Case Studies, Environment, Global
This Statement from Indigenous participants in the 23 rd IUHPE World Conference on Health Promotion (Rotorua, Aotearoa New Zealand) is a call on the health promotion community and the wider global community to make space for and privilege Indigenous peoples’ voices and Indigenous knowledges in promoting planetary health and sustainable development for the benefit of all. It should be read alongside the Rotorua Statement from all participants in this Conference.
Indigenous peoples are diverse and our worldviews, which have developed over millennia of human experience, are specific to peoples and place. However, there are fundamental commonalities in these worldviews that have provided the basis for Indigenous peoples’ movements that draw us together around our shared interests. Core features of Indigenous
worldviews are the interactive relationship between spiritual and material realms, intergenerational and collective orientations, that Mother Earth is a living being – a ‘person’ with whom we have special relationships that are a foundation for identity, and the interconnectedness and interdependence between all that exists, which locates humanity as part of Mother Earth’s ecosystems alongside our relations in the natural world.
Understanding our place in the natural world in relational ways leads us to consider how access to the natural environment shapes human health and wellbeing, the impacts of our activities on the environment, and our inalienable collective responsibilities of stewardship which will benefit future generations.
Within Indigenous worldviews our relationship with the natural world is characterised by reverence and values that include sustainability, guardianship and love. Planetary health is understood as the health and wellbeing of Mother Earth and of humanity as an inextricable part of natural ecosystems. It should also be noted that Indigenous languages are critical in articulating Indigenous worldviews as they
enable the most full and accurate expression of Indigenous conceptualisations, and should be protected.
The forces of colonisation, capitalism and globalisation have caused massive environmental degradation, climate change, loss of biodiversity and the devastation of Indigenous communities. Further, they have led to intellectual imperialism and the widespread subjugation and exclusion of Indigenous worldviews, bodies of knowledge and voices.
Prevailing Western and other worldviews promote individualism and anthropocentric perspectives that to human peril separate humanity from the natural world. This has encouraged human activity that accelerates the depletion of planetary resources, the destruction of ecosystems, pollution, climate change and increase in the risk of ecological collapse.
Environmental degradation impacts disproportionately on Indigenous peoples because of close relationships with the natural world and our already marginalised circumstances in nation states. The silencing of Indigenous voices and the subjugation of Indigenous bodies of knowledge has been detrimental to all, most evident in our global environmental crisis.
Indigenous health promotion (as opposed to the generic form of health promotion which has largely Western origins) emerged in response to Indigenous peoples’ needs to make space for our own ways of seeing the world and as a vehicle to realise our aspirations to sustain future generations who are healthy, proud and confident as Indigenous peoples. It is an Indigenous-led endeavour with origins that stretch back in time to customary systems to maintain health and wellbeing that emphasised social and ecological connections. At the same time, Indigenous health promotion is open to knowledge generated from within other worldviews where there is alignment. Indigenous health promotion can be understood as the process of increasing Indigenous peoples’ control over the determinants of health and strengthening our identities as Indigenous peoples.
Ecological collapse is the greatest threat to human health and survival globally. Health promotion (policy, research, education and practice) needs to change to effectively respond to the challenges of the Anthropocene and bring intergenerational health equity into its systems and frameworks. Engaging with indigenous worldviews and bodies of knowledge
provides opportunities to find solutions to this most pressing threat and ways forward to promote the health of Mother Earth and sustainable development.
We call on the health promotion community and the wider global community to make space for and privilege Indigenous peoples’ voices and Indigenous knowledge in taking action with us to promote the health of Mother Earth and sustainable development for the benefit of all.
Case Studies, Environment, Global
Rotorua Statement
This Statement represents the collective voice of the social movement members, researchers, practitioners and policymakers who participated in the 23rd IUHPE World Conference on Health Promotion, held in Rotorua, Aotearoa New Zealand in April 2019. It should be read alongside the Indigenous Peoples’ Statement for Planetary Health and Sustainable Development from this Conference.
The conference participants call on the global community to urgently act to promote planetary health and sustainable development for all, now and for the sake of future generations. Planetary health is the health of humanity and the natural systems of which we are part. 1 It builds on Indigenous peoples’ principles of holism and interconnectedness, strengthening public health and health promotion action on ecological and social determinants of health. It puts the wellbeing of people and the planet at the heart of decision-making, recognising that the economy, as a social construct, must be a supportive tool fit for this purpose in the 21 st century.
Waiora is an Indigenous concept of our host country, Aotearoa New Zealand, which expresses the interconnections between peoples’ health and the natural environment, and the imperative of sustainable development. 2 3 Waiora represents a call to work with Indigenous peoples to draw on Indigenous knowledge, and to share knowledge from our diverse cultural systems for the wellbeing of the planet and humanity. Sustainable development for all is a clear way to ensure environmental, social and health justice for the people of today and for future generations.
Urgent action is needed because mounting evidence tells us that the current
economic and social development paradigm of infinite growth and endless exploitation of limited natural resources is unjust and unsustainable, leading to inequities within and among countries and across generations.
In 2015, the UN General Assembly adopted the new development agenda
“Transforming our world: the 2030 agenda for sustainable development”. 4 The 17 Sustainable Development Goals (SDGs) integrate economic, social and environmental development around the themes of people, planet, prosperity, peace and partnership. In doing so, they provide an action plan for the global community.
They prioritise the fight against poverty and hunger while focusing on human rights for all, and the empowerment of women and girls as part of the push to achieve gender equality. The SDGs recognise that eradicating poverty and inequality, creating inclusive economic growth and preserving the planet are inextricably linked to each other and to population health. 5
Conference participants call for immediate action from the global community in four key areas.
- Ensure health equity throughout the life course, within and among countries, and within and across generations. This requires:
The development of all peoples as empowered lifelong learners and
engaged contributors to individual health and the health of families,
communities and the planet.
Action and accountability to address the wide and enduring inequities
experienced by Indigenous peoples, while ensuring the protection of
cultural identity and customary ways of life.
Tackling the structural factors that drive the inequitable distribution of power, money, and resources; improving daily living conditions especially of those most in need; and measuring and understanding the problem and assessing the impact of action as outlined by the Commission on Social Determinants of Health. 6 Prioritising intergenerational health equity in systems, frameworks and
decision-making, as a central tenet of a planetary approach to health - Make all urban and other habitats inclusive, safe, resilient, sustainable and conducive to health and wellbeing for people and the planet. This requires: Renewing and strengthening our relationship with planetary ecosystems. Protection of the planet from degradation, including through sustainable production, management and consumption of natural resources so that the planet can support the needs of present and future generations. This requires taking, enabling and advocating for immediate action on climate change and the loss of biodiversity.
Action to reduce disparities in the quality and quantity of resources
available to communities as these disparities are at the root of inequities in health. Current threats will accentuate such disparities. These include threats to food and water supplies associated with climate change, depletion of both renewable and non-renewable resources, the degradation of the environment such as contamination of food chains and ecosystems, poor air quality and massive forced migrations.
Greater cross-sectoral action to protect and improve the health of
populations experiencing inequities, including those in the world’s fast- growing urban areas.
Fostering of peaceful, just and inclusive societies which are free from fear, racism, violation and other violence.
The realisation of the health co-benefits of sustainable ‘One Planet’ living.
3
Ensuring urban decision-makers apply a “health equity lens” to assess the
risks and opportunities posed by policies and programmes and measure
their effects. 7
- Design and implement effective and fair climate change adaptation strategies.
This includes:
The development of new approaches to global, regional, national and local governance and stewardship that will equitably promote health and well- being and prevent and mitigate disastrous climate and environmental breakdown, particularly in Low and Middle-Income Countries.
Repositioning Indigenous and traditional knowledge systems to be on an equal footing with science and other knowledge systems to promote health and well-being and prevent and mitigate disastrous climate change and environmental breakdown.
Development of action-oriented policies and partnerships between health and other sectors to develop policies addressing health and climate. - Build collaborative, effective, accountable and inclusive governance, systems and processes at all levels to promote participation, peace, justice, respect of human rights and intergenerational health equity. This requires:
Respect for and adherence to the inherent rights of Indigenous peoples as articulated in the UN Declaration on the Rights of Indigenous Peoples.
Effective global governance free from the domination of economic considerations and commercial interests.
The promotion of participatory democracy, coherent policy-making and regulation in the public interest and to restrict conflict of interest.
Participants at the 23rd IUHPE World Conference in Rotorua also confirm the critical role and relevant expertise of the health promotion community in promoting human health, planetary health and sustainable development, including implementing the SDGs. Participants urge the health promotion community to provide leadership across our one planet.
References:
- Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch:
report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet
2015;386(10007):1973-2028. - Durie M. An Indigenous Model of Health Promotion. 18th World Conference on Health Promotion
and Health Education. Melbourne, 2004. - Durie M. An Indigenous model of health promotion. Health Promotion Journal of Australia
2004;15:181-85. - UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development.
New York: United Nations 2015 - World Health Organization. Health in 2015: from MDGs, millennium development goals to SDGs,
sustainable development goals. Geneva: World Health Organization, 2015 - Marmot M, Friel S, Bell R, et al. Closing the gap in a generation: health equity through action on
the social determinants of health. The Lancet 2008;372(9650):1661-69. - World Health Organization. Health as the pulse of the new urban agenda: United Nations
conference on housing and sustainable urban development, Quito, October 2016. Geneva:
World Health Organization, 2016.
News
The Mayor of Rotorua has agreed to explore further the idea of Rotorua becoming a healthy city.
Promotion Forum (HPF), Sione Tu’itahi, Rotorua Mayor Steve Chadwick, Dr Faten ben
Abdelaziz, coordinator of Health Promotion with WHO and Dr Viliami Puloka of HPF.
Steve Chadwick told delegates at the closing of the 23 rd International Union of Health Promotion and Education’s conference that she was looking forward to seeing what was involved in the process of becoming a healthy city.
Ms Chadwick was handed the Shanghai Consensus on Healthy Cities by Dr Faten ben Abdelaziz, the coordinator of Health Promotion with the World Health Organisation. (WHO).
Ms Chadwick said as a signatory to the United Nations Global Compact – Cities Programme, which is a worldwide initiative aimed at creating sustainable societies, Rotorua was keen to see what the journey to becoming a healthy city would entail.
She thanked the conference for the Rotorua – Waiora: Promoting planetary health and sustainable development and Indigenous legacy documents.
“We’re looking forward to seeing what is in the legacy statements,” she said.
Executive Director of the Health Promotion Forum (HPF), co-host of the conference, Sione Tu’itahi thanked the mayor for her support and for welcoming delegates to the city.
HPF’s Dr Viliami Puloka thanked everyone on behalf of participants who came from all over the Pacific and presented a mural which was painted by young artists from the Solomons and New Caledonia to the people of Rotorua.
The artists who painted the mural just outside the Energy Events Centre are under the Pacific Community’s (SPC) WAKE UP! Project aimed at encouraging young Pacific Islanders to get involved in efforts to control non-communicable diseases.
“Our hearts are filled with aroha as we present this artwork to the people of
Rotorua,” said Dr Puloka.
News
IUHPE2019 Rotorua put Māori culture on the world stage.
Māori culture was woven through the 23 rd International Union for Health Promotion and Education World Health Promotion conference with a powhiri by Te Arawa for overseas guests and delegates setting the tone.
The theme of ‘Waiora: Promoting Planetary Health and Sustainable
Development for All’ reflected the indigenous focus of the conference, which was attended by more than 1000 delegates from around the world and New Zealand. It was the largest conference Rotorua has ever staged.
For the first time at a world conference, Te Reo Māori was an official language and at an IUHPE conference it was the first time an indigenous legacy statement was released.
An indigenous lounge was set up in the exhibition area of the event, which was co-hosted by the Health Promotion Forum of NZ (HPF), where delegates could watch women from Hapai te Hauora weaving and speak to kaumatua.
Tūhoe leader Tamati Kruger’s speech was met with awe by delegates who
agreed it was powerful and inspiring. “The more we learn, the taller we get. Learning must never have the objective of knowledge. It must lead to action,” he told delegates.
Mr Kruger said it was good for our wellbeing to know who we are. It is not a protest, not a war against anyone but it was a “fight for our rangatiratanga, for our survival … that is our world today.
“Virtues are the habits that all of us need, so we may find the truths in our
culture and in our life,” he said.
“Tūhoe is Mauri ora … Tūhoe are looking for regular experiences of wehi, ihi, wana, in order to build themselves and fix themselves. Wana is a Māori term that generally depicts the thrill, joy and excitement of life and people need that to become decent and healthy people.
“Tūhoe declared Te Urewera, their land is a living being, their mother and can’t be owned. Their truth is based on their identity as Tūhoe. Being Tūhoe is their antidote to despair.”
Mr Kruger explained how Tūhoe was redesigning more appropriate spaces and buildings, criminal justice and crime prevention processes, energy and
recycling procedures and health services.
“Mauri Ora does not have an end date,” he said. He also emphasised the importance of climate change in Te Urewera. “Nature does not need people, people need nature. We don’t own the land. We live with it.
Dame Ann Salmond, Professor in Māori Studies and Anthropology at Auckland University addressed ‘Whaiora: The search for wellbeing”.
Dame Ann shared about the Christchurch shootings and said although there
was a need to acknowledge the racism and hatred that has always been with us, we can be hopeful about the emerging commitment to address these.
“New Zealanders pride themselves on tolerance but there has been much soul- searching in the wake of the Christchurch massacre. It was extraordinary to see New Zealanders reach for Māori values.
“We need to foster aroha and manaakitanga and kotahitanga,” she said.
Dame Ann said effective, accountable and inclusive governance sounded
mechanistic. “We need to look for new ways based on aroha and learn from Māori and Pacific traditions.
“The relations between and among people and other life forms are currently out of balance generating violence. Reciprocity has broken down.
“We need to strive for a state of ora: a balance between the wellbeing of the land, the wind, the sky, the ocean and all forms of life. Human wellbeing is just one element within this network of life,” she said. “If I am the river and the river is me. If the river is dying, I’m dying. It’s not poetry it’s reality, it’s public health. This is a relational theory of how reality works. We cannot separate our people from the environment.
“People are just one element in networks of kinship among all forms of life- health of people, land and oceans are but one.”
Sir Mason Durie who spoke at the launch of the conference emphasised how vital it was that indigenous approaches to planetary health and the health of people were acknowledged.
He talked about Te Pae Mahutonga, also known as the Southern Cross
together with the Matariki or Pleiades constellations to emphasise this.
Both star systems feature prominently across the Pacific as both navigational tools and as frameworks for the health of people and the environment.
He also shared his knowledge of indigenous health promotion and its intimate relationship to the natural world, the cosmos and people.
Sir Mason also reflected on the last two major health conferences held in
Rotorua, the first in 1907 when Māori Sanitary inspectors met for their first general conference. The conference took a health promotion approach.
The second was in 1937 when the Women’s Health League Te Ropu o te Ora, Tunohopu met.
News
It is vital to improve planetary health and achieve sustainable development for all says the Associate Minister for Health, Jenny Salesa.
Mrs Salesa made the comment while opening the 23 rd International Union for Health Promotion and Education (IUHPE) World Health Promotion Conference in Rotorua last night. (April 7).
The conference which has the theme of ‘Waiora: Promoting Planetary Health and Sustainable Development for All’ reflects the indigenous focus and important feature of the event.
Mrs Salesa commended the Health Promotion Forum of New Zealand, which is co-hosting the conference, and IUHPE for putting the conference’s extensive programme together.
“We are at a unique point in history. We have a higher life expectancy, lower child mortality, lower maternal mortality and considerable advances in science and technology. Despite this, we are facing significant challenges to the health of global population and natural systems on which we depend.
“While common to all people and nations, these challenges impact some populations disproportionately. It is imperative that we strive to improve
planetary health and achieve sustainable development for all.”
Mrs Salesa said the Government will demonstrate its commitment to improving wellbeing and living standards for all New Zealanders when it releases the world’s first Wellbeing Budget this year by a Government.
“This approach lifts our gaze from health to wellbeing and reframes our understanding of the determinants of both health and wellbeing. Specific priorities include transitioning to a low-emissions economy, lifting incomes of those at the highest risk of experiencing poverty, for example, our Māori and Pacific communities, supporting innovation in the digital age, improving child and youth wellbeing, and addressing mental health needs, particularly for those under 24 years old.”
Mrs Salesa said the conference provided a valuable opportunity for New
Zealand to learn from the collective expertise and wisdom of the international delegates.
Sione Tu’itahi, the Executive Director for the Health Promotion Forum said HPF and its partners wished Mr Tu’itahi said while climate change was the most significant issue in the world today, the Pacific region was one of the regions where it was most pronounced.
“In the words of one of our Pacific leaders, ‘it is climate crisis for us in the
Pacific.” He pointed out that while New Zealand wished to learn from the world, it also hoped to contribute its experience, especially in indigenous health promotion.
“For centuries we have explored and applied the knowledge of the west, and east. It is timely with where we are now as a world community, to learn also from indigenous knowledge systems.”
IUHPE President and co-chair Graham Robertson said the conference programme provided a platform for the IUHPE’s Global Working Groups and members to showcase their work, as it does for guest speakers and many other contributors.
“It also allows the IUHPE to hear of latest developments and ideas that can inform future plans and advocacy work,” he said.
The conference will continue until Thursday, April 11.
For further information please contact:
Lavinia Ngatoko
Communications Advisor
Health Promotion Forum of NZ
lavina@hauora.co.nz (021) 8964343
News, Newsletter
A general legacy document and an inaugural indigenous legacy document are being drafted for the conference.
The general statement will capture the essence of the conference and represent the voice of researchers, practitioners, social movement members and policymakers who participated in the conference.
HPF’s Dr Viliami Puloka who is coordinating the drafting the general statement says It will call on the global community to: Ensure health equity throughout the life course; make all urban and other habitat inclusive, safe, resilient and sustainable; Design and implement effective and fair climate change adaptation strategies and build effective accountable governance that promotes peace, justice and respect for all creation promoting planetary health.
HPF’s Executive Director Trevor Simpson who is part of the team drafting the indigenous statement says the contributors to this work are looking to draft the document from a specific position of indigenous thought and worldviews.
“Although complementary to the general statement there is an excitement that the Indigenous Statement will, for the first time provide a unique perspective that is neither western nor eastern but rather representative of the way Indigenous people feel about the planet and its co-relationship to health and wellbeing.”
Although confident that the statement will be adopted by the global health promotion community Mr Simpson acknowledges that there is recognition of the challenges faced, particularly given the diversity of indigenous people and their lived experience.
“It will be a very useful starting point, I think. We are trying to articulate indigenous views in an increasingly difficult political situation for many groups. When we consider the plight of the direct impact of climate degradation on indigenous communities, clearly it is incumbent on all of us to bring these things to the fore,” he adds.
News, Newsletter
HPF congratulates Dr Prudence Stone on her appointment as Chief Executive of the Public Health Association (PHA).
Dr Stone (Pictured left with Lee Tuki) who was previously the Executive Director of the Smokefree Coalition said public health was a key pillar of a functional, healthy society.
“There’s so much that can be achieved by taking a public health approach to issues. It is essential that the PHA is an effective watchdog and informant, so the right decisions get made,” said Dr Stone.
“There’s so much that can be achieved by taking a public health approach to issues. It is essential that the PHA is an effective watchdog and informant, so the right decisions get made.
“A lot of the time public health can be up against huge multinationals working in industries such as tobacco, sugar and alcohol. It’s crucial the PHA works to combat the persuasive influence big industry can have by ensuring we promote evidence-based policies. We must be constantly vigilant.”
Dr Stone added that one of her first priorities would be to get to know her
membership and their priorities.
HPF’s Executive Director, Sione Tu’itahi said: “Dr Stone will bring her experience in the public health sector to her leadership role and we look forward to working with her.”
PHA president Lee Tuki said public health needed to be put at the centre of all policy-making if we wanted people in New Zealand to be healthy.
“Dr Stone has the skills, knowledge and connections to get the public health voice clearly heard.
“Dr Stone is committed to making Aotearoa a better place to live for current and future generations of New Zealanders. She’s shown throughout her career that she is a great listener, is able to build consensus, and never gives up. She will be a relentless campaigner for public health in Aotearoa New Zealand.”
News
Health Promotion Forum (HPF) are part of the Planetary Wellbeing Coalition- a group passionate about supporting collective health promotion and public health action at all levels in light of 21st century realities.
The group includes HPF, PHA (Louise Delaney, Warren Lindberg), Papa Nahi and the Prior Policy Centre (Emeritus Professor John Raeburn, Emeritus Professor Robert Beaglehole).
We’re looking forward to sharing more about our group with you over the coming months.
News
Our Senior Health Promotion Strategist Dr Viliami Puloka has recently returned from Whakatane where he engaged an audience on Pasifika Health Promotion: Turning the Tide of NCDs. Participants were thrilled with the interactive and in-depth nature of the workshop and left the day motivated to use health promotion approaches within their practice. If you are interested in one of our workshops or courses there are a small number of spaces for this Friday’s workshop in Napier on Māori Concepts of Health Promotion http://www.hauora.co.nz/News
At the Health Promotion Forum we continue to invest in sector leadership both nationally and globally. Our Executive Director Sione Tu’itahi has just returned from Manila where he worked on the Western Pacific Action Plan on promoting health for sustainable development. Led by the World Health Organisation, the plan is a follow-up on the Shanghai global health promotion conference held last November.
Sione was invited to work on the plan together with other experts from the region. “It is a privilege for the Health Promotion Forum and is also a recognition of our experience and leadership in health promotion in the region and on the global level” said Sione.
“It is also very timely given our hosting in April 2019 of the next world health promotion conference of the International Union of Health Promotion and Education (IUHPE)” he added.
Keep an eye on our website and facebook page for more information on the 2019 IUHPE conference and registration details.
Passionate about health promotion: the Health Promotion Forum
10 years on and growing
(Adapted from an article in the Health Promotion Forum newsletter, Issue 40, April 1997, updated February 2009.) In 1986, the five strands of the Ottawa Charter became the international guiding principles of health promotion practice. In New Zealand these, combined with Te Tiriti of Waitangi, became the foundations on which health promotion practice was to develop. In 1983 Professor Lawrence Green, regarded as one of the leading lights in health promotion, was brought to New Zealand by the Medical Research Council (MRC) to speak at a series of workshops on the planning and evaluation of health education and health promotion. Health promotion as a profession was evolving around the world from a more traditional health education practice. Professor Green’s visit highlighted a need for an independent forum to co-ordinate regional and voluntary opinion on health education and health promotion and to liaise with government organisations in the establishment of national goals. Over the next few years the MRC supported the development of such a forum through the establishment of an ad-hoc steering committee. It included the Departments of Health and Education, Auckland and Otago universities, the Mental Health Foundation, the National Heart Foundation, the Cancer Society, Maori Women’s Welfare League (MWWL), the Accident Compensation Corporation and the Alcoholic Liquor Advisory Council (ALAC). Funding from several of these organisations, as well as grants from the McKenzie and Sutherland Self Help Trusts, provided the financial support which established the Health Promotion Forum secretariat and allowed the appointment of its first research and executive officer in 1986. The Forum’s first home was at the University of Auckland’s Department of Community Health. An interview with former directors Cheryl Hamilton, Candace Bagnall and Kim Conway, provides a historical journey through the Forum’s development. Each of these women share a background of involvement in social change movements and a strong commitment to social justice and community participation. These principles along with the energy and vision of each director helped to create the dynamic organisation the Forum is today. Larry Peters, from Waikato University’s Department of Community Psychology was the Forum’s first director. Larry began to establish a national database of health promotion research and programmes and involved the Forum in co-ordinating a national nutrition symposium before returning to his native Canada after one year. By the time of Larry’s departure, the Forum was ready to develop a broader community base. Kim Conway, who had been working with ALAC, then at the cutting edge of health promotion and community action initiatives, and who had been in the alcohol field for a number of years, was recruited for this purpose on a part-time basis. Kim’s first task was a needs assessment with the health promotion community. This brought a call for information on issues and training, as well as advocacy on behalf of the health promotion field. In response, a directory of health promotion organisations was created and info sheets, which led to the development of the newsletter, were published. An initial series of training workshops was also set up. Kim established the Forum’s legal structure and its inaugural general meeting as an incorporated society was held in November 1988. A national body, the Forum is administered by an Auckland based secretariat. Its governing body is a council of representatives from elected member organisations. Founding members, wanting to ensure a bi-cultural perspective for the organisation, reflected this in the constitution. Kim recalled that in 1988 “a lot of organisations were just finding their feet with treaty issues” and commitment to Te Tiriti o Waitangi was still too controversial for one organisation which withdrew its support. All three past directors acknowledged the Forum’s first chairperson, the late Dr Erihapeti Rehu-Murchie (MWWL), for her commitment to partnership and her wise leadership and nurturing of the Forum during those formative years. By 1990, health promotion as a discipline had grown and so had the Forum. While Kim remained with the organisation part-time she handed over to full-time director, Candace Bagnall. Candace brought a strong social advocacy and policy background as well as education resource production skills to the Forum. She had recently returned to New Zealand from working as a programme and policy advisor in the Premier’s department in Victoria, Australia. She had also spent some years living in Northland at a critical time of what is now called the Maori cultural renaissance. Through her involvement in HART (Halt All Racist Tours) she was part of a small group which hosted the hikoi of 1994 through Tai Tokerau to Waitangi. Candace applied her passion and experience in these areas to the continued bicultural development of the Forum, the production of a national newsletter and launched the Forum’s bi-annual conferences. The Forum’s membership doubled as Candace further strengthened the health promotion networks. “The establishment of the database and health promotion directory named those who were interested in health promotion. It allowed them to feel part of a new and emerging health promotion profession.” Candace’s success in building relationships with key stakeholders also contributed greatly to consolidating the Forum’s position and increasing its profile and credibility. This included gaining the support of the Auckland Area Health Board and the late Dr John McLeod to set up the Forum at the health promotion community resource centre in Newmarket. In March 1992 the Forum shifted to the present site at 27 Gillies Avenue Newmarket. In 1991, Cheryl Hamilton, a women’s health activist enjoying a break from being a parliamentary electorate secretary, came on board to organise Health Workforce Development Fund training workshops. While this one-off series met some of the identified training need, the workforce was also asking for a qualification from a practical course for workers on the ground. Kim developed the course curriculum for a Certificate in Health Promotion for the Central Institute of Technology and, with Cheryl, tutored the first intake in 1992. The development of a rapidly expanding health promotion practice was affected considerably by the changing political environment of the early 1990s. The health reforms signalled a new era for the Forum and its members. The organisation’s focus became on the concept of health promotion rather than the specific issues of much of the workforce. In the new political climate the advocacy role became more of a challenge and the Forum, at times, walked a difficult political tightrope. Contracting and the purchaser provider split were also key components of this new era and the Forum developed contracts with the newly established Public Health Commission for workforce development at the national level and with North Health for regional services. Candace acknowledged the importance of the shift towards the workforce development work “that Kim and then Cheryl took such a strong lead in. In the end I think it became the main reason for the Forum’s continued existence.” In 1995 Cheryl exchanged her training role for that of director when Candace moved on to North Health to establish the structure for joint purchasing of national contracts for the four Regional Health Authorities. Cheryl remained in this role until early 2003 and during her years major initiatives at the Forum included the development TUHA-NZ: Towards an Understanding of Hauora in Aotearoa-New Zealand and Nga Kaitakatanga Hauora mo Aotearoa: Health Promotion Competencies for Aotearoa-new Zealand; three national health promotion Conferences were held biennially, and the course MIT/HPF Certificate of Achievement in Introducing Health Promotion was established.Coming of age, 2009
2003 signalled a period of intensive change for the Forum. For a period after Cheryl left and the Forum was managed by a series of acting directors including Keith Preston, Diana MacDonald and Dallas Honey. Teina Kake took over the reins in 2003. A number of key staff left to further their careers in specialist areas, reflecting a conundrum for the Forum – interest in workforce development and education is often stronger in specific work streams to the detriment of broad based health promotion and generic training. Dr Alison Blaiklock’s arrival as Executive Director late in 2004 signalled a new era for the Forum. She is a public health physician who has worked in health promotion since 1994. Her special interests are the health of children and young people, the determinants of health, and health and human rights. Alison along with others attended the 6th World Conference (conducted by the World health Organisation) where The Bangkok Charter for Health Promotion in a Globalized World (11 August 2005) was agreed on. This Charter articulated new global approaches to health promotion and pointed new directions for the Forum. Also in 2005 the Forum signalled a shift in strategic direction with the launch of a new tohu (logo) and slogan ‘Hauora – Everyone’s Right’. The new focus on human rights approaches to health promotion and the need to address inequities prioritises resources around groups with least advantage such as Māori, Pacific, refugees and migrants. The report, Closing the Gaps, from the World Health Organisation Commission on Social Determinants of Health released in 2008 sanctions these approaches and gives direction to health promotion for the foreseeable future. Many changes such as the amended Constitution in 2008 and strengthened infrastructure position the Forum to serve the future workforce. Alison now leads a small team of health promoters with expertise in strategy and workforce development, support staff, contractors and consultants. Initiatives include, the expansion of the MIT Certificate of Achievement in Introducing Health Promotion, the support for MIT establishing an undergraduate qualification The Diploma in Health Promotion (Level 6, 120 credits), participation in other tertiary education developments, and the establishment of five reference groups – Māori, Pacific, primary health, academic and South Island – from the senior workforce throughout Aotearoa. A change of newsletter name to Hauora, launch of a new website in 2008 and an e bulletin Rongo Korero o Hauora reflect works in progress as the Forum seeks to keep pace with rapidly changing and expanding electronic communications. Within the Forum strong Māori, strengthening Pacific participation and the growing voice of Asian communities in both governance and service delivery reflect commitment to Te Tiriti o Waitangi, determinants of health and human rights based approaches to health promotion.During the annual symposium in July 2009 the Forum celebrated 21 years.
