PHA NEWS ONLINE - 23 August 2006

Vol IX, No 4

2006 Conference - Sustaining public health/Pupuritiai te whare tapa wha

The need for all sectors of society to work together to improve health was a strong message at the Public Health Association annual conference in Palmerston North. The conference, held from 5 to 7 July, attracted some fascinating and high caliber speakers, including Health Minister Pete Hodgson, Professor Mason Durie, Dr Cindy Kiro, Dr Jane Freemantle and Professor Tony McMichael.

Around 280 people from all regions and health disciplines attended the conference. The conference dinner on the Thursday night was a highlight, with great company, good food, and even impromptu karaoke (not such a highlight perhaps!).

Conference delegates could choose from a number of sessions and a diverse range of topics. These topics included Whanau ora, young people and alcohol, approaches to problem gambling, Asian models of public health, growing well, healthy children, and rural perspectives of public health.

PHA communications advisors Liz Price and Anton Blank worked hard to create media interest in the event. This was not always easy - particularly on day one when major storms in Wellington and the Wairarapa gained most of the media coverage.

However, a number of issues were picked up by the media; in particular the issue of adding folate to flour (Dr Jane Freemantle), the health effects of climate change (Professor Tony McMichael), the need for race-based funding (Professor Mason Durie), the influence of alcohol marketing on youth culture (Tim McCreanor and Hector Kaiwai), the link between watching television and childhood obesity (Agencies for Nutrition Action), and the announcement of the 2006 Public Health Champion - Professor Philippa Howden-Chapman.

Philippa Howden-Chapman, our public health champion

Social scientist Philippa Howden-Chapman has been named the Public Health Champion of 2006. The award, presented by former Director-General of Health and 2001 Public Heath Champion Dr George Salmond, recognises individuals who have made an outstanding contribution to public health. It is conferred by the Public Health Association of New Zealand (PHA).

Philippa Howden-Chapman is a Professor in the Department of Public Health. She teaches in the area of health and public policy, and is Director of He Kainga Oranga/the Housing and Health Research Programme.

She was author and editor of Social Inequalities of Health: New Zealand 1999 published by the Ministry of Health and Housing and Health, and is a member of the Heart Foundation Scientific and Public Health Committee and the Strategic Policy Advisory Group of the Ministry for Social Development.

PHA Director Dr Gay Keating says that Professor Howden-Chapman is the latest in a long line of Public Health Champions who have made an outstanding difference to public health in New Zealand.

"Philippa's work has contributed to public health at national and international levels, and has directly influenced public health activities in the Wellington region.

"She is director of the Housing and Health Research Programme. This programme has already demonstrated the many connections that exist between housing conditions, poverty, and ill-health. It is partly thanks to this programme that many families enjoy warmer and better insulated homes, and consequently have lower rates of asthma and other respiratory conditions.

"The success of the Housing and Health Research Programme is helping put pressure on government to ensure that housing provided by the state complies with standards that meet basic health requirements."

Dr Keating says that Professor Howden-Chapman has also contributed to many other areas of public health.

"For example, she chaired the New Zealand Drug Foundation for over seven years. She has also spoken out on the role of non-government organisations in civil society and the particular importance of advocacy."

Philippa Howden-Chapman is well-known internationally for her work on equity in health, as indicated by her membership of the board of the International Society of Equity in Health and membership of the European Network on Interventions and Policies to reduce Socio-economic Inequalities in Health.

More than an apple a day...

Children's Commissioner Cindy Kiro launched More than just an apple a day: children's rights to good health at the PHA conference in Palmerston North.

She said that there had been enough strategy writing, and action was needed now. The report builds on a review by Auckland University of Technology that showed evidence of poor health disparities, systematic disadvantage for some groups of children and young people, and the inability to access appropriate and affordable health services.

"The major finding is that there has been inadequate action on the Child Health Strategy developed in 1998," Dr Kiro said.

"There are particular gaps, especially in adolescent health services, for example, sexual and mental health, and also in other areas such as respiratory infections."

