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.
HAUORA: 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
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Trevor Simpson is HPF’s Deputy Executive Director / Senior Health Promotion Strategist (with Portfolio in Māori development). 
Dr Vollant who grew up in the Côte-Nord region of Quebec was exposed at a young age to the traditional teachings of his grandfather, which were marked by the importance of community values.
He received his degree in medicine from the Université de Montréal in 1989 and his specialisation in general surgery in 1994.
During the first annual “Stanley Vollant Challenge,” a six-kilometre walk to promote health and wellness he told CBC News that he wanted to inspire Indigenous youth across Quebec to follow their dreams, while also leading healthy lifestyles.
He said it was important to bring Indigenous and non-Indigenous walkers together in the spirit of reconciliation.
“My vision is to bring people to celebrate wellness and also to celebrate [being] all together, Indigenous and non-Indigenous people.”
Sir Mason who was born in 1938, of Rangitane, Ngāti Kauwhata and Ngāti Raukawa descent, grew up in Feilding, where his hard-working parents showed him the importance of a strong work ethic.
Between 1986-1988 he served on the New Zealand Royal Commission on Social Policy and in 1988 accepted a position at Massey University as Professor and Head of Te Pūtahi a Toi, School of Māori Studies. Up until retirement in June 2012 he was Deputy Vice-Chancellor and Professor of Māori Research and Development.
He has been at the forefront of a transformational approach to Māori health and has played major roles in building the Māori health workforce for more than 40 years.
He has also championed higher education for Māori and has published widely on Māori health, Māori policy, the Treaty of Waitangi, Māori education and whānau development.
In his book Nga Tini Whetu NAVIGATING MAORI FUTURES he says in the introduction that, “If there is a single message to this book, it is that Maori have the knowledge, skills and foresight to create a future where younger generations yet to come can prosper in the world, and at the same time live as Maori”.
The model he created for healthcare, Te Whare Tapa Wha, successfully challenged the notion that health is the same for people of all cultures.
He has also made significant strides with his work in mental health, and most recently, the prevention of suicide in Maori and Pasifika communities.
During 2009 he chaired the Ministerial Taskforce on Whānau Centred Initiatives and from 2011 was chair of the Whānau Ora Governance Group. In 2018 he was also a panel member for the Inquiry into Mental Health and Addictions.
Upon being awarded the Blake Medal at last year’s Sir Peter Blake Leadership Awards Sir Mason told the NZ Herald: “The most important thing has been the difference to health. That’s where my career started and it’s continued to be what I spent most of my time doing.
“It’s really how to make people more aware that health is not just a question for doctors and nurses, but a question people have themselves.”
Mr Kruger is a Māori advocate and social and political analyst who has dedicated his career to the development of his iwi. From the Ngāti Koura, Ngāti Rongo and Te Urewera hapū of Tūhoe, Mr Kruger was instrumental in securing the largest Treaty of Waitangi settlement to date ($450 million) for the Central North Island Iwi Collective.
He is now a director of CNI Holdings, representing Tūhoe.
More recently, Mr Kruger was chief negotiator of the Tūhoe-Te Urewera Treaty of Waitangi Settlement. The landmark settlement included a Crown apology for historical grievances, a social service management plan for the Tūhoe rohe and a financial and commercial redress package totalling $170 million.
The settlement also included legislative changes to transfer Te Urewera National Park to its own separate legal entity, looked after by the Te Urewera Board, of which Mr Kruger is chair.
Mr Kruger’s contribution is not limited to his tribe. He chaired the Second Ministerial Māori Taskforce on Whānau Violence and developed the Mauri Ora Framework and was awarded the Kahukura award in 2013 in recognition of this work.
In an interview with Asia Pacific Report he said an important part of leadership involved navigating the difference between Māori and Pākehā politics.
“Part of the blessing of Pākehā politics is you have this apparatus called law, where you can bend people to one’s will. But in Tūhoe politics you have to depend on your reputation and integrity for people to find that whatever you have to say has some wisdom and truth in it.”
The official languages of the conference are English, Spanish, French and in a world-first for Māori and other indigenous cultures Te Reo Māori.
Abstracts must be in by August 31 and submissions can be made in the official languages.
For the first time, the World Conference on Health Promotion will be held in New Zealand from April 7-11, 2019. Rotorua is the venue. The conference provides rare opportunities for New Zealand health promoters, other health professionals, policy makers and others whose work impacts directly on our health and wellbeing, to share knowledge with colleagues from around the world, and to co-construct health promoting pathways into the future.
What makes it more challenging is that you have to build an international organisational structure at three levels – global, national and local – to plan and manage across different time zones with colleagues around the world. Put on top of that the fact that you have to have keynote speakers from the four official languages of the conference – English, French, Spanish, and Te Reo Maori, and consider gender balance, linguistic & ethnic diversity, and age. But thanks to technology, our 100 HPF member organisations, our professional conference company (The Conference Company), and the help of Tourism New Zealand, as well as our co-organiser, IUHPE, we are managing well, with the usual hiccups, of course. Challenges are good and timely incentives to help ensure you do your utmost best and become more innovative and prudent at the same time.
