PHA NEWS ONLINE - 19 December 2006

Vol IX, No 6

Sale and supply of liquor review

PHA News talks to Ross Bell, Executive Director of the NZ Drug Foundation, about the defeat of the Bill to raise the minimum purchase age of alcohol, and where to from here?

The Bill that sought to raise the minimum purchase age for alcohol (the 'drinking age') from 18 to 20 years was defeated in Parliament last month by 72 votes to 49. The sudden announcement of a Government review of underage drinking seems to have been critical in Parliament's decision to keep the legal age at 18 and supporters of Labour Hamilton West MP Martin Gallagher's Private Member's Bill were adamant the review had been a major factor in the Bill's defeat.

The Drug Foundation strongly endorses returning the age to 20 years as national and international evidence overwhelmingly shows raising the drinking age is one key part of an overall strategy to change the drinking culture. In addition, surveys consistently show that over 70 percent of New Zealanders think the age should be returned to 20 years.

Executive Director Ross Bell was surprised the vote was not closer but not surprised by the defeat.

"We expected most political parties would treat this as a personal or conscience issue, rather than a party vote and I was surprised by the way some voted, especially the Minister of Health and the Prime Minister voting against the Bill.

"Having said that, it would have been difficult to enforce the Bill, as some messy exemptions were proposed by the committee. The most difficult were the exemptions for minors drinking with their parent, or spouse or partner. Changes in other legislation since 1999 - such as the Care of Children Act 2004, Civil Union Act 2004 and Property (Relationships) Act 1976 - saw the Law and Order Committee propose amendments to account for those laws, including the creation of a farcical category of person called 'former guardian' - otherwise known as a parent.

He says there is a consensus that an alcohol problem exists among youth in New Zealand and that something needs to be done about it. The community's expectation on the government and parliament to actually do something is even greater now and there will be much interest in the timeframe and outcome of the review of underage drinking.

The review will be carried out by the Ministry of Justice, with input from the Ministry of Health. With the debate over the drinking age having revealed widespread community concern about the country's drinking culture, the Drug Foundation hopes the review will be completed quickly.

"Months of detailed evidence has already been gathered - the evidence is there and so are the possible solutions. The 11 month, 180 submission hearing heard all the evidence and the select committee process proved review enough."

It is likely the proposed review will examine the effectiveness of current restrictions on the sale and supply of alcohol to minors, and will take into account changes that have taken place since the purchase age was lowered, such as the increased number of outlets supplying alcohol.

Ross Bell says social supply of alcohol, particularly from people other than parents or spouses is a huge problem.

"There needs to be a clear social message around this. Alcohol is a problem and the community needs to be aware of their role in supervising the consumption of alcohol by young people. Irresponsible supply must stop."

The second issue the Drug Foundation would like to see addressed in the review is around mandatory identification (ID) checks. "It should be the responsibility of the sellers of alcohol - such as in stores or pubs - to ask for ID. An informal policy like this currently exists in supermarkets where anyone who looks younger than 25 is asked for ID - why can't this be part of law everywhere? This would be a simple and effective measure to put in place."

The review would also likely look at the proliferation of liquor outlets, which have increased from about 2000 in 1989 to almost 15,500 in 2004, and which the Associate Minister of Health Damien O'Connor said had affected the supply to minors.

Ross Bell believes liquor licenses are currently too easy to get and impossible to lose.

"The review should also look at the location of liquor outlets, such as their proximity to schools, and consider restrictions on their location."

He says the review needs to take a broader approach than simply focusing on access to alcohol by young people.

"While youth access is an important issue, the review should also examine the alcohol excise tax, the price of alcohol, and the role local governments can play in addressing the harms caused by alcohol. We are looking forward to providing constructive input into the review and hope it will satisfy New Zealand communities. Government needs to show greater leadership on alcohol policy."

The NZ Drug Foundation has developed an Eight Point Plan for Action on Alcohol which includes:

1. increasing the excise tax on alcohol
2. returning the minimum alcohol purchase age to 20 years
3. strengthening the Sale of Liquor Act
4. increasing effective enforcement
5. discontinuing alcohol marketing on television
6. allowing communities more control over liquor licensing
7. improving treatment services nationwide
8. discontinuing 'conscience voting' on alcohol issues.

A parallel review of liquor marketing and sponsorship is also underway.

"Both reviews provide a great opportunity to deal with problems around alcohol. Communities have high expectations of parliamentarians and will remember the words of those MPs who supported the review after the defeat of the Bill. They can't be hollow words or there is likely to be outrage in response," he says.

