Experts, News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Community, Experts, News
Dr Grace Wong has been an avid health promoter for many years and is a leading advocate for tobacco control in Aotearoa.

A part-time senior lecturer in Nursing, Associate of the Centre for Migrant and Refugee Research at AUT, Dr Wong is the founder and co-director of Smokefree Nurses Aotearoa.

The protection of the health of Asian New Zealanders plays a key role in her research. Haoura recently caught up with Dr Wong to discuss what it was like growing up as ‘fourth-generation Aotearoa-born Chinese’ in Christchurch, which at the time had a population of just 400 Chinese, her love for health promotion and what motivated her to get involved in the fight against smoking.

Dr Wong also shares about her work with migrant, refugee and asylum-seeker communities, as well as her involvement with an art-based initiative that aims to reduce racism, which was intensified around the globe and in NZ by Covid-19, against Chinese people.

HAUORA: Can you tell us a bit about what it was like growing up as a ‘fourth-generation Aotearoa-born Chinese’ and what it’s like to belong to a large extended family?

When I was little there were only 400 Chinese people living in Christchurch and not one was an extended family member. My Mum’s family came from Wellington, so we visited every Christmas. I remember roller skating up and down my Popo’s big old hallway. My Uncle Ray converted those skates into skateboards for me and my sister.  And then we whizzed down the drive and turned sharply on to the footpath, so we didn’t get hit by a car. My Popo made the best yum char long before there were lots of Chinese restaurants.

HAUORA:  What were your early career aspirations?

Being in a long line of oldest daughters I guess I was always bossy.
And I wanted to help people. I also wanted to know what to do if someone keeled over in front of  me. So, I became a nurse (and I try not to be bossy!).

HAUORA: You’ve been associated with HPF since the 1990s and we were delighted to welcome you to the HPF Board recently. What drew you to HPF and health promotion?

I love health promotion because it is the most optimistic of health professions. It draws out the best in individuals, families, communities and populations.
It  celebrates diversity. Everybody is welcome here.
That’s what drew me to health promotion and the HPF.

HAUORA: You have been dedicated to tobacco control over the years and have done a lot of research on smoking. What motivated you to enter this field?

DR WONG: In my culture, like others, we never forget a good turn. I will always be grateful to  Emeritus Professor Ruth Bonita, Dr Marewa Glover and Trish Fraser who set me on the tobacco control path. I love our country and its people. Tobacco control is about   equity. Everyone deserves a fair go.

HAUORA: Protecting the health of Asian New Zealanders has played a major part in your research. How big a problem is smoking among Asians here and is the smoke-free message getting through to them?  

DR WONG: I really appreciate this question because the illusion that Asian smoking rates are low   falls away as soon as the data is disaggregated by gender. Asian men smoke at nearly the same rate as the general population. Women’s rates are low. In Auckland we are  lucky to have Smokefree Asian Communities to help Asian smokers quit.

HAUORA: You were also the founder and co-director of Smokefree Nurses Aotearoa and use research to promote nurse action to achieve the Government’s Better Help for Smokers to Quit health target and the Smokefree 2025 goal. Do you see NZ as being on target to be smoke-free by 2025 and is enough being done to hit that target? How can we as health promoters help to achieve this goal?

DR WONG: Aotearoa is at risk of missing the Smokefree 2025 goal. I believe that we can serve people best by listening to them rather than buying into intense debates about what is right and what is wrong. Quitting smoking is incredibly hard. Our role is to advocate for and offer evidence-based options, practical support, and encouragement appropriate to peoples’ culture, circumstances and preferences.

HAUORA: Can you tell us about your work with migrant, refugee and asylum-seeker communities in this country and what sort of initiatives are in place to ensure their health and wellbeing, especially during Covid-19?

DR WONG: I was relieved to hear about the government meeting with leaders of ethnic communities recently. Many migrant, former refugee and asylum-seeker communities are fearful of Covid-19. They rely on sources they trust for information     and direction. Direct service delivery organisations like the Asian Network Incorporated, Asian Family Services and Shanthi Niwas Charitable Trust, listen to their communities, advocate for services for them, and support them mentally,  physically, socially and culturally.

Unfortunately, Covid-19 has exacerbated racism against Chinese people around the world. You are currently a project team member on the Aotearoa Poster Competition, an art-based initiative which aims to reduce racism against Chinese people, which has also been heightened in Aotearoa, by Covid. When did this initiative start, how does it plan to achieve its goal and how is it is progressing?

