On September 16, 170 health professionals from across New Zealand attended the Health Coalition Aotearoa Political e-Forum to hear six of the political parties’ spokespeople discuss their positions on their party’s prevention policies. At that stage several parties had yet to release their health manifestos Below is a summary of the main questions and concerns raised at the Political e-Forum by participants. These are the key issues and key asks of the political parties ahead of the New Zealand General Election tomorrow (October 17). General Will your party act on reducing the supply of tobacco, alcohol and unhealthy food outlets in low social-economic communities? How will your party meet their Treaty obligations to protect Maori from harmful products like tobacco, alcohol and junk food that is causing unacceptable health inequities? What will your party do to reduce the affordability, accessibility and availability of the three key harmful products impacting New Zealander’s health – tobacco, alcohol and junk food? Given how much the Government depended on public health evidence to successfully manage Covid in NZ, how will your party continue this approach to evidence in relation to other pandemics such as childhood obesity? Tobacco When will the Smokefree Action Plan of achieving the 2025 goal be finalized, announced and implemented? Will you commit to its implementation in the first 100 days? Alcohol How does your party plan to meet its Treaty Obligations to prevent alcohol harm to Maori, which has slowly got worse, and the inequity gap has grown over the last 180 years. When will we see much needed alcohol legislative reform such as taxes and restrictions on trading hours and alcohol marketing and promotion? The affordability of alcohol has now reached an all-time high. What will your party do to turn down the tap on affordability? How do you plan to address the challenges faced at local government level where local alcohol policies have been thwarted by industry interference? Food Given the staggering evidence base in support, including modelling showing the cost savings, and the overwhelming public support – will your party introduce a sugary drinks levy? How will you protect our children, and uphold the Government’s commitment under the United Nations Convention on the Rights of the Child by reducing the amount of junk food marketing they are exposed to? Will your party look at ensuring all schools and ECEs are healthy settings for children, with healthy food policies rolled out nation-wide? Commercial interests How are you going to prevent lobby groups in influencing the policymaking processes towards solutions in terms of reducing obesity and tobacco/alcohol related harms? Do you anticipate that the Food Industry Taskforce will continue to be a key approach to addressing obesity even though many of the accepted recommendations are not key evidence-based interventions?

Maori, Maori health promotion
Now more than ever we are able to put a spotlight on tough topics and hold people accountable so we can create a fairer society for everyone, writes HPF’s new Māori Health Promotion Strategist Mereana Te Pere   When I drive through the streets of Manurewa on the way home, I often hear the helicopter hovering above, usually as I am nodding my head to music. When I drive along Great South Road I see the effects of what happens when someone (or in this case a whole community) does not have adequate access to the right health avenues they need or are entitled to. In Manurewa it is not unusual to see queues of people a the local Work and Income office. There are three (soon to be four) prisons all within a 4km radius,  homeless families sleeping rough outside the church and takeaway shops, and Pātaka Kai emptied out. On a positive note, the window-washers are always polite, even if I don’t have any spare change. Despite these things, Manurewa is my home away from home, and a place that has also given me wonderful memories and caring friendships. Times seem to be always be tough in ‘Rewa’, but make no mistake, some of the most talented and generous people I have had the privilege to know and work with, have been born in ‘the south side’.   I love my place here in Tamaki with the wonderful people I consider my city whānau. But sadly the situation here reflects my hometowns of Te Puke and Tauranga. There I see awa that are becoming too polluted from local orchards and factories for our kids to swim in. But we need jobs right? I see too many tangi as a result of suicide. I see whānau being sent home from the GP or hospital with a bill of health, only to end up in the urupā. And I see people resort to drug dealing because its the only realistic option for generating a steady income. In this profession there are no conviction or reference checks, no experience necessary and there is always high demand. This way of life can make perfect sense for the generations of families forced beneath the poverty line.   But surely it’s not all doom and gloom? I reiterate that I love my home. I miss my whenua all the time, and when I am able to return I feel re-nourished. My happiest memories come from a upbringing full of tree-hut building, endless days swimming at the river, adventures through the bush, and playing with all the cousins at the pā, because that was our safe place and the centre of the universe. Twenty years ago this was the norm, but times have definitely changed, and now so must we.   Thirty years ago it was normal to tease someone for being gay, obey your elders with blind loyalty and see parents smoking around the tamariki inside the family home. Fortunately in today’s world, people are more connected, more socially aware and more liberal than ever. Social justice movements like Mauna Kea, Black Lives Matter and #MeToo means we no longer have to ask for permission to be treated with fairness, dignity and respect, because it is our right. Now more than ever we are able to put a spotlight on tough topics and hold people accountable so we can create a fairer society for everyone.   And this is why I put my hat in to the ‘health promotion’ ring. I have always pursued avenues for the most vulnerable members of my whānau, and all Māori, to thrive and have the best opportunities for quality and fulfilling lives. But as simple as that might sound, history shows that progress is slow and arduous. So when I think of the challenges ahead, it is the love for my whānau back home and here in Tāmakimakaurau who have been short-changed, that pushes me to give 100% for everyone and never quit. I feel very fortunate to be in a role where I can tackle those tough issues and serve these communities. Being a Māori Health Promotion Strategist is more than a job and pay packet (although in these uncertain times I am extremely grateful for my job), but it’s also part of a life mission to contribute meaningfully alongside the many other champions around the motu, to the health and wellbeing of all Māori whānau.   Ehara taku toa i te toa takitahi, engari he toa takitini (My success is not my own, but from that of many)