Some of the report's recommendations include:

• continued action on addressing inequalities in health outcomes
• advocacy for a health service responsive to the needs of children
• a less fragmented and more coordinated approach to healthcare delivery
• advocacy for a healthy environment for the children of New Zealand, including protection from family violence.

From Manawatu Evening Standard, 7 July 2006

Health is everyone's business - Public Health Advisory Committee

Also discussed at the PHA conference was the Public Health Advisory Committee's report to the Minister of Health on the implications of a changing context for public health in New Zealand.

The report - Health is everyone's business: working together for health and wellbeing - reviews issues facing public health given that many of the strongest influences on health come from outside the health sector. Because of these influences, the key message to come from the PHAC work is that effective action to improve health and reduce inequalities will involve collaborative effort across sectors.

The PHAC report explores ways to enhance opportunities and to reduce barriers to cooperative ways of working in new settings for public health action. It believes that solutions can be found within current structures.

Alcohol marketing leads to more deaths, PHA conference told

Delegates at the PHA annual conference heard that marketing alcohol to young people is leading to more deaths.

"Since 2000, we have seen an increase in alcohol related injury and deaths amongst young New Zealanders," Massey University researcher Tim McCreanor told delegates.

"It's no coincidence that this is when the drinking age was lowered to eighteen."

"The relentless marketing and promotion of alcohol to young people means that we now have a generation who are pre-disposed to alcohol."

Researcher Hector Kaiwai went on to explain how alcohol companies infiltrate youth culture.

"Companies use masculine stereotypes, and popular culture to saturate the market with their messages."

"What I found was young men had very high recall of alcohol marketing and advertising. It has a huge influence on their drinking behaviour, and their understanding of what it means to be masculine."

Sporting icons like the All Blacks are used by alcohol companies to promote their brands.

"These are important role models for our young men, and I think they are sending out bad messages to our kids."

Race card important factor when it comes to Māori health

Professor Mason Durie told delegates at the Public Health Association's National Conference that race must be taken into consideration when funding health.

"We have tended to consider factors like economics, but there is ample evidence that race is an indicator of health outcomes," Professor Durie said.

"National averages tend to mask what's going on in specific populations."

This theme was reiterated by Dr Jane Freemantle from the University of Western Australia.

"When you look at general population statistics in Western Australia, rates of SIDS and birth defects seem to be trending down. However when you separate out Aboriginal data, we get a very different picture.

"We must consider these groups independently, both in funding and policy if we are to see any decline in sickness and death rates."

PHA Director Dr Gay Keating said the themes emerging from the conference showed that Māori health must be given priority.

"This debate has led to political squabbling in the past, with accusations that more funding for Māori is political correctness gone mad. The information presented at this conference shows that unless we provide more funding for Māori, they will continue to become ill and die at greater rates than other New Zealanders.

"It's not political correctness, it's life or death."

Support for mandatory fortification of flour with folic acid

An Australian academic is right behind the mandatory fortification of flour with folic acid, saying education of some groups hadn't worked.

University of Western Australia post-doctoral fellow Jane Freemantle told the PHA conference that education about the role of folic acid in preventing life-threatening birth defects had not benefited Aboriginal babies.

But she said the failure of the well-funded intervention and education programme would have been masked if data hadn't been reviewed to take account of ethnic differences.

"When we look at infant mortality from birth defects, we can see there has been a significant decrease in the rate among non-Aborigines," she said.

The rate of neural tube defects such as spina bifida has halved from just over 2 to just under 1 per 1000 babies. But the Aboriginal rate remained around 2.5 per 1000.

"The programme introduced in Western Australia on the importance of pre-conception folic acid and the use of supplements clearly has not had an impact on the Aboriginal population.

As a result of the research she helped compile on the incidence of neural tube defects, Food Standards Australia New Zealand is proposing the mandatory fortification of flour with folic acid.

Dr Freemantle said fortification of a basic food product would be an exciting development that would ensure everyone shared the benefits of knowledge about the importance of folic acid in early pregnancy.