 The Aotearoa Poster Competition 2000 is a positive pushback against an ugly    reaction to a frightening pandemic. It is a response to a marked increase in racism against Chinese people. The campaign aims to redirect hearts and minds away from blame and anger, and to encourage everyone to stand up to racism safely. The Museum of New Zealand, Te Papa, just added the four winning posters to their collection. They are expressive, meaningful and beautiful.  

Banner photo: Photo by Stephanie Krist on Unsplash


Experts, News

Dr Trevor Hancock has been a mover and shaker in public health for more than 30 years.

The guest speaker at HPF’s webishop ‘No health without a healthy planet’ on February 17, helped pioneer the (now global) Healthy Cities and Communities movement and initiated early work on the concept of ‘healthy public policy’ in the 1980s.

He has worked as a consultant for local communities, municipal, provincial and national governments, health care organisations, NGOs and the World Health Organisation (WHO), and as a speaker around the world.

Dr Hancock and HPF’s Executive Director, Sione Tu’itahi who will facilitate the webishop are also members of the newly established IUHPE Global Working Group on Waiora Planetary Health and Human Wellbeing, which champions the Rotorua Legacy Statements of the World Conference on Health Promotion 2019 in New Zealand.

But this is just the tip of the iceberg of what Dr Hancock has achieved and it’s hard to believe he didn’t even have public health on his radar when he entered a very specialty-oriented London teaching hospital in 1967.

Graduating six years later wanting to be a family physician and with an active engagement in ecological politics he almost immediately moved to Canada, where he did family practice in rural New Brunswick and then in a community health centre in Toronto. 

It was at this community health centre, where he says they served a ‘somewhat underprivileged community’ that his interest in public health bloomed.

“It was clear to me that many of the health problems my patients experienced were economic, social and environmental problems, not really medical problems, which cemented my interest in public health,” he recalls.

After retiring in 2018 from his role as Professor and Senior Scholar at the School of Public Health and Social Policy at the University of Victoria, British Columbia Dr Hancock turned his attention to new ventures.

His recent focus has been the combination of the relationship between human health and the natural environment and the healthy community approach. 

He established a new NGO in Victoria – Conversations for a One Planet Region. The initiative works to engage the people and governments of the Greater Victoria Region in conversations about what is involved in becoming a region with an ecological footprint of One Planet while maintaining a good quality of life and good health for all.

“We realised early on that we needed to do work with the community to explore what should be the response to the Anthropocene at the local level. We suggested the concept of a One Planet Region as a way to address this locally (an idea we later learned had been pioneered by Bioregional in the UK, a group we now work with). We defined a One Planet Region as one that achieves social and ecological sustainability, with a high quality of life and a long life in good health for all its citizens, while reducing its ecological footprint to be equivalent to one planet’s worth of biocapacity.”

So, what of health promotion’s role in all this?

Health promotion says Dr Hancock has only in the past few years started to pay serious attention to the ecological determinants of health and the concept of planetary health. This is despite the Ottawa Charter for Health Promotion recognising stable ecosystems and sustainable resources as prerequisites for health as long ago as 1986.

“Health promoters must first however learn about the global challenges of the Anthropocene – the new age of humanity as a dominant global force and what new approaches and solutions we need,” says Dr Hancock who will provide a brief update on the Anthropocene at the webishop.

“We must recognise that this calls for an eco-social approach in all our work and all our communities.

“We are not simply health promoters, more importantly we are citizens. So, if we can make it part of the work we do, that is definitely a bonus.”

While there is a need for global and national action, Dr Hancock points out that we also need to recall the sage advice to “Think globally, act locally”.  He will address this in the webishop by focusing on the creation of healthy and sustainable communities, and the role of health promotion, especially in starting the conversation on becoming a One Planet Community and society.

Meanwhile, on the best way for countries to move forward post-Covid Dr Hancock says there is a need to push our elected leaders to pay heed to advice from health authorities such as the director general of the WHO, Dr Tedros Ghebreyesus.

“Ensuring that the recovery from the recession induced by our response to COVID-19 is a healthy, green and just recovery,” he writes in his weekly column on population and public health for Victoria’s Times Colonist.

“That there will be some sort of economic recovery from the Covid-19 pandemic is not in doubt. But the fight that is shaping up is between those who want to go roaring back to the past by promoting fossil fuels and ditching environmental protections and those who want to use this opportunity to bounce forward instead to a green, just and healthy recovery.”

Dr Hancock’s work has not gone unrecognised and in 2015 he was awarded Honorary Fellowship in the UK’s Faculty of Public Health for his contributions to public health. In 2017 he was awarded the Defries Medal, the Canadian Public Health Association’s highest award, presented for outstanding contributions in the broad field of public health, as well as a Lifetime Contribution Award from Health Promotion Canada.


