Question: What do an Indian health manager a pākehā academic and two Māori leaders have in common? Answer: They are all board members of the Health Promotion Forum (HPF). OK, so it wasn’t funny, but it is worth celebrating the diversity of culture, skills and interests and the shared vision and unity of our board.  “Equally heartening is the fact they all share an understanding of Te Tiriti o Waitangi and the Ottawa Charter as the founding documents for health promotion in the New Zealand context,” says Executive Director Sione Tu’itahi
  • Richard Egan is the ‘pakeha academic’; a lecturerat the School of Public Health, University of Otago.
  • Lance Norman is chief executive of the regional Māori health provider, Hapai Te Hauora.
  • His colleague at Hapai and fellow HPF Board member, Zoe Hawke, is the Kaiwhakahaere , National Māori Tobacco Control Leadership Service.
  • Vishal Rishi, originally from India, is the Programme Manager of The Asian Network Inc., a national Asian health provider.
Richard, Lance, Zoe and Vishal joined our board at our 2014 AGM, to work alongside two other Maori professionals, a Pacific health leader and a kaumatua, the latter of whom provides advice and guidance.  They are:
  • Ana Apatu, Chairperson and Chief Executive of U-Turn Trust, Hastings
  • Tevita Funaki, Treasurer and Chief Executive Office of The Fono
  • Tau Huirama,
  • Richard Wallace, HPF Kaumatua
Our board has a wide range of skills and is united in its vision, goals and action.  The recently elected board is now guiding the team to achieve the goals and outcomes of its five-year plan, 2013-2018 drafted late last year.   April 2014 By Sione Tu’itahi Edited by Jo Lawrence-King  

Proposed funding cuts to the longitudinal Growing Up in New Zealand study will drastically affect the study’s potential to improve the health of New Zealanders and reduce health and social inequities, says The New Zealand College of Public Health Medicine (NZCHPM). nzcphm “We know how valuable these longitudinal studies are,” says NZPCHM President Dr Caroline McElnay.  “So why now, when we have some major and escalating issues facing our communities, would government forego further investment in the Growing up in New Zealand study?”   “It doesn’t make sense, given how much valuable data we have already gained, and how much more we can get form this initiative; data that will highly likely enhance the lives of our children and their children.”   Unlike similar studies of this kind, the full cohort of subjects in the study had important representation of Māori, Pacific and Asian communities, says Dr McElnay.   “We need to know how to improve health and health equity for groups that do not experience the same benefit from the services we currently provide.  We need our decisions to be based on robust, independent evidence.”   Taken from a 19 October 2016 NZPCHM press release   26 October 2016  

The Public Health Association of New Zealand (PHA) is calling on New Zealand Government negotiators to oppose clauses in the Regional Comprehensive Economic Partnership (RCEP), currently being negotiated, that would increase the cost of life-saving medicines in poorer countries.   The PHA is one of 94 organisations having signed an open letter to the 16 ministers negotiating the RCEP encouraging them to resist such provisions. Similar to provisions in the Trans Pacific Partnership (TPP) Agreement, the RCEP provisions, which are being championed by Japan and South Korea, would lengthen medicine patent monopoly periods which would delay market entry for more affordable, generic, but essential medicines. This would keep medicine prices high in countries where diseases such as HIV are rife, such as Malaysia, Thailand and Vietnam; and especially in ‘least developed countries’, such as Laos, Cambodia and Myanmar.   PHA Chief Executive Warren Lindberg says it’s important to strike a balance between the rights of patent holders and the needs of impoverished people in the developing world.   “It’s neither right nor ethical that richer countries like ours are negotiating to extend and protect profitability for multinational corporations to the detriment of people in poorer countries who have the basic human right to affordable medicines. There is a disturbing lack of compassion evident here.   “There is no doubt that extending patent periods will increase instances of diseases in these countries, leading to increased death and suffering for the world’s most vulnerable, especially children.”   Mr Lindberg said the data exclusivity and patent extension provisions being negotiated, as revealed by leaked documents, are unnecessary and go way beyond any intellectual property protections required by the World Trade Organization.   The Regional Comprehensive Economic Partnership (RCEP) is a free trade agreement (FTA) currently under negotiation between the ten member states of the Association of Southeast Asian Nations (ASEAN) (Brunei, Burma (Myanmar), Cambodia, Indonesia, Laos, Malaysia, the Philippines, Singapore, Thailand, Vietnam) and countries with existing FTAs with ASEAN which includes Australia, China, India, Japan, South Korea and New Zealand.     Public Health Association media release 21 October 2016  