(Sione pictured catching up with Pacific delegates from Tuvalu and Kiribati at the WHO congress on health promotion, Shanghai, 2016)
From an educational perspective, this is excellent professional development training for our team and others in the country and overseas who have volunteered to help organise the conference. It gives you a real sense of how we live and work as a global village – i.e. we work together across national, geographic and cultural borders to address challenges that confront us all as one human family. As for the conference programme, we have a line-up of public health and health promotion leaders, such as Sir Michael Marmot, Professors Fran Baum, Anthony Capon, and Sir Mason Durie, as keynote speakers. And we are shaping up a highly educational and informative scientific programme that our expected 2000 participants will enjoy and learn a lot from.
You will find more details on the conference website 
Hosting the conference is the latest development of that professionalrelationship with IUHPE. But there are other developments such as having our Deputy Executive Director, Trevor Simpson, as the Chair of the International Network for Indigenous Health Promotion Professionals (INIHPP) of IUHPE. HPF is also leading the work for New Zealand health promotion to become part of the global accreditation framework for health promotion, recently established by IUHPE. IUHPE has a standing work relationship with WHO, which is a partner of the conference, along with the Secretariat of the Pacific Community (SPC), being led by Dr Colin Tukuitonga, and the Australian Health Promotion Association.
(Taking time out for a photo with Professor Ilona Kickbusch, one of the architects of the Ottawa Charter, 1986.)
You have years of working as a journalist in Tonga and the Pacific, then retrained as a teacher and taught at some of the tertiary educational institutions here in New Zealand. Why did you later choose to work in health? And what has the experience been like for you?
Health and education are two important and related determinants of the wellbeing and prosperity of Pacific peoples, in fact, all people. Good education means not only you are enlightened, but you also have a decent income which enables you to afford a healthy life, and be in control of your future. I learned these things early on through my family experience, especially from my grandparents and parents. They were humble folk from humble beginnings in Tonga, but education, being prudent, hard work and serving others were central values and goals.
My mass communication, teaching, and strategic capacity-building experience were very handy when I was invited to set up a Pacific team at the Auckland Regional Public Health Service some 20 years ago. At the time I was starting to build the Pacific capacity of Massey University. I saw the invitation as an opportunity to do the same strategic work for Pacific peoples in the health sector as well. I was later seconded to build the Pacific capacity of HPF, which led to where I am today. For more than 10 years, I shared my time between Massey University and HPF, until I decided recently to focus on my health work, for now.
And your strategic outcomes for the conference?
There are at least three strategic outcomes. And the conference is a platform to enhance those long-term outcomes: Strengthen our co-leadership in health promotion at the global level, such as our work with IUHPE, which not only elevates the prestige of HPF, but more importantly, helps to build the capability and capacity of the health promotion workforce and sector in NZ and the world, for the wellbeing of society. Enhance our leading contribution to the world in Indigenous health promotion; Ensure the sustainable strength and longevity of HPF and the health promotion sector in New Zealand.
Prof Capon is the world’s first professor of planetary health and an authority on environmental health and health promotion while Prof Baum from Flinders University, Adelaide is one of Australia’s leading researchers on the social and economic determinants of health.
Prof Capon, who was born in New Zealand and moved to Brisbane with his family when he was a young boy, is a public health physician with more than 25 years of senior leadership experience, spanning academic, policy and practice roles.
“Planetary health is about safeguarding the health and wellbeing of current and future generations through good stewardship of Earth’s natural systems and by rethinking the way we feed, move, house, power, and care for the world (something missing here?), “ Professor Capon told Lancet recently.
Capon thinks that, “the central challenge of planetary health is to greatly reduce per capita resource consumption in high-income countries (HICs) to make room for further sustainable development in other countries”.
He also told the journal that: “If everyone in the world lived as the average Australian does, we would need four or five planets … we urgently need to contract per capita consumption in HICs to about 20% of what it is now so that all people can have a fair share of the Earth. And with less focus on materialism, we may indeed lead more fulfilling, and healthier, lives in tune with nature for the world.”
The former director of the global health institute at United Nations University (UNU-IIGH) has also since 2008 advised the International Council for Science on its global interdisciplinary science programme on health and wellbeing in the changing urban environment using systems approaches.
Prof Baum is Matthew Flinders Distinguished Professor of Public Health and Foundation Director of the Southgate Institute for Health, Society and Equity at Flinders University.
Prof Baum was named in the Queen’s Birthday 2016 Honours List as an Officer of the Order of Australia (AO) for “distinguished service to higher education as an academic and public health researcher, as an advocate for improved access to community health care, and to professional organisations”.
Prof Baum told ABC Online, in an article on mental illness and poverty last month, that reducing levels of mental distress, and closing health inequalities, would require a rethinking of Australia’s direction as a society.
“I would have thought in the last 30 years, when rates of anxiety and depression have gone up in Western countries, there’s some clear clues from the economic system and society we’re creating.”