The Anthropocene is a new geologic epoch, identified in geological terms as a layer of new materials (e.g. glass, plastic, concrete, radioactive elements and their decay products, elevated CO2 levels) and a change in future fossil deposits (e.g. wild animals now make up only 4% of the mass of land vertebrates, with humans (anthropos in Ancient Greek) and their domesticated species making up the rest) that will be clearly seen as anthropogenic – caused by humans – by future geologists.

  • Dr Trevor Hancock.





Professor Fran Baum, one of Australia’s leading researchers on the social and economic determinants of health has been quite vocal recently about the importance of a ‘social vaccine’ to rebuild a fairer and more sustainable world post Covid-19.

Hauora asked Prof Baum who is the Matthew Flinders Distinguished Professor of Public Health at Flinders University in Adelaide, Australia to explain about what the vaccine is and how it would work.

We also asked the foundation Director of the Southgate Institute of Health, Society and Equity about the role of health promoters in helping to rebuild a better world after Covid, as well as the role of good governance and leadership.

Hauora: I read in an article you wrote recently about when the Covid-19 pandemic eventually ends the inequities it has highlighted will remain, unless a ‘social vaccine’ is developed and applied. Can you please explain what a ‘social vaccine’ is and how this will help to shape the world post-Covid?

Prof Baum: A social vaccine comprises government and other institutional policies which aim to keep people well and mitigate the structural drivers of inequities in daily living conditions, which make people and communities vulnerable to disease and trauma. It also includes the importance of civil society groups who advocate for such policies. The target of the social vaccine is the conditions that underpin four basic requirements for global health and equity to flourish. These are: 1) A life with security; 2) Opportunities that are fair; 3) A planet that is habitable and supports biodiversity, and 4) Governance that is just.

Hauora: You also explain that ‘the delivery of public policies at the heart of a social vaccine require considerable civil society advocacy to ensure their development and effective implementation’. Can you please elaborate on this?

Prof Baum: I have always believed (supported by evidence) that civil society advocacy is vital in bringing about healthy public policy in all sectors. I have used the metaphor of a nutcracker (see illustration) to show that improving health and health equity requires both top-down policy action and bottom-up advocacy. Historical examples make this very clear. For example, in the cases of the abolition of slavery and franchise for women, civil society was vital in arguing for these changes and ensuring politicians listened to them. For an examples from Covid-19 I would give the People’s Health Movement which has launched a campaign to ensure equal access to Covid-19 Essential Health Technologies (EACT)  including vaccines (see here).

Hauora: What contributions do you think health promoters can make in helping to shape a better future?

Prof Baum: I think they can ensure that the debate about Covid-19 goes beyond the need for a vaccine to considering how the inequities that have been laid bare by Covid-19 can be reduced. For example, the pandemic has shown the weaknesses that casualised employment introduces. In India, many migrant workers did not have secure work and had to walk to their home villages often hundreds of miles away. On the way many become sick, had little food, were subjected to police brutality and some even died. In Australia workers in the gig economy have no sick leave or secure employment and have been shown to be a weak link in our defences against a pandemic.

On a broader scale, health promoters can look to the underlying causes of Covid-19 and point to the importance of taking an ecological view of health. There are an increasing number of emerging infectious disease and the evidence suggests that deforestation is a key way in which infectious agents jump from animals to humans.

Hauora: If there is one thing this pandemic has highlighted it is how crucial good governance and leadership is? What is your view on this?

Prof Baum: Yes, the politics of the pandemic are vital. Political will to accept public health advice is crucial. We have seen in the US how a leader who rejects this advice creates catastrophic consequences with Covid-19 deaths in the US topping a quarter of a million. By contrast other countries like Vietnam, Thailand, Australia, and New Zealand have had very low rates.

Hauora: Women leaders, especially, have been lauded for effectively guiding their countries through the Covid-19 pandemic. What common threads do you think have contributed to their success in responding to this crisis?

Prof Baum: In New Zealand you have, of course, the wonderful example of your Prime Minister Jacinda Ardern who has led with empathy, compassion, clear communication and also taken the hard public health advice. I think those characteristics of a political leader are the key to dealing with a pandemic.

Hauora: Is there anything else you would like to add?

Prof Baum: The most central thing for health promoters to keep emphasising is that we need to ensure that our political leaders govern for health not profit in each sector of society.
I argue this point in my book Governing for Health: Advancing Health and Equity through Policy and Advocacy.


