PHA NEWS ONLINE - 9 November 2006

Vol IX, No 5

PHA leads health groups' support of ethical investments Bill

The PHA and other health groups and experts are welcoming MP Maryan Street's Private Member's Bill that would stop Crown investment in tobacco companies.

Ms Street announced on October 20 that she would be putting an Ethical Investments Bill, aimed at requiring Crown Financial Institutions to take social and environmental considerations into account, into the Ballot.

Groups supportive of the Bill include the Public Health Association, Smokefree Coalition, Action on Smoking and Health (ASH), National Heart Foundation, Cancer Society of New Zealand, Te Hotu Manawa Māori, Te Reo Marama and the National Māori SIDS Unit. A large number of health professionals, clinicians, academics and researchers also support discontinuing investment in the tobacco industry.

In December 2005, the Council for Socially Responsible Investment revealed that all five of New Zealand's Crown Financial Institutions invested in tobacco companies. They were the New Zealand Superannuation Fund, the Government Superannuation Fund, the National Provident Fund, the Accident Compensation Corporation and the Earthquake Commission. (Recently the New Zealand Superannuation Fund has adopted the United Nations' Ethical Investment Principles and the Global Compact, and ACC has indicated that it will disinvest from tobacco.)

PHA Director Dr Gay Keating said investment in the tobacco industry is abhorrent.

"Tobacco use is the single largest preventable cause of death in New Zealand - more deaths occur each year because of smoking than from HIV, tuberculosis, motor vehicle crashes, suicide and homicide combined."

She questioned why a Private Member's Bill was necessary. "We'd like to see the Government put forward a bill so this issue is not subject to the uncertainties of the Private Member's ballot."

Health groups and experts believe investment in tobacco companies not only runs counter to the Government's health priority to reduce tobacco use, it is also unacceptable to the majority of New Zealanders.

"This is the only industry that sells a product that when used exactly as the manufacturer intends will likely kill you," said Smokefree Coalition Director Mark Peck.

"Adopting a policy to exclude tobacco companies from all public investment funds is a simple and acceptable solution. The New Zealand Government must show leadership on ethical investing and refuse to profiteer from addiction, disease, and death."

Cancer Society of New Zealand spokesperson Belinda Hughes said the NZ Government should never have permitted investment in the tobacco industry in the first place.

"It doesn't get more serious than 5000 deaths a year. No government should ever help to increase the profits of an industry whose products kill people.

"It is hypocritical of the Government to support international agreements on the Framework Convention on Tobacco Control, while lining its pockets with tobacco industry profits."

The PHA spent a busy couple of days co-ordinating support for the Bill. Groups in favour include Te Hotu Manawa Māori, Te Reo Marama, the National Māori SIDS Unit, Te Kaunihera o nga Neehi Māori (National Council of Māori Nurses), Nga Ngaru Hauora O Aotearoa (national collective Hauora Māori Providers), Hapai Te Hauora Tapui, Public Health Association, Smokefree Coalition, Action on Smoking and Health (ASH), National Heart Foundation, and Cancer Society of New Zealand.

Overwhelming support for the Bill came from all universities concerned with health, New Zealand medical schools, and health academics and researchers. Those in support include: Professor Peter Joyce, Dean of the Christchurch School of Medicine and Health Sciences, Otago University; Dr Charlotte Paul, Professor of Preventive and Social Medicine at the University of Otago Medical School; Professor Julian Crane, Professor Peter Crampton, Dr George Thomson and Dr Nick Wilson of the Wellington School of Medicine and Health Sciences, Otago University; Professor Les Toop and Professor Ann Richardson, Christchurch School of Medicine and Health Sciences, Otago University; Professor Alistair Woodward, Head of the University of Auckland School of Population Health; Professor Neil Pearce of the Centre for Public Health Research at Massey University; Papaarangi Reid, Professor of Māori Health at Auckland University; and Dr John F. Smith, Head of Health Promotion at AUT University.

Conference 2007 - Call for papers

Te Torino: Re-imagining Health

The 2007 Public Health Association Conference will be held on 4 to 6 July in Auckland. Papers are now being called for, and the closing date for abstracts is 31 January 2007. Submitters will be notified by 31 March if their papers are accepted.

To submit your abstract, click on the link which can be found on the PHA homepage - www.pha.org.nz. When you first enter the abstract submission area you will be given a user name and password that you can then use to create or change your abstracts. If you have difficulty in submitting your abstract online, please contact PHA by email pha@pha.org.nz or telephone 64 4 472 3060.

