PHA NEWS ONLINE – 10 February 2009
Vol XII, No 1
A community that has benefited from the programme – Jim Graham, Ministry of Health DWAP Leader (left) with Kutarere Water Supply Committee members Trevor Ransfield, Gaylene Kohunui, Kamelia Hape and Solomon Manuel.
Water facilitators deliver
After reading the October PHA News and seeing Marty Rogers' comment, "How can you persuade people to exercise regularly when what they really need is for their crap water to be fixed?", Raelyn Rika contacted the PHA to say there is help out there for crap water!
Raelyn is one of 10 facilitators across the country who offer technical assistance to people or organisations who supply water to 5,000 people or less. It is part of the Drinking Water Assistance Programme funded by the Ministry of Health.
Under the programme any rural marae, school, or little settlement of houses that has plumbed a deep bore, or is piping water from a stream or river, or is harvesting rainwater from the roof, can get free help and advice on how to properly manage that water supply.
This includes advice on minimising contamination of the source water, removing particles from the water (where many of the pathogens/germs hide), killing or inactivating pathogens, preventing recontamination after treatment (how to keep it free of contamination on its way to the tap), how to take a sample to be sent off to the Ministry of Health laboratories (and then how to read the result!).
Raelyn works for Toi Te Ora Public Health which services Bay of Plenty and Lakes (Rotorua and Taupo) districts. She and her colleagues hold regular workshops for small water suppliers and then help them develop a public health risk management plan. Raelyn says completing a plan is one of the key criteria to attracting funding from government for water supply upgrades or renewals and training.
She says not only do participants learn new skills at workshops but they also learn from each other's experience.
She encourages people to visit the Ministry's Drinking-water Assistance Programme web page or call her on 07 306 0953.
New year, new government
What are the Government's priorities in health?
We've heard its members on the hustings, in debates and in advertisements, but now the National Party is leading the new government, what exactly does it believe are the priorities in the health and social services sector?
Among John Key's stated commitments to New Zealanders is the pledge to tackle health workforce issues by introducing voluntary bonding for new doctors, nurses and midwives, and by boosting the number of funded medical student places by 200 over five years.
Mr Key has also committed to continuing all Working for Families payments at current levels, keeping 20 hours free early childhood education and maintaining caps on doctors' fees.
The Prime Minister also says his government will pass a law to maintain and inflation-index all benefit payments and encourage those who can work to go back to work.
The Government's agenda on health, to be carried out in the first 100 days of office, includes:
The PHA congratulates the new government for reversing its decision to cap the number of state houses. National Executive Officer, Gay Keating, says the government has ditched ideology in favour of evidence.
"Families who are living in garages or sleepouts while they wait for a state house are at far greater risk of ill health. The long-term damage caused by having to live in cold, draughty, damp conditions is immense.
"The decision to continue to build new state houses will also have the spin-off of helping to reduce hospital waiting lists, as fewer people will become sick and need a hospital bed."
Controlling the cost of visiting the doctor
The PHA is also pleased that the National-led government has indicated it will keep the GP fees review process.
In the pre-election period the National Party indicated it would do away with the mechanism that keeps the cost of seeing the doctor affordable. (That mechanism is a review, by a specially convened committee, of how a practice operates and the rationale behind proposed fee increases, if a GP applies to increase them).
Gay Keating says now that the National Party has come to understand the situation it intends to keep that fees review process.
"One of the Ministry of Health's targets is to reduce preventable hospital admissions of people with conditions that are treatable in the community. Getting preventive services, such as regular checks for high blood pressure and diabetes, and the early diagnosis and treatment of conditions in primary care, is much more affordable – and less distressing – than admission to hospital."
Latest figures show that while there has been a reduction in preventable hospital admissions for Pakeha, there is no improvement for Māori or Pacific people.
"Maintaining the fees review process therefore is hugely important because if the government decided not to control the cost of going to the doctor, hospital admissions, particularly for Māori and Pacific people, would grow even further."
Gay Keating says it would be better still if the fees review mechanism was delivered in a more fair and equitable fashion.