Case Studies, Community, Maori
Te Kōpae Piripono is a successful whānau intervention based in Taranaki.  Te Pou Tiringa and the National Centre for Lifecourse Research, University of Otago have formed a research partnership to carry out a robust evaluation of the initiative. Research team members are Dr Mihi Ratima, Aroaro Tamati, Hinerangi Korewha, Erana Hond-Flavell, Dr Will Edwards, Dr Moana Theodore, and Professor Richie Poulton. The research programme is ‘Te Kura Mai i Tawhiti’.   te-kopae-piripono-source-stuff   About Te Kōpae Piripono Te Kōpae Piripono was established in Taranaki in 1994 in the form of an early childhood education centre, and its governance body is Te Pou Tiringa. It was recognised in 2008 by the Government as a ‘Centre of Innovation’, with the potential to be implemented in other settings.   The initiative was premised on the accepted wisdom that early connection to culture, practice and language have a long-term effect on indigenous health and well-being. The emphasis on whānau ora has been integral to Te Kōpae since its establishment, with its underlying objective to respond to the social and cultural impact of historical grievance (massive land confiscations and Taranaki wars) and the continued trauma experienced by Taranaki Māori communities trying to restore their cultural and social strength and health and wellbeing.   Te Kōpae Piripono has been able to advance its vision in a way that is consistent with the Government’s Te Whāriki early childhood curriculum framework. The core aspiration of Te Whariki is for children to grow up as competent and confident learners and communicators, healthy in mind, body, and spirit, secure in their sense of belonging.  The programme’s early-childhood centre setting allowed for greater self-management and provided a more reliable source of funding that reflected the wide range of activity the initiative hoped to achieve and sustain.   Te Kōpae Piripono aims to revitalise Taranaki Māori language use and cultural practices.  
  • 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.
The programme has also developed its own model for positive resolution of issues, called ‘Te Ara Poutama’, which may be used for both children and whānau members. Children learn to advocate for their needs, and to negotiate and find solutions themselves. The process helps isolate the issue from the person, enables constructive dialogue, and fosters trust and confidence to positively resolve issues.  

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 Programme
A 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.    

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: http://www.hauora.co.nz/prof-john-raeburn-health-promotion-advocate.html#sthash.ZfAKn7KJ.dpuf[/vc_column_text][/vc_column][/vc_row]

Global, Pacific
The cluster of Zika virus outbreaks and the associated neurological disorders has caused global concern; particularly in tropical and sub-tropical areas. HPF’s Dr Viliami Puloka offers a perspective for consideration by health promoters working to prevent disease and for the communities under threat. Communities can be empowered with information on prevention of the spread of disease and on how to remain healthy in order to fight the virus, should they become infected, he says.   zika-mosquito   On 1 February 2016 the World Health Organisation declared a Public Health Emergency of International Concern (PHEIC) regarding the high incidence of abnormally small brains and other neurological disorders in babies born to mothers infected with the Zika virus. Much discussion and concern has resulted from the WHO’s decision. Health promotion will play a key role in minimising the effects of Zika on Pacific peoples.  Being well, being informed and taking precautions to reduce exposure to the disease-carrying mosquito will all contribute to communities’ resistance to the virus and its associated issues, says Health Promotion Forum’s Senior Health Promotion Strategist Dr Viliami Puloka. Here in the Pacific region the rainy season – when mosquitoes are most prevalent – has just begun.  We have recently had new cases of the Zika virus declared in Samoa and Tonga.   One case of Guillain-Barré was identified in Waikato and linked to the Zika virus.  The patient was a man who had recently arrived from Tonga, however, and it was considered to represent no risk of an outbreak here.  This is because the virus is spread via a mosquito that is not found in New Zealand’s colder climate.  Meanwhile the virus has been present in French Polynesia for some time.  There, at least 40 cases of Guillain-Barré syndrome have been associated with the virus. Zika was first identified in Brazil in May 2015.  Since then babies born to mothers infected with the virus have been found to have a higher incidence of neurological disorders, the main one of which has been abnormally small brains – or microencephaly.  While it has not been proven that the disorders are a direct result of the virus, this is strongly suspected.  In recent days another possible association has been suggested: the use of an antilarval chemical included in the drinking water of the affected residents in Brazil. Health authorities in New Zealand and the Pacific are putting in place protection measures and public policies to prevent the spread of Zika virus, however Dr Puloka, who is responsible for the HPF’s Pacific portfolio, points out that communities have an equally vital role to play.  Minimising and modifying potential breeding sites is one way in which communities can act to prevent the spread of the Zika, he says. Residents are advised to empty, clean or cover containers that can hold water.  This includes receptacles like buckets, flower pots or tyres.  According to Dr Puloka it is also common practice to have a layer of oil on the top of the water in a septic tank.  This prevents the reproduction of the mosquitoes, whose pupae need oxygen from above the water to survive. He suspects that immunity to mosquito-borne diseases may offer hope to those Pacific island nations to have recently seen the arrival of the Zika virus.  “The mosquito that carries the Zika virus is the same one that carries dengue fever, chikungunya and yellow fever,” he says.  “People of the Pacific islands have been exposed to these mosquitoes for many years and have developed a level of resistance to those diseases.”  This contrasts starkly with the situation in Brazil, where the people had previously not been exposed to those mosquitoes or their diseases. Other precautions – where practicable – include using insect repellent, wearing clothes (preferably light-coloured) that cover as much of the body as possible and using physical barriers such as screens, closed doors and windows. During outbreaks, health authorities may also advise spraying of insecticides. Dr Puloka’s advice to communities threatened by the Zika virus is that now, more than ever, it is important to be well, be informed and take the necessary precautions to minimise the risk of being bitten by the mosquito that carries the disease.  