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

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

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

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

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

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

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

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

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

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

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

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

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

Experts, News, Pacific
Without a doubt, a stand out figure from the global health, health promotion and public health sectors is Colin Tukuitonga.  Speaking from Noumea, Colin shared some thoughts with us on his current work as Director-General of The Pacific Community (SPC). Thank you for your time this afternoon Colin. Firstly, what proportion of SPC work would you identify as health promotion? Given the broad scope of my organisation’s mandate in food security, fisheries management & education, agriculture, public health, human rights and geoscience, this is difficult to answer however all of these things at one level or another are health promoting in their outcomes. We have a separate public health programme that has a large health promotion component and we work in 26 countries.   What are the biggest public health issues in the Pacific nations? Most definitely non-communicable diseases (NCDs). Obesity affects three out of every four adults. We also have the increasing issue of childhood obesity. All islands were part of developing the Pacific NCD roadmap with specific recommended actions. One of these was to introduce a tax on sugary drinks. Another was an increase in tax on tobacco.  The Pacific NCD roadmap is essentially a blueprint for the islands to follow. Some are active on this. Others less so. However, we expect all islands to implement a sugary drink tax. Communicable diseases can affect some islands for example tuberculosis in Papua New Guinea.   What do you see  as the role of health promotion in addressing these issues? Without a doubt this (taking a health promotion approach) is where we need to be overall but resourcing places constraints on this. Many islands are doing their best to help but again, more often than not, hospital and treatment services take up the lion’s share of funding. We do what we can at SPC to encourage island nations to invest in core public health functions but it is challenging.   You have signalled SPC’s strong support for the 2019 World IUHPE conference to be held in NZ. What do you see as SPC’s role at the conference? We have three roles. Firstly, general support for the hui. It is just fantastic that we get to have this event in this part of the world. Secondly, we are planning to provide some financial support. Thirdly, and most importantly, our role is to facilitate an opportunity at this global event for small islands to  share concerns and then work together, to take strength and to think about a way forward as an organisation of small islands. That is what we would hope to achieve.   Climate change is a major issue facing the peoples of the Pacific. What actions do you think are necessary to address this global environmental issue? We made significant gains with the Paris Agreement, the United Nations Framework Convention on Climate Change.  Now with United States of America withdrawing from that, it may take us back to before the agreement so trying to maintain momentum is really difficult. We need political support from many to honour the Paris Agreement. Without this we will be going backwards. Pacific nations have put a lot of energy into the agreement particularly the recommendations to limit emissions and enable funds for good work. Right now we are at risk of inertia with the US not agreeing to continue.   How do you see public health and health promotion developing over the years? Well when I started people talked about more traditional quarantine measures, or the role of legislation to regulate behaviours or control diseases. We’ve come a long way since then. The watershed moment for me was the emergence of the Ottawa Charter. This changed things from a conventional public health approach to one of empowerment of communities and of developing healthy public policy. For me it is about continuing this Ottawa Charter type approach and supporting nations to invest more in health promotion practices. To undertake things like health impact assessment and environmental impact assessment when large development projects are on the table. We have a range of tools to choose from but in general these are not always applied consistently.   Having worked in both New Zealand and the Pacific, how would you characterise the relationship between the two? In some areas it is going well however I would say there seems to be a general lack of awareness in New Zealand about what is happening in the Pacific regions. I do note though that there is more and more interaction taking place. We could learn a lot from the health promotion models and ideas in New Zealand. Smoking continues to be a significant problem in the islands.  We have been impressed with New Zealand’s smoke free work over many years.   Are there any other pointers from your recent work we could learn from? Recently I was part of the World Health Organisation Global Commission on Ending Childhood Obesity as a commissioner. From that we produced a final report with a set of recommendations and cost-effective measures for ending childhood obesity. New Zealand and Pacific nations have been slow to pick these up. One would hope governments provide leadership and look seriously at the recommendations of this report.