Conference themes are urban design, food matters and voices. We are seeking presentations for each of these areas: kaupapa Māori, systems and structures, workforce, inequalities, determinants of health, and globalisation.

Accepted abstracts will be published in the conference book distributed at the conference, including contact details. Conference proceedings will be published on the PHA website after the conference. All presenters must provide a completed paper (5000 words max) or PowerPoint presentation with completed notes.

Media is invited to the PHA conference. When completing details on the website, it will be important to indicate the following on your abstract:

• any reason why media cannot cover your presentation
• if you would be willing to work with the conference media co-ordinator to promote your paper.

If you would like to support 'Te Torino' PHA conference, contact Waitangi Wood for a sponsorship pack (waitangi@hapai.co.nz).

Direct-to-consumer advertising harmful says PHA

The PHA is welcoming reports that the Government may soon ban direct-to-consumer advertising of prescription medicines. Health Minister Pete Hodgson's office has said that an announcement is likely within weeks.

PHA Director Dr Gay Keating said there is evidence that direct-to-consumer advertising causes harm.

"There are a number of concerns, including an effect on doctor-patient relationships - with patients putting pressure on doctors to prescribe specific medicines, and the 'normalising' of the use of medicine to improve health instead of lifestyle changes such as cutting back on fatty foods or exercising more.

"There is a risk that people will purchase pharmaceuticals based, not on what is best for their health, but on which company produces the most convincing advertisements. Rather than provide people with independent information on the risks and benefits, direct-to-consumer advertising focuses on creating a demand for specific products.

"People may end up paying for medicines that they don't need, and that in the worst case scenario, may actually be harmful to them."

She said the PHA believes a ban on direct-to-consumer advertising would be in the best interests of the New Zealand public.

"New Zealand is one of only two countries that allows this sort of advertising - and we need to come into line with the rest of the world.

"There is no benefit, and significant potential harm, in allowing direct-to-consumer advertising to continue in this country."

National Office round up

Gay Keating and Sue Sewell have been busy holding consultation meetings for the generic competencies across public health project. This project identifies a range of public health skills relating to health determinants, environmental health, communication, health systems, and related topics that you need to be competent in if you want to work in public health.

To date, workshops have been held in a number of areas including Tauranga, Rotorua, Hamilton, Christchurch, Palmerston North, Wellington, Auckland, Ratana, and Nelson. Click here for a copy of the draft generic competencies discussion document.

Gay Keating attended the 37th Public Health Association of Australia Annual Conference - Tackling the Determinants of Health - held in Sydney; the Public Health Medicine Specialists Conference, held in Auckland; and the Health Promotion Forum Conference, held at Ratana.

She has also been providing support to the committee organising the 2007 conference, and preparing for the PHA council meeting on November 9 and 10 in Wellington.

PHA has to move out of its existing premises in Panama St, and new premises have been found in Victoria St, Wellington. The move will take place in early 2007.

Submissions and media

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

• Principles of the Treaty of Waitangi Deletion Bill
• Ministry of Health's Review of the Regulation of Alcohol Advertising.

The following media statements have been released:

• Climate change has dire health implications, warns PHA
• Health groups applaud Bill to stop Government investment in tobacco industry
• Direct-to-consumer advertising harmful, says PHA
• PHA applauds pokie money refusal
• Western Bay of Plenty PHO funding efficient use of resources says PHA
• PHA welcomes funding for low-cost GP practices.

The PHA continues to have a healthy (!) media profile, with good radio and print pick up of recent releases. Gay Keating made another appearance on Breakfast, this time discussing the two-day gambling licence suspension handed out to Dunedin Casino, over its failure to properly manage a problem gambler. She was also on TV One's Close Up @ 7 item about food hygiene in Wellington restaurants.

Closing date extended - consultation on core competencies

Feedback on the draft generic public health competencies has been extended until the end of November. The draft generic competencies are available on the PHA website (www.pha.org.nz) for feedback and comment.

The Public Health Association invites everyone who is involved in the provision of public health services to visit the website and contribute to the consultation process. Feedback can be given via an on-line questionnaire or by downloading and posting the completed questionnaire to the PHA at PO Box 11-243, Wellington. For further information, please contact Sue Sewell at ccp@pha.org.nz.