Case Studies, News
In a bid to address health inequalities and the under-representation of Māori in health and disability services, Taranaki DHB is creating new career pathways for secondary and tertiary Māori students.   whyora-logo1   The students are gaining work experience through the DHB’s ‘WhyOra’ programme, to work towards a career in health and disability services.   Established in 2010, the WhyOra programme has included more than 300 Taranaki students; introducing them to a range of roles in the sector and supporting them into roles.   The programme was supported by funding from TSB Community Trust, JR McKenzie Trust and Taranaki DHB.   Read the full story in Scoop.co.nz or visit the WhyOra website.   whyora-you-can-do-it

Case Studies, Community, Maori
  Zoe Aroha Martin-Hawke is National Manager – Te Ara Ha Ora: Māori Tobacco Control Leadership service at Hapai Te Hauora.  Jo Lawrence-King finds out about her work and how it exemplifies the principles of health promotion.   Tupeka kore (tobacco free) Hapai te Hauora has initiated a number of successful health promotion programmes, not least of which focusses on reclaiming a tupeka kore (tobacco free) Māori identify.   According to Zoe the organisation “strongly promotes a working model that focuses on empowering Māori communities to have a voice on tobacco harm, and to create environments that prevent future harm from a product that leaves our communities ill and dying. “   Hapai te Hauora promotes and provides practical examples on how to provide a platform for Māori communities locally, regionally and nationally to take action.  The team also works alongside other local, regional and national organisations who are also showing leadership in these areas.   “We are dedicated to ensuring Māori are strongly represented in local, regional and national policy development opportunities,” explains Zoe.  “Iwi prior to European contact were tupeka kore.  Māori leading and participating in the development of healthy and culturally affirming public policy, which contributes to reclaiming this identity, is one of our key health promotion strategies.“ By having iwi, hapū and whānau leading change, the Hapai Te Hauora team believe it will see more of a positive impact on intergeneration health outcomes.  This, they feel, will contribute more effectively to a sustainably equitable, healthy future for all.   All activities of the initiative have involved a process of evaluating outcomes based on empowering whānau and Māori communities to control their own wellbeing and to influence New Zealand society to ensure that their determinants of health are addressed. More recently Hapai have supported the development of a Rangatahi Māori Tupeka Kore Consumer action group.  The group consists of young Māori wahine who currently smoke, but are on a mission to prevent other young Māori from taking the habit up.  Their work is focused on changing how the product is sold in their local area.  The wahine are informing their local community about rules and regulations regarding the sale of cigarettes and are encouraging communities to monitor local dairies to ensure they are not selling single cigarettes or to people who are under age. They are also to working with merchants; encouraging them to take a stand by becoming smokefree retailers.   Within this work Hapai also provides support for personal health by linking action group members to smoking cessation treatment services; providing them with the expertise they need to successfully stop smoking.  Hapai/Te Ara Hā Ora often works to find ways to seamlessly link people with services, whilst also promoting the message that none of us is independent of our physical environment and that change needs to happen at all levels. Hapai measures both short and long-term olicies, increased numbers of Tupeka Kore hapū, iwi and whānau and reduced rates of smoking initiation.  The growing engagement of Māori in tupeka kore work is also an indicator of the success of this initiative. The quality of the engagement is also measured, including such things as:  transparency of the process; relevant, timely, fitting delivery of information and the degree to which the engagement is inclusive and culturally appropriate.     About Zoe Aroa Martin-Hawke Zoe is a member of HPF’s board. Her broad background includes
  • 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.
Zoe has also been heavily involved in workforce development opportunities and NZQA training programmes.  Her focus has been on increasing knowledge and delivery of best practice health promotion initiatives; with an emphasis on engaging Māori in policy development at a local, regional and national level.   About Hapai te Hauora Hāpai Te Hauora invests in community and whanau wellbeing locally, regionally and nationally. Since 1996 the organisation has supported communities to have a voice on issues that affect them and their whanau so that whole communities can be well. It also provides infrastructural support to the hauora sector to strengthen public health action. Hapai does this through innovative research, workforce development, public health planning, information technology solutions and policy development. Along with its subcontractors or whanau whanui, the team also delivers on public health issues including tobacco control, problem gambling, alcohol and other drug harm minimisation, wellchild, nutrition and physical activity.    

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. www.oecd.org/health/ 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