If you look at recent news on sugary drinks and obesity in New Zealand, chances are you will come across the name Dr Gerhard Sundborn, or the advocacy Dr Sundborn undertakes at FIZZ (Fighting Sugar In Soft Drinks). Health Promotion Forum caught up with Dr Sundborn to find out more about his role and recent work. 
Gerhard, thank you for your time. Could you tell our readers a little about your role and background please?
I have a few varied roles. I am a public health researcher/epidemiologist based at the University of Auckland. In 2013, I with a number of colleagues established FIZZ (which stands for Fighting Sugar in Soft-drinks) a Public Health Advocacy Group to address sugary drink consumption. More recently (since February) I have also started a part-time role for ARPHS as a Project and Public Health Analyst.
I have spent most of my time in Auckland and as a child and teenager lived in Wellington for 2 years and Rotorua for 3 years. My father is originally from Huntly and my Mother is from Vava’u, Tonga. Together with my wife Meliame we have three young children Sola 8y, Wayne 6y and Chloe 5y.     
We are aware that you have a symposium coming up. What is it about and why is it important?
The symposium ‘Taxing Sugary Drinks’ on the 26th June in Auckland is the fourth that FIZZ has run. It will provide information and explain the science as to why sugar and sugary drinks are harmful, profile a large number of initiatives that have been created to address this issue both here in NZ and the USA, and finally we will also focus on the issue of taxing sugary drinks- looking at the most recent examples in Berkley (USA) and determine whether this is or should be an election issue leading up to our vote on 23rd September. To conclude the symposium we will have a political panel debate with representatives from all the major political parties with the only exception being National (Greens, Labour, The Māori Party, NZ First and The Opportunities Party will all be represented).   
What are you hoping to achieve from the symposium?
We hope that the symposium will further raise awareness about the need to look seriously at reducing sugar and sugary drink intake to improve health.
We also hope that by providing a forum to profile the great work that many people and organisations are already doing in this area, it will encourage others to do the same and/or similar things.
We hope that this symposium will also promote wider public debate on a sugary drink tax being a key election issue.    
How has society/ NZ/ communities responded to this issue and how has this changed over the years?
Since we started (back in 2013) the issue of sugar and sugary drinks is now becoming part of normal commentary when we think of the health debate. Our health sector and researchers in academic organisations I think have embraced this issue and driven a lot of great work. The general public too I think now see the need to address sugar and sugary drinks as a high priority. This increase in public awareness/support can be seen in the huge increase in support of a sugary drink tax that went from 44% in early 2014 to 86% in late 2016.    
How does health promotion work alongside other approaches to improve wellbeing in this area?
Health promotion is an essential part of the work needed to address the problem of high sugar intake in NZ. It is important to work with schools, churches, sports clubs and all parts of our community to provide them with accurate and easily understood information about sugar in our diets and the massive amount of sugar in many drinks, the harm it causes but most importantly – possible solutions. There is some amazing health promotion work that is going on in this area where many large Māori and Pasifika festivals have gone sugary-drink free or water only such as Creekfest in Cannons Creek Porirua, Te Wānanga o Raukawa Events in Ōtaki and the Matatini event that was held in Hawkes Bay this year.
What are some of the challenges and opportunities to achieving your goals on this issue? 
Industry present challenges to this work for obvious reasons in that they make money from the sale of sugar, however, we hope that industry will move to creating more low/no sugar products, and there are examples of this happening already.
Other challenges come from an argument that we shouldn’t limit people’s choice! However, we don’t want to limit choice but move the landscape so that healthier choices in the form of very low and no sugar products are the easier choice to make.

Case 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.
In 2009 the Smokefree Coalition published a landmark document, Achieving the Vision: Tupeka Kore Aotearoa 2020 which members used to advocate a radical idea: regulating tobacco’s supply and eliminating demand for tobacco altogether, to return Aotearoa to its original state, free of tobacco. This vision was well-received during the Maori Affairs Select Committee’s Inquiry on the tobacco industry and the consequences of tobacco use for Maori. It was this select committee’s Inquiry report which inspired government’s commitment to making Aotearoa a Smokefree nation by 2025.       October 2016 Jo Lawrence-King

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
  1. Ms Osnat Lubrani, UN Resident Coordinator and UNDP Resident Representative, UNDP Pacific Office,
  2. Dr Viliami Puloka, HPF Pacific Leader and Otago University Research Fellow,
  3. Rt Hon Helen Clark, UNDP Administrator and former Prime Minister of New Zealand,
  4. Ms Leanne Eruera, HPF Business Manager and 2019 Conference Project Manager,
  5. Mr Sione Tu’itahi, HPF Executive Director and IUHPE Vice-President.