"At present the review examines the GP's application to increase fees in terms of the percentage increase. This penalises practices who have previously kept their fees very low, and supports practices who had high fees to start with. For example, a situation where a doctor charges a dollar for a child's visit and applies to raise that by 5 percent, is very different from where a doctor charges $20 for a child's visit and applies for that to be raised by 5 percent."
Children's health in 2009
John Waldon is a Massey University PhD candidate and was first elected on to the PHA Council in 1995. His doctoral thesis is on self-assessed health status for children who speak te reo Māori and he believes the greatest challenge in 2009 will be simply keeping children's health on the agenda.
He says some of the actions of past governments have increased the burden on children living in poverty, (for instance, the Working for Families tax credit not applying to those children whose parents are not in paid employment) but the new government could make a difference and eradicate child poverty.
"But with the challenges facing the country as a result of the global financial crisis, and the favoured initiatives of the new government and its coalition partners, it will be difficult to keep the focus on children's health – particularly children in low-income families," he says.
"The Māori Party is keen to see a review of the Foreshore and Seabed legislation and ACT wants government departments to closely review their balance sheets. Government is going to be so busy, children are at risk of being forgotten.
"I suspect there is little will in the new government to tackle child poverty. It will remain in the too-hard basket, and it, and its consequences, will continue to be a burden placed on all New Zealanders."
John Waldon says during 2009 we will all have to look past the short-term benefits to ourselves of the April tax cuts and the decreasing cost of petrol. If the government will not address children's issues, he says, it is time for ordinary New Zealanders to step up.
"If we use the money wisely, our tax cuts and the money saved from the declining price of petrol could have an important impact on the status of children's health, particularly those in poverty and those with preventable diseases."
The PHA loses a staunch supporter and true Public Health Champion
The PHA notes with great sadness, the passing of Dr Paratene (Pat) Ngata, (Ngati Porou/Te Aitanga a Hauiti/Ngati Ira) aged 62, after a long illness. Dr Ngata was Public Health Champion 2000.
Following in the footsteps of his great-grand uncle, the legendary Sir Apirana Ngata who was the first Māori to complete a university degree, Dr Ngata studied medicine at Otago and while he never found it easy (Dunedin was cold and a long way from his east Coast home) his determination to "just get on with it" saw him graduate in 1970.
After a time at Wanganui Hospital, where he was a house surgeon at National Women's, and where he completed a Diploma in Obstetrics, Dr Ngata entered general practice in Opunake and Whakatane.
During this time, he said, the notion of public health was becoming fashionable. Health officials realised there were disparities between Māori and non-Māori in things like middle ear disease. And he too began to act on a growing passion for Māori public health, moving to Wellington and completing a Diploma in Community Health.
Dr Ngata was a public health medicine registrar when, in 1984 together with Lorna Dyall, Eru Pomare, Mason Durie and George Salmond, he organised Hui Whakaoranga because it was, he said, timely to bring a whole group of people together to talk about health issues. A former director-general of health has described Hui Whakaoranga as "the most important Māori health initiative since the days of Apirana Ngata and Peter Buck".
Dr Ngata served as Director of the Midland Regional Health Authority, helped as an advisor to Ngati Porou Hauora, an integrated health, development and support services provider; and Te Ora, the Māori General Practitioner's Group. He worked to ensure Te Ora maintained a Māori heart – a spiritual and cultural dimension which he said, enhanced and strengthened its members.
From the early 80s he mentored students, encouraging young Māori into the health professions. With Ngati Porou Hauora providing a supportive environment for undergraduate clinical placements, medical students from Otago and Auckland have also had the opportunity to experience learning in a rural, predominantly Māori community. He was an Advanced Vocational Training Co-ordinator for the College of General Practitioners, of which he was a Fellow.
Dr Ngata said the best thing he achieved was the gaining of many friends who were all working toward Māori health development. And he was pleased that people he mentored and supervised in turn became advocates for Māori development.
While acting as a leading advocate for Māori public health, Dr Ngata continued as a general practitioner. At one time, he tried to retire – but he said rural GPs are always in short supply and he continued to practise in Tolaga Bay among his people. He believed the most pressing thing to be addressed in Māori public health was the promotion of healthy lifestyles.