This system includes a dramatic rise in precarious and casualised work, a trend Prof Baum says could exacerbate pressures of powerlessness and poverty.
According to ABC Online she is writing a book on the subject of health inequality, and one of the unavoidable conclusions of her research is that health reform is political.
Her preliminary recommendations include reducing economic inequality, making public education free and available to all and providing more affordable and secure housing, to name a few.
Prof Baum holds grants from the National Health & Medical Research Council and the Australia Research Council which are considering a wide range of aspects of health inequities and social determinants of health. These grants include an NHMRC Centre for Research Excellence on Policies for Health Equity of which she is one of the two co-directors.
Her book, The New Public Health (4th ed. published January 2016 Oxford University Press), is widely cited and used in many public health courses.
Other speakers confirmed for the conference are: Anne Bunde-Birouste, director of the UNSW Yunus Social Business for Health Hub; Dr Trevor Hancock, a public health physician and health promotion consultant from the University of Victoria, Canada; Patrick Mwesigye Sewa, founder and team leader at the Uganda Youth and Adolescents Health Forum; Colin Tukuitonga, Director General of the Pacific Community and Dr Stanley Vollant who 
What was the experience of participating in the conference like?
It was a mixed experience, and I wrote an article about it for a public health magazine in New Zealand when I got back, which was essentially a critique. I’ll start with the negative aspects. It was mainly organised by WHO, who did things in a very grand style with multiple flags and so on, much formality, and participants invited from all around the world. (It wasn’t open to everyone – governments were asked to send representatives). The conference process was awful.
First of all, it was organised out of Europe, and the organisers succeeded in somehow alienating most of the developing world, with the result that most of the attendees were European, white and from industrialised countries.(Only 46 countries were represented).
Second, it was conducted in a very disempowering and top-down way – the opposite of “real” health promotion! They went through the motions of having a participatory workshop format, but the European bureaucrats had already decided the outcomes beforehand.
Third, they didn’t tell us until almost the end of the several-day conference that they had a charter in mind, and it was clear that it had already been pre-written by them. So we were basically there to rubberstamp it. Well, the anger that surged around the huge room when the hundreds of delegates realized what had happened was spectacular.
WHO then had to back down somewhat, and then said they’d accept some of the workshop material. They also said that, although the Charter was ready to be printed, if people wanted to scribble something down and hand them into the printing room, they would be considered for inclusion as well.
I hurriedly wrote a sentence down on the back of an envelope (literally) and handed it in. You can imagine how delighted I was to find that whole sentence in the final Charter. My passion has always been the community dimension of health promotion, and the empowerment of ordinary people, and I’m happy to say that the only time that the term “empowerment” appears in the Charter is in that sentence. It’s in the community action stream (of course!) and says: “At the heart of this process [of community action] is the empowerment of communities, their ownership and control of their own endeavours and destinies”. The sentiments expressed in the sentence are as important to me now, 30 years later, as they were then, and sums up for me the very essence of the health promotion enterprise.
And also on the positive side, on a wider level, thanks to the various changes done at the last moment, the world got a health promotion charter that still remains a brilliant document. And I have to say, that when the conference participants heard what WHO had finally came up with after they had incorporating the workshop materials, there was thunderous applause. What a transformation! By some miracle, WHO had got it right. Once again, it’s proof of how important it is to have full-scale participation.
Did you realise at the time how seminal the conference and charter would be?
Yes I think we were all aware that we were at a history-making event. When Larry and I got back to New Zealand, we spent the next year going around the country promoting the Charter, with the result that New Zealand had arguably the biggest uptake of the Charter of any country in the world, including Canada.
You talk about health promotion moving away from the focus of changing lifestyles and behaviours to one of policy ‘changing society so that people and communities can more easily live healthy lives’. How far do you think NZ (and global) society has come?
This question is a slightly tricky one for me. I have over the last few years presented in various settings a critique of the Ottawa Charter, including one memorable occasion in Canada when I was invited to do a keynote on this topic at a conference to mark the 25th anniversary on the Charter. I was nervous, because the Ottawa Charter is like a sacred document in Canada. Happily it went down well.
Part of my critique is that the movement of health promotion away from the older style of health promotion which emphasised changing lifestyle, behaviour and community, threw the baby out with the bathwater. It’s not by chance that the first action stream in the Charter is to do with policy – that was definitely the main interest of WHO. However, my main interest, and clearly that of most of the participants at the conference, was in people. In the late 90s, I published a book co-authored with Canadian grandfather of health promotion, Irving Rootman, called “People-Centred Health Promotion”, which makes just this point.
My argument is that the focal point of health promotion should be community, a stance that enables one both to look “up” to the larger picture of policy and environment, and “down” to the more intimate and personal level of personal skills and family life. Community is where people do their lives, and is the great meeting point of those two perspectives.