Public Health Association Conference 2007

When: Auckland, 4 to 6 July 2007
Where: Auckland University, Tamaki Campus
Abstracts: Now being accepted, closing date 31 January 2007. Submitters will be notified by 31 March if their papers are accepted. Abstracts can be submitted online on the PHA website: www.pha.org.nz.

The Public Health Association Conference is a 'must attend' for anyone who works in, or has an interest in, public health. Public health workers and practitioners from around the country are invited to attend the 2007 conference. This is the only conference held in New Zealand that focuses specifically on public health.

Conference themes are urban design, food matters and voices. Topics will include kaupapa Māori, systems and structures, workforce, inequalities, determinants of health, and globalisation.

The 2007 conference will have something for everyone - including people who work in strategic management roles, researchers and academics, service providers, advocacy organisations, government and non-government organisations, District Health Boards, public health services, and community workers.

Further information about the conference will be available on the PHA website in the New Year.

Direct-to-consumer advertising bad for public health says PHA

The PHA believes the decision to continue direct-to-consumer advertising of prescription medicines will have negative consequences for public health.

The Therapeutic Products and Medicines Bill has been tabled for introduction into Parliament. The Bill sets out the direction for the continued advertising of therapeutic products in New Zealand.

PHA Director Dr Gay Keating has a number of concerns about direct-to-consumer advertising.

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

"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 says the PHA believes a ban on direct-to-consumer advertising would have been in the best interests of the New Zealand public.

"New Zealand is one of only two countries that allows this sort of advertising - this was a great chance 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."

Depression campaign gets people talking

An overwhelming response to the recently-launched National Depression campaign has seen its dedicated helpline flooded with calls and has people talking publicly about their experiences.

An average of two hundred calls a day have flowed into the confidential 0800 111 757 depression information service, indicating the need for easy access to quality information about depression to those who need it, when they need it.

One encouraging sign is the significant number of men who have called the information line for help, making the gender balance of callers nearly even. The television advertisements, which feature the legendary All Black winger John Kirwan speaking about his experience of depression, are clearly having an impact on men, who would usually respond at a lower rate.

Since the launch of the campaign on the 10 October 2006, the Mental Health Foundation which manages the National Depression Initiative on behalf of the Ministry of Health, has received an increase in the volume of calls from people who are keen to 'lend a hand' and speak out about their experiences of depression at workshops and seminars and through feature articles for publication in magazines and on websites.

The three-year campaign was launched by the Honourable Jim Anderton, Associate Minister of Health, and is part of the Government's efforts to prevent suicide.

National Office round-up

The PHA Council and staff would like to wish you all a happy and restful Christmas and New Year and look forward to working with you to improve and promote public health in 2007.

Council happenings

The PHA National Council met on 9 and 10 November. Council is pleased to announce the following new members:

• Debbie Petersen from Waikato Branch
• Gabrielle Baker from the Māori Caucus
• Sitaleki Finau from the Pacific Caucus
• the return of Vivien Daley from the Canterbury Branch.

The full Council is:

• At the meeting, Philippa Howden-Chapman and John Walden talked about the history of the PHA. It's a fascinating story and one that deserves to be documented. If anyone knows of a student looking for a thesis project, contact Gay.
• The Council extended an invitation to all PHA members to attend council meetings. While members have never been excluded from attending meetings, Council wants to make it clear that they are very welcome. The next meeting is on 16 March 2007 in Wellington.
• Council has supported the proposal from Auckland Branch that the fees charged for the 2007 conference will be in-line with those of the 2006 conference.
• Everyone is looking forward to the final core competencies in public health document. Expected to be ready early next year, the document will incorporate feedback from the consultation meetings held around the country. Council is keen that the PHA continue work on core competencies once the document is published.
• We have continued our contractual relationships with the Ministry of Health with the signing of a new three-year contract. In addition to the previous contract items of facilitating informed debate, co-ordinating input to healthy public policy and enhancing the devleopment of the public health workforce, the contract supports the PHA to maintain regional branches, and the Māori Caucus.

Media

Since the last newsletter, two media statements have been released:

• Direct-to-consumer advertising decision bad for public health says PHA 
  - November 20
• Proposed Section 59 provisions confusing, says PHA
  - December 8.

Two letters to the editor were published, and we have also worked with the Injury Prevention Network of Aotearoa New Zealand to encourage a ban on the use of cell phones while driving.

Office hours over Christmas and New Year

The PHA office will be closed from the end of Thursday 21 December and will reopen on Monday 8 January 2007.

