Case Studies, Environment, Global

This Statement from Indigenous participants in the 23 rd IUHPE World Conference on Health Promotion (Rotorua, Aotearoa New Zealand) is a call on the health promotion community and the wider global community to make space for and privilege Indigenous peoples’ voices and Indigenous knowledges in promoting planetary health and sustainable development for the benefit of all. It should be read alongside the Rotorua Statement from all participants in this Conference.

Indigenous peoples are diverse and our worldviews, which have developed over millennia of human experience, are specific to peoples and place. However, there are fundamental commonalities in these worldviews that have provided the basis for Indigenous peoples’ movements that draw us together around our shared interests. Core features of Indigenous
worldviews are the interactive relationship between spiritual and material realms, intergenerational and collective orientations, that Mother Earth is a living being – a ‘person’ with whom we have special relationships that are a foundation for identity, and the interconnectedness and interdependence between all that exists, which locates humanity as part of Mother Earth’s ecosystems alongside our relations in the natural world.

Understanding our place in the natural world in relational ways leads us to consider how access to the natural environment shapes human health and wellbeing, the impacts of our activities on the environment, and our inalienable collective responsibilities of stewardship which will benefit future generations.

Within Indigenous worldviews our relationship with the natural world is characterised by reverence and values that include sustainability, guardianship and love. Planetary health is understood as the health and wellbeing of Mother Earth and of humanity as an inextricable part of natural ecosystems. It should also be noted that Indigenous languages are critical in articulating Indigenous worldviews as they
enable the most full and accurate expression of Indigenous conceptualisations, and should be protected.

The forces of colonisation, capitalism and globalisation have caused massive environmental degradation, climate change, loss of biodiversity and the devastation of Indigenous communities. Further, they have led to intellectual imperialism and the widespread subjugation and exclusion of Indigenous worldviews, bodies of knowledge and voices.

Prevailing Western and other worldviews promote individualism and anthropocentric perspectives that to human peril separate humanity from the natural world. This has encouraged human activity that accelerates the depletion of planetary resources, the destruction of ecosystems, pollution, climate change and increase in the risk of ecological collapse.

Environmental degradation impacts disproportionately on Indigenous peoples because of close relationships with the natural world and our already marginalised circumstances in nation states. The silencing of Indigenous voices and the subjugation of Indigenous bodies of knowledge has been detrimental to all, most evident in our global environmental crisis.

Indigenous health promotion (as opposed to the generic form of health promotion which has largely Western origins) emerged in response to Indigenous peoples’ needs to make space for our own ways of seeing the world and as a vehicle to realise our aspirations to sustain future generations who are healthy, proud and confident as Indigenous peoples. It is an Indigenous-led endeavour with origins that stretch back in time to customary systems to maintain health and wellbeing that emphasised social and ecological connections. At the same time, Indigenous health promotion is open to knowledge generated from within other worldviews where there is alignment. Indigenous health promotion can be understood as the process of increasing Indigenous peoples’ control over the determinants of health and strengthening our identities as Indigenous peoples.

Ecological collapse is the greatest threat to human health and survival globally. Health promotion (policy, research, education and practice) needs to change to effectively respond to the challenges of the Anthropocene and bring intergenerational health equity into its systems and frameworks. Engaging with indigenous worldviews and bodies of knowledge
provides opportunities to find solutions to this most pressing threat and ways forward to promote the health of Mother Earth and sustainable development.

We call on the health promotion community and the wider global community to make space for and privilege Indigenous peoples’ voices and Indigenous knowledge in taking action with us to promote the health of Mother Earth and sustainable development for the benefit of all.


Case Studies, Environment, Global

Rotorua Statement

This Statement represents the collective voice of the social movement members, researchers, practitioners and policymakers who participated in the 23rd IUHPE World Conference on Health Promotion, held in Rotorua, Aotearoa New Zealand in April 2019. It should be read alongside the Indigenous Peoples’ Statement for Planetary Health and Sustainable Development from this Conference.