My fear has always been that health promotion would increasingly become preoccupied with policy – with statistics and abstract documents – and as far as most academic health promotion is concerned, that’s definitely the case. The result has been, I believe, a major gap between grassroots practitioners of health promotion and communities, and academics and policymakers. And largely, the public likes a lifestyle/community approach, and is turned off by policy approach. I’m not saying we shouldn’t have policy in health promotion – of course we should. But we equally need the community and people level.
My favourite image, which I’ve shown in multiple PowerPoint presentations, is a picture of a gannet in the sky with its wings spread, with one wing labelled “policy”, and the other “people”. This balanced approach is the one I strongly advocate.
So as to the question about how far NZ and global society has come in regard to these issues, I see that health promotion is probably going backwards, and has lost its broad public constituency, mainly because it has got lost in the arid desert of too much policy.
Community development is your passion. In an increasingly populous and multi-cultural society how do you think we are progressing with this area of health promotion?
I don’t think we are progressing at all well. In short, I feel health promotion has gone too far in the policy direction, and needs to go back to its heartland, which is community.
There was a time in the ‘70s and ‘80s when there was fantastic progress, with all sorts of great community initiatives around. One of the best contributions of government here was something called CHIFS; the Community Health Initiatives Funding Scheme, which supported communities coming up with their own empowering projects.
What changed all that was the arrival around 1985 of “Rogernomics”, followed by “Ruthanasia” in the ‘90s, which is to say that both Labour and National governments swung far to the right by adopting wholeheartedly the fashionable new economic policies of neoliberalism. These were first introduced by Maggie Thatcher in the UK, who was famous for a statement that “there’s is no such thing as society”. Rather, she said, there are ony individuals, and unequal ones at that.
Such a philosophy is harmful to community and empowerment of ordinary people, and we still largely live under this system globally and In New Zealand today. So community remains an unpopular concept. But at least now many are more aware of how damaging to society this approach is, and how it favours corporates and the wealthy, and makes the already miserable life of the poor and disempowered even more miserable.
On the other hand, this is offset in Aotearoa by the bicultural and multicultural nature of our society, where Māori and Pacific people in particular see society very much in “true” community terms. This is a perspective where people are indeed the most important thing in life, and where life is about cooperation, whanau, aroha and connectedness with others. So definitely, the saving grace in Aotearoa is the health promotion approach of these populations, and also in other cultural populations. So it’s a mixed bag here. Because government policy is not generally supportive of community and the less well off, it’s an uphill battle. At the same time, we in this country have a deeply embedded belief in the value of community, which for health promoters applies to health and wellbeing in particular. A well-connected and well-liked local community means healthy and happy people. (There’s lots of research to back that statement up). However, for the present time, in spite of positive aspects, at a general level, the community approach to health promotion is currently on the back foot, and has been so for at least two decades.
Talking about your Public Health Champion award 2015, you are quoted as saying that health promotion is the area of public health with which that you identify most. What are your thoughts behind seeing health promotion as a subset of public health?
This is a fascinating question, and when I was working at the University of Auckland’s School of Population Health, I was continually aware of it; surrounded as I was by public health people such as epidemiologists.
Because it has its roots in disease prevention and medical approaches to health, mainstream public health has always had an uneasy relationship with the ‘upstart’ called health promotion, which is largely a non-medical enterprise, and operates out of an entirely different model.
I’ve worked hard over the years to make the point that public health is a combination of three components – protection, prevention and promotion – and it’s important to distinguish the three of them.
One of the other things that has put health promotion on the back foot for decades is the fact that it frequently gets confused with prevention, and therefore is based on concepts of disease rather than concepts of health and well-being. And, while I definitely think that health promotion is part of public health, it has yet to carve out its full identity within that context. I constantly see health promotion being seduced off in the direction of disease-oriented prevention, largely because it doesn’t have a strong kaupapa to the contrary
At the same time, I also think that health promotion goes well beyond what is conventionally regarded as public health. All sorts of things affect our wellbeing outside what’s conventionally regarded as public health. For example, at the simplest level, going to Weight Watchers, playing rugby, being on a marae, or having a good time with friends, all contribute to health and wellbeing in their various ways (again supported by research evidence). In a way, the whole of life can be either health promoting or health destroying.
So yes, while public health has an arm called “health promotion”, I really think that it’s only one expression of health promotion, which is much wider than that. But I can’t say that seems to be a popular view either. Of recent years, I have become enamoured of the concept of wellbeing promotion rather than health promotion, and I think this represents a more inclusive type of health promotion than the public health version currently provides.
You were recently involved in the publication of the Manifesto of Planetary Health. Can you tell us more about this paper and the project?
Well, this question relates directly to what I was just talking about – I see planetary health as also a great new inclusive concept that will benefit both health promotion and public health, and could well be the future.
I was lucky to be involved in this project through my friendship with Robert Beaglehole and Ruth Bonita, who were asked by the Lancet to participate in the authorship of the trailblazing one page article that is the Planetary Health Manifesto. When I saw the first drafts, I thought it was very light on community, and too heavy on policy and government action. So me being me, I pulled out all the stops and kept inserting references to community in the document. And if you now read that document, it almost looks as though community is the number one consideration, so naturally I’m very pleased with all that.
