Evidence, News, Uncategorized

A symposium to highlight the seriousness of scabies and boost treatment of the disease will be held at the School of Population Health in Auckland on September 13.

Improving Scabies Treatment: A Path to Health Equity in New Zealand will look at how common the disease is and why it should be taken more seriously.

The symposium will also examine ways that diagnosis of scabies can be improved; how treatment can be improved; what is known about the biology of the disease and whether scabies should be considered as a disease of public health importance?

The keynote speaker will be Dr Daniel Engelman from the Centre for International Child Health. Dr Engelman has studied the disease extensively in the Pacific.

Dr Simon Thornley of the Department of Epidemiology and Biostatistics at Auckland University who will speak at the symposium told HPF that scabies had been left off the public health and research radar in New Zealand for so long, because it had been assumed to be a nuisance rather than a serious disease.

Dr Thornley said it was only until recently that evidence had emerged that scabies was strongly linked to diseases such as bacterial skin infection, post-streptococcal kidney disease and acute rheumatic fever.

“Strep throat is the traditional explanation about why Maori and Pacific children get acute rheumatic fever,” he said.

“We believe that improving treatment for scabies can reduce ethnic health inequality in this country.”

Dr Simon Thornley, Department of Epidemiology and Biostatistics at Auckland University

On why diagnosis of scabies was often missed Dr Thornley explained that scabies could be difficult to diagnose as it mimicked other skin diseases.

“If doctors don’t think about it, they may make an incorrect diagnosis,” he said.

“However, accumulating evidence suggests that this is not the case. A large government school campaign aimed at preventing rheumatic fever using this approach has yielded disappointing results. Acute rheumatic fever rates in Auckland remain high. Because of this apparent failure, we strongly believe that different approaches, such as aggressively diagnosing and treating scabies should be considered.

“Young children are most likely to be treated,” he said. “Scabies is known to be endemic in many Pacific Island nations, so this is likely to be part of the reason that there are high rates of prescribing for the disease in South Auckland.”

Dr Thornley said although it was not known exactly, drug dispensing data suggested that Maori and Pacific people in socioeconomically deprived regions of Auckland were most affected by the scabies.

Dr Thornley said it is hoped that the symposium will raise awareness of the need to improve scabies treatment in this country, given the strong link between scabies infestation and serious childhood diseases, including rheumatic fever.

“We believe that improving treatment for scabies can reduce ethnic health inequality in this country. The current model of relying on GPs to treat the disease does not seem to be working, so more public health attention and resource to adequately diagnosing and treating the disease, we think, should be considered.”

The meeting will be relevant to nurses, GPs, Paediatricians, public health professionals, public health researchers, scientists and anyone who is interested in the disease.

The Scabies Symposium will be a real eye-opener.

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.
bn-lb211_bkrvma_jv_20151102152610   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  

Evidence, News
New Zealand’s first health promotion book was launched in Wellington on Friday 28 August 2015.  
promoting-health-in-aotearoa 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:
  1. 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.
  2. 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.
  3. 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.
  4. 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.
The launching of Promoting Health in Aoteroa New Zealand today is very timely:
  1. 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.
  2. 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.
  3. 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.
May I offer my hearty congratulations to everyone who has played a part in bringing into the light of day, te ao marama, this wonderful new child of knowledge.  I especially would like to acknowledge the hard-working editors, Associate Professor Louise Signal, and Dr Mihi Ratima.  Your perseverance, dedication, endless patience, and professionalism, have paid off. Well done! And to conclude, may I ask each and everyone here today, to please broadcast this wonderful work as broadly as you can by telling others about it and buying copies, not just a copy for yourself, but copies – for your friends, co-workers and institutions. Thank you, Kia Ora and Malo ‘aupito”   View Otago University’s video launching the book.     Jo Lawrence-King 16 September 2015

Evidence, Global, News
scottish-thistle-from-freestock   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:
  1. Such campaigns do not address the primary causes of inequalities such as poverty and deprivation and
  2. There is greater likelihood that the approaches would be taken up by the more literate and financially-able middle classes than those living in poverty.
It concluded that effective narrowing of the gap will require a multi-agency, multi-initiatives approach. The MSPs pointed out that the primary causes of health inequalities; social and economic problems; lie outside of the health sector.  The National Health Service (NHS) alone cannot these issues. They identified three approaches to tackle inequalities:
  • Measures through the taxation and benefits system;
  • Agencies collaborating to work effectively on related policies such as housing and education;
  • NHS to provide better access to primary health services for the poorest and most vulnerable.
While the life expectancy gap in New Zealand is not as great as that in Scotland, there remain significant differences between different sectors of the population, with Māori and Pacific people faring poorly in health outcomes. “It is particularly important to address this inequity; not only as a moral issue but as a societal one: inequities are linked to poor health outcomes, reduced opportunity, poor economic growth, lack of social cohesion and increased health care costs.,” says HPF Senior Health Promotion Strategist Karen Hicks.  “HPF will watch the development of this initiative in Scotland with interest.”  

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.

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.


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-King

Economics, Evidence, News, What is HP
who_logo_c300   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.
While some of these interventions generate direct cost savings, many will require increased investment but generate additional health (and other) benefits. The study will be published in 2014 as a book “Health Promotion, Disease Prevention: The Economic Case”.  It forms the basis for one of the evidence pillars for WHO’s Health 2020 strategy.   Published: 5 December 2013 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  

Here is a range of resources about the determinants of health and health inequities.

‘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 Williams

Reducing 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 Statement  

Fair 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 Website  

Social 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 ebook

The 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 Environment

Health 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 Practice

Communicating 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/oHZxQN

Closing 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 website

Interview 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) NCDs

Social 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 Alberta

Turning 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.