Funding package to tackle youth obesity announced

The Government has announced the allocation of a $67 million package of initiatives to help young New Zealanders improve their nutrition and be more active. The package 'Mission-On' is aimed at giving New Zealand's children, young people and their families the tools to become healthier, so they can lead active and successful lives.

When announcing the package, Prime Minister Helen Clark said that by improving nutrition and reversing the declining levels of physical activity among young Kiwis, New Zealand will be much better placed to prevent obesity.

The Mission-On package includes:

• improving nutrition in schools and early childhood education services
• school-based health promotion events
• a new 'lifestyle ambassadors' campaign featuring high-profile New Zealanders
• encouraging the advertising industry to take measures to decrease children's exposure to the advertising of less healthy foods
• the creation of youth-focused websites to promote healthy eating and physical activity
• sponsorship of television and radio programmes that promote healthy choices
• a 'screen-free' campaign to encourage less time in front of television and computers
• government departments leading by example in the promotion of healthy workplaces
• an expansion of the 'Green Prescription' programme
• the introduction of Health Impact Assessments for new government policy and legislation (PDF 1.2Mb).

"With the right resources young people, their families and their communities can act together to make healthier choices," said Helen Clark.

Health impact assessment goes live!

Check out the new web pages on the Public Health Advisory Committee website. These pages represent New Zealand's first HIA website. They answer some FAQs, give summaries of completed New Zealand HIAs, point the reader to some useful resources and websites, and give details of training opportunities. The website will be updated regularly so send in any HIA stories and material.

Contacts:
Barbara_langford@nhc.govt.nz or
rob@quigleyandwatts.co.nz.

Health is everyone's business

Geoff Fougere - Chair of Public Health Advisory Committee

Improving New Zealanders' health and wellbeing requires more than the provision of health services. Good health and the prevention of illness, and dealing well with disability, is significantly an outcome of the settings in which people live their lives. Diet, housing, safe neighbourhoods, clean air and water, access to transport, education and employment are just some of the factors determining overall patterns of health and well being.

Most of the central and local government agencies whose actions affect these settings lie outside the health sector. Collaborative action, a 'whole of government' response, is required if health is to be improved, illness prevented, and disability well addressed. Public health practitioners and agencies are well placed to lead or support such an approach. But their success will depend on other stakeholders accepting their share of responsibility for realising health improvements. Health is everyone's business.

Emerging epidemics such as diabetes or potential ones such as avian influenza have drawn new attention to the importance but real limits of curative approaches. These threats to health are already spurring innovative, collaborative, 'whole of government' approaches to prevention, approaches that also include the private sector and non governmental organisations.

This report is firmly grounded in such innovative thinking and action. It takes such developments as a guide to how health policy should evolve. Its concern is to identify some of the new opportunities for collaborative approaches to improving health and to explore the new capacities that public health and other agencies will require if these opportunities are to be realised. It is intended as an invitation to those inside and outside the health sector to develop fresh approaches to sustaining and improving health and wellbeing.

The report's overall goal is a new framing of health issues so as to focus on the importance of prevention and on the development of a 'whole of government' approach to improving the health of New Zealanders. Realising such a goal will require innovative, collaborative action by many different agencies. It will also require the development of robust approaches to 'learning by doing' so that policy makers and practitioners can quickly learn what difference their actions are making.

The committees thanks goes to interviewees, opinion piece authors, those who made submissions on the opinion pieces and discussion document, those who attended the workshops, and others spoken to as part of this project. The material we had to work with was rich and thoughtful.

The report is available at the PHAC website. For a hard copy contact moh@wickliffe.co.nz quoting HP:4243.

Smoking during pregnancy: another form of child abuse

Te Hotu Manawa Māori (THMM) is taking a radical new position on smoking during pregnancy; defining it as child abuse.

"Around half our women smoke and research tells us that almost all continue to smoke during pregnancy, What's worse is that a pregnant women may quit smoking during pregnancy, but her whānau may continue to smoke exposing her to the dangers of second-hand smoke," THMM CEO Mary McCulloch says.

"The impact on our children and babies is terrible. Smoking accounts for higher rates of asthma, burns and fire deaths, childhood cancer, pneumonia, and developmental delay."

In 1996 Sudden Infant Death (SIDS) rates for Māori were around five times higher than that of non-Māori. Forty-six percent of Māori SIDS deaths were attributable to smoking.

"As an organisation, we've looked at the definitions of child abuse, and there's no doubt in our mind that smoking during pregnancy, and smoking around your children constitutes physical abuse."

