We asked three health promotion professionals three questions for the spring/summer 2015 issue of Hauora, focusing on health promotion in Aotearoa New Zealand and the Health Promotion Forum. Here are their responses: What do you see as some of the major issues regarding health promotion in Aotearoa New Zealand and the world today? Zoe Aroha Martin-Hawke identifies two interconnected issues facing health promotion in Aotearoa; the wide-ranging use and understanding of the term ‘health promotion’ and a decrease in the use of the term in workplace titles. “The use and understanding of the term ‘health promotion’ is wide-ranging, with some perceptions overlapping and others quite separate.  The challenge is to find a balance between autonomy of each perspective and enabling collaborative working in the areas that intersect.  The emergence of competitive funding contracts, with a set health promotion agenda, makes this particularly difficult. “Secondly a decrease in the use of the term ‘health promotion’ in job titles, work departments and job descriptions sees fewer people identifying as health promoters.  This may be related to the lack of consensus on the definition of health promotion and/or on  funding directives.  Such a lack of clarity may restrict the ability of people to practice the health promotion model they believe in.  As a result, Zoe is concerned that the discipline is losing its value, respect and presence in Aotearoa.” “Health promotion consists of so many dimensions that are strongly connected with Māori thinking it would be sad to see it disappear in the formal sense,” says Zoe.  “Furthermore people have invested time and money into the study of health promotion and are passionately connected to the discipline.  To not be able to practice what they have been students of for many years seems unethical. “   Much of Wiki Shepherd Sinclair’s 11 year career in health has focused on Health Promotion.  She believes that the challenges facing the Health Promotion space in Aotearoa New Zealand – and the world – today include lack of collaboration and communication, poor cultural awareness, lack of community engagement and an experienced, but unqualified workforce. According to Dr Mihi Ratima – and as outlined in the recent book she edited with Associate Professor Louise Signal (Promoting Health in Aotearoa New Zealand) – major issues facing health promotion include the challenge of neoliberalism, the positioning of health promotion on the periphery, and the difficulty in maintaining the health equity focus. As noted in the book, the health of the planet – and all of us who live on it – is under dire threat from factors such as climate change, obesity and new infectious disease. Progressive health promotion is an approach that can counterbalance threats to health with practice, policy and advocacy for health, well-being and equity. “There is an urgent need for further government investment in this approach”, she says. Perhaps our greatest challenge, according to Mihi, is in achieving health equity. “We are good at the rhetoric around reducing inequities, but are things really changing? If not, why don’t we have a sense of urgency about it? What does the evidence say about some of the issues we know are important from a public health perspective, like income inequality? What is going on with those wider determinants? We know we can be effective, as evidenced by narrowing of gaps in life expectancy between ethnic groups over time.  But we also know that many of our interventions continue to have a majority population focus, leaving out some groups, and inadvertently increasing inequities. We must normalise a commitment to health equity in everything we do in health promotion, use the excellent health equity tools we have at our disposal, and ensure that no one is left out. The lived realities and voices of those who are different from us need to be part of the solutions.”   What do you see as the role of the Health Promotion Forum in population health today?  Zoe Aroha Martin-Hawke:“To lead workforce development to ensure that there is a shared understanding, respect and pathway for health promotion champions throughout the country.” To keep the sector up to date on health promotion internationally and nationally. To keep information flowing into the NZ context to secure a strong health promotion lens and voice to keep us connected and focused on the areas we need to collaborate on. Progressing indigenous perspectives on health, health equity and everyone’s right to health are key messages and activities that the health promotion forum are leading and can continue to lead in the quest for equitable population health. Health promotion leadership is needed and the health promotion forum can build that leadership through its membership. Wiki Shepherd-Sinclair suggested the following;
  • Supporting organisations to gain a better understanding of what health promotion in Aotearoa is and what this looks like in practice
  • Supporting organisations to have a shared understanding and common language of health promotion
  • To have a lead advocacy role in health promotion and public health
  • To promote Healthy public policy
  • Encouraging organisations to grow their networks and/or partnerships
  • To help organisations build awareness and skills to implement the Health Promotion Competencies
  •  Providing a set of practical tools and training around the HP competencies
According to Mihi Ratima “Health promotion is an established approach to addressing public health problems in New Zealand. A key role of the Health Promotion Forum is in supporting the workforce and organisations to develop shared understandings of effective health promotion approaches.  This leads to greater health equity and improved outcomes for individuals, whanau and communities: what works and how to apply health promotion through policy, practice and advocacy”. Mihi also believes the Health Promotion Forum has a role to play in supporting the development and growth of the body of theory and evidence for effective health promotion.   What would you say to an organisation considering membership of the health promotion forum? Zoe Aroha Martin-Hawke : “For clarity, consistency, ongoing workforce development and the ability to connect with like-minded health promotion workers from across the country, to keep up to date with international health promotion movements the Health Promotion Forum is exemplary.” “HPF is one of those rare examples of how to truly work from a reducing inequalities framework.” “As a member of the Health Promotion Forum you can trust that their statements around “prioritising activities that will benefit people communities who are least disadvantage” are not just words.  