The conference participants call on the global community to urgently act to promote planetary health and sustainable development for all, now and for the sake of future generations. Planetary health is the health of humanity and the natural systems of which we are part. 1 It builds on Indigenous peoples’ principles of holism and interconnectedness, strengthening public health and health promotion action on ecological and social determinants of health. It puts the wellbeing of people and the planet at the heart of decision-making, recognising that the economy, as a social construct, must be a supportive tool fit for this purpose in the 21 st century.

Waiora is an Indigenous concept of our host country, Aotearoa New Zealand, which expresses the interconnections between peoples’ health and the natural environment, and the imperative of sustainable development. 2 3 Waiora represents a call to work with Indigenous peoples to draw on Indigenous knowledge, and to share knowledge from our diverse cultural systems for the wellbeing of the planet and humanity. Sustainable development for all is a clear way to ensure environmental, social and health justice for the people of today and for future generations.

Urgent action is needed because mounting evidence tells us that the current
economic and social development paradigm of infinite growth and endless exploitation of limited natural resources is unjust and unsustainable, leading to inequities within and among countries and across generations.
In 2015, the UN General Assembly adopted the new development agenda
“Transforming our world: the 2030 agenda for sustainable development”. 4 The 17 Sustainable Development Goals (SDGs) integrate economic, social and environmental development around the themes of people, planet, prosperity, peace and partnership. In doing so, they provide an action plan for the global community.

They prioritise the fight against poverty and hunger while focusing on human rights for all, and the empowerment of women and girls as part of the push to achieve gender equality. The SDGs recognise that eradicating poverty and inequality, creating inclusive economic growth and preserving the planet are inextricably linked to each other and to population health. 5
Conference participants call for immediate action from the global community in four key areas.

  • Ensure health equity throughout the life course, within and among countries, and within and across generations. This requires:
    The development of all peoples as empowered lifelong learners and
    engaged contributors to individual health and the health of families,
    communities and the planet.
    Action and accountability to address the wide and enduring inequities
    experienced by Indigenous peoples, while ensuring the protection of
    cultural identity and customary ways of life.
    Tackling the structural factors that drive the inequitable distribution of power, money, and resources; improving daily living conditions especially of those most in need; and measuring and understanding the problem and assessing the impact of action as outlined by the Commission on Social Determinants of Health. 6 Prioritising intergenerational health equity in systems, frameworks and
    decision-making, as a central tenet of a planetary approach to health
  • Make all urban and other habitats inclusive, safe, resilient, sustainable and conducive to health and wellbeing for people and the planet. This requires: Renewing and strengthening our relationship with planetary ecosystems. Protection of the planet from degradation, including through sustainable production, management and consumption of natural resources so that the planet can support the needs of present and future generations. This requires taking, enabling and advocating for immediate action on climate change and the loss of biodiversity.
    Action to reduce disparities in the quality and quantity of resources
    available to communities as these disparities are at the root of inequities in health. Current threats will accentuate such disparities. These include threats to food and water supplies associated with climate change, depletion of both renewable and non-renewable resources, the degradation of the environment such as contamination of food chains and ecosystems, poor air quality and massive forced migrations.
    Greater cross-sectoral action to protect and improve the health of
    populations experiencing inequities, including those in the world’s fast- growing urban areas.
    Fostering of peaceful, just and inclusive societies which are free from fear, racism, violation and other violence.
    The realisation of the health co-benefits of sustainable ‘One Planet’ living.

Ensuring urban decision-makers apply a “health equity lens” to assess the
risks and opportunities posed by policies and programmes and measure
their effects. 7

  • Design and implement effective and fair climate change adaptation strategies.
    This includes:
    The development of new approaches to global, regional, national and local governance and stewardship that will equitably promote health and well- being and prevent and mitigate disastrous climate and environmental breakdown, particularly in Low and Middle-Income Countries.
    Repositioning Indigenous and traditional knowledge systems to be on an equal footing with science and other knowledge systems to promote health and well-being and prevent and mitigate disastrous climate change and environmental breakdown.
    Development of action-oriented policies and partnerships between health and other sectors to develop policies addressing health and climate.
  • Build collaborative, effective, accountable and inclusive governance, systems and processes at all levels to promote participation, peace, justice, respect of human rights and intergenerational health equity. This requires:
    Respect for and adherence to the inherent rights of Indigenous peoples as articulated in the UN Declaration on the Rights of Indigenous Peoples.
    Effective global governance free from the domination of economic considerations and commercial interests.
    The promotion of participatory democracy, coherent policy-making and regulation in the public interest and to restrict conflict of interest.