"The data allowed us to recognise what is happening, and put some interventions in place. We just cannot afford not to identify minority populations. And if we don't use this data, we are really abrogating our responsibilities."

The lessons were also relevant to reviewing the effectiveness, or lack of effectiveness, of public health messages on ways to prevent sudden infant deaths among both Aboriginal and Māori babies, she said.

Includes excerpts from the Manawatu Standard, 6 July 2006

Kyoto targets essential to health - international climate change expert

An international expert on climate change is urging New Zealand to stick to its Kyoto targets for reducing greenhouse gas emissions. The plea comes amid reports that the Government appears to have all but abandoned efforts to meet its Kyoto targets by 2012.

Professor Tony McMichael, from the National Centre for Epidemiology and Population Health at the Australian National University, is an international expert on the effect of climate change on health. Professor McMichael was a keynote speaker at the Public Health Association Conference in Palmerston North.

He says that it is vital that countries do everything they can to address global warming. "We now know that climate change is occurring. The severity and frequency of recent storms around the world is just one of the signs. The Kyoto agreement must be supported, and targets met, if we are to avoid the catastrophic effects of climate change on human life and health now and into the future."

Professor McMichael says that higher temperatures increase the risk of disease and illness.

"The World Health Organization estimates that 160,000 deaths a year are caused by climate change. These deaths are due to malaria, food scarcity, diarrhoea, and flooding. Warmer weather assists the spread of insect-borne diseases like malaria and dengue fever, while climatic changes and extreme weather will reduce crop yields.

"Heat waves can also cause illness and death from heat stress."

He says that all countries must reduce their emissions, which, through global climate change, pose a critical threat to our health and to the planet.

"New Zealand is no exception."

The challenge of talking to smokers

It is not exactly news that smoking isn't good for your health. Quit Group Communications Manager Penny St John talks about the latest approach to encouraging people to stop smoking.

Smoking cessation "threat-appeal" campaigns such as Every cigarette is doing you damage aim to cut through the health information overload by showing graphic images of the damage caused by smoking. These commercials result in very high volumes of calls to the Quitline, with Māori smokers also responding to this approach.

There is also research showing these threat appeal commercials are more effective when combined with supportive campaigns. It's about whānau, which features Māori role models talking about the effects of quitting, continues to have an impact on smokers after five years - not bad when you consider that many commercials have a shelf life of a few months.

In a world where people are besieged by health information, The Quit Group faces the challenge of coming up with campaigns that are relevant to smokers. When The Quit Group sat down to plan a new supportive cessation campaign, it looked at four concepts, two of which were sourced from overseas and two that were developed in New Zealand. The Research Team, led by Michele Grigg, organised concept testing, which came up with some surprising results. A concept of an ex smoker talking about the benefits of quitting, was seen as patronising, slightly self centred and of limited persuasiveness by smokers participating in the concept testing. Another idea, where a range of quitters gave positive and inspirational messages around the theme of 'I did it' was seen as smarmy, self-congratulatory and pious.

A concept called Video Diaries, which was developed in New Zealand had the most credibility and persuasiveness. Smokers said the concept of following real smokers as they quit was compelling and "water cooler fodder." Participants felt strongly that the concept would only work featuring real smokers and that smokers wouldn't relate to actors recreating a quit attempt.

Given that only about 20 percent of smokers quit each year, Video Diaries posed a small headache. However The Quit Group decided to go ahead and use the campaign as an opportunity to discuss the highly addictive nature of nicotine and the risks of relapse. Many smokers feel a personal sense of failure when they relapse and do not understand most smokers relapse a number of times before successfully quitting.

After many months of recruiting smokers and production work, the concept has been transformed into reality and Video Diaries is now on air until 8 September 2006. The first quitter to be featured is Natasha (Tash) Tawhara, a 30-year-old Māori mother who smoked up to 15 cigarettes a day when filming started.

The commercials, which are unscripted and filmed in documentary style by Ultimate Productions, don't attempt to hide the stresses of quitting, especially during the first few days.