Forum Council chairs from inception to 2010
Dr Erihapeti Rehu-Murchie (MWWL) June Mariu (MWWL) Druis Barret (MWWL) Sandra Kirby (ALAC) Andrea McLeod (Otago DHB, Public Health South) Te Herekiekie Herewini (AIDs Foundation) Janferie Bryce-Chapman (Age Concern) Gary Brown (Hapai Te Hauora Tapui) Donna Leatherby incumbent – See more at: http://www.hauora.co.nz/history.html#sthash.EaEskPyW.dpufCase Studies, Experts, Smoking
As the Smokefree Coalition prepared to wind down its operations – a victim of its own success – Hauora’s Jo Lawrence-King talked to its outgoing Executive Director, Dr Prudence Stone, about the Smokefree movement as a health promotion initiative.
Smoking cessation as a health promotion intervention
Dr Stone believes both tobacco control and smoking cessation exemplify health promotion. Together they empower communities with knowledge, evidence and resources to take control back from the ‘Big Tobacco’ industry; allowing those who smoke to free themselves from an industry that seeks to keep them addicted.
As a sociologist Dr Stone says she is fascinated with what motivates people. She believes this fascination has helped her in her approach to health promotion. “My sociological imagination really helps me to stay aware of the cultural dymanics and structures underlying people’s motivations. So it was really great when Professor Marmott came to town and spelled out to our public health community the ‘social determinants’ of health and health inequalities. I was already applying this framework when I was rallying submissions from the membership to the Maori Affairs Select committee Inquiry.
“I believe there are too many people in health promotion with qualifications in only health promotion. This area of expertise, from what I have seen, can be counter-intuitive to their role in engaging communities and influencing peoples’ choices and behavior.”
She cites many examples of health promotion messages that presume people simply need to know the right choice to stay healthy, and they will make that right choice. But, she says, health is not what motivates people. “People are unconscious of their health!” She claims. “Asking someone to engage consciously with the healthy choice for the healthy choice’s sake makes the one who asks it seem wacky at best, annoying at worst.” Instead Dr Stone asserts people become conscious of their health only when it is gone, and they become sick.
For this reason, she believes raising the price on tobacco is the single most effective measure that can be taken to reduce demand for tobacco. “The prospect of losing money is what motivates people – the prospect of saving money is what motivates people: effective health promotion ditches the language we learn in the classroom about why it’s necessary for society, and starts talking directly to the values embedded in that society.”
Looking back on the success of the Smokefree Coalition
The bad news for the Smokefree Coalition is that its funding has come to an end. The good news is that this is due to its enormous success: achieving record lows in smoking in Aotearoa New Zealand. “I feel very proud of the unity of voice we’ve demonstrated and the impact it has had on helping New Zealand reach this point,” says Dr Stone.
A longstanding child advocate, Prudence cites as a measure of the Coalition’s success the record low in year 10 children who have never smoked. “I believe we’ve reached a tipping point of public support for further measures [to support the Smokefree movement],” she says. “There is an acceleration of expansive Smokefree environmental policy at local government level, a burgeoning groundswell of retailers removing tobacco from their stores, and a commitment to an endgame from our government leaders.”
But there is a cautionary note from her as well: “so long as there are New Zealanders addicted to tobacco and a marketplace saturated with tobacco products, there is a need for health professionals to lead and coalesce, and develop a cohesive strategy for effective support and advocacy,” she warns.
The Smokefree movement is personal and poignant
Always acutely aware of injustice and the imbalance of power, at university Dr Stone focused on an area of sociology called the political economy of information. This is the field of study that exposes the way multinational corporations manipulate the information the public receives, to keep it unaware of injustices in their business practices and the truth behind their products. “You could say I was in training at university for a job fighting Big Tobacco.”
When Prudence was 11 years old, she was the first to wake up one morning and find her grandmother – ‘my best friend’ – dead. “Her pack of smokes was right there beside her and I still remember seeing the longest line of ash on the butt of a cigarette in the ashtray. She had lit it up and then died before it had gone out.” Prudence later named her daughter after her beloved grandmother.
Smoking cessation measures favour non-Maori populations
Dr Stone is anxious to answer claims that the tax measures and price rises are racist. The claim is based on the fact that Maori are more highly represented than non-Maori in smoking statistics; giving rise to the (misguided) belief that tangata whenua are being targeted with punitive measures.
Looking at the data alone it’s easy to see that proportionally more Māori than non-Maori tend to smoke. “Claims that tax measures are racist go against robust evidence to the contrary.” Says Dr Stone. “People making these claims fail to notice to the government’s ‘population-based approach’ to cessation advice and triage, which by its nature fails to reach a significant proportion of Maori.
The government programme is provided only to those who visit primary and secondary care facilities. According to Prudence up to a quarter of the New Zealand population does not visit a primary or secondary care facility in a given year. She believes much of this sub-section of the population consists of Maori; many of whom have no money to afford healthcare, or whose past experiences with the health system have caused them to lose any faith in it to serve them with cultural competence. Dr Stone postulates that these are the very people the government’ describes as ‘hard to reach smokers’.
What’s impossible to observe from the data, she says, is the story of colonisation, and the introduction of tobacco via trade. “Wahine Maori became addicted to tobacco long before it was considered acceptable for European women to smoke. That background is very important to understand. These are the two hundred year-old social determinants that underlie today’s data.”
The price of tobacco is set in place to motivate those people who are not reached by other cessation programmes, she says.
During her time at the Smokefree coalition Dr Stone has worked hard to frame the inequities of government policy and statistical inequalities in a more constructive way for tangata whenua, but she fears the risk of misinterpretation remains.
Seven years to make significant improvements
Prudence Stone began her solo role at the Smokefree Coalition nearly seven years ago in 2009; the same week Maori Affairs called for submissions to its public inquiry on the tobacco industry and the consequences of tobacco use for Maori.
Over the next few years she built the Coalition to over 50 members; in the process justifying a second staff member to assist her. Her work unified the efforts of the Coalition’s members to support a range of measures that have led to a massive reduction in smoking rates in this country. “The Smokefree Coalition is small and cost-efficient when it comes to its operations, but vast and nationwide when it comes to its broad membership and scope of influence.”
Dr Stone is quick to acknowledge that she and her colleague were strongly supported by a board, active key members and “incredible” DHB and PHU stakeholders. “The readiness and responsiveness of our sector makes it feel as if we’re one awesome whanau.”
Where to next for Dr Stone?
As Prudence prepares to finish her work at the Smokefree Coalition she is eyeing her future with energy and determination. Advocacy will remain central to her, but she is also not ruling out the idea of entering politics one day. “There is just so much I want to get done before I die,” she enthuses. “Luckily I’m a great planner and strategist, so I have the fortune of seeing at least a tenth of it achieved by now. I love to help, I love great ideas, and I’m not jealous at all about whose great idea it is. If it’s someone else’s great idea, I just want to play a part in helping seed it on some fertile ground.”
She cites her children as her motivation. “There’s a world to leave behind, and for now it’s a mess and needs cleaning up!”
About the Smokefree Coalition
The Smokefree Coalition was established back in the ‘90s to be a united voice for action and advocacy for evidence-based tobacco control measures. The premise is that while so many organisations have a vested interest in tobacco control, their core business is focused on representing a particular health-related workforce or a specific non-communicable disease: for efficiency’s sake you need one organisation focused on uniting them all and coordinating their activities for maximum influence and clarity of message.
The Smokefree Coalition is itself a member of the Framework Convention Alliance, a global coalition of organisations supporting and informing the implementation of the World Health Organisation’s Framework Convention on Tobacco Control (FCTC). This Framework provides the raft of evidence-based measures to take, and guidelines for signatory nations in order to implement them. Prudence believes New Zealand is only ‘pretty good’, in staying faithful to the FCTC. “Perhaps only because members of the Smokefree Coalition are vigilantly holding our government representatives accountable to it.”
Members of the Smokefree Coalition have supported and informed all the legislative measures that have been put in place in New Zealand: the Smokefree Environments Bill Amendments which have
- made bars and restaurants Smokefree,
- banned tobacco’s promotional retail display,
- reduce allowances of duty-free tobacco
- raised tobacco’s excise tax,
- currently; introducing standardised packaging of tobacco and banning smoking in cars carrying children.
Case Studies, Pacific
Health Promotion Forum works with organisations at all levels of health promotion and social development. It is forging close working relationships with leaders in the field, to strengthen the health promotion movement. The Fono is working to address health and inequality in communities across Auckland and Northland. Jo Lawrence-King talked to its Chief Executive Tevita Funaki; who recently joined HPF’s board. The connection between HPF and The Fono is clear. HPF’s own definition of the profession emphasises its focus on “empowering people and communities to take control of their health and wellbeing.” “At the Fono we value the significant importance of Health Promotion,” agrees Tevita. “We work closely with families to address their health needs. We provide health education and social support; ensuring both economic and social needs are addressed. We work with churches to develop their health activities to support a healthy environment both for their homes and churches.”
The Fono: a model of Pacific health promotion
The Fono is a health service committed to reducing health inequalities in the communities in which it operates. It finds innovative ways to deliver culturally appropriate services across all its locations.
The Fono works to foster well, safe, vibrant communities and has a commitment to meeting the cultural needs of the people in these communities. These include its original area of West Auckland (based in Henderson) as well as:
- Central Auckland (the CBD)
- South Auckland (Manurewa)
- West Central Auckland (Blockhouse Bay)
- Northland (Kaikohe)
In July this year Tevita Funaki celebrated his sixth anniversary as Chief Executive Officer of The Fono. Backed by an extensive career working with Pacific communities in health and education, and himself of Tongan heritage, Tevita leads the operational arm of the organisation.
Tevita explained his motivation for accepting the role: “I am passionate about Pacific wellbeing and development. Developing our model of care ensures that our services address the holistic needs of Pacific people and support our family to realise their full potential.”
Tevita was previously the Pacific Health Manager for ProCare Health Ltd and the National Pasifika Liaison Advisor for Massey University. He has also managed an Employment Consultancy and Project Management Services firm and worked in health services for many years.
Despite already being on many influential boards, Tevita accepted his nomination to HPF’s board and took up his role in ……. [month?]. He sees the relationship between The Fono and HPF as mutually beneficial. “HPF’s success can only be beneficial to organisations like ours; supporting our work and upholding its principles of community-lead health,” he says.
Bringing with him strong governance and business experience, Tevita has an excellent understanding of the health sector, funding environment and the political landscape.
We look forward to working more closely with Tevita and the people of The Fono.
Uncategorized
Previously medically-focused, the University of Otago’s Department of Public Health has broadened its programme to embrace a range of disciplines including nursing, health promotion, nutrition, social work, physiotherapy and others interested in public health. The new Public Health programmes now offer greater flexibility for students, and the opportunity for general as well as new discipline-specific qualifications, says convener of the University of Otago, Wellington (UOW) Department of Public Health programme, Associate Professor Diana Sarfati. “Public health is a diverse and vital area, encompassing all aspects of our lives. Students can develop skills in health promotion, epidemiology, health economics, environment and health, public health research, hauora Māori, how society affects health, and much more.” Public health training opens up a number of career opportunities, she says. “Regardless of which aspect of public health interests you, it is a field in which you will really make a difference.” The programmes continue to be offered from all three campuses in Dunedin, Christchurch and Wellington and enquiries are welcome from those with an undergraduate degree in any discipline. The latest new 15 point papers are taught in half semester terms enabling students to structure their study around family and work commitments. There are 21 papers on offer, including several distance options, providing students the opportunity to put together a broad programme of study, or tailor their qualification to their interests. Enrolments for 2015 are now open, visit www.otago.ac.nz/publichealth for further information. Courses begin at the end of February 2015.
Jo Lawrence-King
1 December 2014
Video, What is HP
Health Promotion Forum is proud to announce the launch of two short information videos to inform health promotion practice. The first – What is health promotion? – provides an Aotearoa New Zealand perspective on health promotion; its scope, potential and the focus of its work. The second – Health promotion competencies – explain the scope and potential uses for the competencies. HPF’s Senior Health Promotion Strategist Karen Hicks was the mastermind behind the creation of these videos. “This could be the start of greater understanding of the crucial work done by health promoters in Aotearoa New Zealand,” she said. The purpose behind the videos was to make it easier for health promoters around the country to understand the scope and potential of their role – as well as to have a way of explaining it to other. “I encourage all my wonderful colleagues out there to share these videos with their friends, family, colleagues and managers,” said Karen. – See more at: http://www.hauora.co.nz/new-videos-shed-light-on-health-promotion-in-new-zealand.html#sthash.O2plPbZ6.dpufMaori, What is HP
A new paper, published in UK publication Ethnicity and Health in June, indicates we have a way to go to address ongoing inequities for Māori and other indigenous groups. It points out that, in the Aotearoa context, Te Tiriti o Waitangi “is a legislative, policy and professional imperative for the public health community.” HPF Deputy Executive Director, Trevor Simpson has co-authored the paper, which finds that there is variable application of Te Tiriti o Waitangi and there is room for further development in many areas of the New Zealand public health service. It points to Treaty Understanding of Hauora in Aotearoa-New Zealand (TUHA-NZ) as “landmark document” and an essential tool to operationalise the policies outlined in Te Tiriti. The paper Realising the rhetoric: Refreshing public health providers’ efforts to honour Te Tiriti o Waitangi in Aotearoa, New Zealand investigates the ways public health units and non-governmental organisations meet their Te Tiriti o Waitangi obligations in terms of service delivery to Māori. Drawing on data from a nationwide survey of public health providers the article argues New Zealand public health providers can strengthen efforts to advance tino rangatiratanga (Māori control over things Māori) in every day practice. Trevor worked alongside Heather Came (Senior Lecture, Auckland University of Technology), Tim McCreanor (Associate Professor Massey University) and Claire Doole, (Senior Lecturer, Auckland University of Technology), to bring this important paper to fruition. The work was supported with a grant from the Faculty of Health and Environmental Sciences, Auckland University of Technology.What is HP
Mt Wellington (Auckland) based PHO Alliance Health Plus Trust (AH+) announced in July the establishment of the Alliance Community Initiatives Trust (ACIT). This is a standalone charitable trust aiming to address the social determinants of health ‘one social determinant of wellbeing at a time for one person at a time in one NZ community at a time.’ It will focus initially on Mangere in South Auckland. “Complex health and well-being problems require common denominator solutions that cut across multiple domains including social, economic, cultural and environmental,” says AH+ Chairman, Mr Uluomatootua (Ulu) Aiono. “At both AH+ and ACIT we know gains are temporary unless we identify the common denominator and eliminate the root cause through critical thinking based grass roots interventions in the demand side. A critical prerequisite for this is collaboration amongst frontline service providers.” ACIT aims to collect data to “identify common denominators and pin down the root cause.” Commenting on the new initiative, HPF Deputy Executive Director Trevor Simpson said “It’s great to see primary health care organisations are looking into the determinants space, health equity and looking at bottom up, top down interventions. This is a health promotion approach.” Trevor pointed out the existing data available to ACIT – and any other organisation working on addressing the social determinants of health. This includes, for example, the deprivation index, disease distribution studies, reports from groups such as Child Poverty Action Group (CPAG) and the Health Education Health Promotion Policy Research Unit (HePPRU – Otago University) “I’m sure ACIT is aware that the frameworks for implementing this project are already in place in the form of the Ottawa Charter and Te Tiriti o Waitangi.” The strands of the Ottawa Charter provide for the ACIT’s work:- Building healthy public policy,
- Strengthening community action,
- Creating supportive environments,
- Developing personal skills and
- Reorienting health services.
Diet, Family and child
Action to reduce New Zealand’s alarming childhood obesity rate needs to focus on the physical and social environments we live in, says the New Zealand College of Public Health Medicine.
A third of all Kiwi children are now overweight or obese, which the College says “must be urgently addressed to improve their current and future health”.
“Interventions at an individual level alone are unlikely to be successful in the long term,” says the president-elect of the College, Dr Felicity Dumble.
“We need to adapt our environment and change our social norms so that it’s easier for our children to establish and maintain a healthy weight.”
The College recently released a policy statement addressing childhood obesity; the policy recognised the issue as a significant public health challenge.
Dr Dumble says the College recognises the government’s commitment to addressing childhood obesity, but says New Zealand’s childhood obesity plan should be reviewed and amended as a matter of urgency, to fully reflect the World Health Organization’s (WHO) report titled Ending Childhood Obesity.
“If all of our nation’s children are to be healthy there must be a higher priority placed on addressing the issues causing childhood obesity,” she says.
The WHO Report was released earlier this year, stating no single intervention can halt the “rise of the growing obesity epidemic”.
It says that preventing and treating obesity requires a government-wide approach, in which policies across all sectors take health into account, avoid harmful impacts and thus improve population health and health equity.
In line with the WHO report, Dr Dumble says the College strongly supports three strategic objectives to help reduce childhood obesity in New Zealand;
• Tackle the obesogenic environment and norms
• Reduce the risk of obesity by addressing critical elements in the life course
• Treat children who are obese to improve their current and future health.
Experts, Global, News, What is HP
Leaders pledge support for World Conference The leaders of two highly regarded international bodies have signalled their support of the next World Health Promotion Conference. United Nations Development Programme (UNDP) Administrator the Rt Hon Helen Clark and Dr Colin Tukuitonga, Director-General of the Secretariat of the Pacific Community (SPC) have both indicated their organisations’ support of the Conference, to be held in Rotorua in April 2019. Representatives of host organisation Health Promotion Forum met with both Ms Clark and Dr Tukuitonga during a conference in Tonga this month. Ms Clark who, as New Zealand’s Prime Minister has spoken at Health Promotion Forum’s annual symposium, acknowledged the importance of planetary health and sustainable development and expressed her organisation’s interest in being involved. Ms Clark was the keynote speaker on Monday at the Pacific NCD Summit in Nuku’alofa, June 20-22, for health ministers of the Pacific, which was organised by the Secretariat to the Pacific Community (SPC). Dr Tukuitonga has expressed his wish for a strong Pacific presence at the conference and has pledged the involvement of his Pacific-wide organisation to support this aim. The theme of the triennial conference of the International Union for Health Promotion and Education (IUHPE) is “Promoting Planetary Health and Sustainable Development for All.” Pictured from left- Ms Osnat Lubrani, UN Resident Coordinator and UNDP Resident Representative, UNDP Pacific Office,
- Dr Viliami Puloka, HPF Pacific Leader and Otago University Research Fellow,
- Rt Hon Helen Clark, UNDP Administrator and former Prime Minister of New Zealand,
- Ms Leanne Eruera, HPF Business Manager and 2019 Conference Project Manager,
- Mr Sione Tu’itahi, HPF Executive Director and IUHPE Vice-President.
Global, News
Health Promotion Forum of New Zealand – Runanga Whakapiki Ake i te Hauora o Aotearoa (HPF) has been successful in its bid to host the next World Conference on Health Promotion. This will be the first time New Zealand has hosted the conference and represents the country’s recognised leadership in health promotion: particularly indigenous wellbeing. Set to take place in Rotorua, April 2019, the triennial conference of the International Union of Health Promotion and Education (IUHPE) will receive 2,000-3,000 health promotion and education professionals from around the world. The win was announced on May 27 (NZ time) at the closing ceremony of the 22nd world health promotion conference of the International Union for Health Promotion and Education (IUHPE) that was held on May 22-27 in Curitiba, Brazil. “We are delighted by the IUHPE’s confidence in our ability to host one of the most important events in the health promotion calendar,” said HPF’s Executive Director, Sione Tu’itahi. “We are also grateful for the hard work and expertise from our partners in preparing our bid. Now the real work begins to plan and stage a top class conference that upholds our reputation around the world.” HPF was supported by NZ Tourism and engaged the help of The Conference Company to conduct a thorough feasibility study before making its bid. Rotorua was selected for its world-class meeting facilities and accommodation as well as for its reputation as the cultural heartland of New Zealand. The area showcases initiatives in socio-economic development, sustainability, holistic wellbeing and environmental protection: all of which are aspect of health promotion. The organisation received overwhelming support for its bid from influential New Zealanders including Sir Mason Durie, Rt Hon John Key, Hon Dr Jonathon Coleman, as well as tertiary institutes and key local Rotorua bodies. Health Promotion Forum is the national umbrella organisation for health promotion in Aotearoa New Zealand. It also plays a leading role in the development of health promotion in the Pacific region and internationally. IUHPE is an international organisation that leads the on-going advancement of health promotion in the world.
Diet, News
Consumer research by the Health Promotion Agency (HPA) has found food choices for people of all ethnicities are heavily influenced by price and specials. For larger households quantity influences choice as well. After quantity, the next priority is whether the children will eat it, which is closely linked with brand/taste preferences. While many families will try budget brands, taste preferences win over. Consumers mention health, but for most it is a low priority; with healthy choices seen as a luxury for those with more money to spend. Fear of not liking unknown brands leads to entrenched and habitual shopping choices; something the Health Star Rating consumer campaign seeks to influence. The research – aimed at measuring of consumers’ understanding and use of Health Star Ratings – has found around four in every ten shoppers recognise Health Stars when prompted. Pacific shoppers showed higher recognition of the star rating (65%). Around half of all shoppers accurately understand how to use Health Stars with many saying the higher the stars the healthier the product. However, most people did not yet understand Health Stars should be used to compare foods in similar categories. Although when consumers were shown two different products with Health Stars, consumers can easily identify which food is the healthier choice. “The Health Star Rating labelling is a really important step to help people make healthier food choices,” said Dr Fran McGrath, who is a member of the Health Star Rating Advisory Group. “The food industry is adopting the labelling and also making changes so foods are healthier. This is important progress, but only one part of the jig-saw.” The Health Star ratings is a voluntary front-of-pack labelling system developed for use in New Zealand and Australia. Health Star ratings are for packaged foods as these are the foods with which consumers have the most difficulty, when making healthier choices. Health stars takes the guess work out of reading labels and aims to help consumers make healthier choices quickly and easily when choosing packaged foods. For more consumer insights and information generally about the Health Star Rating campaign visit the HPA’s page.