    By celebrating and realising indigenous Māori elements of te Tiriti health promotion, HPF and its members are striving to be at the cutting edge of health promotion both locally and regionally.   Trevor Simpson looks back at how HPF has led the way in developing the relationship between Te Tiriti o Waitangi and health promotion in Aotearoa New Zealand over the past 18 years.   1997: the challenge is laid down In 1997, during the HPF conference “Challenging the Future” an inspiring remit was put to the Health Promotion Forum of NZ and its members: to examine the place of The Treaty of Waitangi and the Ottawa Charter in health promotion practice.  An epic journey began, in which the vast talents and of a wide group of individuals combined to create a significant and forward-thinking document.  Launched in 2002 the Treaty Understanding of Hauora in Aotearoa NZ (TŪ-HANZ) provides a strong basis and strategic framework for health promoters to embed Treaty-based practice into their everyday work. TŪ-HANZ provides the solution to the apparent conundrum of connecting the Treaty to the health sector itself and all who work in it; and health promoters seemingly have been very generous in abating the confusion.   That health promoters themselves called for such a document suggests this is a workforce that recognises not only the importance of the Treaty itself but its direct link to health as a human right; the notion of health equity and the imperative of social justice. There is recognition that failure to act on any one of these would diminish the key values and principles of health promotion itself. This flows from the belief that a true (or truthful) Treaty partnership is equitable rather than based on trust, and is premised on rights and obligations contained in the articles themselves.  The matter of Māori health was a key premise for the drafting of the Treaty in the first place. Busby’s pre-Treaty correspondence with Lord Normanby is testimony to this. Hauora – health and wellbeing – therefore cannot be positioned away from the Treaty discussion – quite the contrary – it is the place start.   2008: HPF constitution amended to reflect values of te Tiriti o Waitangi In 2008 HPF reviewed and amended its constitution to reflect its values and purposes within a new and contemporary context, and to further the development of health promotion from a unique Aotearoa New Zealand perspective. One key amendment included entrenching the key values of respect for – and commitment to – Te Tiriti o Waitangi; utilising the Māori text rather than the English. This signalled a subtle but important shift away from “Treaty” as part and parcel of its constitutional framework to align instead to te Tiriti;  the Māori context.  They say change is constant: sometimes, as in the development of Treaty based health promotion, it happens slowly and one step at a time. A natural evolution through changeable political landscapes and a growing awareness of who we are and where we have come from.   The new constitution also brought in Māori concepts such as manaakitanga (hospitality and kindness), tinana (physical health), wairua (spiritual health), hinengaro (psychological health), rangatiratanga (self-determination) and whanau ora (family health) into its values. In addition the HPF Board composition now requires that half of the members must be Māori – reflecting, in a human resource capacity, a visible Tiriti relationship. By elevating Māori world views to a constitutional level the idea of Tiriti based health promotion is energised or at least given a lift; and it provides a basis to progress to the next step.   Progress continues today As health promoters in Aotearoa New Zealand we are moving ourselves closer to the place where we need to be. Of course we are not there yet but in this space HPF will continue to play an important and ongoing role. For instance we will be exploring the synergies between Whanau Ora and Tiriti based health promotion. We will also look into Māori health promotion and Te Pae Mahutonga as unique but complimentary frameworks to the Ottawa Charter and will take time to review TU-HANZ. At this point we can reflect on where we have come from in the journey and we can nurture the idea of Tiriti based health promotion and – perhaps finally – Tiriti nationhood.   Trevor Simpson is Deputy Executive Director and Senior Health Promotion Strategist at Health Promotion Forum, where he holds the portfolio for Māori health promotion.  He is regarded as a world authority in indigenous health promotion.   April 2015 Written by Trevor Simpson Edited by Jo Lawrence-King  

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  

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  

Community, Maori
chatham-island   In a recent Health and Social Needs report prepared by Litmus Ltd for the Ministry of Health the Chatham Island community was described as having a strong sense of whānau connection, resilience and nurturing (Smith et al, 2013).  Our Deputy Executive Director, Trevor Simpson recently had the opportunity to witness these strengths for himself, when he visited Chatham Island in late March to present a series of workshops. Some great work being done by the Ha o Te Ora o Wharekauri Trust- Māori Community Services (MCS) on Chatham Island is a great example of a “wrap-around” health promotion service in action within a small community.  It was encouraging to see the important role played by health promotion in an integrated approach to health and wellbeing on the Island. Established to improve the health status of Māori, MCS’ three areas of focus are:
  1. Whānau Ora- Māori Community Health Service
  2. Whānau Ora Mobile Service
  3. Community Health Promotion
The Whānau Ora – Māori Community Health Service is underpinned by the notion of Hauora Wananga (health and wellbeing development from a Māori perspective and world view).  It works within and across a range of activities, including:
  • general health
  • education and promotion
  • advisory services
  • liaison and coordination.
The service draws on the four mainstay philosophical aspects of Te Whare Tapa Whā and utilises whānau health plans and face to face sessions to both identify whānau needs and to develop effective strategies for them. The scope of the Whānau Ora Mobile Service is vast.  Two full time kaiawhina; one a community health worker, the other an enrolled nurse; work to improve prevention and self-care by empowering whānau to both manage their own health and develop health literacy. Delivered across multiple settings including schools, kohanga reo, marae and provider clinics, the service provides:
  • health education,
  • health assessments,
  • children under 5 checks
  • smokefree cessation and other smokefree activities
  • health and social service referrals
  • a transport service
  • breastfeeding advice
  • family violence, alcohol, drugs and problem gambling services.
The Community Health Promotion work form the basis of cross generational knowledge sharing and interaction where kaumātua and rangatahi work together, sharing energy, resources and time.  The main focus is on increasing physical activity and healthy eating. A 24/7 fully equipped gym, together with a qualified personal trainer, are available to all members of the community for a nominal $50 annual membership fee.  Classes offered at the gym include yoga, circuit training and line dancing. Healthy eating is encouraged through:
  • Encouraging personal management of diet and nutrition
  • community gardening
  • a fruit tree planting programme
  • education on preserving kai
  • a traditional kai gathering programme
  • a Rongoa project
  • smoking cessation services
  • an after school programme.
The Service also offers a programme of social activities aimed at reducing the burden of isolation and increasing connectedness within the community. Underpinning all these services is a free GP clinic and pharmacy based at the hospital and 24/7 for emergency service. The approach to wide cross-community involvement is evident in all areas of work.  The service’s flexibility also makes it possible to include other social and health projects as they emerge. Barby Joyce, manager of the Māori Community Centre says that, despite the vast array of existing services in place, the service will continue to “branch out” and take on board some of the innovative ideas of the local young people who she says “have much to offer to the community and to the development of the service.” Although infectiously positive, Barby was honest in her appraisal of outstanding issues that need to be addressed. Housing standards, mental health, alcohol and drugs and family violence were still a concern:  “The service is working hard to find effective solutions to these issues,” she said. Judging by the great work being done in this small community, there is a good chance solutions will be found: this service has shown itself to possess patience and perseverance; focusing on creating a strong, adaptive and healthy community. Established in 2003, Ha o Te Ora o Wharekauri Trust- Māori Community Services are contracted to and funded by the Hawke’s Bay DHB and also Te Puni Kokiri to deliver services to all the residents of the Chatham Islands. Although available to the wider community, the service has been tasked with targeting and making inroads into the Māori and Moriori populations. In the 2006 census 64.2% of the total population of the Island identified themselves as belonging to the Māori ethnic group. However the all-encompassing approach to the work means that all community members are valued and seen as important. On observation this has created a positive and warm environment and increasingly a place for many in the community to gravitate to. With an underpinning philosophical approach of nurturance and a deep affection for the people and the land, Te Ha o Te Ora will remain a vital support mechanism for the Chatham Islands and all who live there. Trevor’s workshops were held at Te Ha o Te Ora o Wharekauri Trust Centre in the small western settlement of Waitangi. Supported by staff of the Māori Community Service, these workshops provided a first time opportunity for a member of HPF to contribute in a small way to the workforce development needs of this isolated South Pacific Island. Along with MCS staff, a number of participants from various service providers together with individual community members attended.   Reference: Smith, L., Duckworth, S (2013) Wharekauri, Rekohu, Chatham Islands Health and Social Needs Report. Ministry of Health and Litmus Ltd 2013.   April 2014 By Trevor Simpson Edited by Jo Lawrence-King  