And what is planetary health? It’s a concept designed to revolutionise public health, which is seen as having lost ground both professionally and in terms of public engagement. It’s quite clear that the greatest threats to health and well-being in the future are quite different from what they were 30 years ago, or even 10 years ago. Global warming, terrorism, globalisation, ferocious inequity , ever-growing populations, food and water shortages, new and damaging addictions like gambling and designer drugs, robotization and fewer jobs, are just some of the factors that are going to deeply affect everyone’s health in the future. This manifesto is designed to bring public health kicking and struggling into the 21st century. But its goals won’t be achieved, in my view, simply by government policy being developed in a top-down way, and dumped onto populations. Without community participation, and indeed community leadership rather than just “consultation”, we won’t get anywhere. The only way to change the world, in my view, is by local people working with the things that concern them most, in their own settings and culture, in partnership with government.
How do you see the manifesto impacting on New Zealand health and Health Promotion?
Well so far it’s not very advanced. The manifesto was only published in 2014, and it’s not very well known here yet. I and others have given a few workshops and presentations on it, and I must say there’s been a very positive response to it at those. So definitely, there’s a huge potential for public-health people and other people of good will to become passionately involved in this enterprise. But we’ve got a long way to go yet.
I understand you are writing a book about spirituality. Can you tell us more about this?
Have you got all day? Briefly, ten years ago when I was leaving the University of Auckland, I wanted to spend more time meditating and doing “spiritual” things, given that I had a strong interest in Zen and Taoism. I have a property in the wilds of Great Barrier, and had the romantic vision of spending lots of time there in the bush in the pursuit of – whatever it is one pursues in such a setting. But when the time came, I got cold feet, and wondered whether spirituality was simply a psychological entity dreamed up by humans to provide us with hope and happiness in a stressful world. (My background is as a psychologist). I then got to thinking that there were large numbers of people in the 21st century labelling themselves spiritual, and many declare themselve “spiritual but not religious.” I decided I wanted to know what they meant. What is this thing called spirituality? It’s definitely not religion, although religion has elements of it of course. So what is it? It’s taken me all those years to figure it out , and I’ll give just a clue as to what that might be. I believe it’s in our genes, the result of millions of years of evolutionary development at both the prehuman and human level, and it serves very important survival and well-being purposes. Unsurprisingly, I believe it also has a very strong community dimension in it’s background. But at this point I’ll say no more, partly because I’m still working on it, but also partly because once I start on this topic, it could take all day!
And does it relate to health promotion? Yes indeed it does, and also to planetary health. For several years at the University of Auckland, I used to teach a postgraduate course called Spirituality and Health, and it had a strong health promotion bias. It used to attract students from every kind of background, from atheist to fundamenalist, and all cultures, and this enabled me to develop a concept of spirituality as it related to health promotion. But don’t get me started on that either!
We thank Professor Raeburn for his valuable time, warmth and considered replies.
March 2016
Jo Lawrence-King
– See more at: http://www.hauora.co.nz/prof-john-raeburn-health-promotion-advocate.html#sthash.ZfAKn7KJ.dpuf[/vc_column_text][/vc_column][/vc_row] 
HPF’s Executive Director Sione Tu’itahi was excited about this significant step and its potential implications for health promoters of Aotearoa. “Imagine when New Zealand health promoters can travel anywhere in the world and transfer their competencies to work in any member country,” he said.
The IUHPE has its own European-wide competencies; developed out of its CompHP project. New Zealand was represented by past HPF Health Promotion Strategist Helen Rance on the Global Advisory Committee that developed these European competencies. The IUHPE has also developed a European accreditation process to sit alongside the competencies. It identifies performance criteria to meet the competencies. Within this process individual practitioners submit a portfolio of evidence rather like nursing; identifying their evidence in meeting each competency. This submitted to their National Accreditation Organisation, which assesses the evidence successful accreditation means they can be called a European Health Promoter with the registration lasting three years. Academic institutions that deliver health promotion courses can also become accredited following a similar process.
Because the European and Aotearoa competencies were developed concurrently, the frameworks consist of the same nine competency domains. The detail below each competency domain heading is different in the Aotearoa context, from that in the European domains as ours prioritise health promotion knowledge and practice that is specific to this country’s context. In order to formalise the IUHPE recognition of the New Zealand Competencies, the HPF’s Health Promotion Strategists are providing the global body with detail around the correlation between the two competency documents.
Health Promotion Forum first produced the New Zealand Health Promotion Competencies in 2000 following two years of extensive consultation. The current – 2012 – version of the Competencies was the result of continued discussions and feedback, which identified a need to strengthen the content and context related to Māori values and Te Tiriti o Waitangi. These latest competencies identify the specific knowledge, skills, behaviours and attitudes for effective health promotion practices in the Aotearoa New Zealand context.
The decision to recognise the New Zealand competencies was made at a December 2015 meeting of the IUHPE Accreditation System meeting.