They take a systems approach to tackling these issues by starting with their own organisation – where it should start. “Their team consists of a strong Pacific and Māori team at all levels from the Board, to the Executive Director, to Deputy Executive Director to accountant.  All members of the team understand and are dedicated to viewing the reduction on inequalities in a broad socio-economic context, where promotion, prevention and protection are at the forefront.”   Wiki Shepherd-Sinclair encourages organisations to consider membership of HPF as the health promotion leader in Aotearoa New Zealand.  “The connections with regional and international leaders are a real plus for organisations that also want to grow their networks and strengthen relationships. The sharing of health promotion expertise and best practice, to increase better outcomes for our communities and populations, is of huge importance,” she says.   “It is critical that we have shared understandings of effective approaches to health promotion and work collaboratively,” saysMihi Ratima. “The HPF provides a mechanism through which organisations are able to work together and leverage off one another for the benefit of the entire membership. Member organisations are able to form relationships with one another and access training and expertise that is not otherwise available to them. This network of provision provides an expanded sphere of influence whereby innovation in health promotion is able to be easily shared and its value maximised through uptake within the network.”         Jo Lawrence-King 7 October 2015

First New Zealand Health Promotion book

Promoting Health in Aotearoa New Zealand Promoting Health in Aotearoa New Zealand was conceptualised as a text that equally integrates Māori and Pākehā analysis; consistent with an approach that emphasises the Treaty of Waitangi partnership and indigenous rights. The editors have endeavoured to achieve this through collaboration between Māori and Pākehā editors, advisors and contributors. Contributors to the book include: Professor Sir Mason Durie, Professor John Raeburn, Associate Professor Papaarangi Reid, HPF’s Executive Director Sione Tu’itahi, Associate Professor Cindy Kiro, and HPF’s previous Executive Director Dr Alison Blaiklock. Health promotion in Aotearoa New Zealand has elements that, in combination, make for a unique approach.  Ratima explains: “Key features are the unique contribution of Māori understandings and approaches; the application of a rights-based approach for example in relation to Treaty of Waitangi-based rights and indigenous rights; the strong equity focus; commitment to addressing determinants of health; an emphasis on strengthening community development and self-determination; and the use of local models, frameworks and tools.” There is very little text available that looks at health promotion in New Zealand – particularly as it relates to Māori. In fact Promoting Health in Aotearoa New Zealand is rare internationally for its strong focus on indigenous health. Frequently we refer to overseas texts when teaching and supporting public health practice.  Often these are not relevant to Māori, other New Zealanders or the New Zealand context. This has been of concern to health promotion academics and practitioners for some years. “This book has been written to address that gap,” says Mihi.  It explores ways in which Māori, and other, perspectives have been melded with Western ideas to produce distinctly New Zealand approaches. In doing so it addresses the need for locally written material for use in teaching and practice, and provides direction for all those wanting to solve complex public health problems. The book highlights the “dire threat” to the health of the planet – and all of us who live on it – from factors such as climate change, obesity and new infectious diseases. It concludes that progressive health promotion is an approach that can counterbalance threats to health with practice, policy and advocacy for health, well-being and equity.   HPF’s Executive Director Sione Tu’itahi was invited to speak a the book launch.  He was also a contributor to the book.
“…The process by which the book was produced, both in contents and presentation, reflects a successful partnership that resonates with the letter and spirit of our nation’s founding document, Te Tiriti o Waitangi; an example worth emulating. It also places Matauranga Maori (Maori knowledge)  prominently, while it weaves together the knowledge of the West, the knowledge of the East, and Indigenous knowledge systems as a set of effective solutions for addressing  our health challenges. Although the primary focus is on Aotearoa, the book brings in the experience and knowledge of Moana Nui a Kiwa and other regions, thus making the book a very valuable contribution to our collective effort at the global level to address planetary health. The recent launching of Promoting Health in Aoteroa New Zealand is very timely because: – there is an increasing awareness in all sectors, government, community, and the corporate sectors, that  to be effective in addressing our socio-economic, cultural, physical, ecological and spiritual wellbeing, we have to be health promotional and preventative in our integrated approaches – there is also a marked increase in the number of courses and qualifications on health promotion and public health in universities, polytechs and wananga. This book is a ‘must have’ reading and resources for all learners and practioners – additionally, there is an increasing awareness in other sectors, such as social development and education, of the connectedness of the set of challenges that we all try to address, and therefore, the increasing need to learn from other sectors such as health and some of their comprehensive and effective tools and approaches such as health promotion I would like to congratulate the hard-working editors, Associate Professor Louise Signal, and Dr Mihi Ratima.  Your perseverance, dedication, endless patience, and professionalism, have paid off. Well done!”    
        Jo Lawrence-King 7 October 2015