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  

News, What is HP
student   UNITEC has this year launched a new Bachelor of Health and Social Development with a major in health promotion.  Offered at its Waitakere campus, the course will begin in February or July, and can be full-time (for three years) or part-time. Offering a pathway into a wide variety of health and social development roles, the curriculum identifies ways in which to empower communities to take control of their own wellbeing.  Students develop an understanding of the strategic organisation of health promotion and the use of evidence based research. Lian Wu – who previously worked at the University of Auckland Medical and Health Sciences School – will be the Major Leader for the course. The Health Promotion Forum of New Zealand (HPF) offers a range of training courses, including the Certificate of Achievement in Introducing Health Promotion.

For further information: call 0800 10 95 10 or email study@unitec.ac.nz

  Karen Hicks 31 March 2014 Photo courtesy of Elvis Santana: Stock.Xchng  

te-tiriti-o-waitangi-image Every year Waitangi Day provides a useful basis to reflect on our nationhood and the common historical grounds that brought us all together. At the same time it reminds us about the relationship between Te Tiriti o Waitangi, hauora, health and wellbeing.  For HPF, Waitangi Day emphasises the importance of good human and societal relationships between all people.  HPF’s Deputy Executive Director explains the close relationship between hauora, Te Tiriti o Waitangi and the Health Promotion Forum. HPF has a constitutional arrangement premised on two important factors; firstly an adherence to Te Tiriti o Waitangi and secondly the notion of health and wellbeing as an indomitable human right. When we dissect the story we find information that supports the view that Te Tiriti o Waitangi was in part motivated by the declining health status of Māori. In 1832 James Busby, in communication with Lord Normandy decried the “miserable condition of the natives” much of which was a result of the pre-Treaty effects of unmanaged colonisation. Indeed when we look into the body of the language within Te Tiriti itself we see a direct correlation to health and wellbeing and the legal obligation to protect rights that ensure this. To begin with the preamble declares Queen Victoria’s desire to protect the authority of the chiefs to the own authority and infers a commitment to a peaceful future. The 3 Articles and health Article the First touches on the rights of sovereignty and the notion of governance. Good governance in any circumstance would require that those in power provide the resources and infrastructure that supports health and wellbeing for all citizens. Health promoters recognise that this reinforces the need to increase health equity and to accord the appropriate resources to ensure this happens. Article the Second confers and affirms Māori rights to Tino Rangatiratanga or absolute sovereignty. This includes domain over everything held precious and their lands. Under this article, Māori would consider health to be a taonga. In the wider sense this article speaks about having authority and control over the determinants of health and wellbeing. Article the Third relates to the idea of equal citizenship. In the field of health this, as with Article the Third, communicates the idea of health equity. That is, all people have the right to hauora. This of course resonates with the health promotion principles of social justice and fairness. For HPF, Waitangi Day emphasises the importance of good human and societal relationships between all people. It connects with “hauora- everyone’s right” the vision of HPF and builds on the notion of Te Tiriti o Waitangi as a crucial component in moving Aotearoa New Zealand towards a just and equitable society.   Read more about Māori concepts of hauora.     6 February 2014 Trevor Simpson