– See more at: http://www.hauora.co.nz/nz-health-promotion-competencies-recognised-by-global-body1.html#sthash.YquMnPTF.dpuf 
The International Union of Health Promotion and Education (IUHPE) has recently acknowledged the New Zealand Health Promotion Competencies as equivalent to its own European Competencies. This is a promising step towards the ultimate aim of global competencies and accreditation; which would offer health promoters the potential to broaden employment opportunities and the exchange of knowledge and experience around the world.
HPF’s Executive Director Sione Tu’itahi was excited about this significant step and its potential implications for health promoters of Aotearoa. “Imagine when New Zealand health promoters can travel anywhere in the world and transfer their competencies to work in any member country,” he said.
The IUHPE has its own European-wide competencies; developed out of itsCompHP project. New Zealand was represented by past HPF Health Promotion Strategist Helen Rance on the Global Advisory Committee that developed these European competencies. The IUHPE has also developed a European accreditation process to sit alongside the competencies. It identifies performance criteria to meet the competencies. Within this process individual practitioners submit a portfolio of evidence rather like nursing; identifying their evidence in meeting each competency. This submitted to their National Accreditation Organisation, which assesses the evidence successful accreditation means they can be called a European Health Promoter with the registration lasting three years. Academic institutions that deliver health promotion courses can also become accredited following a similar process.
Because the European and Aotearoa competencies were developed concurrently, the frameworks consist of the same nine competency domains. The detail below each competency domain heading is different in the Aotearoa context, from that in the European domains as ours prioritise health promotion knowledge and practice that is specific to this country’s context. In order to formalise the IUHPE recognition of the New Zealand Competencies, the HPF’s Health Promotion Strategists are providing the global body with detail around the correlation between the two competency documents.
Health Promotion Forum first produced the New Zealand Health Promotion Competencies in 2000 following two years of extensive consultation. The current – 2012 – version of the Competencies was the result of continued discussions and feedback, which identified a need to strengthen the content and context related to Māori values and Te Tiriti o Waitangi. These latest competencies identify the specific knowledge, skills, behaviours and attitudes for effective health promotion practices in the Aotearoa New Zealand context.
The decision to recognise the New Zealand competencies was made at a December 2015 meeting of the IUHPE Accreditation System meeting.
9 March 2016
Jo Lawrence-King 
On 1 February 2016 the World Health Organisation declared a Public Health Emergency of International Concern (PHEIC) regarding the high incidence of abnormally small brains and other neurological disorders in babies born to mothers infected with the Zika virus.
Much discussion and concern has resulted from the WHO’s decision.
Health promotion will play a key role in minimising the effects of Zika on Pacific peoples. Being well, being informed and taking precautions to reduce exposure to the disease-carrying mosquito will all contribute to communities’ resistance to the virus and its associated issues, says Health Promotion Forum’s Senior Health Promotion Strategist Dr Viliami Puloka.
Here in the Pacific region the rainy season – when mosquitoes are most prevalent – has just begun. We have recently had new cases of the Zika virus declared in Samoa and Tonga. One case of Guillain-Barré was identified in Waikato and linked to the Zika virus. The patient was a man who had recently arrived from Tonga, however, and it was considered to represent no risk of an outbreak here. This is because the virus is spread via a mosquito that is not found in New Zealand’s colder climate. Meanwhile the virus has been present in French Polynesia for some time. There, at least 40 cases of Guillain-Barré syndrome have been associated with the virus.
Zika was first identified in Brazil in May 2015. Since then babies born to mothers infected with the virus have been found to have a higher incidence of neurological disorders, the main one of which has been abnormally small brains – or microencephaly. While it has not been proven that the disorders are a direct result of the virus, this is strongly suspected. In recent days another possible association has been suggested: the use of an antilarval chemical included in the drinking water of the affected residents in Brazil.
Health authorities in New Zealand and the Pacific are putting in place protection measures and public policies to prevent the spread of Zika virus, however Dr Puloka, who is responsible for the HPF’s Pacific portfolio, points out that communities have an equally vital role to play. Minimising and modifying potential breeding sites is one way in which communities can act to prevent the spread of the Zika, he says. Residents are advised to empty, clean or cover containers that can hold water. This includes receptacles like buckets, flower pots or tyres. According to Dr Puloka it is also common practice to have a layer of oil on the top of the water in a septic tank. This prevents the reproduction of the mosquitoes, whose pupae need oxygen from above the water to survive.
He suspects that immunity to mosquito-borne diseases may offer hope to those Pacific island nations to have recently seen the arrival of the Zika virus. “The mosquito that carries the Zika virus is the same one that carries dengue fever, chikungunya and yellow fever,” he says. “People of the Pacific islands have been exposed to these mosquitoes for many years and have developed a level of resistance to those diseases.” This contrasts starkly with the situation in Brazil, where the people had previously not been exposed to those mosquitoes or their diseases.