He was a strong advocate for ending violence in families and communities and, in 2004, was awarded by Otago University an honorary Doctorate of Laws.
2009 National Nutrition and Physical Activity Conference
Kia Hono : Kia Awe
25-27 May 2009, Te Papa, Wellington
Connect with colleagues for three days of inspiration as we focus on how we can respond to environmental changes in order to promote nutrition and physical activity.
Top five reasons why you should attend this conference:
If you have a work focus or interest in promoting nutrition and physical activity, then this conference is a must for you.
4 April 2009 – Early Bird registrations close
Visit www.ana.org.nz/conference09.php for registrations, programme details and information on the abstract submissions process.
Council agrees on new strategic plan 2009-2019
Since 1999, the PHA has been guided by strategic plans. The strategic plan drives the work of the PHA by setting priorities for staff activity and spending through annual plans.
In spring 2007, branches discussed the future as part of a review of the PHA strategic plan. Input from those discussions was considered by the PHA Council at the autumn 2008 meeting, from which a discussion paper on the draft strategic plan was developed. Branches, caucuses and individuals gave feedback.
From this, the strategic plan has been finalised as below.
What the PHA wants to see by 2029 (vision)
Good health for all – health equity in Aotearoa .
Mission – what will the PHA be doing over the next 25 years?
The PHA will lead the public health approach to achieve health equity. Te Tiriti o Waitangi underpins all our work.
These are the principles and standards by which the PHA will operate. The PHA will also seek to have these values reflected in the actions of others to achieve our vision of health equity.
Tautoko: Respect must be shown for the rights of all people.
Manakitanga: Equity of outcomes is to be achieved by equal treatment of people in the same situation (with unequal treatment of people who are in unequal situations).
Kotahitanga: Collective action and solidarity is needed at all levels of society (national and local government, iwi, hapu, local communities, whānau, families and individuals) for collective good.
Matauranga: Decisions should be made on the best available evidence; when that evidence is limited the precautionary principle should apply and evidence should be progressively gathered.
Matatika: Integrity, honesty, openness, transparency.
Te Tiriti o Waitangi is integral to public health and defines the relationships among and between all populations that reside in Aotearoa.
This means that we partner with Māori in our decision making, and recognise the rights Te Tiriti affords Māori as the indigenous people of Aotearoa New Zealand. The specific needs of Māori and kaupapa Māori solutions must be factored into all decision-making about public health.
The priority population for 'health equity in a generation' is Māori.
The PHA will also work for health equity for other groups with poorer health such as Pacific peoples, Asian peoples, refugees, gay/lesbian/bisexual/transgender/takatapui/fa'afafine, people with disabilities and families in poverty.
New Asian health e-group established
The Asian population in New Zealand has increased from 3 percent of the population in 1991 to 9 percent of the population in 2006 – a faster rate than other population groupings. In New Zealand, when we use the term 'Asian' it encompasses people coming from a vast area stretching from Afghanistan in the west to Japan in the east.
Within the Asian community there is a variation of health status - with South Indians having a predisposition to cardiovascular diseases, Indian children to asthma and Chinese to stomach cancers. Generally Asians come into the country healthy because of the immigration screening process, but as time progresses, because of dietary and lifestyle changes and their predisposition to certain diseases, their health deteriorates.
To discuss Asian health issues and raise awareness of them, the PHA Asian Caucus decided on setting up an e-group to facilitate discussion. Sandeep Reddy, who is a member of the Asian Caucus, has assisted in setting up this new e-group called Asian Public Health Forum of New Zealand (APHFONZ). Membership is open to all PHA members irrespective of ethnicity and background. You can subscribe to this group by sending an e-mail to APHFONZfirstname.lastname@example.org.
Once you join the e-group, you can post messages, discuss issues, upload photos and files, create polls and databases and send emails to all other members by messaging email@example.com.
Please take this opportunity to support a virtual and national platform to discuss Asian health issues.
Welcome to new Council members
Carol Wrathall has become a new Māori Caucus member on the PHA Council.