Round the branches

Central Districts update

Central Districts Branch has recovered from the recent PHA conference and will be holding the final conference wind-up meeting this month. Looking forward, the branch is focusing on ways to achieve full participation of its members. One option it has trialled is holding teleconference meetings so members from throughout the region can participate. The first teleconference was held in late November and proved very effective, with members from both the Hawke's Bay and Manawatu participating.

Meetings for the Core Public Health Competency consultation have been held in the district. A meeting on 23 November was held prior to the PHA branch meeting at the Manawatu PHO and was attended by 20 health professionals from the MidCentral Health and Good Health Wanganui areas. Attendees came from a range of public health disciplines, including PHO staff and managers and there was also good representation from the Public Health Units. It was pleasing to see both beginner and experienced practitioners participating. There was robust discussion on the draft competency document with general agreement that the core competencies will be useful.

Raising the Profile for Children: Child Health Summit 2006

In October 2006 PHA Canterbury was a co-sponsor of one of the biggest national gatherings of people working with children under the age of five.

A total of 450 participants from all over New Zealand spent two multidisciplinary, community-focused days enhancing their knowledge and understanding on how best to improve health outcomes for children under five.

The Child Health Summit 2006, organised by the Canterbury Well Child Coalition and held in Christchurch, was also a time to share relevant information and to network with others working with young children and their families.

Linda Goodwin from Community and Public Health at the Canterbury District Health Board, who led the co-ordination of the Child Health Summit, said a key focus was making the conference affordable to those who work "at the flax roots level" with children and families.

"We took a 'no frills' approach whereby participants were given only the essentials - a name tag, the agenda for both days, food and water, and keeping the cost to $60 for both days proved a winner.

"Overall, participants rated the Summit highly. They were impressed with the high calibre of the speakers, the information shared, the low cost to attend and the 'no frills' approach taken.

Ninety-nine percent of participants surveyed ranked the Summit as comparably better than any other similar event held nationally.

The speakers included clinicians, advisers, Ministry of Health personnel, and administrators of public and private child health groups. They ranged from Dr Mavis Duncanson, from the Office of the Children’s Commissioner who reminded the audience that childhood poverty is a real issue in New Zealand and discussed how to ensure the best future for New Zealand’s children; to Dr Pat Tuohy, Chief Advisor Child and Youth Health at the Ministry of Health who provided an overview of the Well Child/Tamariki Ora Framework review. Oral health, immunisation, newborn hearing screening, nutrition, sport and activity, and early childhood education were among the wide range of topics discussed.

Overall, the key message was that we need to intervene in children's health and wellbeing earlier rather than later. For example, it is better to focus on children in early childhood education settings rather than leaving health promotion efforts until children commence primary school.

The Summit was sponsored by Mana Whenua ki Waitaha, Community and Public Health, Canterbury District Health Board, Early Start Project, Immunisation Advisory Centre, Maori SIDS, Ministry of Health, Sport Canterbury and the Public Health Association of New Zealand (Canterbury branch).

Participants fully supported another similar event to be held in 2008, which the organising committee is considering.

A full report about the Child Health Summit, including key points made by each of the speakers, is available on Community and Public Health's website: www.cph.co.nz - look for Child Health Summit 2006. The presenters' PowerPoint presentations are also available on the website.

New PHA website

Keep an eye out for the revamped PHA website at www.pha.org.nz, which will be launched in the New Year. A recent analysis of user statistics found the site was under-utilised and many people were visiting the homepage but going no further. In addition, the majority of people (71 percent) visited the site just once. The analysis report said this was likely to be because the site didn't meet visitors' informational needs. The report also found that specific sub-pages of the website were not easily recognised by search engines making it difficult for users to access the information they required.

Over the years several people have worked on and modified the PHA website and it now contains a wealth of information. This presents a challenge for coordinating and arranging the information so site visitors can quickly and easily find what they need.

The aim of the new site is to present information in a more intuitive way. It updates and modernises the PHA's branding and includes some new features for site visitors. These will include a document archive and a feedback form. The feedback form in particular will provide visitors with an opportunity to provide comments on content.

The newly developed site is currently being tested with real users to determine how easy it is to use and how quickly they can find the information they need. Results from the testing will help further inform possible final refinements to the site before it goes live. Watch this space!

Transport health impact assessment gains traction

September 2006 saw the release of a Health Impact Assessment (HIA) of the Greater Wellington Regional Council's (GWRC) Draft Regional Land Transport Strategy (RLTS). The report received extensive media coverage.

The HIA was prepared by public health specialists Quigley and Watts for the GWRC with funding from the council and Regional Public Health (Hutt Valley District Health Board). The HIA was undertaken primarily because both the GWRC and Regional Public Health wanted to strengthen their work across sectors to promote health and wellbeing.