Tash's story will be followed in January next year by 39-year-old Stuart Sutherland, who smoked up to 45 cigarettes a day before quitting.

Early results from the new campaign have been positive in terms of calls to the Quitline. 1682 smokers registered with the

Quitline in the first two weeks of advertising, with Māori making up 24.3 percent of registered callers.

The new campaign is aimed at the whole population but it has a particular focus on Māori. Māori registrations to the Quitline have been steadily increasing over the past year and The Quit Group's goal is to contribute to the work to drastically reduce the number of Māori who smoke.

Making poverty history

The PHA believes that New Zealand Government development assistance should increase to at least 0.7 percent of GDP, in line with its United Nations commitments. This is because development, poverty reduction, universal education, gender equality, the empowerment of women and environmental sustainability are intricately related to public health.

Sir Bob Geldoff's scathing criticism of our level of aid has had our politicians on the back foot in recent weeks. But as Pointseven's Rae Julian points out, if the cap fits...

Sir Bob Geldoff is absolutely correct when he says we are near the bottom of the OECD in our level of official government aid.

Foreign Affairs Minister Winston Peters' protestations that remittances to the Pacific significantly top up our contribution don't stack up. Quite simply, remittances don't count as official aid - they are donations from families to relatives at home.

What we're talking about is official government aid and that's where, as a country, we fall down significantly. This is something the Government has been turning a blind eye to for many years and also why many of the country's aid agencies have joined forces under the Pointseven Campaign (www.pointseven.org.nz) in order to highlight our "pathetic and deplorable" level of aid.

After the United States and Japan, we are the third from the bottom in the generosity scale on the level of aid we give compared to our Gross National Income (GNI). The OECD average is around 0.42 percent of GNI whereas we languish at 0.27 percent of GNI.

The fact that we're way below the average or median in the OECD was pointed out earlier to the Government by New Zealand's permanent representative at the United Nations, Don MacKay in 2004.

In another OECD review on our aid, we were praised for many aspects of our aid programme. The OECD said it was highly effective in poor and conflict-torn countries such as the Solomon Islands but once again, there were questions raised about why our level of aid was so low.

On top of this, it has been revealed that former Foreign Affairs Minister Phil Goff and former Aid Minister Marian Hobbs also warned the government before the last election that our low level of aid could affect our international reputation.

But it's not simply the fact that our aid levels are extremely low. It is significant that we are now one of only two OECD countries not to have either significantly increased aid levels or set a timetable for reaching the UN Millennium Development Goal (MDG) of devoting 0.7 percent of Gross National Income in official development aid by 2015.

Back in 2000 our Prime Minister signed New Zealand up to the United Nations' Millennium Development Goal to eliminate extreme global poverty by 2015. But with less than ten years to go to 2015, New Zealand has done very little towards reaching this goal.

Even Australia, also criticized in the past for its level of aid, recently announced a plan to double aid levels by 2010. On current trends it means that Australia's aid budget will increase to 0.36 percent of gross national income by 2010 while New Zealand has no plans to increase aid beyond 0.28 percent in 2008.

In the end, it's a matter of principle. While the government is being warned that our international reputation is at risk, I'm sure most new Zealanders believe that we should do our fair share to help poor countries because it's the right thing to do. It's only fair.

For more information on the Pointseven Campaign go to www.pointseven.org.nz.

National office round-up

A word from Gay Keating

Phew, another conference done and dusted. Despite all the usual last minute hitches - including a number of presenters being ill - it was all right on the night.

A huge thank you to the Central Districts Branch of the PHA for their months of hard work in arranging every aspect of the conference. Putting together an event for 250 plus people, attracting and liaising with speakers, calling for and selecting abstracts and finding a suitable venue is not a job for the faint hearted. The PHA is very lucky to have members who are so dedicated to furthering public health that they were willing to give up their own time to plan conference 2006.

I have attended a number of conferences now, and I always find that different things stand out for me. This year it was the fact that the conference clearly caters for two quite different audiences - people new to public health, and those with vast public health experience and expertise.