Experts, Global, Policy, What is HP
Health Promotion Forum was fortunate to get some time with Emeritus Professor John Raeburn recently, to ask him about his more than 40 years as a health promotion advocate.   As one of two NZ delegates at the WHO’s first International Conference on Health Promotion, from which the Ottawa Charter emerged, Professor Raeburn made a small but significant contribution to the content of the document; the inclusion of a sentence emphasising the importance of empowerment.  This was the only time the word appeared in the Charter.  He has upheld the principles of community and health promotion ever since.   Invited to attend the 1986 Conference in Ottawa by the Ministry of Health, Prof Raeburn had recently returned from a sabbatical in Canada from his teaching role at the University of Auckland Medical School.  There he had been working alongside Ron Draper; head of the Health Promotion Directorate at Health Canada.  He considered this the ‘Mecca’ of health promotion and Ron Draper one of his heroes. “Canada actually invented health promotion in the 1970s,” says Prof Raeburn.  Little did he know that his year’s sabbatical would see him caught up in the preparations for the seminal Conference at which he was to later play such a significant role.   The other New Zealand delegate to the Conference was a Canadian man called Larry Peters, who was asked to go in his capacity as the first director of the Health Promotion Forum (Larry later went back to Canada and worked in the Health Promotion Directorate).   What was the experience of participating in the conference like? It was a mixed experience, and I wrote an article about it for a public health magazine in New Zealand when I got back, which was essentially a critique. I’ll start with the negative aspects.  It was mainly organised by WHO, who did things in a very grand style with multiple flags and so on, much formality, and participants invited from all around the world. (It wasn’t open to everyone – governments were asked to send representatives). The conference process was awful.    First of all, it was organised out of Europe, and the organisers succeeded in somehow alienating most of the developing world, with the result that most of the attendees were European, white and from industrialised countries.(Only 46 countries were represented).     Second, it was conducted in a very disempowering and top-down way – the opposite of “real” health promotion!  They went through the motions of having a participatory workshop format, but the European bureaucrats had already decided the outcomes beforehand.   Third, they didn’t tell us until almost the end of the several-day conference that they had a charter in mind, and it was clear that it had already been pre-written by them. So we were basically there to rubberstamp it.  Well, the anger that surged around the huge room when the hundreds of delegates realized what had happened was spectacular.     WHO then had to back down somewhat, and then said they’d accept some of the workshop material. They also said that, although the Charter was ready to be printed, if people wanted to scribble something down and hand them into the printing room, they would be considered for inclusion as well.    I hurriedly wrote a sentence down on the back of an envelope (literally) and handed it in. You can imagine how delighted I was to find that whole sentence in the final Charter.  My passion has always been the community dimension of health promotion, and the empowerment of ordinary people, and I’m happy to say that the only time that the term “empowerment” appears in the Charter is in that sentence. It’s in the community action stream (of course!) and says: “At the heart of this process [of community action] is the empowerment of communities, their ownership and control of their own endeavours and destinies”.  The sentiments expressed in the sentence are as important to me now, 30 years later, as they were then, and sums up for me the very essence of the health promotion enterprise.   And also on the positive side, on a wider level, thanks to the various changes done at the last moment, the world got a health promotion charter that still remains a brilliant document.  And I have to say, that when the conference participants heard what WHO had finally came up with after they had incorporating the workshop materials, there was thunderous applause.  What a transformation!  By some miracle, WHO had got it right.  Once again, it’s proof of how important it is to have full-scale participation.   Did you realise at the time how seminal the conference and charter would be?  Yes I think we were all aware that we were at a history-making event.  When Larry and I got back to New Zealand, we spent the next year going around the country promoting the Charter, with the result that New Zealand had arguably the biggest uptake of the Charter of any country in the world, including Canada.   You talk about health promotion moving away from the focus of changing lifestyles and behaviours to one of policy ‘changing society so that people and communities can more easily live healthy lives’.  How far do you think NZ (and global) society has come?     This question is a slightly tricky one for me. I have over the last few years presented in various settings a critique of the Ottawa Charter,  including one memorable occasion in Canada when I was invited to do a keynote on this topic at a conference to mark the 25th anniversary on the Charter.  I was nervous, because the Ottawa Charter is like a sacred document in Canada. Happily it went down well.    Part of my critique is that the movement of health promotion away from the older style of health promotion which emphasised changing lifestyle, behaviour and community, threw the baby out with the bathwater. It’s not by chance that the first action stream in the Charter is to do with policy – that was definitely the main interest of WHO.  However, my main interest, and clearly that of most of the participants at the conference, was in people.  In the late 90s, I published a book co-authored with Canadian grandfather of health promotion, Irving Rootman, called “People-Centred Health Promotion”, which makes just this point.    My argument is that the focal point of health promotion should be community, a stance that enables one both to look “up” to the larger picture of policy and environment, and “down” to the more intimate and personal level of personal skills and family life.  Community is where people do their lives, and is the great meeting point of those two perspectives.   My fear has always been that health promotion would increasingly become preoccupied with policy – with statistics and abstract documents – and as far as most academic health promotion is  concerned, that’s definitely the case.  The result has been, I believe, a major gap between grassroots practitioners of health promotion and communities, and academics and policymakers.  And largely, the public likes a lifestyle/community approach, and is turned off by policy approach.  I’m not saying we shouldn’t have policy in health promotion – of course we should.  But we equally need the community and people level.    My favourite image, which I’ve shown in multiple PowerPoint presentations, is a picture of a gannet in the sky with its wings spread, with one wing labelled “policy”, and the other “people”.  This balanced approach is the one I strongly advocate.    So as to the question about how far NZ and global society has come in regard to these issues, I see that health promotion is probably going backwards, and has lost its broad public constituency, mainly because it has got lost in the arid desert of too much policy.    Community development is your passion.  In an increasingly populous and multi-cultural society how do you think we are progressing with this area of health promotion?   I don’t think we are progressing at all well. In short, I feel health promotion has gone too far in the policy direction, and needs to go back to its heartland, which is community.    There was a time in the ‘70s and ‘80s when there was fantastic progress, with all sorts of great community initiatives around.  One of the best contributions of government here was something called CHIFS; the Community Health Initiatives Funding Scheme, which supported communities coming up with their own empowering projects.   What changed all that was the arrival around 1985 of “Rogernomics”, followed by “Ruthanasia” in the ‘90s, which is to say that both Labour and National governments swung far to the right by adopting wholeheartedly the fashionable new economic policies of neoliberalism. These were first introduced by Maggie Thatcher in the UK, who was famous for a statement that “there’s is no such thing as society”. Rather, she said, there are ony individuals, and unequal ones at that.   