Mary says that THMM has talked to other Māori organisations working in the field and all are in agreement about the dangers posed by smoking during pregnancy.

"Like any health issue, there's a point at which you need to name the problem. We're not trying to demonise our whānau, we're highlighting a very important issue. The next stage is to look at strategies to bring our smoking rates down."

THMM believes that everyone is responsible for looking after the health of Māori children and young people.

"It's everyone's responsibility, and we all have a role to play to keep our children safe from abuse. Whanau should be safe places for children, but they need information so they can make good choices. That's why we raising the issue in this way."

Māori public health workforce development

During September and October, Māori Public Health Workforce Development organisation Te Rau Matatini has been consulting with the public health workforce about their training and development needs.

This new initiative is a direct response to the Ministry of Health's Public Health Workforce Development Programme, which aims to increase responsiveness to the health needs of Māori and reduce health disparities for Māori. This includes strengthening the development of the public health workforce working within and across health.

Seven regional consultation hui were held in Northland, Auckland, Rotorua, Christchurch, Wellington, Tairawhiti, and Ratana Pa. Over 200 people participated in the workshops from a wide range of public health disciplines including health protection, nursing, resource management, water quality, management, and health promotion.

In addition Te Rau Matatini developed a survey, and around 200 surveys are now being analysed.

"We are very pleased with the response to the survey and korero shared at the consultation hui around the country," says Project Leader Lucy Bush. "Workers want a workforce framework that recognises local innovation and diversity. It must also promote Māori leadership, and dual competency training opportunities."

The term "dual competency" is used to describe frameworks that recognise the importance of cultural and technical skills.

Māori and non-Māori played an active role in the workshops. The workshop canvassed issues such as: how the public health workforce could better meet the needs of Māori; workplace support for whānau ora; training needs; preserving maunga and awa for future generations; leadership in public health; and vision or moemoea for the future of Māori public health.

Te Rau Matatini is currently collating the feedback and survey data. This will guide the construction of a national Māori public health workforce development framework, profile and a three-year implementation plan. A national reference provides advice to the project, which is also undertaking a document review.

"With the increase in Māori public health organisations, the demand for a skilled Māori public health workforce has increased," says Te Rau Matatini CEO Kirsty Maxwell-Crawford.

"Because we need to reduce health inequities for Māori, we need to be able to recruit and retain Māori and non-Māori staff who can effectively work with our whānau and communities.

"We hope that with the guidance of our workforce, their experience, expertise, and aspirations, the national framework and implementation plan will create new workforce opportunities and Māori-centred workforce solutions."

If you would like to know more about this project please email k.devonshire@matatini.co.nz and request to be added to the public health mailing list. The framework and implementation plan will be presented to the Ministry of Health by the end of this year.

Around the branches

Putting the 'well' into Wellington

Wellington Mayor Kerry Prendergast spoke at the Wellington Branch of the PHA's AGM in September. Her topic was Putting the 'Well' into Wellington. She was followed by Professors Philippa Howden-Chapman and Peter Crampton. The discussion was hosted by entertainer Ian Harcourt.

Kerry Prendergast said councils were obliged by the Health Act to improve, promote and protect public health, and there were many factors that affected people's health and wellbeing - such as income, housing, education and employment.

The Council's responsibility was to create the infrastructure to promote public health, to create a city to which people were drawn, thereby creating employment and wealth, she said. The Council had a responsibility to build strong, safer communities for a better quality of life.

She acknowledged that there were challenges ahead.

"Coping with our aging population and addressing our ever-increasing rates of obesity, diabetes and heart disease, for instance. There has never been a more important time for us all to work together to protect and promote the health and wellbeing of New Zealanders.

"One of our ways of addressing this issue is to continue our commitment to passive and active spaces. Put simply, we are committed to providing recreational facilities and protecting areas where our residents choose to participate in recreation - the town belt for instance."

Ms Prendergast said that in the 2006/07 year, Wellington City Council had set aside $42 million for sport and recreation. There were a number of projects underway including an extension of the Push Play outreach programme, a shallow water play project at the Wellington Regional Aquatic Centre, upgrading Karori and Newtown Parks, and building a 12-court indoor community sports centre - location still to be determined.

"These upgrades and additions to Wellington's sporting and recreational facilities will go some way towards enticing Wellingtonians to get off the couch, get active and participate in life."

She said, in addition, the Council helped citizens through the provision of grants.