Community, Diet, Pacific
Health Promotion Forum’s Senior Health Promotion Strategist Dr Viliami Puloka presented his thoughts home grown solutions to the Pacific’s obesity problem at a recent conference in Wallis and Futuna.Gardening and Health: Let your garden be your health and your health be your garden
Dr. Viliami PULOKA, Senior Health Promotion Strategist, New Zealand Health Promotion Forum Abstract When Hippocrates, the father of medicine some 2,500 years ago said “Let food be thy medicine and medicine be thy food”, I can assure you he was not talking about fast food like Cheese burgers, Fizzy drinks and French fries. He was talking about fresh produce from people’s home gardens. Being the top physician of his time and a leading scientist in the field of medicine, he knew the importance of good healthy food in providing proper fuel for healthy living. Consumption of foods that are highly processed but empty of proper nutrients is one of the key drivers of the obesity and diabetes pandemic the world is facing today, including Wallis and Futuna. The Wallis & Futuna Chronic Diseases Risk Factor Study in 2009 showed a 17% prevalence of diabetes, and an 87% prevalence of overweight and obesity among the study population. Eating fresh food, locally grown in home gardens is a very good way to prevent and control chronic diseases including diabetes and obesity. The health benefits of growing your own food are well documented. You are in control and decide what to grow. You are not dependent on food produced by someone you do not know, whose interest is your money not your health. Growing your own garden provides opportunities for physical activity which goes hand in hand with good nutrition giving you good health. One can also enjoy fresh air and sunshine, which is good medicine for the whole person. Wallis and Futuna are very fortunate to have such fertile soil, and many people still grow food in their own gardens. The challenge is the ever-increasing amount of readily available imported processed food that competes with traditional local cuisines. I like to suggest that the way forward to good health through home gardening is to ‘return to nature’ and re-claim the socio-cultural and economic value of home gardening and… “Let your garden be your Health and your Health be your garden”. “If I had the same life expectancy as a Tongan man, I’d only have one year and three months left to live.” Statistics show that life expectancy for men in Tonga is 65 years, mainly due to the rise in NCDs[1]. A child born in the Pacific today is more likely to die before their grandparents and parents, largely due to the Obesogenic environments. It does not matter whether we are in Samoa, Tonga Vanuatu or Wallis and Futuna our story is one and the same. A healthy baby is born, fully immunized, is well cared for and loved. We invest in their education and they get good qualification, good job and they may earn good money. The food environment however makes it very easy for us to eat ourselves to death. Young Pacific persons develop diabetes as early as age 30 and many develops complications by age 40 requiring amputation at 50 followed by kidney failure at 55 paving the way for “early preventable death” the plight of Pacifica today. What a loss! Financial/economic investments as well as social and cultural loss that have direct impacts on families and the country as a whole. The presentation discusses NCD issues as related to how we look after our health as “a garden for our food security, health is for our everyday living.” Health isn’t everything, but without health, nothing else matters. Your health is the only resource we have to do life and to contribute to life. Doctors and nurses have known for many years now that health deteriorates when people don’t eat healthy food. Everyone knows that as a fact but knowledge is not enough to make us do what we know we should be doing. In the Pacific, NCDs cause up to 40% of sickness and up to 70% of deaths. Over 20% of countries’ budgets are allocated to NCD control in hospitals. Much more resources is needed for prevention and to address the many social cultural determinants outside the hospitals. Some 2500 years ago, Hippocrates said, “Let food be thy medicine and medicine be thy food”. The NCD issue is directly related to what we eat or do not eat. It is therefore important to look at the food we eat with the same respect we give to any medicine we take for any illness. From the food we eat our body have fuel or energy to carry out daily activities. To be healthy, the energy gain from food we eat should be proportional to the energy required for daily activity. This is the problem in the Pacific, we eat and gain way too much energy but spent too little doing minimal physical activity. We drives to the supermarket, buy processed energy rich food instead of working in our gardens. People in the Pacific don’t walk to the hospital, because when they do decide to go, they are too sick to walk. A 2009 study in Wallis and Futuna revealed high rates of factors causing NCDs. Not enough fruit and vegetables consumed, inadequate physical activity, high rate of high blood pressure and high rates of obesity. Specifically regarding obesity in Wallis and Futuna, the risk factors are visible as early as age 18. In the 18-24 age group, 51% of men and37 % of women are already obese. Many people are obese very early in life.
In Wallis and Futuna, diabetes prevalence was three times higher in 2009 than 1986. High blood pressure was twice as prevalent and obesity remained high.
If the various NCD risk factors in Wallis and Futuna and are compared with American Samoa (the Pacific NCD champions), the figures for both territories are quite similar.
With regard to food security, the issue is access to and the availability and use of food. In Wallis and Futuna, these issues do not really apply, as food is available. The problem is related to the choices local people make in terms of food. We eat what we do not grow, we grow what we do not eat.
Geoff Lawton said that all these issues can be solved by gardening. Gardening can really feed both body and mind.
When people garden, they know exactly what they are growing, unlike shop items produced in unknown places by unknown people whose interest is more in our wallets than our good health. So it is best to grow our own food. Gardening should be medically prescribed.
Uvea is a garden with a few houses dotted around it. Most homes have gardens and gardening has many benefits:
- Stress relief – A study in the Netherlands indicated that gardening is better at relieving stress than other relaxing leisure activities.
- Brain health – A study that followed people in their 60s and 70s for up to 16 years found that those who gardened regularly had a 36% lower risk of dementia than non-gardeners
- Nutrition – Studies have shown that gardeners eat more fruits and vegetables than other people. The freshest food you can eat is the food you grow,
- Healing – Interacting with nature also helps our bodies heal. A landmark study by Roger S. ULRICH, published in the April 27, 1984, issue of Science magazine, found strong evidence that nature helps heal.
- Immunity – In 2007, University of Colorado neuroscientist Christopher LOWRY, then working at Bristol University in England, made a startling discovery. He found that certain strains of harmless soil-borne Mycobacterium vaccae sharply stimulated the human immune system. It’s quite likely that exposure to soil bacteria plays an important role in developing a strong immune system [7].[m1] [VP2]
January 2016: Senior Health Promotion Strategist Karen Hicks contributed this post to the WHO’s This Week in Global Health
Figure 1. Sustainable Development Goals.
Source: http://wfto.com/sites/default/files/field/image/2015-07-21-SDGs.png
Each of the SDGs relate to health and wellbeing with aims, approaches and principles that are concomitant to the discipline of health promotion; a discipline that acknowledges the complexity of health and is based on the principles of human rights, equity and empowerment (Williams, 2011). Consequently, such principles imply that health promotion is an effective approach toward achieving the SDGs. This approach is supported by the global framework and described in “The Ottawa Charter for Health Promotion” (WHO, 1986) (Figure 2) which identifies five key action areas: building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills and reorientating health services through advocacy, enabling mediation for effective practice.
Health Promotion: An Effective Approach to Achieve the Sustainable Development Goals
~Written by: Karen Hicks, Senior Health Promotion Strategist & Lecturer, New Zealand (Contact: karen_ahicks@hotmail.com)
In September 2015 the United Nations adopted seventeen sustainable development goals (SDGs) (Figure 1) as part of the 2030 Agenda for Sustainable Development; which aims to end poverty, fight inequality, injustice, and tackle climate change. These SDGs are acknowledged as going beyond the previous Millennium Development Goals (MDGs) as they aim to address, ‘The root cause of poverty and a universal need for development that will work for all people’ (United Nations, 2015).
Figure 1. Sustainable Development Goals.
Source: http://wfto.com/sites/default/files/field/image/2015-07-21-SDGs.png
Each of the SDGs relate to health and wellbeing with aims, approaches and principles that are concomitant to the discipline of health promotion; a discipline that acknowledges the complexity of health and is based on the principles of human rights, equity and empowerment (Williams, 2011). Consequently, such principles imply that health promotion is an effective approach toward achieving the SDGs. This approach is supported by the global framework and described in “The Ottawa Charter for Health Promotion” (WHO, 1986) (Figure 2) which identifies five key action areas: building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills and reorientating health services through advocacy, enabling mediation for effective practice.
Competencies, News, What is HP
A Master’s Degree dissertation by HPF’s Senior Health Promotion Strategist Karen Hicks has upheld the widely held view that the 2012 New Zealand Health Promotion Competencies (HPC2012) are unique in the world, due to their central inclusion of indigenous Māori perspectives. This central positioning of Māori results in a framework that is an effective capacity-development tool to improve Māori health and reduce inequities. Findings from Karen’s qualitative research confirmed that the HPC2012 provides an example of best practice that is values-driven and inclusive. Karen’s analysis showed that the process’ cultural-sensitivity was made possible by the: a) weaving of Māori tikanga values throughout the development phase. b) inclusion of grassroots workers – the backbone of the health promotion workforce – in the development process for the competencies. c) provision of adequate time to meaningfully consult with Māori. Karen used a two-fold methodology for her research, including the comparative analysis of secondary data from four international health promotion competency frameworks and analysis of primary data obtained from interviews with New Zealand health promotion public health leaders.
The HPC2012 is the second version of the competencies; the first having been published in 2000. The rigorous review and wide consultation with Māori was a response to feedback that identified inadequate consultation with the indigenous people of Aotearoa New Zealand as a shortcoming of the first version.
The current competencies were recently recognised by the International Union of Health Promotion and Education (IUHPE) as equivalent to their own European Health Promotion Competencies. See article.
16 March 2016
Jo Lawrence-King
Competencies, What is HP
From 16 April, the Health Promotion Forum is excited to offer an online course, introducing the social determinants of health: a foundation stone for the understanding of health promotion. This new mode of delivery will allow practitioners across Aotearoa New Zealand to continue their professional development in a convenient and inexpensive way.
Icons for education for all, distance education, training and tutorials
“We are conscious that those working in remote locations do not always have the resource to travel to the main centres for training,” says HPF Executive Director Sione Tu’itahi. “This approach supports flexible learning in your own home or workplace; 24 hours a day, 7 days a week.”
The course is a pilot of what is hoped to be a series of similar courses exploring and demystifying health promotion. Social determinants of health are the underlying ‘causes of the causes’ of health and wellbeing. They form a key foundation for the discipline and practice of health promotion.
With a level four education classification, the course is suitable for learners of all levels. It is also relevant to a wide range of professionals, including those working in public and community health, social services, education and city and county councils.
The course will involve approximately six hours of study: this includes time to read background material and watch video clips, as well as fulfilling course work. Registrations will remain open for just one month and participants will have 7 days from the date of their registration in which to complete it.
It is being offered in collaboration with CLAD Services, a New Zealand company that specialises in online solutions for training. The course fees is $99.00, including GST.
Competencies, Global, What is HP
The International Union of Health Promotion and Education (IUHPE) has recently acknowledged the New Zealand Health Promotion Competencies as equivalent to its own European Competencies. This is a promising step towards the ultimate aim of global competencies and accreditation; which would offer health promoters the potential to broaden employment opportunities and the exchange of knowledge and experience around the world.
HPF’s Executive Director Sione Tu’itahi was excited about this significant step and its potential implications for health promoters of Aotearoa. “Imagine when New Zealand health promoters can travel anywhere in the world and transfer their competencies to work in any member country,” he said.
The IUHPE has its own European-wide competencies; developed out of its CompHP project. New Zealand was represented by past HPF Health Promotion Strategist Helen Rance on the Global Advisory Committee that developed these European competencies. The IUHPE has also developed a European accreditation process to sit alongside the competencies. It identifies performance criteria to meet the competencies. Within this process individual practitioners submit a portfolio of evidence rather like nursing; identifying their evidence in meeting each competency. This submitted to their National Accreditation Organisation, which assesses the evidence successful accreditation means they can be called a European Health Promoter with the registration lasting three years. Academic institutions that deliver health promotion courses can also become accredited following a similar process.
Because the European and Aotearoa competencies were developed concurrently, the frameworks consist of the same nine competency domains. The detail below each competency domain heading is different in the Aotearoa context, from that in the European domains as ours prioritise health promotion knowledge and practice that is specific to this country’s context. In order to formalise the IUHPE recognition of the New Zealand Competencies, the HPF’s Health Promotion Strategists are providing the global body with detail around the correlation between the two competency documents.
Health Promotion Forum first produced the New Zealand Health Promotion Competencies in 2000 following two years of extensive consultation. The current – 2012 – version of the Competencies was the result of continued discussions and feedback, which identified a need to strengthen the content and context related to Māori values and Te Tiriti o Waitangi. These latest competencies identify the specific knowledge, skills, behaviours and attitudes for effective health promotion practices in the Aotearoa New Zealand context.
The decision to recognise the New Zealand competencies was made at a December 2015 meeting of the IUHPE Accreditation System meeting.
– See more at: http://www.hauora.co.nz/nz-health-promotion-competencies-recognised-by-global-body1.html#sthash.YquMnPTF.dpuf
The International Union of Health Promotion and Education (IUHPE) has recently acknowledged the New Zealand Health Promotion Competencies as equivalent to its own European Competencies. This is a promising step towards the ultimate aim of global competencies and accreditation; which would offer health promoters the potential to broaden employment opportunities and the exchange of knowledge and experience around the world.
HPF’s Executive Director Sione Tu’itahi was excited about this significant step and its potential implications for health promoters of Aotearoa. “Imagine when New Zealand health promoters can travel anywhere in the world and transfer their competencies to work in any member country,” he said.
The IUHPE has its own European-wide competencies; developed out of itsCompHP project. New Zealand was represented by past HPF Health Promotion Strategist Helen Rance on the Global Advisory Committee that developed these European competencies. The IUHPE has also developed a European accreditation process to sit alongside the competencies. It identifies performance criteria to meet the competencies. Within this process individual practitioners submit a portfolio of evidence rather like nursing; identifying their evidence in meeting each competency. This submitted to their National Accreditation Organisation, which assesses the evidence successful accreditation means they can be called a European Health Promoter with the registration lasting three years. Academic institutions that deliver health promotion courses can also become accredited following a similar process.
Because the European and Aotearoa competencies were developed concurrently, the frameworks consist of the same nine competency domains. The detail below each competency domain heading is different in the Aotearoa context, from that in the European domains as ours prioritise health promotion knowledge and practice that is specific to this country’s context. In order to formalise the IUHPE recognition of the New Zealand Competencies, the HPF’s Health Promotion Strategists are providing the global body with detail around the correlation between the two competency documents.
Health Promotion Forum first produced the New Zealand Health Promotion Competencies in 2000 following two years of extensive consultation. The current – 2012 – version of the Competencies was the result of continued discussions and feedback, which identified a need to strengthen the content and context related to Māori values and Te Tiriti o Waitangi. These latest competencies identify the specific knowledge, skills, behaviours and attitudes for effective health promotion practices in the Aotearoa New Zealand context.
The decision to recognise the New Zealand competencies was made at a December 2015 meeting of the IUHPE Accreditation System meeting.
9 March 2016
Jo Lawrence-King
Maori
According to the New Zealand Medical Workforce survey released in late January 2016, Māori are under-represented in the medical workforce, when compared to the proportion of Māori in the general population. An article in www.stuff.co.nz examines Nelson Marlborough District Health Board’s Māori workforce, where Māori make up 3% of the staff, compared to Māori residents representing 12% of the local population. The article explores the measures being taken by the DHB to redress the issue. According to the DHB’s Māori Health and Whanau Ora general manager Harold Wereta a long-term aim of the board is to strengthen the diversity of its workforce. The board is exploring ways to improve the recruitment and retention of its Māori employers, he says in the article. In the meantime the health board is working to improve the cultural awareness of all health board staff. “Māori health and health inequalities are the responsibility of all health professionals,” says Wereta
Diet, Pacific
Non-communicable diseases (NCDs) are among the most serious threats to global prosperity and 80% of NCD deaths occur in lower income countries. Dr Viliami Puloka outlined the scale of the challenge at the Population Health Congress in Hobart, Tasmania, in September 2015. View his slides here.
In 2012 -2013 Tairawhiti CAAF (Community Action on Alcohol Fund) steering group worked with Poverty Bay Rugby and a range of several local agencies and organisations to implement a successful Ease Up campaign; making sidelines alcohol- and smoke-free.
The group achieved very good outcomes, including:
The group achieved very good outcomes, including:
- Greater awareness of alchohol and tobbacco-related harms.
- A high level of community ownership
- Policies developed by local sports clubs
- Effective working relationships among the stakeholders
News, Policy
A new charter is a call to action on health and wellbeing at tertiary education centres around the world. The Okanagan Charter was produced in October 2015 at the 2015 International Conference on Health Promoting Universities. “Universities and colleges must be exemplars of health-promoting communities,” says Deborah Buszard, Deputy Vice-Chancellor of the host university. “The Okanagan Charter is a powerful call to action for post-secondary institutions to embed health in our campus policies and services, to create environments which support health and personal development, and to become communities with a culture of well-being.” The Tertiary Wellbeing (Aotearoa New Zealand) – TWANZ – development group is considering a national consultation process to map out ways the Charter can be applied here. Members of the TWANZ development group were among the 45 countries that contributed to the Charter, which is designed to confront increasingly complex issues about health, wellbeing, and sustainability of people and the planet .“Cumulatively the Okanagan Charter and the NZ tertiary sector’s focus on wellbeing is very encouraging,” says Anna Tonks, project coordinator for the TWANZ development group. The group is now calling for stories of best practice and for new members to join them. The Okanagan Charter puts higher education at the forefront of the movement. Conference delegates pledged to take the Charter back to their countries and organisations to mobilise health promotion action; both on and off campuses. The Conference was held at the Okanagan campus of the University of British Columbia in Canada. If you have a story to share or are interested in joining the group please contact Anna Tonks.
http://www.hauora.co.nz/assets/files/News/Okanagan_Charter_Oct_6_2015.pdf
Pacific
The Pacific community in the islands and in New Zealand are nutritionally challenged. They have the lion’s hsare of nutritionally related health issues, including one of the highest rates of obesity and diabetes in the world. This is the conclusion of Dr Viliami Puloka’s 2015 presentation on Pasifika Health and Nutrition Challenges.
This paper – by HPF’s Executive Director, Sione Tu’itahi – aims to contribute to the development of Pacific leadership in health, education and other sectors.
Providing insight into the Tongan concepts of matapoto (intelligence and shrewdness) and lotopoto (wisdom and ethics), the paper explores the underlying values of these terms and how they are reflected in the values of many Pacific nations.
When used conjointly, the two terms indicate multi-dimensional intelligence, wisdom and consciousness. This paper illustrates the dynamic coherence between training the mind and educating the heart and highlights the importance of values as an integral part of knowledge and learning.
Pictured: King George Tupou I
When used conjointly, the two terms indicate multi-dimensional intelligence, wisdom and consciousness. This paper illustrates the dynamic coherence between training the mind and educating the heart and highlights the importance of values as an integral part of knowledge and learning.
Pictured: King George Tupou I
Evidence, Global, News
A glowing review by Henry March was published this month in UK paper NewStatesman of Michael Marmot’s book The Health Gap: the Challenge of an Unequal World. The review – and the book – highlights Marmot’s long-held view that mortality statistics are a question of inequity.
“If everyone in England over the age of 30 had the same low mortality as people with university education, there would be 202,000 fewer deaths before the age of 75 each year . . . 2.6 million extra years of life saved each year.” The reviewer quotes from Marmot’s book.
There has been much argument over the years, says Henry March, about how “health” should be defined. “One might scoff a little at the breadth of the World Health Organisation’s definition: “complete physical, mental and social well-being and not merely the absence of disease or infirmity”. But it is difficult to disagree with the underlying idea that good health is more than just the absence of disease.”
“We need to seek out the “cause of the causes”. Working-class people smoke more, have higher obesity rates, take less exercise and die younger as a result – but why? Those of a right-wing disposition might suggest that it is simply because they are feckless and have not exercised their free will to work hard and live healthy lives. But this, you realise as you read Marmot’s book, is the propaganda of the victors.”
Henry March is clearly convinced by this book; pronouncing it ‘splendid and necessary’.
Rrad the full review
Equality, Maori
In October 2015 HPF’s Deputy Executive Director Trevor Simpson and Senior Health Strategist, Dr Viliami Puloka together presented to a multi-sectoral group in Kaitaia. “Towards Health Equity – putting the tools in the kete” discussed health and social inequities and suggested ways in which the group – from health and social services providers, WINZ and local authority representatives, police and education professionals – could work together to improve outcomes in their local community. A working group formed from the meeting with the group continuing discussions and working more cohesively to improve equity in the wider northern region.
News, Policy, Smoking
campaigns for smokefree cars
Northland Health Provider Te Hiku Hauora is leading a campaign to encourage Government to legislate against smoking in cars carrying children under 18 years of age.
Cathy Cherrington, manager of Te Hiku Hauora’s health promotion team in Kaitaia presented a 2000 signature petition to co-leader of the Maori party Marama Fox earlier this month. The petition calls on Government to protect children agains passive smoking in cars. New rules in Britain now ban smoking in vehicles with children on board. The petition calls for a similar ban here and will be presented to Parliament by Ms Fox.
Marama Fox – an ex-smoker and anti smoking campaigner – was delighted to accept the petition. She said she will accept support for her battle to eliminate smoking in New Zealand by 2025 from wherever it comes.
We asked three health promotion professionals three questions for the spring/summer 2015 issue of Hauora, focusing on health promotion in Aotearoa New Zealand and the Health Promotion Forum.
Here are their responses:
What do you see as some of the major issues regarding health promotion in Aotearoa New Zealand and the world today?
Zoe Aroha Martin-Hawke identifies two interconnected issues facing health promotion in Aotearoa; the wide-ranging use and understanding of the term ‘health promotion’ and a decrease in the use of the term in workplace titles.
“The use and understanding of the term ‘health promotion’ is wide-ranging, with some perceptions overlapping and others quite separate. The challenge is to find a balance between autonomy of each perspective and enabling collaborative working in the areas that intersect. The emergence of competitive funding contracts, with a set health promotion agenda, makes this particularly difficult.
“Secondly a decrease in the use of the term ‘health promotion’ in job titles, work departments and job descriptions sees fewer people identifying as health promoters. This may be related to the lack of consensus on the definition of health promotion and/or on funding directives. Such a lack of clarity may restrict the ability of people to practice the health promotion model they believe in. As a result, Zoe is concerned that the discipline is losing its value, respect and presence in Aotearoa.”
“Health promotion consists of so many dimensions that are strongly connected with Māori thinking it would be sad to see it disappear in the formal sense,” says Zoe. “Furthermore people have invested time and money into the study of health promotion and are passionately connected to the discipline. To not be able to practice what they have been students of for many years seems unethical. “
Much of Wiki Shepherd Sinclair’s 11 year career in health has focused on Health Promotion. She believes that the challenges facing the Health Promotion space in Aotearoa New Zealand – and the world – today include lack of collaboration and communication, poor cultural awareness, lack of community engagement and an experienced, but unqualified workforce.
According to Dr Mihi Ratima – and as outlined in the recent book she edited with Associate Professor Louise Signal (Promoting Health in Aotearoa New Zealand) – major issues facing health promotion include the challenge of neoliberalism, the positioning of health promotion on the periphery, and the difficulty in maintaining the health equity focus.
As noted in the book, the health of the planet – and all of us who live on it – is under dire threat from factors such as climate change, obesity and new infectious disease. Progressive health promotion is an approach that can counterbalance threats to health with practice, policy and advocacy for health, well-being and equity. “There is an urgent need for further government investment in this approach”, she says.
Perhaps our greatest challenge, according to Mihi, is in achieving health equity. “We are good at the rhetoric around reducing inequities, but are things really changing? If not, why don’t we have a sense of urgency about it? What does the evidence say about some of the issues we know are important from a public health perspective, like income inequality? What is going on with those wider determinants? We know we can be effective, as evidenced by narrowing of gaps in life expectancy between ethnic groups over time. But we also know that many of our interventions continue to have a majority population focus, leaving out some groups, and inadvertently increasing inequities. We must normalise a commitment to health equity in everything we do in health promotion, use the excellent health equity tools we have at our disposal, and ensure that no one is left out. The lived realities and voices of those who are different from us need to be part of the solutions.”
What do you see as the role of the Health Promotion Forum in population health today?
Zoe Aroha Martin-Hawke:“To lead workforce development to ensure that there is a shared understanding, respect and pathway for health promotion champions throughout the country.”
To keep the sector up to date on health promotion internationally and nationally.
To keep information flowing into the NZ context to secure a strong health promotion lens and voice to keep us connected and focused on the areas we need to collaborate on. Progressing indigenous perspectives on health, health equity and everyone’s right to health are key messages and activities that the health promotion forum are leading and can continue to lead in the quest for equitable population health. Health promotion leadership is needed and the health promotion forum can build that leadership through its membership.
Wiki Shepherd-Sinclair suggested the following;
“It is critical that we have shared understandings of effective approaches to health promotion and work collaboratively,” saysMihi Ratima. “The HPF provides a mechanism through which organisations are able to work together and leverage off one another for the benefit of the entire membership. Member organisations are able to form relationships with one another and access training and expertise that is not otherwise available to them. This network of provision provides an expanded sphere of influence whereby innovation in health promotion is able to be easily shared and its value maximised through uptake within the network.”
Jo Lawrence-King
7 October 2015
“The use and understanding of the term ‘health promotion’ is wide-ranging, with some perceptions overlapping and others quite separate. The challenge is to find a balance between autonomy of each perspective and enabling collaborative working in the areas that intersect. The emergence of competitive funding contracts, with a set health promotion agenda, makes this particularly difficult.
“Secondly a decrease in the use of the term ‘health promotion’ in job titles, work departments and job descriptions sees fewer people identifying as health promoters. This may be related to the lack of consensus on the definition of health promotion and/or on funding directives. Such a lack of clarity may restrict the ability of people to practice the health promotion model they believe in. As a result, Zoe is concerned that the discipline is losing its value, respect and presence in Aotearoa.”
“Health promotion consists of so many dimensions that are strongly connected with Māori thinking it would be sad to see it disappear in the formal sense,” says Zoe. “Furthermore people have invested time and money into the study of health promotion and are passionately connected to the discipline. To not be able to practice what they have been students of for many years seems unethical. “
Much of Wiki Shepherd Sinclair’s 11 year career in health has focused on Health Promotion. She believes that the challenges facing the Health Promotion space in Aotearoa New Zealand – and the world – today include lack of collaboration and communication, poor cultural awareness, lack of community engagement and an experienced, but unqualified workforce.
According to Dr Mihi Ratima – and as outlined in the recent book she edited with Associate Professor Louise Signal (Promoting Health in Aotearoa New Zealand) – major issues facing health promotion include the challenge of neoliberalism, the positioning of health promotion on the periphery, and the difficulty in maintaining the health equity focus.