The response to the monthly online workshops launched by HPF on August 24 to cover topics on Maori, Pacific and general health promotion topics has been overwhelming.   Comments after the workshops ranged from “very informative,” and “Thank you. This webinar is full of specific information and provides me with a wonderful foundation to help me design services for Pasifika” to “beautiful presentation. Unity, balancing life, working together.” Participants also commented on the timeliness of the workshops and how great it was to learn new ways/ideas.   The workshops are a continuation of a special Covid-19 series of webinars, launched during the full lockdown earlier this year to offer handy tools and guidance.   With HPF’s face-to-face workshops temporarily on hold, HPF remains committed to providing training and wants to ensure that our health promotion workforce and sector continue to be fit for purpose in this fast-changing environment.   The workshops have three phases of learning. These include:
  1. pre-event study and preparation, using resources sent three days prior
  2. participation in the actual webinar with questions and answers as well as discussion
  3. after the webinar, participants receive a copy of the powerpoint presentation and other resources used, as well as exclusive viewing of the webinar (with your co-workers) for two weeks on our YouTube channel. Ask follow-up questions to the presenter and/or facilitator during the two weeks after the webinar
  The webinars/workshops are $29 for members of HPF, and $49 for non-members.

Besides the discounts on webinars, workshops and other events, as a valued member of HPF, you can take advantage of  a number of exciting benefits such as:

  • Exclusive access to any webinars on our YouTube channel – for a limited time only!
  • HPF scholarships (conditions apply)
  • Gain knowledge and skills for the ongoing professional development of your staff from experts in the field of health promotion
  • Advertise job vacancies in HPF’s monthly notice and website
  More benefits for members, through our new membership system, are in progress!    

In the build-up to the election and with obesity in the spotlight over the past week, Professor Boyd Swinburn, one of the world’s leading obesity and food policy experts, has had heaps of airtime. The Professor of Population Nutrition and Global Health in the School of Population Health at Auckland University who chairs the Health Coalition Aotearoa also found time in his busy schedule to answer some questions from Hauora. Hauora was keen to find out from Prof Swinburn about the progress made by the Coalition since it was launched nearly two years ago, the aims of its 2020 Prevention Brief, and how vital it is that the silent voices in the communities be heard to influence change.   HAUORA: It has been nearly two years now since the Health Coalition of Aotearoa was launched with the vision of greater health and equity for all New Zealanders through reduced consumption of harmful products (tobacco, alcohol, unhealthy foods & beverages) and improved determinants of health. How has the progress been and what are some of your achievements? PROF SWINBURN: I think the Health Coalition has made great progress as an organisation, especially in getting ourselves into a strong position to focus on achieving action over the next term of government. We now have all our structures in place in terms of becoming an incorporated society with charitable status, getting more than 50 health organisations on board as members, working with government on several issues related to our kaupapa, and getting all members to define the priority actions needed for action on unhealthy products. Our four Expert Panels on tobacco, alcohol, food policy and public health infrastructure bring huge knowledge and experience to the Coalition’s work. Unfortunately, the Labour-led government over its first three years has achieved disappointingly little in the way of prevention policies, especially for alcohol and childhood obesity. We will really work hard over the next three years to see if greater progress can be made.   HAUORA: The Coalition has released its Prevention Brief for 2020. Can you please explain what the main purpose of this is and what it is hoped will come out of it? PROF SWINBURN: This brief was the culmination of considerable work across the membership to pull together the international evidence and experience to create a consensus of what is needed to reduce the burden of preventable diseases. Very few people realise that tobacco, alcohol and unhealthy foods collectively contribute about one third of the preventable health loss – that’s more than 370,000 healthy life-years lost annually. This is massive, and one of our first jobs is to communicate the magnitude of this damage and the trivial public health effort that goes into preventing this harm – less than half a percent of the health budget. I doubt if there would be a single member of the public who thinks that half a percent is a good prevention investment for dealing with products that cause one third of the health damage.   HAUORA: You mentioned in an article recently about ‘policy inertia’ and how the unheard voices from the people and communities who are suffering the consequences of harmful products contribute to this. How vital is it to get stories from real people in the community, and what suggestions do you have for how we as health promoters can help get these stories out? PROF SWINBURN: Policy Inertia is the term we use for the situation where there is a stack of evidence-based, effective policies to reduce the harm from unhealthy products but very few of them are implemented. The three reasons for policy inertia are; firstly, the strong opposition from the industries who are profiting from these products; secondly, governments who are reluctant to regulate these industries because of the political effort needed to counter the industry lobby, and; thirdly, the lack of public demand for action. The public and communities tend to be very supportive of strong policies to control this harm, but it is a quiet support. The reality is that unless the stories from people who are suffering from this harm come out loud and clear, along with a demand for action, governments can just continue to ignore the problem. We really need to hear the voices of those people who are demanding change.   HAUORA: Do you think Covid-19, which for those with underlying medical conditions can be fatal, will have any/or has had any influence on the need to make healthier choices and the need for more regulation on food, tobacco and alcohol companies? PROF SWINBURN:  Yes it is true that Covid-19 can be especially deadly for people with obesity and various chronic conditions, but I think, more importantly, we have seen the very real benefits of implementing policy based on the evidence and expert opinion and clearly communicating that to the public. It was a rocky road to start with building up the public health capacity and response systems to Covid-19. Public health was at a very low ebb after many years of neglect and underfunding, but eventually we have come to the point where the politics is responsive and adaptive, the public health systems are operating well, and the public is largely on board with the Government’s course of action. Wow, if only we could translate those approaches to prevention of our really big killers – heart disease, cancers, diabetes and so on. Listening to the evidence, being bold and clear in the policy action, and making sure that the whole of the country is aware of what the Government is doing and what communities and individuals can do to contribute.   HAUORA: Is there anything else you would like to add? PROF SWINBURN: I think there is an enormous readiness for action among communities who are sick and tired of living in neighbourhoods where every second shop is selling cigarettes, discount booze and cheap takeaways. They want the Government to match their own leadership and vision for healthier environments for their children and families. If politicians would only stand up to the lobby forces of the vested commercial interests who sell harmful products, they will be fully backed by the communities who want to build back better after Covid.  