This of course provides a challenge in terms of presenting information that is at a level that can be understood by the new comers, while still being of interest to seasoned public health workers and practitioners. I thought that in most cases, the 2006 conference had a good range of papers, and sufficient diversity to accommodate both audiences. For some however, parts of the conference may have repeated knowledge they already had. We will certainly take this on board as we plan future conferences.

The conference evaluation forms are an invaluable guide for what worked well and what could work better next year. Thanks to everyone who filled in their form. Overall, evaluations were positive and had some constructive suggestions for improvements. The keynote speakers were almost universally thought to have been high quality, evidence based, and informative, and most people were satisfied with the conference programme.

The venue - the Palmerston North Convention Centre - seemed to polarise people, some thinking it was ideal, while other saying they were 'very dissatisfied'. In particular, people disliked having to go outside to the science centre. Wet weather was not helpful in this regard! There was also comment about the number of papers/workshops that were cancelled - this was mainly due to the illness of presenters, and therefore difficult to anticipate.

Some suggestions for improvement were:

• more time for questions at the end of sessions
• shorter days and fewer sessions
• more fruit and iced water and more hot food
• more time to question Health Minister Pete Hodgson
• more public health research papers
• better internet access at the conference venue.

All this feedback will be carefully considered as we start to plan the 2007 conference.

Thank you to everyone who attended the Palmerston North conference. Without your support, these conferences could not be held. We look forward to seeing you next year in Auckland.

Submissions and media

Since the last issue of PHA News, PHA Director Gay Keating has:

• presented to the Justice and Electoral Select Committee considering the repeal of section 59 of the Crimes Act. Section 59 provides a statutory defense which can be used by parents if they are prosecuted for assaulting a child.

She is currently working on budget and accommodation issues.

Media releases have been distributed on the following:

• Consider removing fresh chicken from sale says PHA
• PHA congratulates Porirua City Council on 'gutsy' stand on section 59
• PHA supports repeal of 'assault' legislation
• Philippa Howden-Chapman, Public Health Champion 2006
• Health is everyone's business
• Call for ban on fast food advertising
• Alcohol marketing leads to more young deaths
• Asian issues unique when it comes to problem gambling
• Kyoto targets essential to health
• PHA conference 2006
• Race card important factor when it comes to Māori health
• TV watching produces 'teletubby' children
• Link between advertising and children's food choices solid.

Selling sickness

Summit on marketing and public health

The PHA coordinated a meeting on 17 May to look at the advertising and marketing tools and mediums used to promote the purchase of potentially-dangerous products and services.

The aim of the meeting was to consider common issues across the promotion of potentially dangerous products and activities and how these promotional activities can be addressed.

A strategy has been drafted, and will shortly be circulated to those at the meeting for comment.

PHA calls for ban on fast food advertising

The PHA says a report showing a link between watching television and childhood obesity shows the time has come for a ban on the advertising of fast food during children's television programmes.

The study, commissioned by Agencies for Nutrition Action, found that every hour children spend watching television increases their risk of becoming obese.

"The unexpected finding in this study was the likelihood that the increase in obesity was due to children being bombarded by advertising of high fat, high sugar foods and drinks," says PHA Director Dr Gay Keating.

"In other words, the obese, TV watching children were virtually as active as the normal weight non-watchers. The difference was that the TV-watching children ate more snack and treat foods, and fewer fruit and vegetables."

Dr Gay Keating says parents often get the blame if their children are overweight, but the issue is actually far more complex.

"Parents have an important role to play in helping their children maintain a healthy weight. But many are fighting a losing battle because they are living in an environment that constantly promotes unhealthy options.

"For example, it is really difficult to convince your child to have an apple as a snack, when they are bombarded with colourful, enticing advertisements for high fat, high sugar food. Fast food companies spend millions to ensure that their ads push all the right buttons."

She called on the Government needed to put a number of measures in place to address the obesity epidemic.

"This report confirms that a ban on the advertising of high fat, high sugar foods and drinks during children's television programmes is a key strategy to reducing childhood obesity."