As noted in the book, the health of the planet – and all of us who live on it – is under dire threat from factors such as climate change, obesity and new infectious disease. Progressive health promotion is an approach that can counterbalance threats to health with practice, policy and advocacy for health, well-being and equity. “There is an urgent need for further government investment in this approach”, she says.
Perhaps our greatest challenge, according to Mihi, is in achieving health equity. “We are good at the rhetoric around reducing inequities, but are things really changing? If not, why don’t we have a sense of urgency about it? What does the evidence say about some of the issues we know are important from a public health perspective, like income inequality? What is going on with those wider determinants? We know we can be effective, as evidenced by narrowing of gaps in life expectancy between ethnic groups over time. But we also know that many of our interventions continue to have a majority population focus, leaving out some groups, and inadvertently increasing inequities. We must normalise a commitment to health equity in everything we do in health promotion, use the excellent health equity tools we have at our disposal, and ensure that no one is left out. The lived realities and voices of those who are different from us need to be part of the solutions.”
What do you see as the role of the Health Promotion Forum in population health today?
Zoe Aroha Martin-Hawke:“To lead workforce development to ensure that there is a shared understanding, respect and pathway for health promotion champions throughout the country.”
To keep the sector up to date on health promotion internationally and nationally.
To keep information flowing into the NZ context to secure a strong health promotion lens and voice to keep us connected and focused on the areas we need to collaborate on. Progressing indigenous perspectives on health, health equity and everyone’s right to health are key messages and activities that the health promotion forum are leading and can continue to lead in the quest for equitable population health. Health promotion leadership is needed and the health promotion forum can build that leadership through its membership.
Wiki Shepherd-Sinclair suggested the following;
- Supporting organisations to gain a better understanding of what health promotion in Aotearoa is and what this looks like in practice
- Supporting organisations to have a shared understanding and common language of health promotion
- To have a lead advocacy role in health promotion and public health
- To promote Healthy public policy
- Encouraging organisations to grow their networks and/or partnerships
- To help organisations build awareness and skills to implement the Health Promotion Competencies
- Providing a set of practical tools and training around the HP competencies
“It is critical that we have shared understandings of effective approaches to health promotion and work collaboratively,” saysMihi Ratima. “The HPF provides a mechanism through which organisations are able to work together and leverage off one another for the benefit of the entire membership. Member organisations are able to form relationships with one another and access training and expertise that is not otherwise available to them. This network of provision provides an expanded sphere of influence whereby innovation in health promotion is able to be easily shared and its value maximised through uptake within the network.”
Jo Lawrence-King
7 October 2015
First New Zealand Health Promotion book
Promoting Health in Aotearoa New Zealand
Promoting Health in Aotearoa New Zealand was conceptualised as a text that equally integrates Māori and Pākehā analysis; consistent with an approach that emphasises the Treaty of Waitangi partnership and indigenous rights. The editors have endeavoured to achieve this through collaboration between Māori and Pākehā editors, advisors and contributors. Contributors to the book include: Professor Sir Mason Durie, Professor John Raeburn, Associate Professor Papaarangi Reid, HPF’s Executive Director Sione Tu’itahi, Associate Professor Cindy Kiro, and HPF’s previous Executive Director Dr Alison Blaiklock.
Health promotion in Aotearoa New Zealand has elements that, in combination, make for a unique approach. Ratima explains: “Key features are the unique contribution of Māori understandings and approaches; the application of a rights-based approach for example in relation to Treaty of Waitangi-based rights and indigenous rights; the strong equity focus; commitment to addressing determinants of health; an emphasis on strengthening community development and self-determination; and the use of local models, frameworks and tools.”
There is very little text available that looks at health promotion in New Zealand – particularly as it relates to Māori. In fact Promoting Health in Aotearoa New Zealand is rare internationally for its strong focus on indigenous health. Frequently we refer to overseas texts when teaching and supporting public health practice. Often these are not relevant to Māori, other New Zealanders or the New Zealand context. This has been of concern to health promotion academics and practitioners for some years.
“This book has been written to address that gap,” says Mihi. It explores ways in which Māori, and other, perspectives have been melded with Western ideas to produce distinctly New Zealand approaches. In doing so it addresses the need for locally written material for use in teaching and practice, and provides direction for all those wanting to solve complex public health problems.
The book highlights the “dire threat” to the health of the planet – and all of us who live on it – from factors such as climate change, obesity and new infectious diseases. It concludes that progressive health promotion is an approach that can counterbalance threats to health with practice, policy and advocacy for health, well-being and equity.
HPF’s Executive Director Sione Tu’itahi was invited to speak a the book launch. He was also a contributor to the book.
“…The process by which the book was produced, both in contents and presentation, reflects a successful partnership that resonates with the letter and spirit of our nation’s founding document, Te Tiriti o Waitangi; an example worth emulating. It also places Matauranga Maori (Maori knowledge) prominently, while it weaves together the knowledge of the West, the knowledge of the East, and Indigenous knowledge systems as a set of effective solutions for addressing our health challenges. Although the primary focus is on Aotearoa, the book brings in the experience and knowledge of Moana Nui a Kiwa and other regions, thus making the book a very valuable contribution to our collective effort at the global level to address planetary health. The recent launching of Promoting Health in Aoteroa New Zealand is very timely because: – there is an increasing awareness in all sectors, government, community, and the corporate sectors, that to be effective in addressing our socio-economic, cultural, physical, ecological and spiritual wellbeing, we have to be health promotional and preventative in our integrated approaches – there is also a marked increase in the number of courses and qualifications on health promotion and public health in universities, polytechs and wananga. This book is a ‘must have’ reading and resources for all learners and practioners – additionally, there is an increasing awareness in other sectors, such as social development and education, of the connectedness of the set of challenges that we all try to address, and therefore, the increasing need to learn from other sectors such as health and some of their comprehensive and effective tools and approaches such as health promotion I would like to congratulate the hard-working editors, Associate Professor Louise Signal, and Dr Mihi Ratima. Your perseverance, dedication, endless patience, and professionalism, have paid off. Well done!”Jo Lawrence-King 7 October 2015
Following her attendance at the Equity at the Centre Conference in Alice Springs (4-5 September 2014), HPF Senior Health Promotion Strategist Karen Hicks reports on some of the presentations made during the two day event.
“Austerity kills” – that was the claim of Sharon Friel, Professor of Health Equity at the Australian National University, Canberra in her presentation Power and People: a game plan for health equity in the 21st Century. “Health promotion is about freedom and empowerment; giving people a voice,” she said. “What is shaping our everyday living resources is power.” She characterised budget cuts as ‘structural violence’ that threaten equity and wellbeing.
“Injustices are everywhere and they affect peoples’ health. These injustices can and should be eliminated. ….. How we understand, frame, communicate and engage around matters to do with health equity guides the types of actions that are taken, or not, to improve the lives of all groups in society.”
“Health promotion is about freedom and empowerment; giving people a voice,” she said. “What is shaping our everyday living resources is power.” She characterised budget cuts as ‘structural violence’ that threaten equity and wellbeing.
Asked what health promoters can do in their everyday practice, Prof Friel said “We need to think about our work with an equity lens on every day; otherwise we are not addressing the social determinants of health.”
Prof Friel’s game plan for health promoters consisted of three steps:
1. Keep equity at the centre.
Rather than focusing on selective social determinants of health (such as housing or education) we need to keep equity as a whole at the centre of everything we do.
2. Frame your messages to fit your audience.
Realpolitik (based on power and on practical factors) rather than ideology is the way to go in the current Australian climate, for example.
Data is powerful. Evidence will support the value of health promotion and initiatives.
Social media is a powerful way to create a movement. It will succeed where traditional media often meet with resistance from the industry that fund them.
3. Release the power.
The strength of health promotion lies in its ability to work collaboratively with a range of people and disciplines. We can release the power of these networks by:
Recognising the skills and capacity of our workforce and empower them to make a difference.
Foster relationships with a wide range of complementary disciplines to create a team effort.
About Sharon Friel
Sharon Friel is Professor of Health Equity, incoming Director of Regulatory Institutions Network (RegNet) and Director of the Menzies Centre for Health Policy, The Australian National University, Canberra
She is is from the east end of Glasgow. After leaving Scotland in 1990, she pursued an academic career in public health following a brief stint making carpets in Germany and smelling beer in England. Sharon Friel is currently Professor of Health Equity at the National Centre for Epidemiology and Population Health and Director of the Menzies Centre for Health Policy at the Australian National University. Between 2005 and 2008 she was the head of the Scientific Secretariat, based at University College London, of the World Health Organisation’s global Commission on Social Determinants of Health. In 2010 she was awarded an Australian Research Council Future Fellowship to investigate the interface between health equity, social determinants and climate change (particularly through food systems and urbanisation), based at the National Centre for Epidemiology and Population Health, ANU. Before moving to Australia, she worked for many years in the Department of Health Promotion, National University of Ireland, Galway. She is co-founder of the Global Action for Health Equity Network (HealthGAEN), a global alliance concerned with research, training, policy and advocacy related to action in the social and environmental determinants of health equity, and chairs Asia Pacific-HeathGAEN.
Jo Lawrence-King
10 September 2014
“Injustices are everywhere and they affect peoples’ health. These injustices can and should be eliminated. ….. How we understand, frame, communicate and engage around matters to do with health equity guides the types of actions that are taken, or not, to improve the lives of all groups in society.”
“Health promotion is about freedom and empowerment; giving people a voice,” she said. “What is shaping our everyday living resources is power.” She characterised budget cuts as ‘structural violence’ that threaten equity and wellbeing.
Asked what health promoters can do in their everyday practice, Prof Friel said “We need to think about our work with an equity lens on every day; otherwise we are not addressing the social determinants of health.”
Prof Friel’s game plan for health promoters consisted of three steps:
1. Keep equity at the centre.
Rather than focusing on selective social determinants of health (such as housing or education) we need to keep equity as a whole at the centre of everything we do.
2. Frame your messages to fit your audience.
Realpolitik (based on power and on practical factors) rather than ideology is the way to go in the current Australian climate, for example.
Data is powerful. Evidence will support the value of health promotion and initiatives.
Social media is a powerful way to create a movement. It will succeed where traditional media often meet with resistance from the industry that fund them.
3. Release the power.
The strength of health promotion lies in its ability to work collaboratively with a range of people and disciplines. We can release the power of these networks by:
Recognising the skills and capacity of our workforce and empower them to make a difference.
Foster relationships with a wide range of complementary disciplines to create a team effort.
About Sharon Friel
Sharon Friel is Professor of Health Equity, incoming Director of Regulatory Institutions Network (RegNet) and Director of the Menzies Centre for Health Policy, The Australian National University, Canberra
She is is from the east end of Glasgow. After leaving Scotland in 1990, she pursued an academic career in public health following a brief stint making carpets in Germany and smelling beer in England. Sharon Friel is currently Professor of Health Equity at the National Centre for Epidemiology and Population Health and Director of the Menzies Centre for Health Policy at the Australian National University. Between 2005 and 2008 she was the head of the Scientific Secretariat, based at University College London, of the World Health Organisation’s global Commission on Social Determinants of Health. In 2010 she was awarded an Australian Research Council Future Fellowship to investigate the interface between health equity, social determinants and climate change (particularly through food systems and urbanisation), based at the National Centre for Epidemiology and Population Health, ANU. Before moving to Australia, she worked for many years in the Department of Health Promotion, National University of Ireland, Galway. She is co-founder of the Global Action for Health Equity Network (HealthGAEN), a global alliance concerned with research, training, policy and advocacy related to action in the social and environmental determinants of health equity, and chairs Asia Pacific-HeathGAEN.
Jo Lawrence-King
10 September 2014
Alice Springs, September 2014
In September HPF Senior Health Promotion Strategist Karen Hicks represented Aotearoa New Zealand at the Australian Health Promotion Association Conference Equity at the Centre: Action on Social Determinants of Health in Alice Springs. Highlights from the event included
In September HPF Senior Health Promotion Strategist Karen Hicks represented Aotearoa New Zealand at the Australian Health Promotion Association Conference Equity at the Centre: Action on Social Determinants of Health in Alice Springs. Highlights from the event included
- Sharon Friel’s plenary session on politics, power and people
- Karen’s own presentation on Indigenous health promotion and workforce development
- Martin Laverty’s discussion of the economics of social justice
- Kerry Taylor’s findings about the power of language as a determinant of health
- TUHANZ (a Treaty Understanding of Hauora in Aotearoa New Zealand),
- the health promotion competencies and the
- health promotion society
- high staff turnover due to staff feeling ill equipped,
- poor access to healthcare
- language becoming a significant social determinant of health.
Evidence, News
New Zealand’s first health promotion book was launched in Wellington on Friday 28 August 2015.
Edited by Associate Professor Louise Signal and Dr Mihi Ratima, the book’s contributing authors include HPF’s Executive Director, Sione Tu’itahi, past Pacific Health Promotion Strategist Dr Ieti Lima and past HPF Executive Director Alison Blaiklock.
Sione was invited to speak at the launch. A transcript of his speech (below) summarises the many reasons this book is a welcome addition to the texts of all those involved in population health in Aotearoa New Zealand.
“Tena koutou, tena koutou, tena koutou katoa.
Warm Pasifika Greetings and good afternoon one and all.
Firstly, may I acknowledge the unifying spirit that has brought to fruition this challenging but very rewarding process. Together we have woven our diverse knowledge together for the hauora – the collective and holistic health wellbeing of our communities and peoples – in Aotearoa and abroad.
Secondly, may I acknowledge, the Mana Whenua of Whanganui a Tara, Wellington; the leadership of Otago University and, in particular, its School of Public Health
My sincere thanks to Louise for her kind invitation for me to say a few words. I am honoured and privileged.
This book is significant in a number of ways:
- It is the first health promotion textbook that is based on our Aoteaora New Zealand experience and realities. It is therefore of marked relevance to our context and applies directly to our joint effort to address the determinants of health and inequities.
- The process by which the book was produced, both in contents and presentation, reflects a successful partnership that resonates with the letter and spirit of our nation’s founding document, Te Tiriti o Waitangi; an example worth emulating.
- The book gives prominence to Matauranga Maori, while weaving together the knowledge of the west, the knowledge of the east, and indigenous knowledge systems. It holds them up as a set of effective solutions for addressing our health challenges.
- While the primary focus is on Aotearoa, the book brings in the experience and knowledge of Moana Nui a Kiwa and other regions, thus making it a very valuable contribution to our collective effort at the global level to address planetary health.
- There is a growing awareness in all sectors; government, community, and corporate; that, to be effective in addressing our socio-economic, cultural, physical, ecological and spiritual wellbeing, we must take an integrated health promotional and preventative approach.
- There has also been a marked increase recently in the number of courses and qualifications on health promotion and public health in universities, polytechnics and wananga. This book is a ‘must have’ reading and resources for all learners.
- Finally, awareness is of the connectedness of the challenges is grown in other sectors, such as social development and education. They see the increasing need to learn from other sectors, such as health, with some of their effective approaches such as health promotion.
Community, Maori
Health Promotion: Enlightenment, engagement and empowerment View the powerpoint presentations from a workshop with Professor Sir Mason Durie on 17 September 2009.- Power point presentations Part 1 discusses the progress to date and looks to the future for Māori health Part 2 focusses on the key role of whānau in Māori health.Equality, Maori, News, Racism
A feature article on an Australian TV website has highlighted the issue of the indigenous health gap; an issue that echoes the situation of Māori here in Aotearoa New Zealand. The article, by Bianca Nogrady, highlights the fact that indigenous Australians have a life expectancy ten years lower than non-indigenous Australians. She identifies social determinants of health such as income, access to affordable housing, stress and race as key factors in this gap. Crowded housing and ear infections
Nogrady cites an example, by Professor Dennis McDermott from Adelaide’s Flinders University, of housing and ear infections. Where a large number of people live at close quarters – as is more common among poorer indigenous people – children are more likely to suffer repeat ear infections as they are passed around the household.
“What happens is that non-Indigenous kids get it maybe once, they have a brush with it, and then it’s gone,” says Prof McDermott. “But with Indigenous kids in an overcrowded situation, it goes around and comes back, goes around and comes back, such that it’s a huge impact on hearing loss.”
This hearing loss has life-long effects. Children can’t hear in school, adults can’t hear on the job, it can impact on mental health, anger management, and wellbeing, McDermott says.
The impact is doubled with racism
According to Prof. McDermott racism has a clear and proven impact on people, as does connection to country – or the land from which people come.
“That psycho-spiritual connection to country, and doing these ceremonies, observing, burning the country when necessary…, is actually a positive contributor to health.”
In Australia there is hard evidence to support that those people living ‘on country’ and experiencing at least some elements of a traditional lifestyle are healthier. They tend to be more physically active, have a better diet, lower body-mass index, lower blood pressure, lower blood glucose levels, lower prevalence of diabetes and a lower risk of cardiovascular disease.
Despite the issue seeming insurmountable Prof. McDermott is optimistic. He compares the health gap to climate change, explaining that there is no vested interest in listening to the evidence and making a change. However, he says; “I think if we can only get that message through and build a critical mass of discourse in the community, then the politicians will fall in line.”
The original article appeard on www.abec.net.au. Read it here.
Exercise, News
A paper published in the British Journal of Sports Medicine has found that boosting physical activity levels in elderly men seems to be as good for health as giving up smoking. Researchers suggest more effort should go into promoting physical activity in this group.
The researchers based their findings on 15,000 men born between 1923 and 1932 for who took part in a health check in 1972-3 (Oslo I).
Some 6000 of the surviving men repeated the process in 2000 (Oslo II) and were monitored for almost 12 years to see if physical activity level over time was associated with a lowered risk of death from cardiovascular disease, or any cause, and if its impact were equivalent to quitting smoking.
Overall, the results showed that 30 minutes of physical activity–of light or vigorous intensity–6 days a week was associated with a 40% lower risk of death from any cause.
Men who regularly engaged in moderate to vigorous physical activity during their leisure time lived five years longer, on average, than those who were classified as sedentary.
This is an observational study so no definitive conclusions can be drawn about cause and effect, and the researchers point out that only the healthiest participants in the first wave of the study (in 1972-3) took part in the second wave (in 2000), which may have lowered overall absolute risk.
But the differences in risk of death between those who were inactive and active were striking, even at the age of 73, they suggest.
Journal Reference:
1. I. Holme, S. A. Anderssen. Increases in physical activity is as important as smoking cessation for reduction in total mortality in elderly men: 12 years of follow-up of the Oslo II study. British Journal of Sports Medicine, 2015; 49 (11): 743 DOI: 10.1136/bjsports-2014-094522
Jo Lawrence-King
15 July 2015
– See more at: http://www.hauora.co.nz/physical-exercise-linked-to-lower-death-rate.html#sthash.TVMvUQjt.dpuf
Global, What is HP
University professor and physician Trevor Hancock has urged society to rethink the role and effectiveness of health care as a determinant of our health. According to his December 2014 article in Canadian newspaper Times Colonist “…as a society we should be investing more in creating social conditions and environments that make people healthy, rather than in increasingly expensive high-tech care.” This is very sound advice, according to HPF’s senior health promotion strategist Dr Viliami Puloka. Traditionally, we have given hospitals, doctors and the health care system the responsibility to look after our health. “That relationship seemed to work well in the days where most of our health issues were largely acute infective processes that required urgent but short term medical interventions by doctors and nurses,” says Viliami. “However, the major health problems we face today are not acute infections from a single organism treatable with antibiotics, but chronic conditions with multiple risk factors that lie outside the remits of the existing health care system.” Dr Hancock’s article highlights two main points that are very relevant to the situation in New Zealand. Firstly, the importance of shared responsibility for the management of people’s health; between the individuals themselves, the wider community and health care providers. This is particularly critical in the management of chronic conditions, such as diabetes and obesity, where the individual has to make healthy choices and behaviour modifications in order to be well. The role of health care providers here is to support and empower individuals to make these healthy choices. Secondly, the importance of enabling-environments where healthy choices are the easy choices. These enabling-environments must include socio-economic and political environments. Dr Hancock refers to these as the upstream – or health – determinants that are outside the reach of the individuals and the jurisdictions of the health system.
As in Canada, we here in New Zealand have identified these health problems and their solutions. The solutions include cost-effective ‘upstream’ strategies such as community health promotion. However we have, to date, failed to address the processes that prevent individuals from benefitting from these upstream approaches. “We have been busy rescuing half-drowned people downstream. It is time that we work with our leaders putting in place policies and legislations to prevent people from falling into the river in the first place.”
Author: Viliami Puloka
Editor: Jo Lawrence-King
6 January 2015
Maori
Five key elements, outlined in a 2010 paper by Dr Mihi Ratima remain imperative to the success of Māori health promotion today. Commissioned and published by HPF, Dr Ratima’s paper Māori health promotion – a comprehensive definition and strategic considerations looked at what was, at the time, a relatively new field of health promotion. Five years on, HPF Deputy Executive Director Trevor Simpson revisits these key elements as a timely reminder that there is much yet to be done to solidify and affirm Māori health promotion as a discipline and practice. 1. Consistent with Māori World Views A key facet of the Māori world view is the belief that all things in the universe: animate and inanimate; seen and unseen; are interdependent and interconnected. All things connect to – and are impacted on by – the individual. The individual is not separate from – or “above” – the natural environment. The Māori storytelling tradition not only provides a foundation for beliefs of origin: it also constructs for the individual a model for behaviour, of collective aspirations and exemplars for human potential (see teara.co.nz website). Clearly there is a correlation here with ecological health promotion. However more is needed to articulate the idea that an understanding, acceptance and incorporation of Māori world views into health promotion approaches can affect Māori health in a positive way. 2. Māori holistic view of hauora- health and wellbeing If we accept that the Māori view of health and wellbeing is holistic then there is an argument for health promotion to work in a holistic way too. There is a need to investigate how we are designing health promotion interventions. The most problematic thing is the current narrow focus on issues such as tobacco, physical activity and nutrition. Issues-based and results-based accountability contracting present significant challenges to holistic health promotion. Positive health outcomes are often quite difficult to claim when health promoters are working across the wider social determinants of health. A new form of strategic and longer term thinking is required. There are some parallels between the western model of health and indigenous Māori concepts of hauora – health and wellbeing. Both share the concepts of physical and mental health. But there are two other components of the Māori model of health that need further examination. Professor Sir Mason Durie’s now widely acclaimed Te Whare Tapa Whā model identifies the two other key facets – whānau (family) and wairua (spirituality). Together with physical and mental health, they make up the four cornerstones of Māori health. The importance of whānau (immediate and extended whānau) as an indicator for health is now fairly well accepted in the health sector. The Whānau Ora programme was first rolled-out in 2010. As interventions are evaluated, there will be an increasing body of evidence to inform future practice in relation to this aspect of Māori health promotion. There is also growing acceptance that wairua is critical to Māori health status. Establishing the link between wairua and health outcomes can be difficult to validate, quantify and/or qualify, however and, while there is some research under way more investigation will be needed; particularly from an indigenous Māori perspective. 3. Increased control by Māori (individuals and whānau) A key tenet of health promotion is empowerment; both of individuals and communities. It is an aspect that comes to the fore when contemplating health promotion work in Māori communities. Gone are the days of doing things “to” Māori communities. Regardless of what the intervention is, if Māori feel that they are not in control of, or party to the process, then the likelihood of success is diminished. Working “with” these communities rather than “on” them will ensure authentic relationships are maintained and nurtured, and increase the likelihood of good outcomes. 4. Foster Māori identity A strong identity for Māori is critical in all facets of life. Access to te ao Māori (the Māori world), a sense of belonging, marae, knowledge of whakapapa, tikanga and te reo are all part of this. It loosely relates to the notion of tino rangatiratanga, or self-determination, encouraging Māori participation and ownership. Māori health promotion interventions must take this into account. Any interventions must incorporate a clear demonstration that Māori identity is valued and promoted thus increasing feelings of cultural acceptance and support rather than “othering”. Including things such as karakia, powhiri, mihimihi and manaakitanga into a Māori community health promotion programme would assist in assuring success. 5. Interventions are culturally competent The key issue in developing culturally competent health promotion interventions is that a culturally competent person must be involved throughout the process; ensuring the Māori content of the proposed health promotion project is appropriate. Any human resource component will require a demonstrable level of cultural competence that goes beyond cultural “safety” practices and possibly means more than simply learning and knowing “about” Māori culture. From the point of view of the capacity of the Māori workforce, though; this person may not always be Māori.
“Inequalities in health exist both within and between countries. They are both unnecessary and unjust. They also create a great cost to societies…” These are the opening words of the latest Eurohealth; the quarterly publication of the WHO-hosted European Observatory on Health Systems and Policies. Reporting on the 7th European Public Health Conference, this special edition for 2015 focuses on the issues discussed at the November 2014 event in Glasgow, Scotland. 
With the theme of the conference being “Mind the Gap: Reducing Inequalities in Health and Health Care”, EuroHealth articles look at:
With the theme of the conference being “Mind the Gap: Reducing Inequalities in Health and Health Care”, EuroHealth articles look at:
- How Roma communities are responding to inequalities;
- The adaptation of health promotion and disease prevention interventions for migrant and ethnic minority populations;
- The Glasgow Declaration;
- Learning from each other – where health promotion meets infectious diseases;
- Public health monitoring and reporting;
- Changing your health behaviour – regulate or not;
- Developing the public health workforce;
- Building sustainable and resilient health care systems;
- Leaving a legacy in Glasgow;
- Conclusions; and Eurohealth Monitor.
A paper published this year in Social Science & Medicine Journal has concluded that income inequality does indeed have a negative effect on population health and wellbeing; and that narrowing this gap will improve it. The paper suggests ways in which governments need to act to address this growing problem.
“It comes as no surprise to us that this is the conclusion of this paper,” says HPF’s Executive Director Sione Tu’itahi. “What surprises us is that there was ever any doubt. This will be a strong addition to our body of evidence. We implore governments in Aotearoa New Zealand and around the world to address inequality as the key to improving the health and wellbeing of their people.”