Participants at the 23rd IUHPE World Conference in Rotorua also confirm the critical role and relevant expertise of the health promotion community in promoting human health, planetary health and sustainable development, including implementing the SDGs. Participants urge the health promotion community to provide leadership across our one planet.


  1. Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch:
    report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet
  2. Durie M. An Indigenous Model of Health Promotion. 18th World Conference on Health Promotion
    and Health Education. Melbourne, 2004.
  3. Durie M. An Indigenous model of health promotion. Health Promotion Journal of Australia
  4. UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development.
    New York: United Nations 2015
  5. World Health Organization. Health in 2015: from MDGs, millennium development goals to SDGs,
    sustainable development goals. Geneva: World Health Organization, 2015
  6. Marmot M, Friel S, Bell R, et al. Closing the gap in a generation: health equity through action on
    the social determinants of health. The Lancet 2008;372(9650):1661-69.
  7. World Health Organization. Health as the pulse of the new urban agenda: United Nations
    conference on housing and sustainable urban development, Quito, October 2016. Geneva:
    World Health Organization, 2016.


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

Case Studies, Pacific
Health Promotion Forum works with organisations at all levels of health promotion and social development.  It is forging close working relationships with leaders in the field, to strengthen the health promotion movement. The Fono is working to address health and inequality in communities across Auckland and Northland. Jo Lawrence-King talked to its Chief Executive Tevita Funaki; who recently joined HPF’s board. The connection between HPF and The Fono is clear.  HPF’s own definition of the profession emphasises its focus on “empowering people and communities to take control of their health and wellbeing.” “At the Fono we value the significant importance of Health Promotion,” agrees Tevita.  “We work closely with families to address their health needs. We provide health education and social support; ensuring both economic and social needs are addressed.  We work with churches to develop their health activities to support a healthy environment both for their homes and churches.”     The Fono: a model of Pacific health promotion The Fono is a health service committed to reducing health inequalities in the communities in which it operates.  It finds innovative ways to deliver culturally appropriate services across all its locations. The Fono works to foster well, safe, vibrant communities and has a commitment to meeting the cultural needs of the people in these communities.  These include its original area of West Auckland (based in Henderson) as well as:
  • Central Auckland (the CBD)
  • South Auckland (Manurewa)
  • West Central Auckland (Blockhouse Bay)
  • Northland (Kaikohe)
The Fono operates a comprehensive model of care, with a full range of affordable health services to people who need it most.  Its services include medical, dental, pharmacy, health promotion, social services, education and Whanau Ora.  It has a focus on reaching Pacific Peoples with its stop smoking programme. Pacific people have been identified as being hard to reach by conventional stop smoking efforts[1]. With its community-led scope of services, its expertise and geographic spread, The Fono delivers stop-smoking services to Pacific peoples across the metropolitan Auckland region.  This region represents 65% of all Pacific smokers in New Zealand according to needs data[2] (26,523 of the national total of 41,139). From its beginnings 25 years ago, as a West Auckland community-developed GP clinic, The Fono today provides an integrated range of services in five locations across Auckland and Northland. An experienced leader in Pacific health In July this year Tevita Funaki celebrated his sixth anniversary as Chief Executive Officer of The Fono.  Backed by an extensive career working with Pacific communities in health and education, and himself of Tongan heritage, Tevita leads the operational arm of the organisation. Tevita explained his motivation for accepting the role: “I am passionate about Pacific wellbeing and development. Developing our model of care ensures that our services address the holistic needs of Pacific people and support our family to realise their full potential.” Tevita was previously the Pacific Health Manager for ProCare Health Ltd and the National Pasifika Liaison Advisor for Massey University. He has also managed an Employment Consultancy and Project Management Services firm and worked in health services for many years. Despite already being on many influential boards, Tevita accepted his nomination to HPF’s board and took up his role in ……. [month?].  He sees the relationship between The Fono and HPF as mutually beneficial.  “HPF’s success can only be beneficial to organisations like ours; supporting our work and upholding its principles of community-lead health,” he says. Bringing with him strong governance and business experience, Tevita has an excellent understanding of the health sector, funding environment and the political landscape.   We look forward to working more closely with Tevita and the people of The Fono.