Advertising-obesity link denials from industry don't wash

Study findings that suggest there is a link between exposure to fast food advertising and childhood obesity have upset industry groups. PHA Communications Manager Liz Price suggests that history may be repeating itself.

Recently, a report commissioned by Agencies for Nutrition Action suggested that there was a link between fast food advertisements on television and childhood obesity; and that the cause was likely to be greater exposure to fast food advertisements.

This brought howls of outrage from the food and advertising industries, who denied any link between advertising and overweight. But to paraphrase the infamous words of Mandy Rice-Davies, they would, wouldn't they?

First to disagree with the ANA report findings were the Food Industry Group (FIG), made up of representatives from the food and advertising industry. FIG executive director Rob Bree accused the PHA and ANA of misrepresenting studies. He said that there was 'no link whatsoever' between what children were watching on television - the programmes or advertisements - and the food they were eating.

Mr Bree fell back on the personal responsibility mantra, stating that 'obesity is caused by factors such as individual food choice, total calories consumed, parental and peer influence, lack of nutritional education and lack of physical activity'.

He made no mention of the contribution of living in a society that constantly promotes unhealthy options, including multimillion dollar campaigns featuring colourful, enticing advertisements.

Next cab off the rank was Glen Wiggs, a former chief executive of New Zealand's Advertising Standards Authority - an agency that has been criticised in the past for its seeming reluctance to uphold complaints against advertisements. Mr Wiggs, now director of a Queensland-based company called Foundation for Advertising Research, 'slammed' the call by the PHA for a ban on advertising of fast foods and soft drinks.

In an article published in The Independent, he said there was no evidence an advertising ban would help reduce obesity, suggesting that it might even have the opposite effect, as 'forbidden fruit tastes best'.

These protestations will seem strangely familiar to those who have worked in tobacco control. The moves in the late 1980s to ban tobacco advertising brought about fierce resistance from the advertising industry, and from the media that stood to lose those advertising dollars. However, there is no doubt that tobacco advertising bans, along with a raft of other measures, have been instrumental in reducing smoking prevalence and, in particular, tobacco consumption rates in New Zealand.

Calls for bans on alcohol advertising are met with similar scorn by advertisers and the alcohol industry. The Law and Order Select Committee is currently considering the Sale of Liquor (Youth Alcohol Harm Reduction) Amendment Bill, which has a focus on controlling the advertising and promotion of alcohol. The PHA's view - if the Government wants to get serious about changing our binge drinking culture it needs to ban alcohol advertising and sponsorship.

As Emerson Foote, former Chair of tobacco industry PR company McCann-Erickson once said:

"I am always amused by the suggestion that advertising, a function that has been shown to increase consumption of virtually every other product, somehow miraculously fails to work for tobacco products."

He could have been referring to the advertising of alcohol, or of high fat, high sugar food and drinks.

The ANA study is not the only one to suggest a link between food advertisements and children's weights. The World Health Organization says that the heavy marketing of energy-dense foods and fast-food outlets is a probable cause of obesity. This is backed up by a comprehensive review of evidence, prepared for the British Food Standards Agency, which concluded that food advertising can influence the food children like, buy and eat.

As public health devotees, we may be guilty of occasionally getting a little over zealous, and of caring too much about our particular topic.

But we're not stupid.

Council update

Last year the constitution was amended to create a seat at council for a representative from the Pacific caucus. This year is the first time the seat has been taken up, and we are delighted to welcome Sitaleki Finau. We will profile Sitaleki in the next issue of PHA News. Welcome also to Deb Petersen from Waikato-BOP and Gabrielle Baker, representing the Māori caucus. Many thanks to our departing council members Dallas Honey, Gillian Abel and Ngamata Skipper - you have made a tremendous contribution to PHA and we really appreciate the many hours of work you have put in.

Around the branches

Submission on proposed gaming venue and tab policy

The Canterbury Branch of the Public Health Association recently made a submission to the Christchurch City Council on the proposed gambling and TAB policy. The proposal is that any premises with a Sale of Liquor Licence and designated area can become a gaming machine venue. The submission is reproduced below.