Family and child, Global, Maori, What is HP
tariana-turia   A speech to parliament on Wednesday 28 January 2014 by Minister Tariana Turia has highlighted the groundswell of support for Whanau Ora as a model for health and wellbeing applicable to all New Zealanders.  Health Promotion Forum (HPF) Executive Director Sione Tu’itahi believes that the model goes even further; with relevance to people around the world.   “Whanau Ora [……] has been openly embraced by New Zealanders of all cultures and creeds,” said Ms Turia in her speech “[It is] about empowering and enabling families to set their own priorities, to focus on outcomes.”  According to Ms Turia 160 providers are now using the Whanau Ora tool, with approximately 33,000 New Zealanders benefitting from the approach.  Ms Turia is not alone in seeing the value of community health promotion, with Minister of Health Hon Tony Ryall reportedly considering funding for such a programme.  
Ms Turia is not alone in seeing the value of community health promotion, with Minister of Health Hon Tony Ryall reportedly considering funding for such a programme. – See more at: http://www.hauora.co.nz/whanau-ora-a-model-for-people-around-the-world.html#sthash.eWk0Ul5D.dpuf
Ms Turia is not alone in seeing the value of community health promotion, with Minister of Health Hon Tony Ryall reportedly considering funding for such a programme. – See more at: http://www.hauora.co.nz/whanau-ora-a-model-for-people-around-the-world.html#sthash.eWk0Ul5D.dpuf
    Tu’itahi welcomed Ms Turia’s speech and Mr Ryall’s interest in community health programmes.  “We are rapidly moving from a model of hauora (health and wellbeing) by and for Māori to one that is widely recognised as being of value to all peoples of Aotearoa New Zealand,” he said.  “I predict that it won’t stop there: this will become a model followed by peoples across the globe.”   Aotearoa New Zealand – and HPF –  are highly regarded internationally.  In particular our approaches to indigenous health promotion were well-received at last year’s International Union of Health Promotion and Education (IUHPE) conference. Key elements of these approaches include a focus on the holistic view of health and wellbeing, increased control by communities over interventions and incorporating indigenous world views into health promotion planning. All of these aspects are reflected in the Whanau Ora approach.   Whanau Ora is founded on the principle of self-determination.  Unlike the conventional models of health care, the Whanau Ora approach empowers whanau and communities to have control over their own wellbeing.  Instead of focussing on illness and its treatment, Whanau Ora helps participants identify those elements that determine hauora and to prioritise strategies to improve outcomes.   “This is not an exclusively indigenous issue,” says Tu’itahi.  “There is a broad movement towards self-determination – in health and many other issues.  People around the world are taking an increasing interest in being well, rather than treating illness; on looking at the big picture of what affects our ability to fulfil our potential and doing something to address those determinants of our health.”   He believes that the Whanau Ora model will be one that is taken up and adapted for people around the world.  “Once again New Zealand will be a pioneer,” he said.  “Perhaps what we do need to recognise is that we owe Māori a debt of gratitude for a model that has the potential to revolutionise the hauora of people around the world.”   Visit the Government’s web-page about Whanau Ora.   Jo Lawrence-King

Global, Maori, Smoking

HPF – and New Zealand – is making a significant contribution to world health agendas.  Its most recent input was to the scientific programme of the 16th World Congress on Tobacco or Health. As a member of the board of the International Union for Health Promotion and Education (IUHPE), HPF’s Executive Director Sione Tu’itahi ensured the needs of indigenous peoples and ethnic minorities were included in the recommendations invited from the global organisation.

“This is a big step for New Zealand, the HPF and for Maori and all other indigenous peoples,” says Sione.  Smaller countries and ethnic minorities are often overlooked and vulnerable to the driving force of large companies and countries.  “Having a voice at this level is a wonderful opportunity to advocate for the rights of these less-represented peoples.”

Recommendations about the conference from the IUHPE included:

Discussions about the post-2015 development agenda to ensure health, including non-communicable diseases and social determinants are given the appropriate attention. Discussion around support for politicians in the battle with tobacco industry on initiatives such as plain packaging. Seeing outputs and outcomes of the WHO Europe NCD ministerial event focussing primarily on tobacco.
  • Focussing on ‘how to do’ as much as ‘what to do’
  • Including the health needs of indigenous peoples and ethnic minorities in all strategies.

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 will be 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.

Sione recently attended a meeting of the IUHPE’s Global Executive Board in Paris.  Read more about the trip here.

The HPF is a national umbrella organisation for health promotion organisations and teams in New Zealand.