[1] Ibid  p.31
[2] Review of Tobacco Control Services – Shore /2014 – MoH – College of Health, Massey University – Smoking number and prevalence (ordered by number of Pacific smokers)         October 2016 Jo Lawrence-King

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

Longitudinal research shows that influences in early life matter greatly in terms of how a person fares later in life across a wide range of domains. It has been demonstrated that high quality early life interventions represent one of the best ‘investments’ a society can make to ensure an optimal start to life – one which will net significant returns over time via long-term benefits for individuals, whānau and society. There is huge potential for intervention in the early years to lead to substantial health gains later in life across a broad range of health issues that disproportionately impact Māori. These include health outcomes related to non-communicable diseases such as diabetes, coronary heart disease, stroke and also mental health issues and disability. While there is clear evidence around early years interventions leading to improved outcomes, what is largely missing are proven interventions that address ethnic inequalities, are effective for Māori and achieve sustainable positive health outcomes across the life-course. The aim of the Te Kura Mai i Tawhiti research is to contribute to generating an evidence base around what constitutes effective early life kaupapa Māori programming for tamariki and whānau that will lead to improved health outcomes later in life for tamariki.

Te Kura Mai i Tawhiti – research programme

Figure 1: Te Kura Mai i Tawhiti Research Programme
A feasibility or Proof of Principle study is under way in 2016 to firstly demonstrate the ability of the team’s research methods to determine change over time in tamariki and whānau on key constructs of interest (e.g. tuakiri, whānauranga, self-control). The Proof of Principle study will focus on whether, over the course of a year, an individual changes over time, taking into account developmental changes.   Findings from the Proof of Principle study will be used to design two future studies. Firstly, a 10-year prospective project to compare same age cohort tamariki in Te Kōpae Piripono, with at least two comparison early years programmes selected from Taranaki or similar regions. This involves conducting a longitudinal study to compare groups across key child behavioural and whānau development measures (i.e. the measures used in the Proof of Principle study). In addition to the prospective study, a retrospective (historic) study will be undertaken (Figure 1 – as a part of Tangi ana te Kawekaweā). This will focus on previous graduates and whānau of Te Kōpae Piripono from the past 20 years (n>150 whanau) with an emphasis on graduate outcomes in health, education, Te Ao Māori and other determinants areas that may have been influenced by the kaupapa Māori child and whānau programming.   If the research generates robust evidence of the success of the Te Kōpae  Piripono model, there is potential for the overall approach and/or key elements of the intervention to be scaled up for implementation in other settings (e.g. other ECE and Māori medium) to complement broader approaches to addressing determinants of health and education and in other domains. The research is currently supported by the Health Research Council of New Zealand, the Ministry of Education, the New Zealand Council for Educational Research and the University of Otago.    

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

In 2012 -2013 Tairawhiti CAAF (Community Action on Alcohol Fund) steering group worked with Poverty Bay Rugby and a range of several local agencies and organisations to implement a successful Ease Up campaign; making sidelines alcohol- and smoke-free. The group achieved very good outcomes, including:
  • Greater awareness of alchohol and tobbacco-related harms.
  • A high level of community ownership
  • Policies developed by local sports clubs
  • Effective working relationships among the stakeholders
According to their case study, the group maximised these successes with a sustained programme of communication throughout the 2013 rugby season.  Māori wardens, secondary school students, clubs and local organisations such as Tauawhi Mens Centre, Turanga Health and Tairawhiti District Health all worked together to build awareness and engagement among the local community. Read the full case study.