Experts, Global, News
HPF caught up with leading global advocate for action on the social determinants of health and health inequalities, Sir Michael Marmot recently to get his views on issues including lessons learned from Covid-19, how it has amplified underlying health inequalities and the need for governments to follow NZ’s lead and put a wellbeing approach at the heart of policy. The Professor of Epidemiology and Public Health at University College London and the Director of The UCL Institute of Health Equity (pictured speaking at the world health promotion conference in Rotorua last year) also touches on the climate crisis and the role of health promoters in helping to tackle these global challenges.  

HAUORA: What are some of the lessons we have learned from Covid-19?

SIR MICHAEL: Two keys lessons from the UK, that I think are more widely applicable, came with the onset of the pandemic. First, was respect for science and evidence. In the UK there had been overt disregard for the opinions of experts. For example, the assessments from economists that Brexit would harm the economy – probably making inequality worse – were dismissed as fear-mongering. In the US, the dismissal of science was worse, imperilling the planet, when the US President labelled climate change “a hoax”. Come the pandemic, suddenly our politicians were openly expressing their appreciation for the science in countries across Europe but, catastrophically, not in the US or Brazil. A second lesson relates to public expenditure. After the financial crisis of 2007/8 many governments adopted austerity as their creed. With the economic shock that followed lockdown, suddenly austerity and concern about government debt was put on hold. “Whatever it takes”, said the British Prime Minister. Countries at high levels of human development spent a great deal, and increased national debt, to reduce the economic burden of the pandemic and societal response to it. I would like to think there is third lesson: the importance of government in delivering the public good. That lesson has only partly been learned.  

: When the pandemic first hit, many commented that it had been the “great leveller” or “equaliser” but you have pointed out that it has actually exposed “underlying health inequalities” and amplified them. Can you please elaborate on this?

SIR MICHAEL: There are two aspects to these inequalities, at least: the toll that Covid-19 is taking on the population health; and the effect of the societal response, lockdown, on inequalities. In the UK, our Office of National Statistics (ONS) has been impressive in the regular and timely output of publications on the pandemic. Related to my theme, there are three observations that both reveal and amplify the underlying inequalities in society. First, is the high mortality from Covid-19 in those in front-line occupations: workers in social care, drivers, shop assistants, and chefs. These occupations were already at the lower end of the social hierarchy, and lowly paid. Second, mortality rates from Covid-19 follow the social gradient: the more deprived the area the greater the mortality rate. This Covid-19 gradient looks very similar to the gradient from all causes. This suggests that the causes of inequalities in health more generally are likely to be the causes of inequalities in Covid-19 mortality. Third, there is high mortality among Black, Asian and Minority Ethnic Groups. Much of this excess can be accounted for statistically by deprivation. We can no longer ignore structural racism that gives rise to the systematic disadvantage of some ethnic groups, not just in Britain, but more generally. Lockdown itself has exaggerated inequalities. People in higher status occupations were far more likely than those in lower status to be able to work from home. Higher income people could spend less on entertainments and dining out, thus increasing their income and savings. It was precisely these occupations where workers lost their jobs or were exposed to the virus. We have seen exaggerations of food poverty during the pandemic.  