The paper’s authors cite world leaders, including the US President, the UK Prime Minister, the Pope and leaders at the International Monetary Fund, the United Nations, World Bank and the World Economic Forum; all of whom have described income inequality as one of the most important problems of our time. Several of these leaders have also emphasised its social costs. “Inequality is increasing in most regions of the world, rapidly in most rich countries over the past three decades,” they say.
“The evidence that large income differences have damaging health and social consequences is already far stronger than the evidence supporting policy initiatives in many other areas of social and economic policy, and the message is beginning to reach politicians,” say the authors. “The reason why politicians do not do more is almost certainly a reflection of the undemocratic power of money in politics and the media. Narrowing the gap will require not only redistributive tax policies but also a reduction in income differences before tax. “
The paper, by Professors Kate Pickett and Richard Wilkinson (pictured above), was drawn from a ‘very large’ literature review, including those papers that have previously thrown doubt over the causal link between income inequality and population health. The outcome was a strong body of evidence to support the link, while those few papers that drew different conclusions were found to have been based on studies using inappropriate measures.
Photo: Guardian.co.uk
Story: Jo Lawrence-King
April 2015
The paper’s authors cite world leaders, including the US President, the UK Prime Minister, the Pope and leaders at the International Monetary Fund, the United Nations, World Bank and the World Economic Forum; all of whom have described income inequality as one of the most important problems of our time. Several of these leaders have also emphasised its social costs. “Inequality is increasing in most regions of the world, rapidly in most rich countries over the past three decades,” they say.
“The evidence that large income differences have damaging health and social consequences is already far stronger than the evidence supporting policy initiatives in many other areas of social and economic policy, and the message is beginning to reach politicians,” say the authors. “The reason why politicians do not do more is almost certainly a reflection of the undemocratic power of money in politics and the media. Narrowing the gap will require not only redistributive tax policies but also a reduction in income differences before tax. “
The paper, by Professors Kate Pickett and Richard Wilkinson (pictured above), was drawn from a ‘very large’ literature review, including those papers that have previously thrown doubt over the causal link between income inequality and population health. The outcome was a strong body of evidence to support the link, while those few papers that drew different conclusions were found to have been based on studies using inappropriate measures.
Photo: Guardian.co.uk
Story: Jo Lawrence-King
April 2015
Uncategorized
In the latest of HPF’s Keeping Up to Date series of peer-reviewed papers, Dr Kate Morgaine discusses how the fluoridation of community drinking water meets all the values and aims of health promotion. “Oral health inequalities across the world are large and long standing, but not immutable,” says Dr Morgaine in her paper. “Within New Zealand, dental caries is a significant disease that impacts both physical health and quality of life. A clear social gradient is also evident, with the heaviest burden being borne by those who experience the most deprivation in our society.“
“Fluoride is important in oral health and in the prevention of caries as it has three functions. It enhances remineralisation following consumption of food; once incorporated into the enamel is inhibits demineralisation; and it inhibits the ability of bacteria to adhere to, and thus attack, tooth enamel.“
Fluoride is a naturally occuring mineral, but it’s concentration in local water supplies is wide ranging. In some countries, fluoride levels are adjusted downwards to prevent the harmful effects of high doses. In New Zealand, however, they are adjusted upwards to provide optimal health benefits.
26 March 2015
Jo Lawrence-King
Global, Video, What is HP
Two videos from the Health Promotion Forum of New Zealand (HPF) are receiving widespread praise – and calls for more – across the population health community in Aotearoa and the world.
Viewed by more than 750 people to date, What is Health Promotion? answers the vexed question for many about this much-misunderstood discipline, while Health Promotion Competencies introduces health promoters to a useful resource for developing their role.
Renowned Professor and author John Raeburn commented “Really good. Very succinct and to the point,” and, on a poignant note, he added; “Ah, if only we could achieve that!”
WHO’s Professor Margaret Barry – Head of World Health Organization Collaborating Centre for Health Promotion commented: “There are very nicely produced short videos, which provide a useful snapshot of what Health Promotion practice is about and the skills and competencies that health promoters apply. They will be of interest to all those studying and working in Health Promotion and related areas globally.”
University lecturers up and down Aotearoa, and from as far afield as Scotland, say they have added the videos to their teaching resources.
HPF hopes to produce more videos in the future. Keep up to date on our videos by liking us on facebook or by e-mailing Barb to subscribe to our biannual newsletter Hauora.
19 March 2015
Jo Lawrence-King
Case Studies, Community, Family and child
Plunket’s Asian strategy is expected to be implemented in July 2015. The strategy addresses all levels of the organisation, including the staff, volunteer groups and Plunket Line; aiming to increase customers’ access to-, use of-, and satisfaction with Plunket’s services.
Plunket is developing culturally appropriate professional services, and encouraging ongoing feedback from service users about their work. They will set and update yearly goals; ensuring the inclusion of the Asian service-user’s voice in their business planning and strategies.
The new strategy follows extensive research commissioned by Plunket in 2013. Conducted among their service users, staff and stakeholders; the research investigated Asian mothers’ experience of access to health care. It included interviews, consultations and focus groups held with Chinese, Korean and Burmese mothers as well as members of The Asian Network Incorporated (TANI), and Plunket’s internal staff. The results indicated that Asian mothers were not proactively seeking help, despite the superficial appearance that access to the services was good. At the time only 4% of the Plunket staff were of Asian ethnicity, while 15% of babies among the service users were of Asian descent. Mothers spoke of access barriers to service, including language barriers and lack of understanding of available services.
It found that Asian mothers mainly accessed Plunket information via the internet and from their GP and concluded that it was important to provide more information about the culturally appropriate services available from Plunket.
For more information, please contact Vivian Cheung on 021 246 3398 orvivian.cheung@plunket.org.nz
Evidence, Global, News
Scottish MPs (MSPs) have called for a multi-agency approach to tackle inequalities. This follows the publication of the Report on Health Inequalities after 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:
- Such campaigns do not address the primary causes of inequalities such as poverty and deprivation and
- 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.
- 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.
ActiveAsian aims to improve access to physical activity information and opportunities for Chinese children and their parents on Auckland’s North Shore. To date it has included events such as a Chinese Sport Forum volunteering programme for Asian youth in the community, tramping, bike training, and leadership development through sports.
The project also offers an Asian community engagement model and toolkit and a wealth of resources and contacts for the Asian (Chinese and Korean in particular) communities.
ActivAsian was established by Harbour Sports in 2009 in response to the need to focus on the health needs of the growing Asian population on Auckland’s North Shore. It was the result of extensive research and ground work with the Asian community in the years preceding its initiation. Sprouting from this ground work included several important decisions and documents.
Contact ActivAsian’s project coordinator Jenny Lim atactivasian@harboursport.co.nz and DDI: 09 415 4654 for more information.
Case Studies, Community
John Wong, the Chair of Chinese Positive Ageing Charitable Trust (CPA), talked to the Eldernet Gazette in July 2014 about what ageing in New Zealand means to elderly Chinese, and about the services provided by CPA. Formed by a group of volunteers, CPA aims to promote quality of life for the Chinese elderly residing in New Zealand. John Wong explains the considerations that an older Chinese person might take into account when considering aged care. He also gives examples of culturally appropriate services that might be useful for aged care services when providing care to the Chinese elderly.
-An employment service by Framework
Workfocus aims to provide employment support for mental health clients for a range of ethnicities. The Workfocus team, based in Epsom, is comprised of ten employment consultants, including Asian consultants. Clients access the service through any form of referral, however, those approaching the service themselves must acknowledge their mental illness. Clients and consultants work in partnership in seeking employment and the client must be motivated to find work. Consultants support clients in all steps of the job application; including providing tips on filling in application forms and practising interview skills; however, clients must apply for jobs themselves. Workshops and training are also available (please contact Workfocus or Framework for more details).
The employment consultants, covering different areas of Auckland, provide ongoing support to clients in their employment journey, until they achieve a year of employment. However the main focus of the service is on finding a desired and attainable job.
According to Milly Zhang, an experienced employment consultant with the organisation, there are a number of challenges Asian clients might face when finding employment. Although they are usually hard workers and are motivated to find a job, their overseas qualifications and experiences are often invalid in New Zealand. Asian clients also face additional challenges as they adapt to a new social and employment environment.
Workfocus has been providing its service for over four years. For more information regarding Workfocus, please e-mail Milly Zhang or call her on 021 976 556.
Smokefree Communities aims to provide support to families, Asian people and their families and pregnant women and their families to quit smoking and live smoke free. Based in Albany, in Auckland, the service currently provides free smoking cessation service to those residing in the Rodney, Waitakere and North Shore areas. The Quit Bus service is also now available for both Counties Manukau and Waitemata District Health Board (CMDHB and WDHB) regions. The team, made up of staff from varying ethnic backgrounds, are able to provide service to people from different ethnicities. Both self- and GP-referrals are accepted.
The service was initiated as a pilot in response to a need for a smoking cessation service, revealed in WDHB research. Its success led to ongoing funding, and it is looking to expand its culturally-appropriate service to other Auckland regions.
The client-centred, service takes into consideration clients’ religion, interests and preferences. The holistic approach also takes into account family and other environmental factors. After initial contact, coordinators will visit the client to make assessments and provide appropriate suggestions to the client. They suggest treatment plans and will provide support and follow-up until the client achieves six months’ cessation. A willingness and motivation to quit are important success factors for smoking cessation, however, if clients relapse, they are welcome to approach the service again.
For more information visit www.comprehensivecare.co.nz or contact Zhoumo Smith on 09 448 0475 or 027 357 1800 or zsmith@comprehensivecare.co.nz .
Zhoumo, an experienced Smokefree Coordinator, has been involved with the service for 10 years.
The Ottawa Charter for Health Promotion is a 1986 document produced by the World Health Organization. It was launched at the first international conference for health promotion that was held in Ottawa, Canada. I lays the foundation for health promotion action.
The health promotion emblem provides a graphic interpretation of health promotion. Explanation of the emblem
The ‘Bangkok Charter for Health Promotion in a globalized world’ was agreed to by participants at the 6th Global Conference on Health Promotion held in Thailand from 7-11 August, 2005. It identifies major challenges, actions and commitments needed to address the determinants of health in a globalized world by reaching out to people, groups and organizations that are critical to the achievement of health. – See more at: http://www.hauora.co.nz/global-context.html#sthash.0YtkIBgQ.dpuf
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care, Almaty (formerly Alma-Ata), currently in Kazakhstan, 6-12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It recognises the primary health care approach as the key to achieving the goal of “Health for All”.
The Alma-Ata Declaration is considered by many to be the founding framework for health promotion internationally. It came from an International Conference on Primary Health Care, in Alma-Ata, USSR, 1978.
“The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world ….. “
This literature review, commissioned by the former Health Funding Authority in December 2000, examined the most relevant literature on strategies that improve Māori and Pacific peoples’ access to primary health care services. It may help inform PHOs when planning services to improve access.
Effective co-ordination of primary care beyond treatment and prevention services to include comprehensive disease prevention and health promotion is central to the success of the Primary Health Care Strategy. To achieve effective health promotion in a PHO, public health and primary care practitioners will need to work together.
The purpose of this guide is to assist PHOs and DHBs develop, assess and deliver health promotion programmes aimed at improving the health status of the population and reducing health inequalities. A Guide to Developing Health Promotion Programmes
World Health Report 2008 – Primary Health Care – Now More than Ever
“Globalization is putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should.
People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in ways that correspond to their expectations. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.” The 2008 WHO report Now More Than Ever outlines Primary Healthcare (PHC) reforms to mee the health challenges of today’s world.
Family and child, Policy
The first 1000 days of a child’s life are critical to their long term development. One thousand days is also approximately the duration of one term of parliament. So either way we have about 1000 days to get it right. The future of New Zealand depends on it.” Getting it right in those first thousand days means today’s young children are given every opportunity to develop their full potential as healthy, emotionally mature, socially engaged and well-educated, productive adults.” Read the 2011 report from Every Child Counts.Global, News
The World Health Organization (WHO) identified a need for the development of public health leadership at a conference in November. The global body called on governments, acadaemia, civil society and public health institutions to commit greater effort to developing the skills needed in the field; in order to protect public health values and to mitigate against public health threats.
WHO also emphasised the need to strengthen the collective capacity for systems-thinking*, which focuses on population-based approaches as well as personal approaches to health and wellbeing improvement.
Over 1,400 public health practitioners, researchers and policy- makers from more than 65 countries participated in sessions at the conference; covering topics such as the changing public health roles, gaps in health systems research and effective communication.
Dr Elke Jakubowski, programme manager of public health services at the WHO’s Division of Health Systems and Public Health,was speaking at the 7th European Public Health Conference: Mind the Gap-reducing inequalities in health and health care in Glasgow, 19-22 November 2014.
Read the WHO article.
*Systems thinking involves interventions and engagement with key stakeholders and organisations across many sectors. It is a framework for seeing interrelationships; understanding that everything is connected and that every action has an effect. It is consistent with the social ecological model where health promoters appreciate the interconnectedness that exists through the relationships people have with and between family, friends, organizations, teams, communities, faith groups, etc. The social ecological model is a systems thinking model.
18 December 2014
Karen Hicks and Jo Lawrence-King
Equality, News, Pacific
| “Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system. Keeping people well, it seems, is the much cheaper option.”
Trevor Simpson, Deputy Executive Director, Health Promotion Forum – Runanga Whakapiki Ake i te Hauora o Aotearoa |
Equality, News, Pacific
|
“Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system. Keeping people well, it seems, is the much cheaper option.”
Trevor Simpson, Deputy Executive Director, Health Promotion Forum – Runanga Whakapiki Ake i te Hauora o Aotearoa |
rather structural i.e. how society is arranged. The entire breadth of a situation must be considered when questioning why any health outcome occurs. For example if Māori and Pacific people are experiencing higher rates of psychological duress then the reasons for this could emanate from a range of social, environmental, political and economic factors. Chrissy further provided an important clue by referencing the fact that negative health statistics are found in “[Deprivation] Decile 10 areas,” that is communities that experience higher levels of deprivation.
On this topic it is timely, for proponents of preventative health, that a nationwide discussion has focussed on poverty and the widening gap between the ‘haves’ and ‘have nots’. For example, Bryce Edwards, in his NZ Herald opinion piece on Monday 15th December suggests that ‘Inequality’ could be the word of the year in New Zealand politics. The correlations between poverty and health outcomes are now very well-known and understood. It is true that poverty exists across all ethnicities but it is hard to overlook the stark contrast between Māori and Pacifica peoples and other groups.
Children are a case in point. The Child Poverty Monitor: 2014 Technical Reportshows that 1 in 3 Māori and Pacifica children live in poverty as compared to 1 in 6 European children. It also states that three out of 5 of these children are likely to live this way for many years. The impact of this on health across the life continuum is obvious, not to mention extremely costly. For example rates of hospitalisations for children living in the most deprived areas (NZDep deciles 9–10) were nearly 3 times higher than for those in areas with the least deprivation (NZDep deciles 1–2). Further the majority of hospital admissions were due to infectious and respiratory diseases among children aged 0–14 years. During 2009–2013, 82% of these admissions were for asthma and wheeze, acute bronchiolitis, acute upper respiratory infections, gastroenteritis, viral infection of unspecified site, skin infections or pneumonia (bacterial, non-viral). In many cases these outcomes were completely preventable.
One simple solution is to reinstate a universal child benefit; to lift not only poor families, but all struggling whānau, above the bread line. Other answers can be found in the Office of the Children’s Commissioners report Choose kids: why investing in children benefits all New Zealanders.
Making inroads into the elimination of child poverty may just be the remedy we all need for the ever increasing costs to the health system and our communities. Keeping people well, it seems, is the much cheaper option.
16 December 2014
Trevor Simpson
Family and child
The 2014 Child Poverty Monitor released this month shows that reducing child poverty will require bold and sustained commitment from government. Child Poverty Action Group welcomes the latest Child Poverty Monitor and congratulates the Office of the Children’s Commissioner, the JR McKenzie Trust and the University of Otago’s NZ Child and Youth Epidemiology Service on their commitment to measuring and monitoring child poverty. The Monitor brings together all the known statistics about child poverty in Aotearoa New Zealand with current statistics on health outcomes. CPAG health spokesperson Dr Nikki Turner says, “The 2014 Child Poverty Monitor shows there has been little change over the past year and far too many New Zealand children still live in poverty. This problem is too difficult to be addressed by piecemeal measures – substantial commitment is needed to improve incomes and housing for families with children.” Nikki Turner says, “We know childhood poverty has life-long consequences for people’s health and well-being. For children to stay healthy, families need enough money for affordable, decent and stable housing, nutritious food, doctor’s visits and prescription fees. They need cooking and laundry facilities, access to hot water, soap, clean towels, clothing, shoes, bedding and basic first aid. Income adequacy is pivotal and insufficient money continues to affect children’s health, as the statistics in the Child Poverty Monitor show. There are a range of issues to be tackled and some progress is being made, such as the reduction in costs for GP visits, but income adequacy is an urgent need, particularly for our most vulnerable children.” Child Poverty Action Groups calls on the government to lead a cross-party agreement on an action plan to reduce child poverty, including: • Treating all low-income children equally. • Improving incomes significantly for low income families and access to affordable housing and healthcare for all children • Ensuring an accelerated rate of poverty reduction for Mäori and Pasifika, so they achieve equity with other children. • Introducing child poverty legislation to ensure proper, regular measurement of child poverty on a range of measures. In addition, targets and timelines for child poverty reduction should be set with annual reporting to Parliament on progress towards these targets by the responsible Minister.
Child Poverty Action Group
8 December 2014
The 2014 Child Poverty Monitor released this month shows that reducing child poverty will require bold and sustained commitment from government.
Child Poverty Action Group welcomes the latest Child Poverty Monitor and congratulates the Office of the Children’s Commissioner, the JR McKenzie Trust and the University of Otago’s NZ Child and Youth Epidemiology Service on their commitment to measuring and monitoring child poverty.
The Monitor brings together all the known statistics about child poverty in Aotearoa New Zealand with current statistics on health outcomes.
CPAG health spokesperson Dr Nikki Turner says, “The 2014 Child Poverty Monitor shows there has been little change over the past year and far too many New Zealand children still live in poverty. This problem is too difficult to be addressed by piecemeal measures – substantial commitment is needed to improve incomes and housing for families with children.”
Nikki Turner says, “We know childhood poverty has life-long consequences for people’s health and well-being. For children to stay healthy, families need enough money for affordable, decent and stable housing, nutritious food, doctor’s visits and prescription fees. They need cooking and laundry facilities, access to hot water, soap, clean towels, clothing, shoes, bedding and basic first aid. Income adequacy is pivotal and insufficient money continues to affect children’s health, as the statistics in the Child Poverty Monitor show. There are a range of issues to be tackled and some progress is being made, such as the reduction in costs for GP visits, but income adequacy is an urgent need, particularly for our most vulnerable children.”
Child Poverty Action Groups calls on the government to lead a cross-party agreement on an action plan to reduce child poverty, including:
• Treating all low-income children equally.
• Improving incomes significantly for low income families and access to affordable housing and healthcare for all children
• Ensuring an accelerated rate of poverty reduction for Mäori and Pasifika, so they
achieve equity with other children.
• Introducing child poverty legislation to ensure proper, regular measurement of child poverty on a range of measures. In addition, targets and timelines for child poverty reduction should be set with annual reporting to Parliament on progress towards these targets by the responsible Minister.
Case Studies, Community, News
A pilot sexual health training programme for Asian youth workers in 2012 provided invaluable insight into the best ways to reach Chinese youth with important sexual health messages. Concerned by the high rate of pregnancy terminations occurring in the young Asian women of their community, The Chinese Women’s Wellness Community Group devised a sexual health training programme that provided culturally appropriate ways of reaching them with health information. Fifteen to 20 volunteer youth trainers attended a one-day training session with experts from the Family Planning Association (FPA), Primary Health Organizations (PHOs) and sexual health providers. The Group also provided ongoing support and mentoring to the volunteers. As well as training youth workers, the Group developed resource packs for distribution to citizens’ advice bureaux (CABs) and local high schools across Papakura, Manukau, Auckland City and Waitakere. It is estimated that the volunteers went on to directly reached an estimated 200 young Asian women with their newfound skills and information, while the printed resource packs reached countless more.
HPF’s Senior Health Promotion Strategist in charge of the Pacific portfolio, Dr Viliami Puloka, reports that non-communicable diseases (NCDs) – many of which are preventable – are the overwhelming cause of death in Tonga. The good news is that Tonga recognises the problem and is prioritising it at a government level. Dr Puloka believes the situation there is reflected across the Pacific and that we should keep a close eye on the results of the work being done in Tonga to address the problem.
Babies in Tonga have an excellent survival rate, with just 15 out of 1,000 dying before they reach the age of five – a mortality rate of 1.5%. However this picture changes dramatically once Tongans reach 15, where 25.6 % of males and 35.1% of females die before they reach 60 years of age. [i] Much of this dramatic increase in mortality is accounted-for by NCDs, of which diabetes and cardiovascular disease are the main culprits.
Tonga top of the obesity league table
According to an article in British newspaper The Guardian in August 2006, more than 90% of Tongans are overweight; making it the world’s fattest nation .[ii] In 2012 a league table from the London School of Hygiene and Tropical Medicine, supported this figure; putting Micronesia and Tonga at the top of the obesity league table, just ahead of the United States.[iii]
Non-communicable diseases account for approximately 74% of all deaths in the Pacific nation. Of these the vast majority are preventable diseases such as diabetes and cardiovascular disease. [iv]
It’s not hard to see why NCDs are so prevalent here. Two research papers, summarised in Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004) found that overall 60.7% of the Tongan population was at high risk of NCDs, with three to five risk factors from the following list:
Tonga top of the obesity league table
According to an article in British newspaper The Guardian in August 2006, more than 90% of Tongans are overweight; making it the world’s fattest nation .[ii] In 2012 a league table from the London School of Hygiene and Tropical Medicine, supported this figure; putting Micronesia and Tonga at the top of the obesity league table, just ahead of the United States.[iii]
Non-communicable diseases account for approximately 74% of all deaths in the Pacific nation. Of these the vast majority are preventable diseases such as diabetes and cardiovascular disease. [iv]
It’s not hard to see why NCDs are so prevalent here. Two research papers, summarised in Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004) found that overall 60.7% of the Tongan population was at high risk of NCDs, with three to five risk factors from the following list:
- Smoking (46.2% of males and 16.3% of females aged 15-64 years)
- Alcohol consumption (22.2% of males and 4.8% of females aged 15-64 years)
- Low fruit and vegetable intake (approximately 92.8% of Tongans aged 15-64 reported they eat less than the require five servings of fruit and vegetables a day)
- Low physical activity (54.8% of females and 32.4% of males aged 15-64)
- Obesity (76.3% of females and 60.7% of males aged 25-64)
- High blood sugar (16.4% of Tongans aged 25-64 had elevated blood glucose levels)
- High blood cholesterol (66.1% of men and 34.2% of women aged 25-64 had blood cholesterol levels of more than 5.00 mmol/L)
[i] S. Hufanga et al Mortality Trend in Tonga . Population Health Metric 2012
[ii] The Guardian, Thursday 3 August 2006 http://www.theguardian.com/lifeandstyle/2006/aug/03/healthandwellbeing.health
[iii] http://www.telegraph.co.uk/earth/earthnews/9345086/The-worlds-fattest-countries-how-do-you-compare.html
[iv] WHO Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004)
[v] Doran C. Pacific Action for Health Project: Economic impact assessmentof noncommunicable diseases on hospital resources in Tonga, Vanuatu and Kiribati. 2003
Following her attendance at the Equity at the Centre Conference in Alice Springs (4-5 September 2014), HPF Senior Health Promotion Strategist Karen Hicks reports on some of the presentations made during the two day event.
Read an overview of the highlights from Karen.
The economics of social jutice – cost benefit analysis to achieve social determinants action
The main thrust of Martin Laverty’s presentation was that equity is an economic asset for a country and should be valued as such.Politics, Power and People
“Austerity kills” – that was the claim of Sharon Friel, Professor of Health Equity at the Australian National University, Canberra in her presentationPower and People: a game plan for health equity in the 21st Century.Economics, News, Policy
Health professionals are calling for a comprehensive health impact assessment of the Trans-Pacific Partnership (TPP) agreement to protect the health of New Zealanders. According to leaked information, international big business – such as the tobacco or alcohol industries – could sue the New Zealand government if the country’s health-based policies threaten their profits. Clauses designed to protect the intellectual property rights of the pharmaceutical industry would apparently prevent PHARMAC purchasing cheaper generic drugs; making medicines more expensive in New Zealand.
“The negotiations are all being carried out in secret, and the little that has leaked out is very worrying,” says Dr Joshua Freeman, a spokesperson for the ten health organisations involved.
“New Zealand should have the sovereign right to make laws and policies for the wellbeing of its people without interference. Under the TPP it appears that New Zealand could find itself in the international trade tribunal if it brings in new policy around, for example, tobacco, alcohol, unhealthy food, or environmental regulation.”
Read the full media release.
28 October 2014
Jo Lawrence-King
A briefing by the New Zealand College of Public Health Medicine (NZPCHM) for the incoming Health Minister focuses his attention on seven key issues:
- health equity
- child poverty and child health
- climate change
- housing
- nutrition and physical activity
- smoking
- alchohol.
Uncategorized
Election 2014: NZ political parties state their position
All but one of all New Zealand’s political parties have responded to last month’s invitation, by the Institutional Racism Special Interest Group (IRSIG), to state their position on addressing institutional racism in Aotearoa New Zealand. Responses were as wide-ranging as the political parties. A brief paragraph from the Act party suggested the issue centres on preferential treatment of Māori, while the Green Party issued an in-depth statement acknowledging that health and wellbeing is a basic human right and needs to be upheld for all New Zealanders, regardless of their ethnicity. The New Zealand Labour Party was the only party to decline to respond Institutional racism is defined as “an entrenched pattern of differential access to material resources and power determined by race, which advantages one sector of the population while disadvantaging another”[1]. Present-day examples of institutional racism can be seen in Waitangi Tribunal claims and lead to inequities in health, education, employment and criminal justice outcomes for Māori [and other ethnic minorities?]. The IRSIG is a tripartite group, with members from the Health Promotion Forum of New Zealand – Runanga Whakapiki Ake i te Hauora o Aotearoa, the Public Health Association and the Māori Public Health Leaders Alumni. Read the report on the parties’ responses.Beginning to address institutional racism within the public health sector: insights from a provider survey – Keeping up to Date paper – Autumn/Winter 2013
Dr Heather Came’s paper identifies ongoing institutional racism and privilege in the public health sector, that breach Te Tiriti o Waitangi and contravene the stated public health and health promotion ethical principles. It identifies a range of actions health funders can take to address the problem. This was the 38th edition of the HPF’s Keeping Up to Date series of peer-reviewed papers. Dr Came is Programme Leader/Lecturer in Community Health Development and Aucklant University of Technology (AUT).