Carol is the Kaiwhakahaere, National Manager Māori, for the Injury Prevention Network of Aotearoa New Zealand (IPNANZ). Her role is primarily to support the Māori membership of IPNANZ and involves advocacy, workforce development, and promoting the development of kaupapa Māori injury prevention programmes. Carol also works in partnership with other national injury prevention organisations on a range of injury areas. She is also a Trustee of Te Whare Rokiroki, Wellington Māori Women's Refuge.
Carol's particular interest in public health is a commitment to promoting equitable access, service provision and outcomes, specifically for Māori.
Manaia Paki King has moved from Māori Caucus observer to Māori Caucus member of the Council. Manaia works as a Senior Portfolio Manager with the Ministry of Health, and is also the issue lead for Māori public health and Māori public health workforce development.
He believes the most important issue facing public health officials is their ability to be able to implement public health interventions which protect not only the health status of communities but also their cultural values and practices.
Manaia has a Bachelor and Masters in Law and a Post Graduate Diploma in Public Health. He is currently in the process of registering for his PhD in public health law through the University of Auckland.
Haere mai to Callie Corrigan (Ngati Kahu), who has taken over from Melanie Dalziel as the representative of Te Tai Tokerau on the PHA council.
Callie has a Bachelor of Sports and Exercise Science and a Masters of Science from Wintec (Waikato Institute of Technology) and works within the Korikori a Iwi service at Te Hauora o Te Hiku O te Ika in Kaitaia, promoting physical activity and eating healthy kai.
Prior to moving home to Te Tai Tokerau, Callie was with Sport Waikato for three years as a Healthy Lifestyle Coach and a part time tutor with the Department of Sports and Exercise Science at Wintec in Hamilton.
Callie says the most important aspect of public health for her is to ensure whānau and hapu input is incorporated into public health discussions and issues because "that's where it's all happening".
She says rather than a top-down flow of decision-making about communities' health, it should always be from the bottom up: communities have the ability to shape solutions to their own health issues and should be supported to do that regionally and nationally.
Callie lives in Kaitaia with her tane, Kaiaua and their tamariki, nine-year-old Kahurangi and Ihaia, three.
Suaree Borell is taking over from Sitaleki Finau as Pacific Caucus representative on the PHA Council.
Suaree is a researcher and evaluator of health projects and currently lead Māori lecturer on the Whariki Evaluation Training Contract with the Ministry of Health. She has been the principal evaluator for Te Ropu Whariki's National Auahi Kore Service Evaluation 2006-2008. She is of Māori-French-Samoan heritage and remains committed to improved health equity and outcomes for all.
Her foundation degree from the University of Auckland was comprised of a double major in psychology and sociology. Suaree then went on to do an honours degree in sociology and post-graduate diploma in political studies.
She was tumuaki of Nga Tauira Māori and worked with various leading Māori academics to ensure increased recruitment of Māori students and their retention were a priority at Auckland University. In addition to her primary role of teaching, she is currently working on an evaluation for the New Zealand Breastfeeding Association in three sites across the country.
Her expertise and background in public health research around alcohol marketing has also seen her working in a formative evaluation role with rangatahi (young people) and alcohol issues in rural Aotearoa/New Zealand. She is author of a number of technical reports and co-author of multiple peer-reviewed publications.
Suaree, who is "born and bred rural" sometimes regrets her academic background and city-based life, and wishes she was a "homegrown soldier" working only on rural issues.
"I am always interested in who is setting the agenda about which rural issues are to be addressed. The opinions of the people living rurally are often ignored, which isn't right. I like to defend the rural position because that is where my heart is, but I find my academic achievements are sometimes a drawback because they limit my access to certain rural populations."
She believes honesty and commitment to human welfare are forgotten values that public health, including the Public Health Association, should be charged with reinstating. Her biggest driver is providing well for her family and one day Suaree wants to return to her father's Tauranga homelands.
Haere ra to Melanie Dalziel and Sitaleki Finau
Two energetic supporters of the Public Health Association have moved on to other pastures.