Such a philosophy is harmful to community and empowerment of ordinary people, and we still largely live under this system globally and In New Zealand today. So community remains an unpopular concept. But at least now many are more aware of how damaging to society this approach is, and how it favours corporates and the wealthy, and makes the already miserable life of the poor and disempowered even more miserable.   On the other hand, this is offset in Aotearoa by the bicultural and multicultural nature of our society, where Māori and Pacific people in particular see society very much in “true” community terms.  This is a perspective where people are indeed the most important thing in life, and where life is about cooperation, whanau, aroha and connectedness with others.  So definitely, the saving grace in Aotearoa is the health promotion approach of these populations, and also in other cultural populations.   So it’s a mixed bag here.  Because government policy is not generally supportive of community and the less well off, it’s an uphill battle. At the same time, we in this country have a deeply embedded belief in the value of community, which for health promoters applies to health and wellbeing in particular.  A well-connected and well-liked local community means healthy and happy people.  (There’s lots of research to back that statement up).  However, for the present time, in spite of positive aspects, at a general level, the community approach to health promotion is currently on the back foot, and has been so for at least two decades.   Talking about your Public Health Champion award 2015, you are quoted as saying that health promotion is the area of public health with which that you identify most.  What are your thoughts behind seeing health promotion as a subset of public health?     This is a fascinating question, and when I was working at the University of Auckland’s School of Population Health, I was continually aware of it; surrounded as I was by public health people such as epidemiologists.   Because it has its roots in disease prevention and medical approaches to health, mainstream public health has always had an uneasy relationship with the ‘upstart’ called health promotion, which is largely a non-medical enterprise, and operates out of an entirely different model.    I’ve worked hard over the years to make the point that public health is a combination of three components – protection, prevention and promotion – and it’s important to distinguish the three of them.    One of the other things that has put health promotion on the back foot for decades is the fact that it frequently gets confused with prevention, and therefore is based on concepts of disease rather than concepts of health and well-being. And, while I definitely think that health promotion is part of public health, it has yet to carve out its full identity within that context.  I constantly see health promotion being seduced off in the direction of disease-oriented prevention, largely because it doesn’t have a strong kaupapa to the contrary   At the same time, I also think that health promotion goes well beyond what is conventionally regarded as public health. All sorts of things affect our wellbeing outside what’s conventionally regarded as public health. For example, at the simplest level, going to Weight Watchers, playing rugby, being on a marae, or having a good time with friends, all contribute to health and wellbeing in their various ways (again supported by research evidence).  In a way, the whole of life can be either health promoting or health destroying.    So yes, while public health has an arm called “health promotion”, I really think that it’s only one expression of health promotion, which is much wider than that. But I can’t say that seems to be a popular view either. Of recent years, I have become enamoured of the concept of wellbeing promotion rather than health promotion, and I think this represents a more inclusive type of health promotion than the public health version currently provides.   You were recently involved in the publication of the Manifesto of Planetary Health.  Can you tell us more about this paper and the project? Well, this question relates directly to what I was just talking about – I see planetary health as also a great new inclusive concept that will benefit both health promotion and public health, and could well be the future.   I was lucky to be involved in this project through my friendship with Robert Beaglehole and Ruth Bonita, who were asked by the Lancet to participate in the authorship of the trailblazing one page article that is the Planetary Health Manifesto.  When I saw the first drafts, I thought it was very light on community, and too heavy on policy and government action.  So me being me, I pulled out all the stops and kept inserting references to community in the document.  And if you now read that document, it almost looks as though community is the number one consideration, so naturally I’m very pleased with all that.   And what is planetary health? It’s a concept designed to revolutionise public health, which is seen as having lost ground both professionally and in terms of public engagement.  It’s quite clear that the greatest threats to health and well-being in the future are quite different from what they were 30 years ago, or even 10 years ago.  Global warming, terrorism, globalisation, ferocious inequity , ever-growing populations, food and water shortages, new and damaging addictions like gambling and designer drugs, robotization and fewer jobs, are just some of the factors that are going to deeply affect everyone’s health in the future.  This manifesto is designed to bring public health kicking and struggling into the 21st century.  But its goals won’t be achieved, in my view, simply by government policy being developed in a top-down way, and dumped onto populations.  Without community participation, and indeed community leadership rather than just “consultation”, we won’t get anywhere.  The only way to change the world, in my view, is by local people working with the things that concern them most, in their own settings and culture, in partnership with government.   How do you see the manifesto impacting on New Zealand health and Health Promotion? Well so far it’s not very advanced.  The manifesto was only published in 2014, and it’s not very well known here yet.  I and others have given a few workshops and presentations on it, and I must say there’s been a very positive response to it at those.  So definitely, there’s a huge potential for public-health people and other people of good will to become passionately involved in this enterprise.  But we’ve got a long way to go yet.   I understand you are writing a book about spirituality.  Can you tell us more about this? Have you got all day?  Briefly, ten years ago when I was leaving the University of Auckland, I wanted to spend more time meditating and doing “spiritual” things, given that I had a strong interest in Zen and Taoism.  I have a property in the wilds of Great Barrier, and had the romantic vision of spending lots of time there in the bush in the pursuit of – whatever it is one pursues in such a setting. But when the time came, I got cold feet, and wondered whether spirituality was simply a psychological entity dreamed up by humans to provide us with hope and happiness in a stressful world. (My background is as a psychologist). I then got to thinking that there were large numbers of people in the 21st century labelling themselves spiritual, and many declare themselve “spiritual but not religious.”  I decided I wanted to know what they meant. What is this thing called spirituality? It’s definitely not religion, although religion has elements of it of course. So what is it?   It’s taken me all those years to figure it out , and I’ll give just a clue as to what that might be.  I believe it’s in our genes, the result of millions of years of evolutionary development at both the prehuman and human level, and it serves very important survival and well-being purposes.  Unsurprisingly, I believe it also has a very strong community dimension in it’s background.  But at this point I’ll say no more, partly because I’m still working on it, but also partly because once I start on this topic, it could take all day!   And does it relate to health promotion?  Yes indeed it does, and also to planetary health.  For several years at the University of Auckland, I used to teach a postgraduate course called Spirituality and Health, and it had a strong health promotion bias.  It used to attract students from every kind of background, from atheist to fundamenalist, and all cultures, and this enabled me to develop a concept of spirituality as it related to health promotion.  But don’t get me started on that either!     We thank Professor Raeburn for his valuable time, warmth and considered replies.   March 2016 Jo Lawrence-King – See more at:[/vc_column_text][/vc_column][/vc_row]