"Council has a social partnerships programme that supports organisations making important contributions to social wellbeing in the city; organisations like Catacombs, the Life Flight Trust, Wellington Free Ambulance, Volunteer Wellington, and the Wellington Women's Refuge."

She stressed that the Council was committed to providing housing in Wellington.

"We own more than 2300 housing units in Wellington, which are allocated

according to need. A recent change has been to allow five percent of our properties to be housed by people outside current criteria, at market rentals, This is expected to result in more working people living in the flats, which will add to diversity in the mix of tenants."

Following her presentation, Kerry Prendergast took a number of questions from the floor.

Manukau City Council street prostitution Bill voted down at second reading

An attempt by Labour MP George Hawkins to give the Manukau City Council the power to control street prostitution has been opposed by his own party. The Manurewa MP's Private Members Bill was voted down on a conscience vote at its second reading in Parliament on 11 October 73 votes to 46.

The Local Government and Environment Committee last month recommended the Bill should not go any further, saying it did not believe there should be local laws which were different to national laws. It said there were options available to the council to increase street safety without resorting to new legal powers.

Labour MP George Hawkins sponsored the bill on behalf of the council.

The Bill aimed to prohibit street prostitution by making it an offence to solicit for prostitution in a public place in Manukau City and would be applicable to both sex workers and clients. It also created offences for conduct associated with prostitution, such as 'loitering' and provided police with the powers to require information and to arrest suspected offenders.

Health groups argued that the Bill was counter to the Prostitution Law Reform Act (2003) which provided human rights protection to sex workers encouraging them to operate in the safety and discretion of brothels. If passed, the Bill would have again criminalised sex workers, and created significant public health risks, rather than address the causes.

The Committee stated that the behaviour of sex workers on the streets is generally regulated more effectively by their peers and outreach groups working with them than by legislation. "We believe that it is important for non-government organisations doing this work to be adequately funded and subject to proper accountability to produce the best results."

Climate change has dire health implications, warns PHA

Increases in illness and death from malaria, dengue fever, injuries, and heat stress are some of the implications of climate change, warns the PHA.

Commenting on the climate change report by former World Bank chief economist Nicholas Stern, PHA Director Dr Gay Keating said the health impacts of global warming needed to be considered alongside economic and environmental fallout.

"Climate change affects health in a number of ways, including the impact of higher temperatures, and the increase in injury, illness and death caused by extreme weather such as floods and storms.

"It also has significant indirect health effects, such as an increase in the transmission of infectious diseases such as malaria and dengue fever as insects carrying diseases travel further."

She said more frequent and severe heat waves and humidity could lead to increases in smog and air pollution.

"Increases in pollens and mold spores would compound the situation and affect those with cardiovascular disease, respiratory disorders such as asthma, emphysema and chronic bronchitis, and allergy problems. Trees and other vegetation that give rise to allergenic pollens grow more profusely in a warmer climate. When combined with smog and other atmospheric pollutants, illness from allergic respiratory disease, particularly asthma, could increase."

The World Health Organization estimates that 160,000 deaths a year are caused by climate change.

Dr Keating said that it was vital countries did everything they could 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.

"All countries must reduce their emissions, which, through global climate change, pose a critical threat to our health and to the planet."

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Asian Health Foundation

Dr Kawshi De Silva - Chair, Asian Health Foundation of NZ

The Asian Health Foundation is taking public health action for Asian health in New Zealand. The Foundation was formed this year after the community was consulted at the Asian Women's Symposium held in August 2005.

We aim to work collaboratively at a national and regional level with existing mainstream organisations as well as community organisations. Recognising many Asian community organisations are functioning with minimum budgets and a large volunteer base, we would like to advocate nationally for the needs of the Asian population in New Zealand. We recognise the difficulties in classifying "Asians" in NZ. However, we strongly believe this is a start to promote national policy and much-needed research to highlight issues related this population.

In New Zealand, the population is becoming increasingly ethnically diverse through migration. Asians make up the fastest-growing ethnic community in New Zealand today. Between 1991 and 2001, the number of people who self-identified as "Asian" grew by 140 percent to 238,180 people, or 6.7 percent of the New Zealand population (Statistics New Zealand, 2002).

Asians are now the third largest ethnic group in New Zealand, just after European and Māori. Chinese are the largest ethnic group within the Asian population (105,057), followed by Indians (62,190), and Koreans (19,023) (Statistics New Zealand, 2002). The percentage increase in the Asian population has been mainly due to large gains in migration. The Asian population is expected to grow to 600,000 by year 2016.