We support no change to the present policy.

• Gambling is a public health problem, with the impacts unevenly distributed across society. Those already disadvantaged (including Māori and children) tend to be further disadvantaged by gambling (Raeburn 2004).
• Gaming machines were the main method of gambling for the great majority of people (78 percent) who sought help for problem gambling in New Zealand in 2003/4 (Ministry of Health 2005).
• In Australia and New Zealand gambling accounts for 21 percent of all fraud, with the average loss from a fraud incident arising from gambling on electronic gaming machines being $131,000 (KPMG 2004).

Healthy public policy to support a decline in gambling involves a range of strategies, including the provision of other interesting (substitute) activities, public education, early intervention before the problem becomes serious, and preventing an increase in the number of machines.

The Council's policy, along with the government and community initiatives, has contributed to a decline in gambling overall, and the Council should be proud of its role in this. There is good public access to electronic gaming machines at present, and the Council can contribute to improved public health and social well-being by preventing their spread.

The preferred option proposed by the Council, while designed to minimise immediate expenditure on regulation, will only lead to social costs incurred elsewhere. The Council already has an effective policy to limit the number of gaming machines and it should not be beyond the Council to devise an inexpensive policy that allows for redistribution of machines, if necessary, while maintaining limits on numbers overall.

The argument that restraints on gambling will disadvantage community groups is spurious; there is no evidence for this. The experience of the removal of tobacco sponsorship indicated that alternative sources can generally be found.

References

KPMG, Forensic Fraud Survey. KPMG/University of Queensland, 2004.

Ministry of Health, Preventing and minimising gambling harm: strategic plan 2004-2010. Wellington: Ministry of Health, 2005.

Raeburn, J, Towards Healthy Gambling: A Health Promotion Approach to Gambling in New Zealand. Gambling Studies Institute, Auckland, 2004.

Healing our spirits alcohol and drug conference

The international conference of Healing our Spirit Worldwide (HOSW) was held in Edmonton, Alberta, Canada from 6 to 11 August.

A number of Māori attended, with representatives from an array of public health organisations. The Alcohol Advisory Council (ALAC) sponsored twelve young Māori to attend.

Native Canadians initiated HOSW, and the first conference was held in Edmonton in 1992. Maggie Hodgson, a Carriere First Nation woman, began her lobbying efforts with the International Congress on Alcohol and Addictions (ICAA) and the World Health Organization in the late 1980's. And by 1990 the ICAA included a special track on indigenous addictions issues at their Berlin Conference.

What began as one person's vision has now developed into an international forum and movement, focused on the alcohol and drug abuse issues and programmes in indigenous communities throughout the global community.

Strengthening the family, the community, the nation and the world are the themes of HOSW, and presentations and sessions this year focused on the cycle of life, from child, through all the life stages, to elder.

Boyd Broughton from Hapai Te Hauora in Auckland, one of the sponsored attendees, said that ALAC wanted to provide rangatahi Māori with an opportunity to present their ideas to HOSW.

"We had been planning our presentations since October last year, through a series of wananga. We pulled together a keynote address on wairua, as well as five smaller workshops."

The workshops covered issues like Poverty and Justice, Te Tiriti, Mahi Toi, and Mau Rakau. ALAC left it up to this group of rangatahi to decide the themes and contents of their presentations, and they developed a range of presentations that explored the context and politics of indigenous health in Aotearoa.

"It's been a wonderful process because we went there with nothing," Boyd says.

The group represents the new breed of young Māori emerging in public health, and reflect the creativity that has evolved in Māori public health and health promotion. The roopu included a student of medical sciences, the performing arts - as well as media professionals, and health promoters.

"The conference was a great opportunity to debate our issues with other native peoples, and to bring back ideas that work for Māori."

The 2006 gathering was a celebration of the health and healing of indigenous peoples around the world. Organisers say it was a testament to the resiliency, courage, tenacity and the will of indigenous peoples everywhere to overcome the barriers to achieving self-determination in health and in healing.