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;
  • 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
According to Mihi Ratima “Health promotion is an established approach to addressing public health problems in New Zealand. A key role of the Health Promotion Forum is in supporting the workforce and organisations to develop shared understandings of effective health promotion approaches.  This leads to greater health equity and improved outcomes for individuals, whanau and communities: what works and how to apply health promotion through policy, practice and advocacy”. Mihi also believes the Health Promotion Forum has a role to play in supporting the development and growth of the body of theory and evidence for effective health promotion.   What would you say to an organisation considering membership of the health promotion forum? Zoe Aroha Martin-Hawke : “For clarity, consistency, ongoing workforce development and the ability to connect with like-minded health promotion workers from across the country, to keep up to date with international health promotion movements the Health Promotion Forum is exemplary.” “HPF is one of those rare examples of how to truly work from a reducing inequalities framework.” “As a member of the Health Promotion Forum you can trust that their statements around “prioritising activities that will benefit people communities who are least disadvantage” are not just words.  They take a systems approach to tackling these issues by starting with their own organisation – where it should start. “Their team consists of a strong Pacific and Māori team at all levels from the Board, to the Executive Director, to Deputy Executive Director to accountant.  All members of the team understand and are dedicated to viewing the reduction on inequalities in a broad socio-economic context, where promotion, prevention and protection are at the forefront.”   Wiki Shepherd-Sinclair encourages organisations to consider membership of HPF as the health promotion leader in Aotearoa New Zealand.  “The connections with regional and international leaders are a real plus for organisations that also want to grow their networks and strengthen relationships. The sharing of health promotion expertise and best practice, to increase better outcomes for our communities and populations, is of huge importance,” she says.   “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