The HIA therefore aimed to check the draft RLTS - prepared for the period 2007-2016 - delivered on its objective of 'promoting and protecting public health' (draft objective four) by assessing the impact of the RLTS against key determinants of health and wellbeing. The RLTS sets out the vision, objectives, policies and plans for land transport in the Wellington region for the next ten years. By its very nature any RLTS generates a great deal of interest from a variety of sectors.

The HIA was undertaken within tight time and budget constraints, so focus on priority areas was critical. A steering group recommended a focus on a priority list of health determinants:

• physical activity
• accessibility to services and the community
• accident rates and changes in injuries and fatalities
• community effects and severance as a result of traffic
• stress and anxiety.

In addition, the following populations were identified as important for the HIA:

• Those with access issues:
• households without cars
• school children
• people with disabilities
• Those with affordability issues:
• low socio-economic groups
• Those affected by geographical location:
• rural people
• communities close to existing routes
• communities close to proposed routes.
• Māori.

It also focused on packages identified for the Regional Transport Programme. These were:

• public transport (scheduled train and bus services) infrastructure improvements
• public transport (scheduled train and bus services) ease of use improvements
• travel demand management, walking and cycling
• roading, the Grenada to Gracefield link.

The assessment of the RLTS found that while the draft objectives have the potential to positively impact on public health, the RLTS overall is unlikely to protect and promote public health for the region's population. In particular, it was found that the draft RLTS is likely to be damaging to public health and to increase inequalities in health. The HIA also found the RLTS contains mixed messages, with public health-protecting and aspirational objectives in part of the strategy, while there were public health damaging 'advanced roading' messages in other parts.

The major recommendations of the HIA were to:

• incorporate social equity and affordability into the RLTS objectives and outcomes
• investigate changes in fare pricing structures and fare boundaries to improve equity and affordability
• increase the proportion of funding for public transport, walking and cycling, and reduce the proportion of funding for new roading, as new roading is not likely to promote health, while other modes of transport are
• make trade-offs explicit with regard to the mis-match between objectives and policies in the front of the strategy and funding allocations in the back
• initiate HIA in projects that flow out of this RLTS, and initiate HIA earlier in future RLTS planning processes
• strengthen the aims of the RLTS towards increased mode share for public transport and active modes and reduced dependence on private motor vehicles.

Director of Quigley and Watts, Rob Quigley, has received positive feedback on the HIA, including from travel planners in Wellington region's other DHB - Capital and Coast Health. He says there is a need for this kind of analysis of any regional strategies as health impacts are often either overlooked or given less than optimal attention.

"The cross-sector team involved in this HIA contributed a range of knowledge, skills and experience which helped ensure the recommendations in the report are practical. It's critical now that these results are used by public health advocates within submissions on the strategy."

The draft RLTS is currently out for consultation with a closing date for submissions of 16 February 2007 (see the online submission form at http://www.gw.govt.nz/section2372.cfm).  The Regional Council's Land Transport Committee will consider submissions, recommendations from the HIA and a strategic environmental assessment, and will finalise the strategy in April 2007.

Go to http://www.quigleyandwatts.co.nz/contracts.htm for a copy of the full HIA.

Workplace Injuries - a major public health problem

A recent report shows the cost to New Zealand society of workplace injuries has been grossly under-estimated. The economic and social costs of workplace-related diseases and injury are up to four times higher than previous estimates calculated and just two percent of the total cost is for compensation by organisations such as ACC and the Ministry of Social Development. The report was commissioned by the National Occupational Health and Safety Advisory Committee (NOHSAC) which is responsible for providing independent advice to the Minister of Labour on occupational health and safety issues in New Zealand.

The Centre for Disease Control puts workplace safety as one of the Ten Great Public Health Achievements in the 20th Century. But the World Health Organization says workplace fatalities, injuries and illnesses remain at an unacceptably high level. It seems that New Zealand in the 21st Century is starting to slide backwards from the great public health achievements of last Century.

In New Zealand between 700 and 1000 people die from occupational disease and a further 100 people die from occupational injury each year. There are also up to 20,000 cases of new work-related diseases and about 200,000 work-related injuries that result in claims to ACC. These injuries and deaths are often preventable and are a significant public health problem in New Zealand.

The report analysed a number of previous studies and examined all new cases of occupational disease and injury that occurred between March 2004 and March 2005. The full economic and social cost of these types of injuries and diseases amounted to $20.9 billion. This figure is considered by the authors as a conservative estimate as there is limited literature available on the annual incidence of occupational disease and injury for New Zealand. The report notes that the number and proportion of uncompensated cases is quite likely to be higher than the estimates used in the report.