HAUORA: You have said you would like to see a ‘wellbeing economy’ emerge from this crisis and in fact it was just last year at the global health promotion conference in Rotorua, NZ that you commended the ‘wellbeing approach’ taken by NZ. Recently you were quoted as saying: “The New Zealand Treasury shows what is possible. Before the COVID-19 pandemic, it put a wellbeing approach… at the heart of its policies.” Would you like to see governments following a similar direction post-Covid?

SIR MICHAEL: In Britain, my colleagues and I published a report, Health Equity in England: the Marmot Review 10 Years On, on the eve of lockdown, February 2020. I had published the Marmot Review in 2010 on what we could do to address health inequalities, in the light of the Commission on Social Determinants of Health. My 10 Years On Review, Marmot 2020, presented a grim picture: marked slowing of the improvement of life expectancy; increased health inequalities; and falling life expectancy for women in the most deprived areas outside London. Therefore, as we emerge from the pandemic, the status quo ante is hardly something we want to reproduce. Ideally, we need to use this dramatic shock to create a better society, to deliver sustainable health equity. And, to do that, we need to put wellbeing at the heart of what we are seeking to achieve.  

HAUORA: The NZ Government, and our PM, have been lauded world-wide for their handling of the Covid crisis. What is your view?

SIR MICHAEL: From the outside, it appeared that Prime Minister Ardern displayed several characteristics that were key to controlling the pandemic: she was decisive in initiating control measures in quick and timely fashion; she was clear in her communication about the threat faced and what was needed from the population to combat the threat; her actions were evidenced-based; she was empathetic. Honesty, clarity, decisiveness, consistency and human warmth were not characteristics that were in abundant display elsewhere.  

HAUORA: While Covid-19 has been the overriding issue for the world over the past few months, the call to fight climate change is ramping up again – particularly as experts have linked Covid-19 to planetary health. What is your advice to countries/governments on how to tackle this? Do you feel that indigenous knowledge needs to play a more major role?

SIR MICHAEL: Sustainable health equity has to be the watchword as the global community recovers from the biological, social and economic shocks attendant on the pandemic. The twin challenges of dramatic inequalities and the climate crisis have to be tackled together.  

HAUORA: How can health promotion contribute more effectively towards addressing these global challenges?

SIR MICHAEL: I see health promotion as tackling the social determinants of health. Health, and health inequalities are good measures of how we are doing as societies. Therefore, those of us committed to improving health and reducing health inequalities need to be active participants in what constitutes the good society. @MichaelMarmot

Maori, News
The significant contribution that Trevor Simpson has made over the past decade to HPF, Maori health promotion and the world was reflected on at a farewell morning tea on Friday, October 9. Mr Simpson who is Co-Executive Deputy Director and Senior Māori Health Promotion Strategist at HPF will take up the inaugural role of Chief Advisor, Māori, at PHARMAC at the end of this month. HPF’s Board Chairman Mark Simiona thanked Mr Simpson on behalf of himself and the Board for his service and wished him well in his new role. HPF’s Executive Director Sione Tu’itahi said he had really enjoyed working with Mr Simpson and thanked him for his wisdom, fantastic leadership, humility and fearless resolve and adherence to the values of the Forum. “You built valuable relationships over the years with leaders and networks and generously shared your knowledge with everyone.” Mr Tu’itahi said he was confident Mr Simpson would be more than capable of taking on the challenge of his new role at PHARMAC. “We are glad that Trevor’s new role is testimony to our HPF culture of building capacity to deliver outcomes, and enhancing service-leadership.” Mr Simpson looked back on the many people he had worked with at HPF and some of the highlights of his time with the organisation. “Over the years I have had the deep satisfaction of being part of an organisation that both demonstrates and entrenches its constitutional values and overarching principles in all that it does,” he said. “I leave here a different person.” Mr Simpson (Tuhoe, Ngāti Awa) also acknowledged his ‘tipuna’, adding that the legacy they had left was a “blueprint of leadership’. “Our elders back home are big on humility and humble servitude. If you don’t have that, then you can’t be a good leader.” Meanwhile in a press release PHARMAC said: “Trevor, as our Chief Advisor Māori, will ensure we receive robust Māori advice at a senior leadership level to inform and shape how we give effect to our commitment to Te Tiriti o Waitangi, including equity for Māori, into all of our work.”