
Ecological collapse is the greatest threat to human health and survival globally. Health promotion (policy, research, education and practice) needs to change to effectively respond to the challenges of the Anthropocene and bring intergenerational health equity into its systems and frameworks. Engaging with indigenous worldviews and bodies of knowledge
provides opportunities to find solutions to this most pressing threat and ways forward to promote the health of Mother Earth and sustainable development.
We call on the health promotion community and the wider global community to make space for and privilege Indigenous peoples’ voices and Indigenous knowledge in taking action with us to promote the health of Mother Earth and sustainable development for the benefit of all.
This Statement represents the collective voice of the social movement members, researchers, practitioners and policymakers who participated in the 23rd IUHPE World Conference on Health Promotion, held in Rotorua, Aotearoa New Zealand in April 2019. It should be read alongside the Indigenous Peoples’ Statement for Planetary Health and Sustainable Development from this Conference.
The conference participants call on the global community to urgently act to promote planetary health and sustainable development for all, now and for the sake of future generations. Planetary health is the health of humanity and the natural systems of which we are part. 1 It builds on Indigenous peoples’ principles of holism and interconnectedness, strengthening public health and health promotion action on ecological and social determinants of health. It puts the wellbeing of people and the planet at the heart of decision-making, recognising that the economy, as a social construct, must be a supportive tool fit for this purpose in the 21 st century.
Waiora is an Indigenous concept of our host country, Aotearoa New Zealand, which expresses the interconnections between peoples’ health and the natural environment, and the imperative of sustainable development. 2 3 Waiora represents a call to work with Indigenous peoples to draw on Indigenous knowledge, and to share knowledge from our diverse cultural systems for the wellbeing of the planet and humanity. Sustainable development for all is a clear way to ensure environmental, social and health justice for the people of today and for future generations.
Urgent action is needed because mounting evidence tells us that the current
economic and social development paradigm of infinite growth and endless exploitation of limited natural resources is unjust and unsustainable, leading to inequities within and among countries and across generations.
In 2015, the UN General Assembly adopted the new development agenda
“Transforming our world: the 2030 agenda for sustainable development”. 4 The 17 Sustainable Development Goals (SDGs) integrate economic, social and environmental development around the themes of people, planet, prosperity, peace and partnership. In doing so, they provide an action plan for the global community.
They prioritise the fight against poverty and hunger while focusing on human rights for all, and the empowerment of women and girls as part of the push to achieve gender equality. The SDGs recognise that eradicating poverty and inequality, creating inclusive economic growth and preserving the planet are inextricably linked to each other and to population health. 5
Conference participants call for immediate action from the global community in four key areas.
- Ensure health equity throughout the life course, within and among countries, and within and across generations. This requires:
The development of all peoples as empowered lifelong learners and
engaged contributors to individual health and the health of families,
communities and the planet.
Action and accountability to address the wide and enduring inequities
experienced by Indigenous peoples, while ensuring the protection of
cultural identity and customary ways of life.
Tackling the structural factors that drive the inequitable distribution of power, money, and resources; improving daily living conditions especially of those most in need; and measuring and understanding the problem and assessing the impact of action as outlined by the Commission on Social Determinants of Health. 6 Prioritising intergenerational health equity in systems, frameworks and
decision-making, as a central tenet of a planetary approach to health
- Make all urban and other habitats inclusive, safe, resilient, sustainable and conducive to health and wellbeing for people and the planet. This requires: Renewing and strengthening our relationship with planetary ecosystems. Protection of the planet from degradation, including through sustainable production, management and consumption of natural resources so that the planet can support the needs of present and future generations. This requires taking, enabling and advocating for immediate action on climate change and the loss of biodiversity.
Action to reduce disparities in the quality and quantity of resources
available to communities as these disparities are at the root of inequities in health. Current threats will accentuate such disparities. These include threats to food and water supplies associated with climate change, depletion of both renewable and non-renewable resources, the degradation of the environment such as contamination of food chains and ecosystems, poor air quality and massive forced migrations.
Greater cross-sectoral action to protect and improve the health of
populations experiencing inequities, including those in the world’s fast- growing urban areas.
Fostering of peaceful, just and inclusive societies which are free from fear, racism, violation and other violence.
The realisation of the health co-benefits of sustainable ‘One Planet’ living.
Ensuring urban decision-makers apply a “health equity lens” to assess the
risks and opportunities posed by policies and programmes and measure
their effects. 7
- Design and implement effective and fair climate change adaptation strategies.
The development of new approaches to global, regional, national and local governance and stewardship that will equitably promote health and well- being and prevent and mitigate disastrous climate and environmental breakdown, particularly in Low and Middle-Income Countries.
Repositioning Indigenous and traditional knowledge systems to be on an equal footing with science and other knowledge systems to promote health and well-being and prevent and mitigate disastrous climate change and environmental breakdown.
Development of action-oriented policies and partnerships between health and other sectors to develop policies addressing health and climate.