Other precautions – where practicable – include using insect repellent, wearing clothes (preferably light-coloured) that cover as much of the body as possible and using physical barriers such as screens, closed doors and windows.
During outbreaks, health authorities may also advise spraying of insecticides.
Dr Puloka’s advice to communities threatened by the Zika virus is that now, more than ever, it is important to be well, be informed and take the necessary precautions to minimise the risk of being bitten by the mosquito that carries the disease.
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 
As in Canada, we here in New Zealand have identified these health problems and their solutions. The solutions include cost-effective ‘upstream’ strategies such as community health promotion. However we have, to date, failed to address the processes that prevent individuals from benefitting from these upstream approaches. “We have been busy rescuing half-drowned people downstream. It is time that we work with our leaders putting in place policies and legislations to prevent people from falling into the river in the first place.”
Author: Viliami Puloka
Editor: Jo Lawrence-King
6 January 2015
Scottish MPs (MSPs) have called for a multi-agency approach to tackle inequalities. This follows the publication of the 
The 
WHO also emphasised the need to strengthen the collective capacity for systems-thinking*, which focuses on population-based approaches as well as personal approaches to health and wellbeing improvement.
Over 1,400 public health practitioners, researchers and policy- makers from more than 65 countries participated in sessions at the conference; covering topics such as the changing public health roles, gaps in health systems research and effective communication.
Dr Elke Jakubowski, programme manager of public health services at the WHO’s Division of Health Systems and Public Health,was speaking at the 
The two international membership bodies will officially launch their Recommendations towards a Global Convention to protect and promote healthy diets at the World Health Assembly in Geneva.
The Recommendations call on governments to make a binding commitment to introduce a raft of policy measures designed to help consumers make healthier choices and improve nutrition security for everyone.
Measures include placing stricter controls on food marketing, improving the provision of nutrition information, requiring reformulation of unhealthy food products, raising standards for food provided in public institutions and using economic tools to influence consumption patterns.
Publication of the Recommendations comes on the 10th anniversary of the WHO Global Strategy on Diet and Physical Activity and Health, which recognised the impact of unhealthy diet and lifestyle.
Since then however, global deaths attributable to obesity and overweight have risen from 2.6 million in 2005 to 3.4 million in 2010, thus intensifying the pressure on governments to take stronger action to tackle the rising epidemic of obesity and consequent chronic disease.
Consumers International Director General, Amanda Long says: “The scale of the impact of unhealthy food on consumer health is comparable to the impact of cigarettes. The food and beverage industry has dragged its feet on meaningful change and governments have felt unable or unwilling to act.
“The only answer remaining for the global community is a framework convention and we urge governments to seriously consider our recommendations for achieving that. If they do not, we risk decades of obstruction from industry and a repeat of the catastrophic global health crisis caused by smoking.”
“If obesity was an infectious disease we would have seen billions of dollars being invested in bringing it under control,” said Dr Tim Lobstein, World Obesity Fediration Director of Policy. “But because obesity is largely caused by the overconsumption of fatty and sugary foods, we have seen policy-makers unwilling to take on the corporate interests who promote these foods. Governments need to take collective action and a framework convention offers them the chance to do this.”
Here in New Zealand the Government has recently announced funding for the Healthy Families NZ scheme, aimed at reducing obesity and improving the health outcomes for more disadvantaged communities around the country. Read our 
The Recommendations call on governments to make a binding commitment to introduce a raft of policy measures designed to help consumers make healthier choices and improve nutrition security for everyone.
Measures include placing stricter controls on food marketing, improving the provision of nutrition information, requiring reformulation of unhealthy food products, raising standards for food provided in public institutions and using economic tools to influence consumption patterns.
Publication of the Recommendations comes on the 10th anniversary of the WHO Global Strategy on Diet and Physical Activity and Health, which recognised the impact of unhealthy diet and lifestyle.
Since then however, global deaths attributable to obesity and overweight have risen from 2.6 million in 2005 to 3.4 million in 2010, thus intensifying the pressure on governments to take stronger action to tackle the rising epidemic of obesity and consequent chronic disease.
Consumers International Director General, Amanda Long says: “The scale of the impact of unhealthy food on consumer health is comparable to the impact of cigarettes. The food and beverage industry has dragged its feet on meaningful change and governments have felt unable or unwilling to act.
“The only answer remaining for the global community is a framework convention and we urge governments to seriously consider our recommendations for achieving that. If they do not, we risk decades of obstruction from industry and a repeat of the catastrophic global health crisis caused by smoking.”
“If obesity was an infectious disease we would have seen billions of dollars being invested in bringing it under control,” said Dr Tim Lobstein, World Obesity Fediration Director of Policy. “But because obesity is largely caused by the overconsumption of fatty and sugary foods, we have seen policy-makers unwilling to take on the corporate interests who promote these foods. Governments need to take collective action and a framework convention offers them the chance to do this.”