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

Case Studies, Community, Family and child
Plunket’s Asian strategy is expected to be implemented in July 2015.  The strategy addresses all  levels of the organisation, including the staff, volunteer groups and Plunket Line;  aiming to increase customers’ access to-, use of-, and satisfaction with Plunket’s services. Plunket is developing culturally appropriate professional services, and encouraging ongoing feedback from service users about their work.  They will set and update yearly goals; ensuring the inclusion of the Asian service-user’s voice in their business planning and strategies. The new strategy follows extensive research commissioned by Plunket  in 2013.  Conducted among their service users, staff and stakeholders; the research  investigated Asian mothers’ experience of access to health care. It included interviews, consultations and focus groups held with Chinese, Korean and Burmese mothers as well as members of The Asian Network Incorporated (TANI), and Plunket’s internal staff.   The results indicated that Asian mothers were not proactively seeking help, despite the superficial appearance that access to the services was good. At the time only 4% of the Plunket staff were of Asian ethnicity, while 15% of babies among the service users were of Asian descent.  Mothers spoke of access barriers to service, including language barriers and lack of understanding of available services. It found that Asian mothers mainly accessed Plunket information via the internet and from their GP and concluded that it was important to provide more information about the culturally appropriate services available from Plunket. For more information, please contact Vivian Cheung on 021 246 3398

ActiveAsian aims to improve access to physical activity information and opportunities for Chinese children and their parents on Auckland’s North Shore. To date it has included events such as a Chinese Sport Forum volunteering programme for Asian youth in the community, tramping, bike training, and leadership development through sports. The project also offers an Asian community engagement model and toolkit and a wealth of resources and contacts for the Asian (Chinese and Korean in particular) communities. ActivAsian was established by Harbour Sports in 2009 in response to the need to focus on the health needs of the growing Asian population on Auckland’s North Shore. It was the result of extensive research and ground work with the Asian community in the years preceding its initiation. Sprouting from this ground work included several important decisions and documents. Contact ActivAsian’s project coordinator Jenny Lim and DDI: 09 415 4654 for more information.

Case Studies, Community
John Wong, the Chair of Chinese Positive Ageing Charitable Trust (CPA), talked to the Eldernet Gazette in July 2014 about what ageing in New Zealand means to elderly Chinese, and about the services provided by CPA. Formed by a group of volunteers, CPA aims to promote quality of life for the Chinese elderly residing in New Zealand. John Wong explains the considerations that an older Chinese person might take into account when considering aged care. He also gives examples of culturally appropriate services that might be useful for aged care services when providing care to the Chinese elderly.

Smokefree Communities aims to provide support to families, Asian people and their families and pregnant women and their families to quit smoking and live smoke free. Based in Albany, in Auckland, the service currently provides free smoking cessation service to those residing in the Rodney, Waitakere and North Shore areas. The Quit Bus service is also now available for both Counties Manukau and Waitemata District Health Board (CMDHB and WDHB) regions. The team, made up of staff from varying ethnic backgrounds, are able to provide service to people from different ethnicities. Both self- and GP-referrals are accepted. The service was initiated as a pilot in response to a need for a smoking cessation service, revealed in WDHB research. Its success led to ongoing funding, and it is looking to expand its culturally-appropriate service to other Auckland regions. The client-centred, service takes into consideration clients’ religion, interests and preferences. The holistic approach also takes into account family and other environmental factors. After initial contact, coordinators will visit the client to make assessments and provide appropriate suggestions to the client. They suggest treatment plans and will provide support and follow-up until the client achieves six months’ cessation. A willingness and motivation to quit are important success factors for smoking cessation, however, if clients relapse, they are welcome to approach the service again. For more information visit or contact Zhoumo Smith on 09 448 0475 or 027 357 1800 or . Zhoumo, an experienced Smokefree Coordinator, has been involved with the service for 10 years.