In the report from the Equity at the Centre Congress in Alice Springs (4-5 September 2014), HPF Senior Health Promotion Strategist Karen Hicks Martin Laverty’s presentation.
According to Martin Lavety, CEO of Catholic Health Australia; equity is an economic asset for a country and should be valued as such. His advice to those advocating equity with governments that focus on indivicual respoinsibility was to argue the case that investiment in social capital (e.g. housing, safe pregnancy, economic development) is necessary in order to make individual responsibility possible.
“If we want people to be productive and to have economic growth,” said Lavety, “we need a healthy population.” He pointed out that people are unable to take individual responsibility for their health if it is already compromised.
The 2008 World Health Organisation’s Commission on Social Determinants of Health Closing the Gap report provided a road map for governments to improve population wide health outcomes. The WHO’s work received little attention in Australia when Closing the Gap was released, and its recommendations were ignored by the then Federal Government. In 2011, 40 social determinant advocates contributed to the book Determining the Future: A fair go and health for all. The book outlined actions Australia could take to implement the WHO’s recommendations and argued a Senate Inquiry should inform Australia’s next steps. Associated with the book’s publication was the emergence of the Social Determinants of Health Alliance (SDOHA), which is today leading national advocacy for action on social determinants. In mid-2012, a tri-partisan Senate Inquiry with backing of the Liberal Party, Labor Party, and Greens recommended the Australian Government adopt the 2008 WHO Closing the Gap report and commit to addressing the social determinants of health relevant to the Australian context. The Senate said government should adopt administrative practices that ensure consideration of the social determinants of health in all relevant policy development activities, particularly education, employment, housing, family, and social security policy. The Senate further said the National Health and Medical Research Council (NHMRC) should give greater emphasis in grant making to social determinants research. It concluded its recommendations by saying annual progress reports to Federal Parliament should be a key requirement of addressing the social determinants of health. With tri-partisan support for these Senate recommendations on social determinants, this presentation will state the social and economic case for adoption of the WHO social determinants framework, outline success to date in working to instil social determinants within government decision making, and also propose the next stages of an advocacy campaign to see the Senate recommendations implemented nationally.
Abstract for Martin Laverty’s presentation
The 2008 World Health Organisation’s Commission on Social Determinants of Health Closing the Gap report provided a road map for governments to improve population wide health outcomes. The WHO’s work received little attention in Australia when Closing the Gap was released, and its recommendations were ignored by the then Federal Government. In 2011, 40 social determinant advocates contributed to the book Determining the Future: A fair go and health for all. The book outlined actions Australia could take to implement the WHO’s recommendations and argued a Senate Inquiry should inform Australia’s next steps. Associated with the book’s publication was the emergence of the Social Determinants of Health Alliance (SDOHA), which is today leading national advocacy for action on social determinants. In mid-2012, a tri-partisan Senate Inquiry with backing of the Liberal Party, Labor Party, and Greens recommended the Australian Government adopt the 2008 WHO Closing the Gap report and commit to addressing the social determinants of health relevant to the Australian context. The Senate said government should adopt administrative practices that ensure consideration of the social determinants of health in all relevant policy development activities, particularly education, employment, housing, family, and social security policy. The Senate further said the National Health and Medical Research Council (NHMRC) should give greater emphasis in grant making to social determinants research. It concluded its recommendations by saying annual progress reports to Federal Parliament should be a key requirement of addressing the social determinants of health. With tri-partisan support for these Senate recommendations on social determinants, this presentation will state the social and economic case for adoption of the WHO social determinants framework, outline success to date in working to instil social determinants within government decision making, and also propose the next stages of an advocacy campaign to see the Senate recommendations implemented nationally.
Biography
Martin Laverty is the CEO of Catholic Health Australia, a network comprising ten percent of the nation’s not-for-profit hospital and aged care beds. He is also the inaugural Chair of the Social Determinants of Health Alliance and co-editor of the 2011 book Determining the Future: A Fair Go & Health for All, a book that contributed to a Senate Inquiry being established on social determinants of health. He is a member of the National Disability Insurance Scheme board, a member of the NSW Public Service Commission board, and a member of the Federal Government’s Aged Care Sector Committee. He is the Board Chair of the NSW Heart Foundation, and a member of the National Heart Foundation Board. He is also a member of the National Health Performance Authority Advisory Committee for Private Hospitals, and a member of the Australian Catholic University Faculty of Health Sciences advisory board. Martin is a lawyer by training, and is near to completing a PhD in governance of not-for-profit health services. 25 September 2014 Jo Lawrence-KingNews, Policy, Racism
All but one of all the political parties of New Zealand have responded to last month’s invitation, by the Institutional Racism Special Interest Group (IRSIG), to state their position on addressing institutional racism in Aotearoa New Zealand.
Responses were as wide-ranging as the political parties. A brief paragraph from the Act party suggested the issue centres on preferential treatment of Māori, while the Green Party issued an in-depth statement acknowledging that health and wellbeing is a basic human right and needs to be upheld for all New Zealanders, regardless of their ethnicity.
The New Zealand Labour Party was the only party to decline to respond
Institutional racism is defined as “an entrenched pattern of differential access to material resources and power determined by race, which advantages one sector of the population while disadvantaging another”[1]. Present-day examples of institutional racism can be seen in Waitangi Tribunal claims and lead to inequities in health, education, employment and criminal justice outcomes for Māori [and other ethnic minorities?].
The IRSIG is a tripartite group, with members from the Health Promotion Forum of New Zealand – Runanga Whakapiki Ake i te Hauora o Aotearoa, the Public Health Association and the Māori Public Health Leaders Alumni.
Read the ISRIG’s report on the parties’ responses.
Competencies, News
A recent evaluation of HPF’s Certificate of Achievement in Introducing Health Promotion – often referred to as the ‘short course’ – has revealed that the course is highly valued by attendees and has had a positive effect not only on them but on their practice, their colleagues and, in many cases, their organisation. Read more in our training section. – See more at: http://www.hauora.co.nz/certificate-of-achievement-course-highly-valued-survey-results1.html#sthash.4vjgnBES.dpuf
A new occasional paper published this week argues that, in building the capacity of the HP workforce, models of good practice in education and training should be explored and utilised that truly reflect inherent HP values and principles. She proposes that self-directed and work-based learning are relevant and should be explored in more detail by trainers and educators across the globe.
Caroline is a Research Fellow at the Centre for Health Research, University of Brighton, UK.
News, What is HP
Sixteen people met in Auckland on Monday 9 June to ratify the founding constitution of the world’s first health promotion professional society. “This is a significant phase in what has been a wonderful journey,” said HPF’s Deputy Executive Director Trevor Simpson, who has been a driving force behind the Society for the past 4 years. “It was a privilege to be given this portfolio.”
At the meeting the health promotion supporters agreed the founding constitution of the Society. It will be an independent organisation with paid membership open to anyone who observes the ethos and values of health promotion, regardless of their academic or professional qualification.
The next step will be to lodge documentation with the Companies Office with a view to creating a registered Society, a formal legal body.
The concept of a professional organisation in Aotearoa was first mooted 18 years ago and has undergone close scrutiny and questioning over this time. Trevor Simpson is confident that this robust discussion around its establishment will result in a thoughtfully planned, “nimble, stand-on-its-own-two-feet organisation”.
Providing an overview of the history of the Society’s formation, Trevor referred to the country’s heritage of leadership in change and human rights. “New Zealanders have shown over and over that we are leaders in standing up for what we think we should have,” he said; citing Te Whiiti (Parihaka), Kate Sheppard (votes for women) and David Lange (nuclear-free NZ) as just some examples.
Present at the meeting were two members of the Professional Society Interim Committee. Ann Shaw, of both the PHA and the Cancer Society has been involved in the initiative since its inception. Grant Hocking, from Action on Smoking and Health (ASH), joined the committee three years ago. Trevor acknowledged their contribution as well as that of past members including:
- Dr Alison Blaiklock (past HPF Executive Director)
- Cheryl Ford (of Cancer Society Christchurch)
- Helen Rance (past Health Promotion Strategist at HPF)
- Grant Berghan (Public Health Consultant)
Diet, News
The NZ College of Public Health Medicine is backing the New Zealand Medical Association’s call for more urgent and coordinated action on the country’s obesity time bomb, claiming it will soon be a bigger problem than smoking.
With two thirds of adults and one third of children either overweight or obese, the College says that New Zealand is on track for obesity to overtake tobacco as the leading cause of health loss by 2016.
“We can’t afford to overlook the severity and long-term ramifications of this issue and how it will affect children as they grow and develop,” says College president Dr Julia Peters.
“What is needed is a comprehensive approach including legislative and regulatory controls, similar to what has been applied to smoking over the last 30 years.”
Programmes designed to address the issue need to focus on prevention, particularly amongst children and communities in which the epidemic is most profound. We need to be “making the healthy choice the easy choice.”
Fortunately, we have lessons from our success with tobacco control that can be applied to the obesity issue and also some examples of successful community based programmes. However, as a society, we need to galvanise around a long term, comprehensive strategy.
“This problem has crept up on us over 40 years and it is not going to go away overnight. A good place to start is the list of recommendations from the New Zealand Medical Association” said Dr Peters.
The NZCPHM and NZMA echo the recent call by Consumers International (CI) and World Obesity Federation (WOF) on the international community to develop a global convention to fight diet-related ill health, similar to the legal framework for tobacco control. Read more.
– See more at: http://www.hauora.co.nz/obesity-worse-than-smoking-for-health-impacts-on-kiwis.html#sthash.hMzfxyuT.dpuf
Diet, Global, News
Consumers International (CI) and World Obesity Federation (WOF) are calling on the international community to develop a global convention to fight diet-related ill health, similar to the legal framework for tobacco control. Unhealthy diets now rank above tobacco as a global cause of preventable non-communicable diseases (NCDs).
The two international membership bodies will officially launch their Recommendations towards a Global Convention to protect and promote healthy diets at the World Health Assembly in Geneva.
The Recommendations call on governments to make a binding commitment to introduce a raft of policy measures designed to help consumers make healthier choices and improve nutrition security for everyone.
Measures include placing stricter controls on food marketing, improving the provision of nutrition information, requiring reformulation of unhealthy food products, raising standards for food provided in public institutions and using economic tools to influence consumption patterns.
Publication of the Recommendations comes on the 10th anniversary of the WHO Global Strategy on Diet and Physical Activity and Health, which recognised the impact of unhealthy diet and lifestyle.
Since then however, global deaths attributable to obesity and overweight have risen from 2.6 million in 2005 to 3.4 million in 2010, thus intensifying the pressure on governments to take stronger action to tackle the rising epidemic of obesity and consequent chronic disease.
Consumers International Director General, Amanda Long says: “The scale of the impact of unhealthy food on consumer health is comparable to the impact of cigarettes. The food and beverage industry has dragged its feet on meaningful change and governments have felt unable or unwilling to act.
“The only answer remaining for the global community is a framework convention and we urge governments to seriously consider our recommendations for achieving that. If they do not, we risk decades of obstruction from industry and a repeat of the catastrophic global health crisis caused by smoking.”
“If obesity was an infectious disease we would have seen billions of dollars being invested in bringing it under control,” said Dr Tim Lobstein, World Obesity Fediration Director of Policy. “But because obesity is largely caused by the overconsumption of fatty and sugary foods, we have seen policy-makers unwilling to take on the corporate interests who promote these foods. Governments need to take collective action and a framework convention offers them the chance to do this.”
Here in New Zealand the Government has recently announced funding for the Healthy Families NZ scheme, aimed at reducing obesity and improving the health outcomes for more disadvantaged communities around the country. Read our article from February 2014 on this initiative.
Obesity is a major risk factor for a wide range of non-communicable diseases. Figures show that in 2008, 36 million people died from non-communicable diseases, representing 63 per cent of the 57 million global deaths that year. In 2030, such diseases are projected to claim the lives of 52 million people.
Read the full recommendations from CI and WOF.
Press release from Consumers International
Photo: Byron Solomon – StockXchng.com
20 May 2014
Diet, Global, News
Consumers International (CI) and World Obesity Federation (WOF) are calling on the international community to develop a global convention to fight diet-related ill health, similar to the legal framework for tobacco control. Unhealthy diets now rank above tobacco as a global cause of preventable non-communicable diseases (NCDs). The two international membership bodies will officially launch their Recommendations towards a Global Convention to protect and promote healthy diets at the World Health Assembly in Geneva.
The Recommendations call on governments to make a binding commitment to introduce a raft of policy measures designed to help consumers make healthier choices and improve nutrition security for everyone.
Measures include placing stricter controls on food marketing, improving the provision of nutrition information, requiring reformulation of unhealthy food products, raising standards for food provided in public institutions and using economic tools to influence consumption patterns.
Publication of the Recommendations comes on the 10th anniversary of the WHO Global Strategy on Diet and Physical Activity and Health, which recognised the impact of unhealthy diet and lifestyle.
Since then however, global deaths attributable to obesity and overweight have risen from 2.6 million in 2005 to 3.4 million in 2010, thus intensifying the pressure on governments to take stronger action to tackle the rising epidemic of obesity and consequent chronic disease.
Consumers International Director General, Amanda Long says: “The scale of the impact of unhealthy food on consumer health is comparable to the impact of cigarettes. The food and beverage industry has dragged its feet on meaningful change and governments have felt unable or unwilling to act.
“The only answer remaining for the global community is a framework convention and we urge governments to seriously consider our recommendations for achieving that. If they do not, we risk decades of obstruction from industry and a repeat of the catastrophic global health crisis caused by smoking.”
“If obesity was an infectious disease we would have seen billions of dollars being invested in bringing it under control,” said Dr Tim Lobstein, World Obesity Fediration Director of Policy. “But because obesity is largely caused by the overconsumption of fatty and sugary foods, we have seen policy-makers unwilling to take on the corporate interests who promote these foods. Governments need to take collective action and a framework convention offers them the chance to do this.”
Here in New Zealand the Government has recently announced funding for the Healthy Families NZ scheme, aimed at reducing obesity and improving the health outcomes for more disadvantaged communities around the country. Read our article from February 2014 on this initiative.
Obesity is a major risk factor for a wide range of non-communicable diseases. Figures show that in 2008, 36 million people died from non-communicable diseases, representing 63 per cent of the 57 million global deaths that year. In 2030, such diseases are projected to claim the lives of 52 million people.
Read the full recommendations from CI and WOF.
Press release from Consumers International
Photo: Byron Solomon – StockXchng.com
20 May 2014
Global, News, Policy
An in-depth paper published in The Lancet this February urges policy makers to recognise and address global political determinants of health inequity. “Grave health inequity is morally unacceptable,” the authors say; it is a “global political responsibility” to ensure “transnational activity does not hinder people from attaining their full health potential.”
The paper, produced by the Commission on Global Governance for Health challenges the ‘biological’ argument for health inequalities and places the main responsibility for them firmly at the feet of national governments around the world; calling on them to redress the imbalance of fairness and justice that currently exist. “Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven,” say the paper’s authors.
“Health equity should be a cross-sectoral political concern, since the health sector cannot address these challenges alone”. The Commission recognises the crucial role of the health sector in addressing health inequalities it points out that the sectors efforts “often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.”
“This is a timely development for the discourse about our health and the wellbeing of our planet,” says HPF Executive Director Sione Tu’itahi. “What happens at the international level impacts directly on the local level, whether we like it or not: take global warming and trade, for example. Worldwide political determinants are rising fast but our governance and policy framework are still largely focused on local and national interests at the expense of our collective wellbeing. As a global family, we can no longer afford to focus on the room that we occupy when the whole house is battered by the storm.”
The political origins of health inequity: prospects for change
The Lancet, Volume 383, Issue 9917, Pages 630 – 667, 15 February 2014
Access the article online at The Lancet here (you will need to register, but it is free)
1 May 2014
By: Sione Tu’itahi
Edited: Jo Lawrence-King
Pacific, Policy, What is HP
South West Pacific health promotion leaders have undertaken in March to develop a work plan that includes research, New Zealand representation at global health promotion meetings and to develop a health promotion work plan for the region.
The decisions were taken at a March meeting of the South West Pacific regional committee of the International Union of Health Promotion and Education (IUHPE)
Health promotion work plan for the South West Pacific
The committee is to begin work on a plan for health promotion development for the South West Pacific region. Priority areas for the three-year plan include
- workforce development
- research,
- indigenous health promotion and health issues.
Highlights from the International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion
– “Best Investment for Health” IUHPE President Michael Sparks took time out of his busy schedule to present the highlights of the conference for HPF.
The 21st International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion in Pattaya Thailand was noted for its truly global focus. More than 2,000 delegates, from over 80 countries attended the event this August. The theme – ‘Best Investment for Health” – provided many opportunities to discuss and debate this crucial question, as well as to share good practice, network and socialise.
It was the first time the conference was held in a developing Asian nation. This gave participants from the region an unprecedented opportunity to participate. In turn, it afforded a greater understanding among all participants of the varying levels of investment in health promotion across countries and of the broad range of issues affecting the practice of health promotion across the different contexts.
Highlights of the 21st International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion:
|
New Zealand contribution
Of particular interest was the work done by the IUHPE’s Indigenous Health Promotion Network. Work done in the South West Pacific region with Māori and Indigenous Australian populations is often viewed as cutting edge and sessions were well attended by conference participants from other countries. Presentations from the region included a well-received one by HPF’s Deputy Executive Director Trevor Simpson. Another development of particular interest to health promoters of Aotearoa New Zealand was the shifting of the leadership in the South West Pacific region of the IUHPE to this country. The Health Promotion Forum of New Zealand Executive Director, Sione Tu’itahi, has been elected Vice-President of the South West Pacific Region of IUHPE, while Associate Professor Louise Signal, Director of the Health Promotion and Policy Research Unit (HePPRU) and Health, Wellbeing & Equity Impact Assessment Research Unit (HIA), Department of Public Health, Otago University is its Regional Director. Until now these positions have been drawn from Australia for many year.Delegates weighed in to support local battle to improve tobacco control in Thailand
During the conference there were also interesting developments in relation to local tobacco controls. The tobacco Giant Philip Morris challenged in court the Thai Ministry of Public Health’s legislation to increase health warnings on cigarette packages to 85% of the outer surface. The country’s lower court issued an injunction against the Public Health Ministry to suspend enforcement of the regulations. Informed of these developments, conference delegates took action: developing a letter of support to the minister and petitioning the IUHPE General Assembly to write to the minister. Delegates also participated in a local media event to publicise the global support for tobacco control clearly evident at the conference. Following the conference The Ministry, encouraged by the support from the global health promotion community, has appealed against the injunction to the Supreme Court. A ruling is expected late this year or early in 2014.New awards created
Two new awards were created this year: the “most liked” daily poster session and the “Health Promotion Practice” awards. Recipients of the latter were three distinguished practitioners:- Dr. Gene R.Carter, the Executive Director and CEO of ASCD (formerly the Association for Supervision and Curriculum Development)
- Prof.Prakit Vathesatogkit, Executive Secretary, The Action on Smoking and Health Foundation
- Dr. Don Eliseo Lucero-Prisno III, Lecturer, University of Liverpool
Commission on Global Governance for Health calls on national governments to address global political determinants
An in-depth paper published in The Lancet in February 2014 urges policy makers to recognise and address global political determinants of health inequity. “Grave health inequity is morally unacceptable,” the authors say; it is a “global political responsibility” to ensure “transnational activity does not hinder people from attaining their full health potential.”
The paper, produced by the Commission on Global Governance for Health challenges the ‘biological’ argument for health inequalities and places the main responsibility for them firmly at the feet of national governments around the world; calling on them to redress the imbalance of fairness and justice that currently exist. “Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven,” say the paper’s authors.
“Health equity should be a cross-sectoral political concern, since the health sector cannot address these challenges alone”. The Commission recognises the crucial role of the health sector in addressing health inequalities it points out that the sectors efforts “often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.”
“This is a timely development for the discourse about our health and the wellbeing of our planet,” says HPF Executive Director Sione Tu’itahi. “What happens at the international level impacts directly on the local level, whether we like it or not: take global warming and trade, for example. Worldwide political determinants are rising fast but our governance and policy framework are still largely focused on local and national interests at the expense of our collective wellbeing. As a global family, we can no longer afford to focus on the room that we occupy when the whole house is battered by the storm.”
The political origins of health inequity: prospects for change
The Lancet, Volume 383, Issue 9917, Pages 630 – 667, 15 February 2014
Access the article online at The Lancet here (you will need to register, but it is free)
February 2014
Jo Lawrence-King
An in-depth paper published in The Lancet in February 2014 urges policy makers to recognise and address global political determinants of health inequity. “Grave health inequity is morally unacceptable,” the authors say; it is a “global political responsibility” to ensure “transnational activity does not hinder people from attaining their full health potential.”
The paper, produced by the Commission on Global Governance for Health challenges the ‘biological’ argument for health inequalities and places the main responsibility for them firmly at the feet of national governments around the world; calling on them to redress the imbalance of fairness and justice that currently exist. “Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven,” say the paper’s authors.
“Health equity should be a cross-sectoral political concern, since the health sector cannot address these challenges alone”. The Commission recognises the crucial role of the health sector in addressing health inequalities it points out that the sectors efforts “often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.”
“This is a timely development for the discourse about our health and the wellbeing of our planet,” says HPF Executive Director Sione Tu’itahi. “What happens at the international level impacts directly on the local level, whether we like it or not: take global warming and trade, for example. Worldwide political determinants are rising fast but our governance and policy framework are still largely focused on local and national interests at the expense of our collective wellbeing. As a global family, we can no longer afford to focus on the room that we occupy when the whole house is battered by the storm.”
The political origins of health inequity: prospects for change
The Lancet, Volume 383, Issue 9917, Pages 630 – 667, 15 February 2014
Access the article online at The Lancet here (you will need to register, but it is free)
February 2014
Jo Lawrence-King
The World Health Organisation (WHO) has published five new policy guides for addressing health inequity. The guides have been produced by New Zealand Doctor Belinda Loring, a past Fellow of Health Promotion Forum with a strong interest in health equity and action on the social determinants of health. While she was still in New Zealand Dr Loring worked on health equity and public health at local, regional and national government levels, with a strong focus on Māori health inequities.
The equity action spectrum: taking a comprehensive approach
Alcohol and inequities
Injuries and inequities
Obesity and inequities
Tobacco and inequities
The interdisciplinary nature of health promotion places it at the cutting edge of health and wellbeing: offering creative and effective ways to promote wellbeing and protect groups, communities and populations from health challenges. It shares a common ground with several disciplines that focus on human and ecological wellbeing. One such discipline is social development.
We have reached a point where the challenges facing social and economic wellbeing are global; requiring action at all levels from local and national to regional and worldwide. We have seen the limitations of a narrow, discipline-focused approach. According to Sir Mason Durie:[1] “…the failure of groups working in isolation to make substantial gains requires new approaches that are not handicapped by sectorial limitations or simplistic conclusions that one body of knowledge or one professional group has all the answers.”
Health promotion and social development share many common principles
Although based in different sectors, the fields of social development and health promotion share some common underlying principles. This common ground provides a strong framework for closer collaboration between the different disciplines; yielding benefits, effectiveness and efficiency for all concerned.
Some of these common principles are:
- The aim of advancing the holistic health and wellbeing of peoples and communities
- A core set of underlying causes or determinants that can make or break the health and social wellbeing of peoples and communities
- The understanding that health and development must be achieved with approaches that are sustainable for both humans and the rest of the ecology
- A belief in the inherent power and ability of peoples and communities to take control of these underlying causes, and, therefore, be the masters of their own futures[i]
- Similar strategies, such as community development, whānau and family capacity building, for addressing the needs of peoples and communities.
HPF video answers the question; What is health promotion?
Watch the 2 minute 30 second video, including contributions from IUHPE president Michael Sparks and HPF Deputy Executive Director Trevor Simpson.Prof John Raeburn: Health Promotion advocate
Read this warm, humble and in-depth interview with Emeritus Prof John Raeburn, whose 40+ years in health promotion have helped shape the profession.Defining health promotion
Health promotion is both a discipline and a process. It focuses on empowering people and communities to take control of their health and wellbeing. Ranging from action at a community level to developing policies, it is founded on the principle that health and wellbeing begins in the settings of everyday life. Read more
Video: What if?…. health promotion campaigns actually worked?
In this 50 minute video, Dr Ekant Veer from the University of Canterbury discusses the severe limitations of NZ’s heavy reliance on mass media as a way of sharing knowledge to attempt health promotion. He explores the other factors needed to create successful health promotion initiatives, such as:- social norms
- past experience
- perceived consequences
- environment
- personal ability
The need for health promotion as a distinct approach
The World Health Organisation (WHO) asserts that factors such as where we live, our environment, genetics, education and relationships have a greater influence on our health and wellbeing than the commonly considered factors such as access to health care services [vi]. Although the causal pathway between the two is long, evidence to support this correlation is growing. Health promotion includes work to build that evidence and identify ways to build population health by improving the determinants.Health promotion is at the cutting edge of hauora
The interdisciplinary nature of health promotion places it at the cutting edge of health and wellbeing: offering creative and effective ways to promote wellbeing and protect groups, communities and populations from health challenges. Read moreHealth promotion: a distinct discipline
In his 2013 paper, Prof. John Kenneth Davies concludes health promotion has a unique and specialised role within a wider multidisciplinary approach to maintaining and improving health.Video: The close link between human rights and health promotion
“States and others have legally binding obligations to engage in health promotion,” says Paul Hunt at the 20th Conference of the International Union of Health Promotion and Education. Health promotion is part of the government’s role in upholding a person’s right to the hightest attainable standard of health. Also see HPF’s The Right to Health – Proceedings of the Health and Human Rights Workshops, 2012.Video: Understanding Health Promotion (Canada)
Ass’t Prof Suzanne Jackson discusses health promotion under the frameworks of the Ottawa and Bangkok charters. (8 mins)Keeping Up to Date paper: Health promotion and spirituality: making the implicit explicit
Richard Egan explores the place of spirituality in health promotion in the 34th of HPF’s Keeping Up to Date peer-reviewed papers. “In New Zealand, partly due to the contributions and aspirations of Māori, spiritual concerns are understood as an essential component of health.” Egan’s paper argues that, due to growing evidence and a principled approach, attending to spirituality in health promotion is an ethical imperative, critical to our reflective practice and necessary for comprehensive planning, action and evaluation. Richard is a Research and Teaching Fellow at the Cancer Society Social and Behavioural Research Unit, Te Hunga Rangahau Arae Mate Pukupuku, Department of Preventive and Social Medicine, University of Otago, Dunedin.