Here in New Zealand the Government has recently announced funding for the Healthy Families NZ scheme, aimed at reducing obesity and improving the health outcomes for more disadvantaged communities around the country. Read our 
The paper, produced by the Commission on Global Governance for Health challenges the ‘biological’ argument for health inequalities and places the main responsibility for them firmly at the feet of national governments around the world; calling on them to redress the imbalance of fairness and justice that currently exist. “Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven,” say the paper’s authors.
“Health equity should be a cross-sectoral political concern, since the health sector cannot address these challenges alone”. The Commission recognises the crucial role of the health sector in addressing health inequalities it points out that the sectors efforts “often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.”
“This is a timely development for the discourse about our health and the wellbeing of our planet,” says HPF Executive Director Sione Tu’itahi. “What happens at the international level impacts directly on the local level, whether we like it or not: take global warming and trade, for example. Worldwide political determinants are rising fast but our governance and policy framework are still largely focused on local and national interests at the expense of our collective wellbeing. As a global family, we can no longer afford to focus on the room that we occupy when the whole house is battered by the storm.”
The political origins of health inequity: prospects for change
The Lancet, 
The 21st International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion in Pattaya Thailand was noted for its truly global focus. More than 2,000 delegates, from over 80 countries attended the event this August. The theme – ‘Best Investment for Health” – provided many opportunities to discuss and debate this crucial question, as well as to share good practice, network and socialise.
It was the first time the conference was held in a developing Asian nation. This gave participants from the region an unprecedented opportunity to participate. In turn, it afforded a greater understanding among all participants of the varying levels of investment in health promotion across countries and of the broad range of issues affecting the practice of health promotion across the different contexts.
An in-depth 
A 
Health Promotion Forum (HPF) Executive Director Sione Tu’itahi is calling on health promoters at all levels to join forces and make a difference to hauora here and around the world. “They say think globally, act locally, but these days we must think and act on all levels,” says Sione .
Sione returned last Friday from Paris, France, where he attended a two-day meeting of the GlobalExecutive Board of the International Union for Health Promotion and Education (IUHPE). At the meeting the Board put together a work plan to contribute to solving global health challenges and ensuring the long-term sustainability of the IUHPE. One of the key resolutions was to redouble efforts to unify and energise the health promotion movement and Sione hit the ground running when he arrived back in Aotearoa New Zealand.
“The world is but one global village and challenges impacting on the international level influence the national and local levels as well,” said Sione. “Take the economic recession or global warming, for instance. Both challenges affect everyone at every level, whether you are in Paris, Auckland, or Ha’ano, [Sione’s home Island in Tonga]. “We must work together or we will all be affected by these common challenges, many of which are human-made and, therefore, can be resolved.”
Sione is the first Indigenous person from the Pacific region to hold an official post with the IUHPE. He is a member of the global board in his role as Vice-President of IUHPE, South West Pacific Region, which covers New Zealand, Australia, all small Pacific island nations and some countries in Asia.
IUHPE is a global umbrella organisation for health promotion professionals and organisations of the world. Its headquarters are in Paris. For the next three years (2013-2016) its South West Pacific Region office is co-hosted by the Health Promotion Forum and the Health Promotion and Research and Evaluation Unit (HePPRU) of Otago University’s School of Public Health. HePPRU’s Director, Associate Professor Louise Signal, is also the Director of IUHPE for the South West Pacific Region.
The HPF is a national umbrella organisation for health promotion organisations and teams in New Zealand. While its primary focus is on the national level, HPF has both a global reach and a local impact.
Sione issued a personal invitation to health promoters around the country: “If you wish to be part of the solution on all levels, join a global movement and a national organisation.”
Join IUHPE and HPF by contacting Emma at HPF 
Trevor Simpson – Deputy Executive Director at the HPF – presented a plenary session to showcase a health promotion module developed by Maori and in close collaboration with the Maori service users for whom it was being designed. “This is a point of difference from many other health promotion approaches to indigenous peoples,” says Trevor. Very often health promotion resources and practices are developed centrally, with little or no involvement of – or representation from – the people for whom they are being developed. “We have found our approach to be highly successful in inspiring and empowering people to make beneficial changes to their health.”
The HPF’s Senior Health Promotion Strategist Karen Hicks presented her abstract “A Contribution to the Global Dialogue”. In her presentation she will discuss how health promotion competencies, the advent of a professional society and a code of ethics together give health promotion professionals the tools they need to make effective improvements in health.
New Zealand is strongly represented in health promotion globally. The HPF’s Executive Director, Sione Tu’itahi, is Vice-President of the South West Pacific Region of IUHPE, while Associate Professor Louise Signal, Director of the 
“New Zealanders are the 13th happiest in the world.” That’s the finding of the recently published World Happiness Report 2013.
A post this month on Otago University’s Public Health Expert blog highlights some of the relevant findings of the report, which looked at the happiness of 156 countries.
Of particular note to health promotion professionals is the finding in the report that public spending needs to focus more on prevention than on care. It acknowledged the need for better evidence to support this shift.
Also highlighted in the Otago University’s blog is the emphasis on mental health as the “single most important determinant of individual happiness.”
Read the