Equality, Maori, Pacific

  Bruce Jesson Lecture 2013

“Assertive, if not aggressive approach” called for by the Right Hon Sir Edmund Thomas

The Rt Hon Sir Edmund Thomas   Retired Court Appeal Judge the Right Hon Sir Edmund Thomas (pictured right – from 3 News) called for an “assertive, if not aggressive approach” by communities and community groups; to reverse the extreme inequality that currently exists in Aotearoa New Zealand.  He was speaking to a packed Maidment Theatre in Auckland, late October.   HPF Health Strategist Dr Ieti Lima was in the audience and reports on some of Sir Edmund’s key points to support his argument.   Call for “sufficient force” In his powerful, engaging and, at times, challenging lecture, Sir Edmund proposed a focussed campaign to promote substantive human rights.  He further called for “sufficient force” to ensure people claim the minimal social, economic and cultural standards to which they have a right.  Sir Edmund asserted that, if the governing bodies or the courts cannot generate the required assertive approach to support people’s rights, the community must initiate the action needed.  “Discussion and debate will not suffice,” he said.  “This legacy is now too entrenched to be so readily reversed.”   Neo-liberalism at the heart of the problem Sir Edmund was unequivocal in linking the “extreme – even obscene – inequality” that exists in Aotearoa New Zealand to the “traumatic neo-liberal transformation” that has been pursued here.   According to the retired judge, the top ten per cent of New Zealand’s population today owns half of the country’s wealth, while the bottom 50 per cent owns just five per cent of the wealth.   He pointed to Maori health statistics as appalling, and declared that he finds “the neglect of a people socially and culturally offensive.”   So how has this gross inequality been tolerated in a country that once prided itself on its egalitarian culture and sense of social justice?  Sir Edmund’s explanation was blunt; it has been fostered and sustained by the rich and powerful, to perpetuate their own wealth and privilege.  Sir Edmund argued that the term ‘equality’ is today more often than not defined in terms of equality of opportunity.  By suggesting that all people have the same opportunity, the term obscures the true extent of inequality within the community.  If this definition remains, it simply provides the opportunity for those in an advantaged position to further advance their superiority and privilege.   “This perspective of equality in turn impairs social mobility,” he said. “The disadvantaged are stuck with being disadvantaged. … It becomes a vicious circle”.   Neo-liberalism – according to Sir Edmund – is a theory that insists human well-being can best be advanced by ensuring strong property rights, free enterprise, free market and free trade.  He identified eight features of the neo-liberal legacy:  
  1. Values directed by economic order
  2. Exploitation
  3. Equality
  4. Governmental intervention
  5. Unemployment
  6. Taxation
  7. Trade unions
  8. Social justice
Assertive action by community groups Sir Edmund challenged his audience to consider who will speak for “losers” in a capitalistic society? How can they be guaranteed their basic economic, social and cultural human rights?  He proposed that a first step in any campaign to achieve a more equal and just society is to identify and challenge the damaging features of neoliberalism. Ultimately the aim is to arrest and reverse them.   In the absence of legal options to redress the inequalities, Sir Edmund called on a focussed campaign by community groups.  “They [must] possess sufficient force for people to claim that the minimum social, economic and cultural standards they reflect are theirs as of right”.   Sir Edmund was the speaker at the annual Bruce Jesson 2013 at the Maidment Theatre, University of Auckland.  He is a retired Court of Appeal Judge and former acting judge of the Supreme Court.  His lecture was made to a mainly academic audience.     Author: Dr Ieti Lima Editor: Jo Lawrence-King

Family and child, News
sad-boy-photo-from-stock-xchng   The release, on Monday 9 December, of the first annual monitor of child poverty shows that one in four children in Aotearoa New Zealand live in income poverty.  One in six live without basic essentials like fresh fruit and vegetables, a warm house, decent shoes and visits to the doctor.   It has long been known that child poverty creates life-long health issues.   According to Iain Hines, Executive Director of the J R McKenzie Trust child poverty today is twice that of the 1980s.  “If New Zealand’s road toll was twice that of the ‘80s ther would be outrage and immediate action taken to reduce it.  We need the same momentum and action on child poverty.”   Children’s Commissioner Dr Russell Wills says the project is about giving New Zealanders the full picture on child poverty and to get New Zealanders talking about it.  “Child poverty hurts all of us. It harms the individual child and it has substantial long-term costs to society. If we want to be a thriving, progressive and successful country – we’re not going to get there with 25 percent of our kids in poverty,” he says.   The Child Poverty Monitor is a joint project by the Children’s Commissioner, J R McKenzie Trust and Otago University’s NZ Child and Youth Epidemiology Service (NZCYES). For the next five years it will publish four measures of child poverty: income poverty, material hardship, severe poverty and persistent poverty. The initiative aims to raise awareness of the problem and monitor New Zealand’s progress in reducing each of these measures.   The Monitor is supported by an extensive technical report.   More information on child poverty and health can be found in our Children and Young People section.  
Key findings of the Child Poverty Monitor 2013:
Income poverty: 265,000 children (one in four). This looks at the amount of money families have to pay bills and purchase everyday essentials. This is defined as having less than 60% of median household income, after housing costs are removed.   Material hardship: 180,000 children (17%). This means regularly going without things most New Zealanders consider essential – like fruit and vegetables, shoes that fit, their own bed and a warm house.   Severe poverty: 10% of children. This means they are going without the things they need and their low family income means they don’t have any opportunity of changing this. These are the children experiencing material hardship and who are in families in income poverty.   Persistent poverty: 3 out of 5 children in poverty are in poverty for long periods. These children are likely to live in poverty for many years of their childhoods. Persistent poverty is defined as having lived in income poverty over a seven year period.   Visit our Children and Young People section to read more, including reports from the Children’s Commissioner and a report from the Public Health Advisory committee.   Published: 10 December 2013 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  