The $20 billion cost is comprised of $4.9 billion in financial costs (3.4 percent of GDP) and $16 billion in costs associated with suffering and premature death. Financial costs are categorised into six sub-groups. These reflect the range of costs being borne by different parts of society, including employers, employees and society generally. The largest financial cost is for human capital. This amounts to $3.05 billion per year and relates to the lost productive capacity of a worker over the longer term - until retirement age.

Health and rehabilitation costs are the second largest financial cost at $694 million, followed by production disturbance costs at $573 million, transfer costs at $238 million, and administration costs at $55 million. Other costs (such as those for carers and aides, equipment and home modifications) total $293 million.

The three main groups identified as bearing such costs include employers, workers, and society. In 2004-05 employers bore an estimated 5.9 percent of the total financial costs ($287 million). Workers bore around 46.4 percent ($2.28 billion) and society - mainly through the compensation system and government sector - bore the remainder (47.7 percent or $2.34 billion). The report states that if the value of suffering and premature death is included and attributed to workers, their estimated share of the costs of workplace injury and disease is 87.4 percent, with 11.2 percent borne by society and 1.4 percent by employers.

The analysis also found that just over three-quarters of the total annual cost of workplace injuries and disease (76 percent or $15.8 billion) is due to injuries and the remainder (24 percent or 5.1 billion) is due to disease.

Professor Neil Pearce (chair of NOHSAC and director of the Centre for Public Health Research at Massey University) stated when the report was released that "the effects are much more than financial - there are often significant and long-term social consequences for the injured and sick and for their families, workplaces and communities - and further down the track, the health system, the Government and the economy."

He said this report provides an excellent snapshot of the current state of play. This more accurate costing information will help to inform policy and practice decisions so appropriate programmes and long-term benefits can be delivered to reduce workplace diseases and injuries by keeping workers and workplaces safe, healthy, and productive.

For a copy of the report and more information, including cost comparisons for different age groups, ethnicities, industry types, and injury/disease types go to www.nohsac.govt.nz/documents.

An eco-friendly building for workers at Waitakere City

Thirteen years ago Waitakere declared itself an eco city, and committed itself to principles such as growing the economy, caring for the environment, and building strong communities.

At the time the many arms of Waitakere City Council were scattered - housed in different buildings around Henderson and its environs. "It meant that staff spent a lot of time travelling between buildings, and many staff didn't know who one another were," says Group Manager John Schermbrucker. "As the council grew and new departments formed, we had to find new space for staff."

After years of planning, seven hundred staff are now housed in an impressive new building on Henderson Valley Road. Apart from bringing staff together, the Council has sought to meet its commitment as an eco city.

So for a start, the building is situated right next to the North Auckland Railway line, bus station, and main taxi rank. "This was deliberate. We wanted to encourage staff to use public transport, so we've limited the number of staff car parks, and allocated them to staff who car pool. What we're looking for is a 10 percent shift away from car use."

Access from the building across to Henderson CBD, and the transport centre is made easy for staff and public, with a covered bridge that is quite a feature and also serves as a grand entry to the main building.

Eco-friendly design has been carried through every aspect of the building. Louvres on the outside stop heat from entering the building, which means that there is less pressure on the ventilation system.

Each floor is connected by an atrium and huge staircase that runs down one side of the building. "Apart from giving staff easy access to all the floors, it also ensures continual air circulation throughout the building," John Schermbrucker says.

Throughout the building, concrete is left in its raw state to create thermal mass for passive heat gain. Environmentally-friendly materials are also used throughout with plantation timbers and even a recyclable carpet.

There is also New Zealand's first 'extensive' or lightweight greenroof, which is designed to filter rainwater and slowly release it back into the environment. "It also enables us to test water, and determine what level of pollutants are being released into streams."

The Council has also chosen to create more esoteric connections with its environments and communities by incorporating functional art into different parts of the building. The Council chamber is particularly impressive; its curved and panelled ceiling representing a gourd which is dotted with stars from the Matariki.

Elsewhere there are huge pouwhenua, and the main reception area features artwork that tells the story of the Waitakere ranges and its flora and fauna. There is also a Japanese Garden. This is a development from the much smaller Japanese Garden at the previous Civic Centre, and gifted by Waitakere's sister city, Kakogawa in Japan.

When he considers the overall impact and transition to the new building, John Schermbrucker feels very positive about the project.

"Generally the feedback has been extremely positive. It has brought our people together and it's a pleasure to work in such a nice environment."