The majority of Asians living in New Zealand were born overseas (77.7 percent) and their mean age is 28.3 years. Most of these Asians have lived in NZ for a period of 5-15 years. Geographically, more than 100,000 Asians are living in Auckland.

Acculturation is broadly defined as "those phenomena which result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original cultural patterns of either or both groups" (Slant & Lauderdale, 2003). During this process the first generation and the second generation of migrants undergo various forms of cultural changes. While some try to continue their cultural practices, others try to adapt to the dominant culture. The support systems they have and the environments in which they live have a major influence in their health outcomes in New Zealand.

There is increasing evidence that shows specific health and social issues are faced by Asian population living in New Zealand. Major health concerns are for heart health, diabetes, cancer, mental health, sexual health, obesity, physical inactivity, unhealthy dietary habits and poor access to health services.

Asian women are the least active population in New Zealand followed by Asian men. Asian obesity rates are similar to Europeans. Asian women's utilisation of breast cancer and cervical screening services is low. The increasing number of Asian people working in the sex industry is of concern given the rise in sexually transmitted infections, including HIV/AIDS. Asian abortion rates are increasing in NZ. There is a lack of understanding and appreciation of cultural differences by health professionals.

The Asian Health Foundation will be focusing on the Ministry of Health's Healthy Eating Healthy Action Plan (MoH-HEHA). As a representative of the MoH-HEHA external coordination group we intend to facilitate and coordinate the services delivery by forming partnerships with established Chinese and Indian providers. We are also working with Agencies for Nutrition Action (ANA) by having a representative on the board.

Asian sexual health issues are of major public health concern. There are more than 300 sex workers in Auckland region alone. This population does not access mainstream services and many have cultural barriers which do not allow them to openly communicate about sexual health issues. A few case studies have shown there is a threat of an HIV/AIDS epidemic if we do not develop interventions to address this issue amongst this population. We are currently looking at conducting research to highlight these hidden issues related to the sexual health of Asians in New Zealand.

The key strategic objectives of the Asian Health Foundation are:

• Leadership: To provide national leadership in initiatives that promote the health of the Asian population in New Zealand
• Advocacy: To promote Asian health policy across sectors to address Asian health
• Workforce Development: To support the development of a culturally competent health workforce that works effectively with Asian communities
• Collaboration: To promote a collaborative approach with communities, health professionals, policy makers and researchers to enhance Asian health.

The key priority areas are: physical activity, nutrition, sexual health, mental health, problem gambling, chronic disease prevention (CVD, Diabetes, Stroke and Cancer), and access to health services.

Welcome Sitaleki Finau

Last year the PHA's 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.

Sitaleki Finau was born in Masilamea, Tonga. He attended several primary schools at Te'ekiu, Nukunuku, Nuku'alofa and Toloa. He entered Tonga High School in 1961, and Auckland Grammar School in 1967. He later attended the University of Queensland, graduating in 1975 from the School of Medicine, and in 1981 graduated from the University of Otago with a Postgraduate Diploma of Community Health. Since 1994, he has been a registered public health specialist in New Zealand, Australia and the Pacific.

Sitaleki returned to Tonga in 1983 and took over the Community Health Services, consisting of primary health care, non-communicable disease programmes, epidemiology, and the rural health centres of Tonga's Ministry of Health. In December 1985 he became the lecturer and coordinator of the Health Management Programme, and later the Assistant Head of the School of Social and Economic Development, at University of the South Pacific in Fiji.

He has since worked as Assistant Professor for the University of Hawaii in Pohnpei, the Manager of Community Health Service for South Pacific Commission; Senior District Medical Officer and Public Health Specialist with the Remote Health Services and the Royal Australian Flying Doctors in Alice Springs, Central Australia; senior lecturer at the University of Auckland Medical school, and Professor of Public Health at Fiji School of Medicine, Fiji in 2001 to 2006.

In June 2006 Professor Sitaleki became the Director of the Pasifika@Massey Strategy. The primary aim of the strategy is to increase gains for Pacific peoples through teaching, research and consultancy services at Massy. The secondary aims are to assist Massey to meet its Charter obligations for Pacific peoples and to make a positive contribution to Pacific communities and Pacific nations.

Sitaleki is also interested in tennis, rugby, people, and food. He dabbles in writing of poetry and short stories mainly for his three children. He is passionate about all matters Pacific and cultural democracy.