Competencies, Maori
    Māori mental health patients are twice as likely as non-Māori to be put into seclusion.  Workforce development has been identified as one of the ways to address this disparity.     Seclusion means being placed in a locked, bare room alone. The person is monitored through a window and family members are kept away.  It is widely accepted that seclusion is not a legitimate form of treatment for escalating behaviour and can be highly distressing for the patient. The Ministry of Health reportedly has a plan to eliminate seclusion of Māori patients over five years.   In an interview on Radio New Zealand with Marion Blake, Chief Executive of The Platform Trust, said there are a number of possible reasons for the disparity, but there is no evidence to suggest Māori are any more violent than other people with mental illness.  She suggested one of the ways to tackle this disparity is workforce development – particularly in tikanga Māori.   Anne Brebner at health research organisation Te Pou says cultural issues aren’t on the top of everyone’s list of priorities when people seek treatment for mental health problems.   Health Promotion Forum offers workshops and courses to provide understanding Māori culture and health models.   The Platform Trust is a national mental health network of community organisations.    

Find out about HPF’s training programmes:

  • A Treaty Understanding of Hauora in Aotearoa New Zealand (TUHANZ).  This is a practical, hands-on course, which explains how the articles of the Treaty can be applied to health promotion planning.
  • Working with the whanau ora tool  A practical guide to developing health programmes where Whanau, Hapu, Iwi and Māori communities play a leading role in achieving Whanau Ora.
  • Māori indigneity, whanau ora and the determinants of health.  Explores the link between Māori indigenous notions of health and wellbeing, the wider determinants of health and elements of whānau ora. As well as informing workplace practice this interactive workshop will provide an open platform for learning, sharing and personal development.
  • Māori concepts of health promotion.  Introduces participants to shared understandings of traditional Māori concepts, ideologies and practices in relation to health and wellbeing.
  Story published 12 November 2013 Jo Lawrence-King Photograph courtesy of Ophelia Cherry  

Family and child, News

Children’s health disparities require urgent action

  “The large health disparities in the health status of New Zealand children, which have led to an alarming number of hospital admissions for a range of preventable illnesses, must be urgently addressed says the New Zealand Medical Association (NZMA) in response to this year’s Children’s Social Health Monitor report.”   Read the press release: From the New Zealand Medical Association 29 August 2011 Content sourced from www.scoop.co.nz   Key Points Emerging from the Children’s Social Health Monitor  “…. the overall picture painted by the 2011 Children’s Social Health Monitor remains concerning, with one in five (20%) New Zealand children being reliant on Government Benefits as the main source of their family’s income, and the 2008 Living Standards Survey suggesting that these benefits may inadequately protect them from exposure to material hardship (e.g. having to wear worn out shoes or clothing, sharing a bed, cutting back on fresh fruit and vegetables, and postponing doctors visits because of cost). Further, while the increases in hospital admissions for medical conditions with a social gradient seen during 2007–2009 were less steep in 2009–2010 (and for Pacific children may be beginning to taper off), large social gradients persist for many conditions (e.g. hospital admission for injuries arising from the assault, neglect or maltreatment of children are 5.6 times higher for those living in the most deprived (NZDep Index decile 9–10) areas, and mortality from sudden unexpected death in infancy is 7.4 times higher). Key Points Go to Children and Young People for more information and opinions.  

[pdf-embedder url=”http://hauora.info/hauora/wp-content/uploads/2016/10/maori_health_model_tepaemahutonga.pdf”]    
Te Pae Mahutonga (Southern Cross Star Constellation) brings together elements of modern health promotion.   View Te Pae Mahutonga (PDF, 153 KB)
Te Pae Mahutonga text
    IUHPE presentation by Prof Sir Mason Durie [pdf-embedder url=”http://hauora.info/hauora/wp-content/uploads/2016/10/tepaemahutongatxtvers.pdf”]

Maori, What is HP
The purpose of this paper is to provide a definition of Māori health promotion and to discuss Māori health promotion strategic issues to inform practice.   Māori health promotion is the process of enabling Māori to increase control over the determinants of health and strengthen their identity as Māori, and thereby improve their health and position in society (Ratima 2001). While this brief definition gives an indication of what Māori health promotion is about, by itself it does not convey completely the meaning and uniqueness of Māori health promotion. To more fully understand Māori health promotion, it is useful to refer to two models for Māori health promotion – Te Pae Mahutonga (Durie 2000) and Kia Uruuru Mai a Hauora (Ratima 2001). Together, these models describe both the breadth of Māori health promotion and its defining characteristics. The characteristics include the underlying concept of health, purpose, values, principles, pre-requisites, processes, strategies, key tasks, and markers.   A full definition of Māori health promotion is necessary to guide practice and enable common understandings as a basis for clear communication and advocacy for Māori health promotion. – See more at: http://www.hauora.co.nz/m%C4%81ori-health-promotion-comprehensive-deiniiton-and-strategic-considerations.html#sthash.LEDe55tb.dpuf