Experts, News

Answering the call for social justice and equity

Dr Kate Morgaine has worked professionally in health promotion for about 15 or so years and is an academic (teaching and research) in Te Tari Hauora Tūmatanui at the University of Otago.

In this interview with Hauora Dr Morgaine gives some insight into why health promotion was so appealing to her as a ‘young feminist’ and the progression of her career from a high school teacher of physical education and health to her current role.

Wanting to share her experience with the next generation of health promoters prompted her move into academia and she gained a PHD focused on evaluating an occupational safety programme that had been rolled out nationwide.

She also discusses the advantages for health promotion that the National Accreditation Standards will have in Aotearoa and has some great advice for up-and-coming health promoters.

Hauora: You launched your career in health promotion in the mid-1980s? Can you tell us a bit about your early days in health promotion and what attracted you to this field?

Dr Morgaine:
What attracted me to health promotion, and public health more generally, was the call to social justice and to equity. I was already a young feminist and health promotion gave me a framework for thinking about and addressing social justice and equity issues. It was love at first sight, and a “long obedience in the same direction [that results in] something which has made life worth living” as Nietzsche put it, although in a somewhat different context.

I started my professional career as a high school teacher of physical education and health. At that stage, schools were only allowed to teach about menstruation and the basics of biology. Teaching about sexuality was restricted to Public Health Nurses and Family Planning educators. In my first year of teaching at a rural girls’ high school the Family Planning education team came to school for a week. I thought “that is what I want to do”, so I knocked on the FPA education door in Christchurch. Thankfully, they employed me to work in sexuality education with young people. As a 24-year-old, I was practically a peer. As we know, NGOs don’t have a lot of money, so that job was time limited. The training I received in developing teaching sessions and group work leadership was excellent and has stood me in good stead for my entire career. Two years on, and a job was advertised for a Health Education Officer (HEO) at a pilot Area Health Board (AHB). I was lucky enough to secure that job. In the 1980s most HEOs were employed in the district offices of the Department of Health.  All newly employed HEOs were formally trained through a one-year certificate at the Department of Health. Each region usually only had one person employed by the DoH or area health board. This was the case in my AHB; however, I was fortunate enough to have an NGO colleague to work alongside with. Although called an HEO, the work was what we now call health promotion. The Ottawa Charter for Health Promotion was published during this time for me. It was an exciting and heady time for all of us involved. My professional health promotion practice has been primarily in the areas of sexuality, and alcohol harm reduction; with a couple of years working in the UK in a sexual health clinic that included counselling and support for people with HIV in the time before treatment was available. On my return home, I worked in health promotion for a few years in Otago. Just before entering academia, I returned to the UK and did a short term (6 month) stint in Oxfordshire developing, writing and workshopping with the community, a rural health promotion plan for them. Rurality in southern England is a whole lot different than it is here.  

What prompted you to enter the ‘world of academia’ in the early 2000s and what universities did you start teaching in before you commenced your role as health promotion academic at the University of Otago?

Dr Morgaine:
After working professionally in health promotion for about 15 or so years, I decided that what I wanted to do was share my experience with the next generation of health promoters. The only way to really do that in New Zealand (and get paid enough to support myself) was to move into academia; and the only way to get a job in academia in the current climate is to have a PhD. So that is the path I followed. My PhD focused on evaluating an occupational safety programme that had been rolled out nationwide. Although occupational safety wasn’t something I had done previously, evaluating the development, implementation and impact of a health promotion/education programme was definitely in my wheelhouse.

During that time, an academic position in public health opened up in the Faculty of Dentistry in Dunedin. There are precious few academic health promotion jobs across the country, so I jumped at the chance. Teaching public health and health promotion in a clinical setting was challenging and interesting. It certainly made for interesting days. After 8 years I spread my wings and moved to the UK to be the Subject Co-ordinator for the public health Master’s programme at Oxford Brookes University. I taught and supervised across the breadth of public health, while also teaching the health promotion courses. Probably half the students were international students with really broad experience in the world of public health. I think they taught me as much as I taught them.

I moved back to an academic position at the University of Otago almost five years ago. It is a joy to be home.

How would you describe your current role, and have you seen an increased interest in health promotion from young people since you started?