The Health Promotion Forum has been striving to encapsulate the discipline of health promotion in a few words. This is a challenge that has vexed the profession since it first emerged several decades ago. It is widely acknowledged that we need a clear definition of health promotion to effectively communicate its purpose and value to others.
Below is our definition, which we invite health promoters around the country – and the world – to adopt.
At HPF the discussions around defining health promotion have covered a wide range of topics. Our conclusions – on some of these topics – have been:
April 2014
By Jo Lawrence-King, Karen Hicks and Sione Tu’itahi
Edited by Jo Lawrence-King
| Health promotion is both a discipline and a process. It focuses on empowering people and communities to take control of their health and wellbeing. Ranging from action at a community level to developing policies, it is founded on the principle that health and wellbeing begins in the settings of everyday life.
Health Promotion Forum of New Zealand
Runanga Whakapiki Ake i te Hauora o Aotearoa
April 2014 |
- There are three perspectives on health promotion relevant to the Aotearoa New Zealand setting.
- Health promotion is a unique discipline and is distinct from public health and health education.
- Health promotion is one of the disciplines that together work towards optimising population health.
- From a Western perspective, health promotion is a public health discipline. It is the process of enabling peoples and communities to take greater control of their health[ii].
- From a Māori view point, health promotion is the enabling of Māori to take greater control of the determinants of their health and therefore their future[iii].
- From a Pasifika perspective, health promotion is the empowering of Pasifika peoples to control their wellbeing and their future[iv].
We look forward to continuing discussions around this complex question.
[i] World Health Organization. 1986. Ottawa Charter, Geneva
[ii] World Health Organization 1986. Ottawa Charter, Geneva
[iii] Mihi Ratima, M. 2010. Māori health promotion – a comprehensive
definition and strategic considerations, Health Promotion Forum, Auckland
[iv] Tu’itahi, S. & Lima, I. 2014. Pacific health promotion, a chapter soon to be published in textbook of health promotion, Otago University Press.
Pacific families and communities are taking increased control over their wellbeing and future, with initiatives such as Whanau Ora and Fanau Ola. With this trend comes a corresponding need to better understand the philosophies of these indigenous cultures.
Here HPF Executive Director Sione Tu’itahi explores kautaha: one of the underlying concepts that inspire and inform the Māori and Pacific view of self-sufficiency and self-determination.
Kautaha is a model for working together towards a common goal. It is underpinned by a set of related and coherent principles that takes a unified approach and focuses on strengths, potential, and solutions rather than on accentuating problems and deficits. For these reasons the kautaha approach has been highly effective across history and could be successfully adapted to collective endeavours such as Fanau Ola, socio-economic and community development.
Kautaha is a Tongan term and a Pacific concept with several layers of meaning. Its Samoan equivalent is ‘aufa’atasi. The Māori synonym iskotahitanga.
The concept and practice of kautaha seems to draw on the collective nature of Tongan culture, which is also a common feature of other Pacific cultures. The approach is strengths-based and complementary rather than being competitive and adversarial. It promotes striving for excellence and the common good of all. The final outcome is a more equitable distribution of wealth and wellbeing.
In the Tongan context, one definition of kautaha is that of a group of people or parties who agree to work collaboratively in order to achieve their common purpose. In Tonga ‘ufi (yam) farmers in the village would come together and form a collective labour force (kautaha toungaue) that moved around and tended the yam garden of each member. Similarly, the women would form a kautaha toulalanga or koka’anga/kautaha of weavers or tapa makers.
On a regional level, a few decades back, some of our great tufunga (nation builders) established a kautaha, now called the Pacific Islands Forum, so that they could talanoa (talk) more freely about our political and socio-economic needs as island nations.
The philosophy
Unity in diversity is a philosophy that embraces biological and cultural diversity as essential to human existence. Unique differences are seen not only as inherent characteristics and rights but also appreciated as strengths to be respected, celebrated and utilised for the collective good[i].
To illustrate the efficacy of unity in diversity, let us briefly look at two examples. First, all human organs and body parts are of different shape and form and they all have different functions. But they all contribute to one purpose: the wellbeing of the whole human being. Second, cultural and ethnic groups of the world may be different in colour, shape and form, but they all belong to the human race and are dwellers of one planet. They have a choice to share their collective, common, global resource in order to live together, or they continue to squabble over it and, consequently, die together.
Importantly also within the process of kautaha, is the central principle of va(space)[ii]. The maintaining of that relational space (tauhi va) guards the wellbeing and progress of the individuals as well as the collective .
The kautaha approach is effective when its underpinning principles are adhered to, and used to inform the practice.
Some of these principles are: angatonu (integrity), fefaka’apa’apa’aki (mutual respect), lelei fakakatoa (collective good), tukupa (commitment), tu’unga tatau (equality), and tuha mo taau (equity).
The word and its meaning
Analysed linguistically, kautaha is made up of two related but distinct root words. The first is kau – to belong, to join, to participate, or to become a partner. The second is taha – to collectively unite, to become one, to collaborate.
In one sense, kau reflects an invitation by a caller, and a choice of the called to join, or not to join. Taha implies that the intention of the caller is to collaborate with the invitees, and to work in unity towards a common purpose which will serve the common good.
The invitees are expected to subscribe to the same set of values and goals. In another sense, kautaha means coming together to talanoa[iii] (talk) and then agree to collaborate on common needs and aspirations. There are no callers and there are no called. While all are equal collaborators, this is not to say that kautaha means unity by conformity or uniformity. Rather, kautaha is about unity in diversity.
Kautaha offers us a model of unity and cooperation that empowers and benefits all members of the cooperative. It is a valuable concept of Whanau Ora and can be applied across a wide range of health promotion initiatives.
[i] Pacific Islands Forum. (2005) The Pacific Plan, Pacific Islands Forum, Suva
[ii] Mahina, ‘O. (2004). Reed Book of Tongan Proverbs, Auckland, Reed Publishing (NZ) Ltd
[iii] Manu’atu, L. (2000). Tuli ke Ma’u Hono Ngaahi Malie: Pedagogical possibilities for Tongan students in New Zealand secondary schooling, unpublished Doctoral thesis, University of Auckland, Auckland
April 2014
By: Sione Tu’itahi
Edited by: Jo Lawrence-King
In a consultation draft published in 2013, the Ministry of Health (MoH) 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 articleabout the initiative here.
The consultation document is part of a review of public health service specifications.
Jo Lawrence-King
18 March 2014
Equality, Family and child, News
Child Poverty Action Group’s Associate Professor Susan St John has decried the Working for Families scheme and called for the correction of “the moral bankruptcy of a social security tax-funded payment for children that deliberately excludes the poorest children….” This follows the discovery of a data error at Statistics New Zealand, which led to an underestimate of the number of families living below the poverty line. The new figures released from the Ministry of Social Development (MSD) on 27 February reveal a worse household income situation than previously thought for Aotearoa New Zealand.
It is clear, from the revised statistics, that the Global Financial Crisis had a greater impact in 2009 on the incomes of lower-income households than originally thought. The 2011/12 figure for children living below the poverty line has been revised to 150,000 from the original 125,000. The number of children estimated to be living below the very low income line during this period has been revised to 285,000 from 265,000.
“This is a huge indictment of the failure of government policies to protect the poorest children in a recession.” Her blog on the subject goes on to quote the Court of Appeal’s finding in 2013 that the Work Tax Credit policy discriminated “with harmful effect” against 230,000 of New Zealand’s poorest children.”
Equality, News
Child Poverty Action Group’s Associate Professor Susan St John has decried the Working for Families scheme and called for the correction of “the moral bankruptcy of a social security tax-funded payment for children that deliberately excludes the poorest children….” This follows the discovery of a data error at Statistics New Zealand, which led to an underestimate of the number of families living below the poverty line. The new figures released from the Ministry of Social Development (MSD) on 27 February reveal a worse household income situation than previously thought for Aotearoa New Zealand. It is clear, from the revised statistics, that the Global Financial Crisis had a greater impact in 2009 on the incomes of lower-income households than originally thought. The 2011/12 figure for children living below the poverty line has been revised to 150,000 from the original 125,000. The number of children estimated to be living below the very low income line during this period has been revised to 285,000 from 265,000. “This is a huge indictment of the failure of government policies to protect the poorest children in a recession.” Her blog on the subject goes on to quote the Court of Appeal’s finding in 2013 that the Work Tax Credit policy discriminated “with harmful effect” against 230,000 of New Zealand’s poorest children.”
4 March 2014
Jo Lawrence-King
Family and child
Children’s Commissioner: “Prioritise child poverty in 2014 elections”
Children’s Commissioner Dr Russell Wills has called for child poverty to be a key issue in the elections of 2014. In an opinion piece in the NZ Herald, he has suggested that the public will need to make some ‘tough decisions’ to put child poverty high on the agenda. “We will need to send clear messages to decision makers about our priorities,” he said.
Dr Wills suggested that it is voters and influential organisations who must throw their support behind his call, in order to influence all parties to prioritise this issue. “…no government will go further than the public mood will allow,” he said “… as the debates around election year start to heat up, what will your contribution be? Will you leave the tough choices to the politicians, or will you stand up in your own organisations and ask: what can we do to prioritise children in this election year?”
HPF Executive Director Sione Tu’itahi welcomed Dr Wills’ article. “Child poverty is the root cause of so much ill-health in Aotearoa New Zealand,” he said. “An investment in this tragic situation would go a long way to improve the wellbeing of a large sector of our society.”
Dr Wills’ article directed his challenge at older people, motorists and health managers; asking them to call for greater prioritisation of child poverty. Acommentary in the same paper provides responses from the Automobile Association, Grey Power, Social Development Minister Paula Bennett and Labour children’s spokesperson Jacinda Ahern; the latter of whom offered assurances that Labour would prioritise child poverty.
HPF has reported on the the Child Poverty Monitor, released on 9 December 2013, which revealed that a quarter of New Zealand children currently live in poverty.
Visit our Children and Young People page to read more on this topic.
Pictured: Dr Russell Wills with a young patient (photo: www.BayBuzz.co.nz)
Jo Lawrence-King
Global, Policy
Health Promotion Forum (HPF) Executive Director Sione Tu’itahi is calling on health promoters at all levels to join forces and make a difference to hauora here and around the world. “They say think globally, act locally, but these days we must think and act on all levels,” says Sione .
Sione returned last Friday from Paris, France, where he attended a two-day meeting of the GlobalExecutive Board of the International Union for Health Promotion and Education (IUHPE). At the meeting the Board put together a work plan to contribute to solving global health challenges and ensuring the long-term sustainability of the IUHPE. One of the key resolutions was to redouble efforts to unify and energise the health promotion movement and Sione hit the ground running when he arrived back in Aotearoa New Zealand.
“The world is but one global village and challenges impacting on the international level influence the national and local levels as well,” said Sione. “Take the economic recession or global warming, for instance. Both challenges affect everyone at every level, whether you are in Paris, Auckland, or Ha’ano, [Sione’s home Island in Tonga]. “We must work together or we will all be affected by these common challenges, many of which are human-made and, therefore, can be resolved.”
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 is 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.
The HPF is a national umbrella organisation for health promotion organisations and teams in New Zealand. While its primary focus is on the national level, HPF has both a global reach and a local impact.
Sione issued a personal invitation to health promoters around the country: “If you wish to be part of the solution on all levels, join a global movement and a national organisation.”
Join IUHPE and HPF by contacting Emma at HPF emma@hauora.co.nz.”
Read about the benefits of HPF membership.
Pictured above are (from left):
IUHPE President, Professor Michael Sparks, of the Australian National University, Ms Marie-Claude Lamarre, Executive Director of IUHPE, and Sione Tu’itahi, HPF Executive Director and Regional Vice-President of IUHPE, at the meeting held at the Paris Global Centre of Columbia University.
Story published: 13 December 2013
By: Sione Tu’itahi
Edited: Jo Lawrence-King
Pacific health researchers called for a greater focus and action around Pacific children in their early years to break the cycle of poverty before this sad legacy is passed on to the next generation. Read the full press release here.
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.
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. * Following the discovery of a data error at Statistics New Zealand and Treasury, these figures have now been revised: Income poverty is now recognised as affecting 285,000 children. Read more about this error. Published: 10 December 2013 Jo Lawrence-KingEconomics, Evidence, News, What is HP
A new policy summary, issued by the WHO (World Health Organisation) on 4 November, reveals substantial evidence to support the economic case for health promotion and prevention of non-communicable diseases.
The document summarises data from a major international study by the European Observatory on Health Systems and Policies, OECD and WHO/Europe. The findings demonstrate the effectiveness of a wide range of actions, addressing some of the main risk factors to health including:
- tobacco and alcohol consumption
- impacts of diet and patterns of physical activity
- children’s exposure to environmental harm
- the protection of mental health
- road safety.
Family and child, Women
HPF Deputy Executive Director and White Ribbon Ambassador Trevor Simpson joined the call this month to New Zealanders to take the White Ribbon Pledge. In the Pledge men agree never to commit, condone or remain silent about violence towards women. “Show your respect for women;” he said. “Speak out against any form of violence towards them; physical, emotional, verbal or sexual.”
The recent Roast Busters story has caused a public outcry over the issue of sexual violence by men against women and girls in this country. White Ribbon chairman Judge Peter Boshier lamented the misogyny that he says permeates Aotearoa New Zealand. “These attitudes are epidemic in our country,” he said. The White Ribbon Campaign pledge seeks to engage support from the broader New Zealand community in addressing this serious issue.
Trevor is proud to be entering his third year as White Ribbon Ambassador. At the time of his appointment, in November 2011, he said “I believe that White Ribbon ambassadors and men who get involved symbolise ‘nurturing warriors’ who together spread peaceful and powerful messages within their communities. They show other men how to be protectors and providers for their families, and above all how to do it in a non-violent manner”. Take the Pledge. Item published: 11 November 2013 Jo Lawrence-KingEquality, News
An article published in Christchurch’s The Press newspaper proposes the way we engage the broader public in the inequality debate is to make the issue relevant to them. “The answer is to persuade people that they are affected,” says the article’s author Philip Matthews. He suggests that the living wage debate is a good start to addressing the issue.
Matthews argues inequality is “not just immoral but has a social cost.” Closing the gap doesn’t have to be a Left versus Right issue, he says.
The living wage seems to be capturing the imagination of the public more than the broader and less tangible subject of inequality. Matthews theorises that, like child poverty, the living wage is a more easily grasped concept and therefore may be more easy to address.
Read the full article here.
Article published: 30 October 2013
Economics, News
Papers published this month in England, Wales and Scotland further support the case for a reduction in health inequalities.
An article published in the UK’s Independent newspaper has highlighted the life expectancy gap between rich and poor in England and Wales. Referencing newly released statistics from the country’s Office for National statistics, the authors conclude that the gap in life expectance is directly linked to economic inequality.
Another paper, issued this month by NHS Health Scotland has drawn similar conclusions. The authors of What would it take to eradicate health inequalities? call for measures to tackle the underlying inequalities in wealth, income and power, saying it is likely the only way health inequality can sustainably be achieved. The authors make a well-researched argument to support the link between life expectancy and these socioeconomic factors. They argue that measures to approach the more directly identified causes of morbidity and mortality (such as tobacco and alcohol) will ultimately fail to bridge the gap.
Story published: 29 October 2013
Maori, Policy
Three key project areas were agreed at a recent hui taumata (summit) of Māori Public Health Leaders at Te Ohāki Marae in Huntly.
The three agreed areas of focus are to:
1. provide support infrastructure like communications, a clearing house, agenda setting and a mobilisation plan (dubbed He Mahi Kaitiaki).
2.promote action around institutional racism
3.foster wider social and political change.
All three of the projects will be interconnected: aiming to increase participation in Public Health dialogue, increase a sense of collective responsibility to make change and challenge the current political arrangements in health to do better.
The project ideas will seek further support and mandate at the national annual hui being held at Turangawaewae Marae this 14-15th November.
The hui drew on the knowledge of Māori public health Leadership programme graduates to develop a plan of action for Māori public health. Led by Tania Hodges of Digital Indigenous.com Ltd and Grant Berghan, Public Health Consultant hui asked the question “If there was just one thing we could do as leaders…?”
The agreed focus areas were arrived-at following two days of intense and challenging discussion, with debate focussed on improving health for Māori communities and whānau.
There are nearly 500 graduate members of the programme, with membership of the alumni covering the length and breadth of the Aotearoa New Zealand and involves people from a wide gamut of Public Health. There was much discussion around the importance of mobilising this expertise to improve Māori health outcomes.
Te Ohāki Marae itself was a significant venue for the summit, with historical references to Te Kirihaehae Te Puea Herangi who famously placed a stake in the ground where the marae and wharenui was to be situated. For the attendees at the hui the stake was seen to symbolise the point from which stronger Māori public health action would be advanced.
Further information:
The Health Promotion Forum offers training in several areas specific to Māori health. Click here to find out more about our workshops and other training opportunities.
Read about Māori health models here.
Click here to find out about the Maori Public Health Leadership course.
Wordle created by Papatuanuku Nahi
Article created: 15 October 2013
The Health Promotion Competencies 2012 provide a framework of values, knowledge and skills for health promotion practice in Aotearoa-New Zealand.
This latest version follows extensive consultation and revision of the original 2000 version.
Watch our video outlining the competencies; their scope, potential and how they can help you in your work.
Your questions answered
We have prepared answers to some of the most commonly asked questions about the Health Promotion Competencies.Health Promotion competencies: Cancer Society self assessment template and guidelines
The Cancer Society has worked with HPF to produce a personal development plan for health promoters. They may be helpful to inform personal development reviews or appraisals; identifying an individual’s competencies and providing ideas for further development. Feel free to download the template here.Health promotion competencies: personal development review
Toi Te Ora in the Bay of Plenty DHB have given permission to HPF to share their personal development review blank template. This includes desired competencies for reference in a Health Promoter/Health Improvement Advisor’s personal development review.
Please feel free to contact Sharon Muru at Toi Te Ora if you would like to discuss how this template might be applied in your work setting.
Health Promotion Competencies survey reveals benefits to users
Users of the Health Promotion Competencies say that their role is clearer after referring to the document. They speak of greater clarity in job descriptions and performance development and say it helps them plan, implement and evaluate their health promotion activities. These are just some of the findings of HPF’s survey in May 2013; examining how useful the document is and how its usefulness might be maximised. Read a summary of the findings here.Generic competencies for public health in Aotearoa New Zealand
The Generic Competencies for Public Health provide a baseline set of competencies that is common to all public health roles across all public health sectors and disciplines. The Health Promotion Competencies sit on this base line. See the PHA website for the Generic Competencies (PDF) andkey documents about their development and implementation. For more information please contact HPF’s Senior Health Promotion Strategist Karen Hicks.Developing a competent global health promotion workforce: pedagogy and practice – HPF occasional paper
“… with the UN Political Declaration on Non-Communicable Diseases in place as well as global momentum to utilise the Health in All policies approach (IUHPE, 2014), now is a crucial time for the HP community to unite, to share resources and to build upon advances made within our evolving discipline over the last 40 years,” says Caroline Hall, Research Fellow at the University of Brighton in her July 2014 paper for HPF. “Fundamental to this process is accessing and harnessing opportunities to utilise inter-sectoral approaches and to build upon evidenced-based practices as a way of increasing capacity within the HP workforce. This should be combined with continued efforts to ensure the quality of these processes and practices, including increasing and recognising professional competence through recognised training and education pathways and which include ongoing workplace assessment.” Read other occasional papers hereExercise, News
A recent study shows that exercise is at least as good as most medications at preventing death from heart disease, diabetes, and stroke.
The authors lamented the lack of research into the health benefits of exercise and lifestyle. They pointed out that, over time, government health recommendations have become skewed in favour of medicines over lifestyle choices.
The study suggested that one implication of the results might be that more health professionals prescribe an ‘exercise’ pill for their patients as an alternative to – or in addition to – medications. In New Zealand doctors can issue a ‘green prescription‘ for those patients they think would benefit.
The metaepidemiological analysis was published in the highly regarded British Medical Journal (BMJ) on 1 October. It examined 16 meta-analyses, including 305 randomised controlled trials with 339 274 participants
Click here to read the study.
Article created: 3 October 2013
Global, Maori, News, What is HP
Health promotion programmes in Aotearoa New Zealand were held up as models of best practice in August at the annual conference of the world’s most highly respected health promotion organisation. Senior Health Promotion Strategists from the Health Promotion Forum (HPF) are participating at the conference of the International Union of Health Promotion and Education (IUHPE) in Pattaya, Thailand, August 25-29 2013.
Trevor Simpson – Deputy Executive Director at the HPF – presented a plenary session to showcase a health promotion module developed by Maori and in close collaboration with the Maori service users for whom it was being designed. “This is a point of difference from many other health promotion approaches to indigenous peoples,” says Trevor. Very often health promotion resources and practices are developed centrally, with little or no involvement of – or representation from – the people for whom they are being developed. “We have found our approach to be highly successful in inspiring and empowering people to make beneficial changes to their health.”
The HPF’s Senior Health Promotion Strategist Karen Hicks presented her abstract “A Contribution to the Global Dialogue”. In her presentation she will discuss how health promotion competencies, the advent of a professional society and a code of ethics together give health promotion professionals the tools they need to make effective improvements in health.
New Zealand is strongly represented in health promotion globally. The HPF’s Executive Director, Sione Tu’itahi, is Vice-President of the South West Pacific Region of IUHPE, while Associate Professor Louise Signal, Director of the Health Promotion and Policy Research unit (HePPRU) and Health, Wellbeing & Equity Impact Assessment Research Unit (HIA), Department of Public Health, Otago University is its Regional Director. Together the HPF and HePPRU co-host the IUHPE’s South West Pacific Regional Office.
Global, What is HP
“New Zealanders are the 13th happiest in the world.” That’s the finding of the recently published World Happiness Report 2013.
A post this month on Otago University’s Public Health Expert blog highlights some of the relevant findings of the report, which looked at the happiness of 156 countries.
Of particular note to health promotion professionals is the finding in the report that public spending needs to focus more on prevention than on care. It acknowledged the need for better evidence to support this shift.
Also highlighted in the Otago University’s blog is the emphasis on mental health as the “single most important determinant of individual happiness.”
Read the full report here. Or read the Public Health Expert blog here.
Entered: 24 September 2013
What is HP
In March 2013 an online survey was emailed to the Health Promotion Forum’s database, networks and reference groups to gain baseline data on the current knowledge of and implementation of the Nga Kaiakatanga Hauora mo Aotearoa Health Promotion Competencies for Aotearoa New Zealand 2012 amongst the health promotion workforce. 105 responses were collated from a variety of organisations and individuals. The collated responses will inform the development of work to support the implementation of the competencies amongst the workforce. Easy to read, colourful survey report can be found here.
Health Promotion Infrastructure is the newest Thinkpiece in our Occasional Paper series
Commissioned by HPF and written by Paul Stephenson see it here
Other Occasional papers can be found here
A New Zealand safe driving resource, “Just Another Saturday Night”, has received national and international recognition for its impactful message about alcohol and driving. Featuring Jared Thomas, the resource tells the story of four young men, who drank alcohol and took to the road; driving up to 180 km per hour around a bend with a speed advisory of 55 km per hour.
The crash killed the driver and one of the passengers. Jared – the front seat passenger – is now in a wheel chair, with little feeling from his chest down, while the third passenger lives with a brain injury.
Jared now visits schools and events to promote road safety. He has received an award for his commitment to this work.
The resource was developed by Senior Constable Iain Cheyne, from the New Zealand Police, and Linda Anderson, Regional Manager of Road Safe Hawkes Bay.
To find out more about the resource, please click here.
Entered: 24 September 2013
Equality, Family and child, Maori
Inquiry into the determinants of wellbeing for tamariki Māori. A report, issued in December 2013 by the Māori Affairs Committee, concludes that poverty is a major barrier to the wellbeing of tamariki Māori. The authors call on all New Zealanders to support the work being done to improve the wellbeing of our tamariki, and New Zealand as a whole. They encourage a collaborative approach between agencies and organisations to support the Whānau Ora – and similar – approach to working with Māori whānau. They unambiguously reject a silo mentality.Pacific, What is HP
A new paper, published today, makes a further contribution to the development of Pacific leadership in health, education and other sectors. Providing insight into the Tongan concepts of matapoto (intelligence and shrewdness) and lotopoto (wisdom and ethics), the paper explores the underlying values of these terms and how they are reflected in the values of many Pacific nations.
When used conjointly, the two terms indicate multi-dimensional intelligence, wisdom and consciousness. This paper illustrates the dynamic coherence between training the mind and educating the heart and highlights the importance of values as an integral part of knowledge and learning.
Matapoto pea Lotopoto – Exploring intelligence and wisdom from a Tongan perspective for enhancing Pacific leadership in health, education and other sector – is by HPF’s Executive Director, Sione Tu’itahi. It is published as part of the HPF’s Occasional Papers series.
Visit our Pacific health promotion pages.