Case Studies, Community, News
A pilot sexual health training programme for Asian youth workers in 2012 provided invaluable insight into the best ways to reach Chinese youth with important sexual health messages.   Concerned by the high rate of pregnancy terminations occurring in the young Asian women of their community, The Chinese Women’s Wellness Community Group devised a sexual health training programme that provided culturally appropriate ways of reaching them with health information.   Fifteen to 20 volunteer youth trainers attended a one-day training session with experts from the Family Planning Association (FPA), Primary Health Organizations (PHOs) and sexual health providers. The Group also provided ongoing support and mentoring to the volunteers.   As well as training youth workers, the Group developed resource packs for distribution to citizens’ advice bureaux (CABs) and local high schools across Papakura, Manukau, Auckland City and Waitakere.   It is estimated that the volunteers went on to directly reached an estimated 200 young Asian women with their newfound skills and information, while the printed resource packs reached countless more.

HPF’s Senior Health Promotion Strategist in charge of the Pacific portfolio, Dr Viliami Puloka, reports that non-communicable diseases (NCDs) – many of which are preventable – are the overwhelming cause of death in Tonga.  The good news is that Tonga recognises the problem and is prioritising it at a government level.  Dr Puloka believes the situation there is reflected across the Pacific and that we should keep a close eye on the results of the work being done in Tonga to address the problem. Babies in Tonga have an excellent survival rate, with just 15 out of 1,000 dying before they reach the age of five – a mortality rate of 1.5%.  However this picture changes dramatically once Tongans reach 15, where 25.6 % of males and 35.1% of females die before they reach 60 years of age. [i]  Much of this dramatic increase in mortality is accounted-for by NCDs, of which diabetes and cardiovascular disease are the main culprits. Tonga top of the obesity league table According to an article in British newspaper The Guardian in August 2006, more than 90% of Tongans are overweight; making it the world’s fattest nation .[ii]  In 2012 a league table from the London School of Hygiene and Tropical Medicine, supported this figure; putting Micronesia and Tonga at the top of the obesity league table, just ahead of the United States.[iii] Non-communicable diseases account for approximately 74% of all deaths in the Pacific nation.  Of these the vast majority are preventable diseases such as diabetes and cardiovascular disease. [iv] It’s not hard to see why NCDs are so prevalent here.  Two research papers, summarised in Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004) found that overall 60.7% of the Tongan population was at high risk of NCDs, with three to five risk factors from the following list:
  • Smoking (46.2% of males  and 16.3% of females aged 15-64 years)
  • Alcohol consumption (22.2% of males and 4.8% of females aged 15-64 years)
  • Low fruit and vegetable intake (approximately 92.8% of Tongans aged 15-64 reported they eat less than the require five servings of fruit and vegetables a day)
  • Low physical activity (54.8% of females and 32.4% of males aged 15-64)
  • Obesity (76.3% of females and 60.7% of males aged 25-64)
  • High blood sugar (16.4% of Tongans aged 25-64 had elevated blood glucose levels)
  • High blood cholesterol (66.1% of men and 34.2% of women aged 25-64 had blood cholesterol levels of more than 5.00 mmol/L)
At an obesity workshop for health workers held in Tonga in May 2013, delegates heard that one in 10 people admitted to hospital –  in Tonga, Vanuatu and Kiribati – were there because of an NCD.  However the money spent on NCDs is disproportionately high, with one in every five dollars spent on treatment being for those with an NCD [v]   Tonga is leading the way in tackling NCDs at a policy level The good news is that Tonga is one of the few countries in the world to be prioritising NCDs.  It is just one of a handful of nations to consider NCDs as a development issue.  They have been identified a key result area in the Tonga National Development Strategy.  Tonga has a multi-sectoral National NCD cabinet committee and sub-committes for NCD prevention and control. The National Health Promotion Foundation – TongaHealth was set up in 2007 to respond to the nation’s NCD crisis and 20 National NCD nurses have been employed to address NCD prevention. Dr Puloka advises us to watch the progress in Tonga closely.  “If there can be a favourable result from a regional approach to NCDs it will be in the Kingdom of Tonga,” he says.  

[i] S. Hufanga et al Mortality Trend in Tonga . Population Health Metric 2012
[ii] The Guardian, Thursday 3 August 2006
[iv] WHO  Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004)  
[v] Doran C.  Pacific Action for Health Project: Economic impact assessmentof noncommunicable diseases on hospital resources in Tonga, Vanuatu and Kiribati. 2003