Dr Morgaine:
My current role is as an academic (teaching and research) in Te Tari Hauora Tūmatanui or the Preventive and Social Medicine Dept (an old name for Public Health). Although it was a generic position, I am lucky enough to be teaching almost exclusively in my specialty of health promotion for the first time. I teach the undergraduate introduction to health promotion. In the time I have been back the class size has increased from about 70 to about 90 on average each year. The Bachelor of Oral Health students make up a good portion of the class. The numbers have increased since Otago has offered a Bachelor of Health Sciences majoring in either Public Health, Māori Health, Global and Pacific Health, or Community Health. It is exciting to work with young people who are also interested in social justice and equity. I also teach postgraduate papers – one focused on the broader determinants of health, and one focused on the practicality of planning and evaluating health promotion projects/programmes. Our class sizes have grown in this area too. Young people in both the undergrad and postgrad courses are strongly driven by what they can contribute to addressing social justice. I particularly enjoy the reciprocity in these classes.

My research is focused on evaluation of programmes and projects, how best to improve what we do. I do this work with people employed in Public Health Services as well as people who work in their communities. I like to work alongside people, and I like to be useful to them. This is what drives my approach to research.

You have said that you are really interested in best practice in health promotion and bringing evaluation into everyday practice. Can you please elaborate on this?

Dr Morgaine:
I love my profession. I want us all to be the best we can be. I think knowing about the ‘how’ and ‘why’ of what we do is really important. It means we can serve our communities and contribute to wellbeing in a way that is both helpful to them and justifiable to those who fund programmes. Without even realising it, we all undertake planning and evaluation every day. We make plans for our families, our friends, our selves, to address our own needs; and we evaluate them too, to decide if it was worth doing, worth doing again, or something we are going to steer clear of. Planning and evaluation in health promotion is taking those everyday things and getting formal about it. In my teaching, I try to make the various theories and approaches to planning and evaluation as practical as possible, so the skills can be used in real-life practice.

As you know HPF is working on the development of an accreditation framework for health promoters and providers in New Zealand with the goal to establish a national accreditation organisation (NAO), under the global accreditation framework of the International Union for Health Promotion and Education (IUHPE). How do you see this benefitting health promoters and health promotion in Aotearoa?

Dr Morgaine:
Health promotion is still a fledgling profession, even though the Ottawa Charter is 35 years old. Many people across all sorts of health professions say they do health promotion. And of course, they do to some extent. However, to be a Health Promotion practitioner you need to understand the depths and strengths of health promotion; its underlying principles and values; and the skills that are needed to practice well.

Having a formal process for recognition of experience, training, skills and knowledge, allows us as a profession to have a place to stand, and stand tall. It is an important part of being acknowledged as having speciality skills and values. It signals to the other health professions as well as to the community that we value ourselves and our communities. The NAO within Aotearoa New Zealand will specifically recognise our communities and approaches, as well as ensuring we meet international standards.

Having an internationally recognised accreditation signals our professionalism to other countries and makes it easier for our practitioners to travel to other countries to work if they want (once we are allowed to travel)

Do you plan to stay in the academic world and if so why?

Dr Morgaine:
Well, I am an old lady now. Changing jobs when you are my age is difficult. And I truly love my job – I love teaching especially, working with young people, seeing them make their way in the world – where else would I be?

Unless someone offers me some random other spectacular job that allows me to do all the things I love, this is where you will find me.

What would your advice be for up-and-coming health promoters?

Dr Morgaine:
Get some training under your belt so you have frameworks to help you approach new and different topics, projects, and so forth. Grab as much continuing professional development as you can. This will help you in your personal practice AND help you justify your plans and practices to those in the hierarchy.

  • Be open to working across different areas, so you gain as much experience as you can.
  • Find a way to challenge the status quo (in a way that means you can keep your job, if possible)
  • Find yourself a peer group who you can talk through the challenges and celebrate the good things with.
  • Find yourself a more experienced health promoter who can be a mentor.
  • And finally, in the words of my mentor many years ago, if you are not in trouble you are not doing your job properly. If our plan is to achieve social justice, we are bound to upset those who have power. Don’t be surprised if you find yourself in trouble, but be safe as well (hence the peer group, good training, etc)