Pictured: King George Tupou I
Published: 5 May 2013
By: Jo Lawrence-King
Economics, Evidence, What is HP
“The Health Promotion Forum originally asked us to develop a full cost-benefit analysis (CBA) of measures to prevent smoking and obesity in young adults in New Zealand, as two examples of public health programmes. We lacked the funding or resources to do this. This report is to pave the way for such a cost-benefit analysis. We argue that health promotion has for too long been stymied by a perception that they lack the data and indeed the funds to do a perfect cost benefit analysis. This is a scoping study which seeks to illustrate that building a case for health promotion need not be excessively costly, nor does it need to wait for the perfect data. We illustrate the ideas using obesity and smoking as exemplars. We would however caution the use of the results.” Savings from Prevention
These Competencies were first published in 2000. Following extensive review and consultation they were republished in 2011. They describe a framework of values, knowledge and skills for health promotion practice in Aotearoa-New Zealand.
Competencies 2000 (PDF)
Competencies 2012 (PDF)
Community, Diet, Maori
He Mara Kai (the food garden) is an initiative focusing on good nutrition and physical activity by supporting Kohanga Reo (Māori speaking early childhood centres) to grow vegetables. It was originally created as part of the Labour Government’s Healthy Eating, Healthy Action (HEHA) initiative 2004-2010. Theresa Wharekura, then Manager Te Kupenga Hauora, paints a picture of the initiative, its origins and its plans for the future.Exploring the Whanau Ora Policy for Pacific health Promotion
Workshop h
eld in Porirua March 15 2011. The presenter was Sione Tu’itahi of HPF.
Sione presented Fānau Ola: A Pasifika Perspective on Whānau Ora; below are his text and power point presentations.
Fānau Ola power point presentation in pdf format
Fānau Ola A Pacific Perspective on Whanau Ora (text version to come)
Maori
Another model of Māori health is based on Te Wheke, the octopus and the eight tentacles that collectively contribute to waiora or total wellbeing. View Te Wheke (PDF, 1 MB) [pdf-embedder url=”http://hauora.info/hauora/wp-content/uploads/2016/10/maori_health_model_tewheke.pdf”]More than 50% of health promoters use M-Health: intern survey
A survey, by HPF intern Ancy Paul, has revealed that more than half the health promotion workforce use M-health – a health information programme for smart devices.
Savings from Preventing Lifetime Smoking and Obesity in Young Adults: A Scoping Study
Rhema Vaithianathan Department of Economics University of Auckland, April 2013 This is a scoping study which seeks to illustrate that building a case for health promotion need not be excessively costly, nor does it need to wait for the perfect data. We illustrate the ideas using obesity and smoking as exemplars. Savings from PreventionHealth Evidence Health promotion effectiveness: intuition with evidence
This ‘Keeping Up to Date’ aims to increase awareness of the reasons to use evidence in practice, to stimulate debate about evidence, and to encourage the health promotion workforce to contribute to the evidence base by designing, delivering, and evaluating rigorous programmes. Nicki Jackson. Nicki is a lecturer at AUT University and has extensive experience in the field of evidence-based practice. Her work has provided her with the opportunity to work alongside international public health professionals to move forward the debate in using evidence in health promotion practice and develop the capacity of the health promotion workforce in using evidence. Keeping Up to Date – 22 editionHealth Evidence
Health Evidence is a Canadian service and research organization located at McMaster University, Hamilton, aimed at assisting public health decision makers in their use of research evidence. Health Evidence offers a suite of services to support the development of knowledge, skill and culture for evidence-informed decision making. Launched in 2005, a key resource, thehttp://www.health-evidence.ca/ registry of systematic reviews, provides free, user-friendly access to a searchable database of public health relevant, quality-appraised reviews. Tailored capacity assessments for evidence-informed decision making, workshops and presentations on evidence-informed decision making ‘how to’, and Knowledge Broker services to mentor individuals/teams/organizations are available to support incorporation of evidence into practice.The Cochrane Library
The Cochrane Library is available free to all Nzers at:http://www.thecochranelibrary.com/ Accessing the library this way will help ensure the continued MoH funding for the subscription to continue.The Campbell Collaboration
The Campbell Collaboration aims to help people make well-informed decisions by preparing, maintaining and disseminating systematic reviews in education, crime and justice, and social welfare. The Campbell Collaboration is an international research network that produces systematic reviews of the effects of social interventions. Campbell is based on voluntary cooperation among researchers of a variety of backgrounds. Campbell’s strategic and policy making body is the Steering Group. Visit their website and library.Evidence Based Health Promotion
The movement to develop ‘evidence based practice’ which first began in the field of medicine has spread to all parts of the health sector and other public sector activity. It is now widely accepted that activities to improve health should be supported by sound evidence. What is evidence? •At the most basic level, evidence involves ‘the available body of facts or information indicating whether a belief or proposition is true or valid’. •Evidence based public health and policy is an exercise in constructing realities and interventions within particular contexts. For policy-decision makers, evidence may be defined as ‘anything that establishes a fact or gives reason for believing something’. Visit the NSW Government Health websitefor more information and links to other useful sites.Evidence of intervention effectiveness & cost-effectiveness
Research evidence, where available and of good quality, is an important component of decision making. We aim to make this type of evidence more accessible to decision makers by providing short summaries of relevant existing research that also consider the possible application of the research to policy and practice. The types of summaries that will become available in the short term are known as rapid reviews and evidence summaries. Results of relevant cost-effectiveness, cost-utility or cost-benefit analyses are also included. The Victorian Government Health web page also includes Overview | Rapid Reviews | Evidence Summaries | Evidence-based resources | Other evidence syntheses | Cost-effectivenessThe Question of Evidence in Health Promotion
Health promoters require credible evidence to identify relevant determinants of health, choose activiities to promote health, and then evaluate the effectivenss of these chosen activities. This issue of evidence in health promotion is a complex one that requires critical examination of what is meant by health promotion, the focus of health promotion activities, and the ideological isssues and prinicples that inform health promotion practice. It is argued that health promoters should be explicit about the prinicples and values behind their health promotion activities, and consider how ideology, values and data interact to produce evidence. Dennis Raphael, Health Promotion International Vol 5,No 4.The Evidence of Health Promotion Effectiveness
A Report for the European Commission by the International Union for Health Promotion and Education Assessing 20 years Evidence of the Health, Social, Economic and Political Impacts of Health Promotion,and Recommendations for Action. In order to contribute to the debate on Europe’s developing public health policy, the International Union for Health Promotion and Education (IUHPE) decided to undertake an ambitious and innovative project which would assess and collect the evidence of 20 years of health promotion effectiveness. Shaping Public Health in a New EuropeEvidence Supporting Population Health Promotion Initiatives
Population health promotion is about creating the conditions that support the best possible health for everyone. Promoting health is a shared responsibility that requires the co-ordinated action of many sectors working together to improve well-being. The following document provides evidence from the literature supporting the need for health promotion. The document evidence is included in the areas of health promotion, healthy child development, heart health, home care, nutrition, physical activity/recreation, tobacco control and the workplace. Selected Literature Review Population Health Branch, Saskatchewan HealthA Maori overview of programme evaluation The evaluation hikoi:
This book aims to:- Provide the reader with an overview of the issues surrounding public health programme evaluation by and for Maori
- Give examples of the range of approaches that might be useful
- Highlight areas that evaluators may need to consider.
The Partnership Analysis Tool For Partners in Health Promotion
A resource for establishing, developing and maintaining productive partnerships. Produced by John McLeod on behalf of Vic Health, it assists organisations to develop a clearer understanding of the range of purposes of collaborations, reflect on established partnerships and look at ways to move forward. The Partnership Analysis Tool
Collaborative Strategies
We expect the site will be useful to partnership members, researchers, policy makers, and funders interested in using collaborative approaches to improve community health and well-being. Center for the Advancement of Collaborative Strategies in HealthIntegrated Health Promotion
Health Promotion, Primary and Community Health Victorian Department of Human Services, Australia have developed Integrated health promotion: A practice guide for service providers and Measuring health promotion impacts: A guide to impact evaluation in integrated health promotion, resource kit.Publications
The Ministry of Health has an extensive collection of publications about child health in New Zealand These include the 1998 Child HealthStrategy. Child health publicationsInfluences in Childhood on the Development of Cardiovascular Disease and Type 2 Diabetes in Adulthood: An Occasional Paper (2005)
This paper examines the medical literature on the childhood determinants which correlate to adulthood diabetes and cardiovascular disease in an effort to inform policy decisions and program implementation in the health sector. It also provides important information for health practitioners who are striving reduce the chronic disease trends for adults in NZ. Influences in ChildhoodHealth Eating Healthy Action: Strategic Framework (2003)
This strategy calls for a more integrated and multi-sectoral approach to addressing nutrition, physical activity and obesity, and highlights the importance of both individual behaviour and our environment. Strategic FrameworkFamily and child, Policy
Children and Young People: Indicators of Wellbeing in New Zealand 2008
This the second indicator report published by MSD highlighting indicators of social well-being of children and young people, how these have changed and the status of health for different child and youth groups in the current population. MSD has utilized the findings from this report to advise the UNCROC report to be submitted to the United Nations. Summary of findings Full ReportRaising Children in New Zealand: The Influence of Parental Income on Children’s Outcomes
This report examines the impact parental income has on many child outcomes including health and well-being. By focusing on the correlation between net family income and child outcomes this report contributes in advising public policy on income support. Influence of Parental IncomeThe Social Report 2010: Indicators of Social Well-being in New Zealand
This site provides in-depth information on the social health and well-being status of New Zealand society, through the use of indicators to monitor trends over time and to make global comparisons. The site also contains the full 2008 Social report and areas dedicated to the different indicators. The Social Report 2010Family and child
Where Health Begins
‘New Zealand’s child health outcomes compare poorly internationally. In a 2009 report from the Organisation for Economic Co-operation and Development (OECD 2009), Doing Better for Children, New Zealand ranked 29th out of 30 countries for child health and safety. In fact, some of New Zealand’s disease patterns among children are closer to those of developing countries’ (PHAC, 2010). What can advocates, clinicians, policy-makers and researchers do to strengthen the promotion of child health in New Zealand? This was the topic of a workshop of key stakeholders hosted by the Health Promotion and Policy Research Unit, University of Otago, Wellington. 28 October 2010 Power point presentation
Milestones in Health Promotion. Published by World Health Organisation (WHO) in 2009, this is a collection of global statements in one booklet. Or you can access individual statements below:
Adelaide Statement on Health in all Policies -Report from the International Meeting on Health in All Policies, Adelaide 2010. The purpose of this report was to engage leaders and policy-makers at all levels of government – local, regional, national and international. It emphasizes that government objectives are best achieved when all sectors include health and well-being as a key component of policy development. This is because the causes of health and well-being lie outside the health sector and are socially and economically formed. Although many sectors already contribute to better health, significant gaps still exist.
WHO Global Conferences on Health Promotion
The Eighth Global Conference on Health Promotion: Health in all Policies. Helsinki, Finland 10-14 June 2013. Two items were produced from this conference: the Helsinki Statement and a Framework for Country action. Thestatement asserts that “health inequities between and within countries are politically, socially and economically unacceptable, as well as unfair and avoidable. Policies made in all sectors can have a profound effect on population health and health equity.” It called on governments to fulfil their obligations to their peoples’ health and wellbeing. Both the Statement and the Framework for Country Action can be found here. The Seventh Global Conference on Health Promotion, Nairobi, Kenya 26-30 October 2009, produced a Call to Action, whichidentified key strategies and commitments urgently required for closing the implementation gap in health and development through health promotion. The sixth Global Conference on Health Promotion – Thailand; 7-11 August 2005 – produced theBangkok Charter (above) The Fifth Global Conference on Health Promotion: Bridging the Equity Gap, Mexico City, June 5th, 2000. Signed by Ministers of Health, the brief 8-pointMexico Ministerial Statement for the Promotion of Health: From Ideas to Action acknowledges the duty and responsibility of governments to the promotion of health and social development. The Fourth International Conference on Health Promotion: New Players for a New Era- Leading Health Promotion into the 21st Century, meeting in Jakarta from 21 to 25 July 1997, came at a critical moment in the development of international strategies for health. It was the first to be held in a developing country and the first to involve the private sector in supporting health promotion. The Jakarta Declaration on Leading Health Promotion into the 21st Century identified the directions and strategies needed to address the challenges of promoting health in the 21st century. The Third International Conference on Health Promotion, Sundsvall, Sweden 9-15 June 1991: Supportive Environments for Health. This conference called upon people in all parts of the world to actively engage in making environments more supportive to health. Examining today’s health and environmental issues together, the Conference points out that millions of people are living in extreme poverty and deprivation in an increasingly degraded environment that threatens their health, making the goal of Health For All by the Year 2000 extremely hard to achieve. The way forward lies in making the environment – the physical environment, the social and economic environment, and the political environment – supportive to health rather than damaging to it. The Sundsvall Statement on Supportive Environments for Healthis a call to action, directed towards policy-makers and decision-makers in all relevant sectors and at all levels. The Second International Conference on Health Promotion in Adelaide, South Australia, 5-9 April 1988, continued in the direction set at Alma-Ata and Ottawa, and built on their momentum. Two hundred and twenty participants from forty-two countries shared experiences in formulating and implementing healthy public policy. The resulting Adelaide Recommendations on Healthy Public Policyreflect the consensus achieved at the Conference. The first International Conference for Health Promotion in Ottawa, Canada 21 November 1986 produced the Ottawa charter (above) The WHO has links to all its past conferences on health promotion.
The central tenet of this English review is that avoidable health inequalities are unfair and putting them right is a matter of social justice. “…health inequalities are not inevitable and can be significantly reduced.”
According to Michael Marmot’s report “social justice is a matter of life and death. It affects the way people live, their consequent chances of illness and their risk of premature death.”
“This position statement uses the term equity in preference to equality because it better recognises that people differ in their capacity for health and their ability to attain or maintain health. Consequently, equitable outcomes in health may require different (i.e. unequal) inputs to achieve the same result. This is the concept of vertical equity (unequal, or preferential, treatment for unequals) in contrast to horizontal equity (equal treatment for equals).”
Te Tiriti o Waitangi has been identified as the founding document of Aotearoa and the key to health promotion in this country.
Pacific
“Seitapu – sei is a flower worn in your hair, tapu is the sacred position of the flower on the head, put together it is a strong force of beauty, spirituality and power.” Fuimaono Karl Pulotu-Endemann Seitapu consists of a framework of cultural competencies covering core and essential skills. The framework is not restricted to the workforce alone. Instead, the framework focusses on broader interactions with people, covering key theme areas of working with families, language, tapu considerations and organisations. Seitapu framework
Maori
This essential document, produced by HPF in 2002, provides understanding of the application of te Tiriti o Waitangi in health promotion practice in Aotearoa New Zealand. HPF also provides a two day practical, hands on course to explain how the articles of Te Tirit can be applied to health promotion practice.
Here is a range of resources about the determinants of health and health inequities.
A new way to talk about the determinants of health and a great way of talking about public health!
It is a report on how to talk about the determinants of health to people who haven’t thought about it before. It makes sense to people and with people across a range of personal beliefs. – “Health starts where we live, learn, work and play” which is also a great way of talking about public health!
The report is based on research with Americans but its ideas are also useful for New Zealand health promoters. Download it here
‘Inequalities stymie health gains for Polynesians’ – Manawatu Standard
An article in the 15 December 2014 Manawatu Standard makes a poignant statement and raises important concerns on Māori and Pacific health. HPF Deputy Executive Director, Trevor Simpson comments.The Auckland Supercity and Future Health Equity
Report on the Symposium held at the School of Population Health, University of Auckland, 12 July 2011 The recent changes to Auckland’s governance to integrate local and regional authorities into a single Auckland Council, combined with new provisions to produce an Auckland Spatial Plan, marks an unparalleled opportunity to commit to a shared agenda to improve the wellbeing of all Aucklanders. This is a unique chance to ensure that fairness and wellbeing underpins the way Auckland develops over the next 30 years. Improvements to wellbeing or equity will not occur by accident nor good intentions alone. Specific strategies are needed now, drawing upon multiple sources of evidence and shared knowledge if the Auckland Plan is to improve wellbeing for all. A full-day symposium “The Auckland Supercity and Future Health Equity” was convened to discuss these issues and to consider how health equity could feature in the Auckland Plan. This report provides an overview of the presentations (with links), discussion and summation. Auckland Supercity Marmot Report
Fact and action sheets on health inequities
These fact and action sheets were prepared in the lead up to a visit by Sir Michael Marmot in July 2011, hosted by the New Zealand Medical Association. The purposes of these sheets are several:- To attempt a brief stocktake on health inequities in New Zealand, both on what the current state of play is and what the future policy priorities might be.
- To provide background material for participants of the Auckland and Wellington Symposia.
- To provide material for the media in the lead up to, and during, Sir Marmot’s visit. Fact sheets
Health Promotion, Human Rights and Equity
In this issue of ‘Keeping Up To Date’ we look at the important and practical role of health and human rights in the health promotion armoury to redress these inequities, and not just by resorting to judicial processes. All people working in health promotion are working for the right to health! See HPF Publications Keeping Up to Date Autumn/Winter no. 35 – Carmel WilliamsReducing New Zealand’s health inequities requires urgent action
New Zealand Medical Association Health Equity Position Statement, March 2011 “It is now well recognised that a society’s health status is closely linked to various social determinants. Minimising the impact these social determinants have on health is now a focus of concern for many high income nations including New Zealand. Apart from the obvious societal gains from a more healthy and equitable nation, there is the potential for addressing the ever increasing cost of healthcare.” Read the Health Equity Position StatementFair Society, Healthy Lives The Marmot Review
February 11th marks the first anniversary of the publication of the Marmot Review. In February 2010, the Marmot Review Team published Fair Society, Healthy Lives. This was the culmination of a year long independent review into health inequalities in England which Professor Sir Michael Marmot was asked to chair by the Secretary of State for Health. The review proposes the most effective evidence-based strategies for reducing health inequalities in England from 2010. Since publication we have seen, and worked to support, many developments based on the approach advocated by the review…read more. New Inequalities Data,News Coverage, Implementation Download the Executive Summary (4.8 MB) The Full Report (25MB) can be found on the Marmot Review WebsiteSocial determinants approaches to public health from concept to practice
Editors – Erik Blas, Johannes Sommerfeld and Anand Sivasankara Kurup About this ebook The thirteen case studies contained in this publication were commissioned by the research node of the Knowledge Network on Priority Public Health Conditions (PPHC-KN), a WHO-based interdepartmental working group associated with the WHO Commission on Social Determinants of Health. The case studies describe a wealth of experiences with implementing public health programmes that intend to address social determinants and to have a great impact on health equity. This publication complements the previous publication by the Department of Ethics, Equity, Trade and Human Rights entitled Equity, social determinants and public health programmes, which analysed social determinants and health equity issues in 13 public health programmes, and identified possible entry points for interventions to address those social determinants and inequities at the levels of socioeconomic context, exposure, vulnerability, health outcomes and health consequences.Down load this ebookThe Economic, Social and Environmental Determinants of Human Development and Health Equity
Three internationally renowned speakers discuss how environmental, political,economic and cultural characteristics of societies shape conditions in which people live, work and age. Inequities in these factors play a major role in producing health inequities in Australia,across the Asia Pacific region and globally. If set up well, economic development, trade, working conditions, urbanisation and health care for example could simultaneously improve development, social inclusion and health, but if done badly these factors can all increase health inequities. Podcast Professor Sir Michael Marmot in conversation with ANU academics Presented by Asia Pacific HealthGAEN and ANU College of Medicine, Biology & the EnvironmentHealth starts where we live, learn, work and play
A new way to talk about the determinants of health and a great way of talking about public health!
It is a report on how to talk about the determinants of health to people who haven’t thought about it before. It makes sense to people and with people across a range of personal beliefs. – “Health starts where we live, learn, work and play” which is also a great way of talking about public health!
The report is based on research with Americans but its ideas are also useful for New Zealand health promoters. Download it here
World Conference on Social Determinants of Health
2011 World Conference on the Social Determinants of Health
WHO held a conference in Rio de Janeiro, Brazil, to get support from governments on actions to improve health equity and the social determinants of health.
A report written for the Conference by the Asia-Pacific Global Action on Health Equity (HealthGAEN) includes many stories of actions being taken in Asia and the Pacific (including New Zealand) to improve health equity.
Sharon Friel, the Chair of Asia-Pacific HealthGAEN, blogged about the conference saying it showed the best and worst of global health politics
Fran Baum who is an Australian public health leader, co-chair of the People’s Health Movement, and was one of the Commissioners for the WHO Commission on Social Determinants of Health, blogged for the British Medical Journal before, during and at the end of the meeting.
There were many expert speakers and frank discussions. The governments attending the conference, after considerable negotiations between their representatives, agreed to the Rio Declaration on Social Determinants of Health. The Rio Declaration, while useful, does not recognise the effects on health of unfair trade practices and climate change. When Professor David Saunders pointed this out to the Conference, he received a standing ovation from the floor. Civil society organisations produced an alternative declaration. Visit thePeoples Health Movement website to read the Alternative Declaration. You can read WHO’s summary of the meeting and find many useful resources about social determinants and the Conference here. 24 June, 2011 – A new WHO publication entitled “Social determinants approaches to public health: from concept to practice” takes the discussion on avoidable and unfair inequities in health to a practical level. The book follows the publication in early 2010 of “Equity, social determinants and public health programmes”, which analysed social determinants from the perspective of a range of priority public health conditions, exploring possible entry points for addressing health inequities at the levels of socioeconomic context, exposure, vulnerability, health-care outcome and social consequences. from Concept to PracticeCommunicating the Social Determinants of Health Scoping Paper
“……..Barriers to media coverage of the SDH must be overcome, including a lack of knowledge of the concepts, a perceived difficulty in telling stories that capture the social determinants in tangible, measurable terms, and the perception that the social determinants are not new and therefore not newsworthy. Media have also expressed concern over stigmatizing the poor, unemployed, and less educated in society through reporting on SDH research. Constraints on advocacy activity among public health practitioners may also hinder support among this important audience. Some have suggested that public consultation in health issues amounts to little more than tokenism, as policy-makers are under heavy pressure to achieve specific national policy targets, and may feel that community involvement slows the process down and results in a loss of control….” This report was prepared for the Canadian Reference Group on social determinants of health (CRG), March 2011 Available online PDF at: http://bit.ly/oHZxQNClosing the Gap in a Generation
The Final Report of the Commission on Social Determinants of Health sets out key areas – of daily living conditions and of the underlying structural drivers that influence them- in which action is needed. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health HPF was privileged to print and distribute copies of the Executive Summary from the Commission’s report. This extremely important document featured comments about the importance of the report from Dame Silvia Cartwright, Professor Mason Durie and others. The Executive Summary can be it can be downloaded from the HPF web siteExecutive summary. The full report can be downloaded from the WHO websiteInterview with Sir Michael Marmot
Sir Michael Marmot Professor for Epidemology and Public Health at the University College London and Chair of the The World Health Organisation Commission on Social Determinants of Health; authors of the report Closing the Gap in a Generation. He was interviewed by Dr Thomas Mattig, Director of Health Promotion Switzerland, on 1 December 2008. Read his thoughts about social and health inequalities and other issues in theinterview.Taking up the challenge of Non-Communicable Diseases in the Commonwealth: 17 Good-practice case studies
Non-communicable diseases (NCDs) – mainly cancers, diabetes, chronic respiratory diseases and cardio vascular diseases account for the majority of death and illness in almost every region of the world, affecting both men and women. This important publication supports two of the objectives of the Commonwealth’s ‘Road Map’ on NCDs, adopted by health ministers in 2010. (*In this context, ‘intervention’ means ‘action taken to improve a situation’ – it is not referring to medical intervention) NCDsSocial Support Research Programme
Research undertaken by Dr. Miriam Stewart in the Social Support Research Program of the Centre for Health Promotion Studies at the University of Alberta addresses social support as an important determinant of health in a variety of populations and contexts. The Social Support Research Program at the University of AlbertaTurning the Tide
Turning the Tide: Why Acting on Inequity Can Help Reduce Chronic Disease is a tool kit designed to support the use of the document, The Tides of Change:Addressing Inequity and Chronic Disease in Atlantic Canada; A Discussion Paper. The package was produced for use by community organizations in examining their work and policies in light of the information presented in the discussion paper. Tool kit here. Public Health Agency of Canada’s Atlantic Regional Office.Health promotion Aotearoa goes international
Health, Equity and Sustainable Development 20th IUPHE World Conference on Health Promotion This inspiring conference focused on building bridges between health promotion and sustainable development. Link here to the conference Journaland in the massive list on the downloads page you will find the HPF presentation The next World Conference on Health Promotion was in August 2013 in Pattaya, Thailand.
Access statements from key global conferences since 1978.
Read papers, reports and reviews from around the world.
Workshop held at the Wellington campus Massey University, 7 September 2009. The presenters were Ieti Lima, Sione Tuitahi, both of the HPF, and Fuimaono Karl Pulotu-Endemann, a Pacific health consultant. Ieti gave an overview as to why we need Pacific health promotion models. Fuimaono presented on Fonofale, a model that he led its development in the 1980s. Sione presented on Fonua, a model that he developed and introduced into the public health sector in 2007.
Overview of Pacific Health Promotion – Ieti Lima
Fonofale Model – to be read in conjuction with the Explanation – Fuimaono Karl Pulotu-Endemann
Fonua Model – Sione Tuitahi
Participants at the Pacific Health Promotion Models Workshop
Christchurch May 2010
Sione Tu’itahimiddle, Fuimaono Karl Pulotu-Endemann right
Sione Tu’itahimiddle, Fuimaono Karl Pulotu-Endemann right
Indigenous health gap – social determinants key
A feature article on an Australian TV website has highlighted the issue of the indigenous health gap; an issue that echoes the situation of Māori here in Aotearoa New Zealand.A feature article on an Australian TV website has highlighted the issue of the indigenous health gap; an issue that echoes the situation of Māori here in Aotearoa New Zealand. – See more at: http://www.hauora.co.nz/indigenous-health-gap-social-determinants-key.html#sthash.KN5CTT39.dpuf
A feature article on an Australian TV website has highlighted the issue of the indigenous health gap; an issue that echoes the situation of Māori here in Aotearoa New Zealand. – See more at: http://www.hauora.co.nz/indigenous-health-gap-social-determinants-key.html#sthash.KN5CTT39.dpuf