- Build collaborative, effective, accountable and inclusive governance, systems and processes at all levels to promote participation, peace, justice, respect of human rights and intergenerational health equity. This requires:
Respect for and adherence to the inherent rights of Indigenous peoples as articulated in the UN Declaration on the Rights of Indigenous Peoples.
Effective global governance free from the domination of economic considerations and commercial interests.
The promotion of participatory democracy, coherent policy-making and regulation in the public interest and to restrict conflict of interest.
Participants at the 23rd IUHPE World Conference in Rotorua also confirm the critical role and relevant expertise of the health promotion community in promoting human health, planetary health and sustainable development, including implementing the SDGs. Participants urge the health promotion community to provide leadership across our one planet.
- Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch:
report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet
- Durie M. An Indigenous Model of Health Promotion. 18th World Conference on Health Promotion
and Health Education. Melbourne, 2004.
- Durie M. An Indigenous model of health promotion. Health Promotion Journal of Australia
- UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development.
New York: United Nations 2015
- World Health Organization. Health in 2015: from MDGs, millennium development goals to SDGs,
sustainable development goals. Geneva: World Health Organization, 2015
- Marmot M, Friel S, Bell R, et al. Closing the gap in a generation: health equity through action on
the social determinants of health. The Lancet 2008;372(9650):1661-69.
- World Health Organization. Health as the pulse of the new urban agenda: United Nations
conference on housing and sustainable urban development, Quito, October 2016. Geneva:
World Health Organization, 2016.
- made bars and restaurants Smokefree,
- banned tobacco’s promotional retail display,
- reduce allowances of duty-free tobacco
- raised tobacco’s excise tax,
- currently; introducing standardised packaging of tobacco and banning smoking in cars carrying children.
- Central Auckland (the CBD)
- South Auckland (Manurewa)
- West Central Auckland (Blockhouse Bay)
- Northland (Kaikohe)
- It actively promotes the use of Taranaki mita (regional language variation), tikanga (cultural practice) and taonga (oral and cultural resources).
- There is critical awareness among leaders of the importance of whānau participation beyond the walls of the centre in the revival of language.
- The initiative maintains a firm stance on active language use and acquisition and has a rigorous whānau selection and induction process.
Longitudinal research shows that influences in early life matter greatly in terms of how a person fares later in life across a wide range of domains. It has been demonstrated that high quality early life interventions represent one of the best ‘investments’ a society can make to ensure an optimal start to life – one which will net significant returns over time via long-term benefits for individuals, whānau and society. There is huge potential for intervention in the early years to lead to substantial health gains later in life across a broad range of health issues that disproportionately impact Māori. These include health outcomes related to non-communicable diseases such as diabetes, coronary heart disease, stroke and also mental health issues and disability. While there is clear evidence around early years interventions leading to improved outcomes, what is largely missing are proven interventions that address ethnic inequalities, are effective for Māori and achieve sustainable positive health outcomes across the life-course. The aim of the Te Kura Mai i Tawhiti research is to contribute to generating an evidence base around what constitutes effective early life kaupapa Māori programming for tamariki and whānau that will lead to improved health outcomes later in life for tamariki.
Te Kura Mai i Tawhiti – research programme
Figure 1: Te Kura Mai i Tawhiti Research ProgrammeA feasibility or Proof of Principle study is under way in 2016 to firstly demonstrate the ability of the team’s research methods to determine change over time in tamariki and whānau on key constructs of interest (e.g. tuakiri, whānauranga, self-control). The Proof of Principle study will focus on whether, over the course of a year, an individual changes over time, taking into account developmental changes. Findings from the Proof of Principle study will be used to design two future studies. Firstly, a 10-year prospective project to compare same age cohort tamariki in Te Kōpae Piripono, with at least two comparison early years programmes selected from Taranaki or similar regions. This involves conducting a longitudinal study to compare groups across key child behavioural and whānau development measures (i.e. the measures used in the Proof of Principle study). In addition to the prospective study, a retrospective (historic) study will be undertaken (Figure 1 – as a part of Tangi ana te Kawekaweā). This will focus on previous graduates and whānau of Te Kōpae Piripono from the past 20 years (n>150 whanau) with an emphasis on graduate outcomes in health, education, Te Ao Māori and other determinants areas that may have been influenced by the kaupapa Māori child and whānau programming. If the research generates robust evidence of the success of the Te Kōpae Piripono model, there is potential for the overall approach and/or key elements of the intervention to be scaled up for implementation in other settings (e.g. other ECE and Māori medium) to complement broader approaches to addressing determinants of health and education and in other domains. The research is currently supported by the Health Research Council of New Zealand, the Ministry of Education, the New Zealand Council for Educational Research and the University of Otago.
- Greater awareness of alchohol and tobbacco-related harms.
- A high level of community ownership
- Policies developed by local sports clubs
- Effective working relationships among the stakeholders
- Māori medium early childhood education,
- Business and community partnership roles,
- Managing strategic community engagement and bottom-up leadership movements for health issues such as problem gambling, nutrition and physical activity, tobacco control; alcohol and other drugs.
- 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)