Melanie Dalziel (Te Aupouri me Ngati Kuri) was council member for Te Tai Tokerau from 2005 until last year. Over that time she did sterling work for the PHA in the north and we are particularly grateful for all the essential 'backroom' work she took on that helped to make the 2008 annual conference the success it was.
Our very best wishes go with her.
Sitaleki Finau was instrumental in building up the Pacific membership of the PHA and was the Pacific Caucus representative on council for the two years of its crucial development. Professor Finau and his wife have moved to Niue where he has taken up the directorship of the Department of Health there.
Our grateful thanks to him and we wish him well.
Māori Caucus succession planning
For some years the Māori Caucus has been consciously planning succession for the caucus positions on PHA Council by nominating an 'observer' on Council. This has meant that when there is a Māori Caucus vacancy on Council there is a person who is fully familiar with the issues and processes of Council who can immediately step up as a full Council member. Māori Caucus pays the travel and accommodation costs for the observer to attend Council meetings.
PHA Council meetings are open to all members to attend as observers. Other branches and caucuses may like to think about succession for their current representative on Council and encourage and support an upcoming member to attend Council meetings.
Stephen Te Moni is the new Māori Caucus Observer, filling the role vacated by Manaia Paki King. Stephen has been a health promoter with the Tipu Ora Charitable Trust in Rotorua since April, which was a complete change of direction from six months as a performer (singing and dancing) in a five-star hotel in Dubai. Prior to this he was a Māori Liaison/Te Pou Kōkiri working for Māori Health Services/Te Whānau a Irākewa, at the Whakatāne Hospital.
Stephen is keen to work with the Public Health Association because he wants to see how public health issues are managed at a governance level. He says he has grassroots knowledge but wants to see how things shake down in the corridors of Wellington. He says he has a "whole lot of learning to do!"
To Stephen, the most important thing to achieve in public health is the amelioration of inequalities in health between Māori and non-Māori, and this is his main driver.
Stephen has a BA in Māori and Linguistics from the University of Waikato and lives in Rotorua with his wife Tiffany Haehaetu Kiwha Te Moni (nee Hicks), and two "children" Henry Blade Te Kowhai (their cat), and Subie, their 2001 Impreza WRX Sti!
Public health practitioners recognised
Two long time champions of public health were recognised in the New Year's honours.
Professor David Skegg, Vice Chancellor of Otago University, was made a Distinguished Companion of the New Zealand Order of Merit. Previously Professor of Preventive and Social Medicine in Dunedin, David Skegg is an internationally renowned cancer researcher.
For more than 15 years he has advised the World Health Organization's Special Programme of Research, Development and Research Training in Human Reproduction. He was chair of the Public Health Commission and of the Health Research Council and has also served on several government committees.
He has an outstanding record both as a researcher – with more than 140 publications in academic journals – and as a strong advocate of improved public health.
Philippa Howden-Chapman has received three honours in as many months. Professor Howden-Chapman, PHA Champion for 2006, received two national awards in November, honouring her ground-breaking research into housing and health.
The two awards, the Dame Joan Metge Medal and the Liley Medal, were presented at the annual Royal Society of New Zealand Honours Dinner in Wellington.
Professor Howden-Chapman is internationally recognised for her research which demonstrates for the first time links between New Zealand's cold and thermally inadequate housing, health outcomes and energy use. She has authored 150 publications on this and other public health issues.
Both medals were awarded jointly with University of Auckland scientists, Professor Diana Lennon and Professor Edward Baker.
In the New Year's Honours, Philippa Howden-Chapman was appointed Companion of the Queen's Service Order for services to public health.
The Alma-Alta – 30 years on
The explicit goal of the 1978 Alma-Ata Declaration on Primary Health Care was 'Health for all by the year 2000' and comprehensive primary health care was seen as the means to achieve it. The Declaration recognised that primary health care was much bigger than just medical treatment and it identified health equity as a core principle. It also identified community participation and control, as well as action on the social determinants of health, as key approaches.
Dr Pat Neuwelt of the University of Auckland's School of Population Health says New Zealand, 30 years later, has a long way to go to truly enact the Declaration's principles.
In the years following Alma-Ata, 'third sector' primary health care organisations grew in New Zealand, such as union health centres and Māori and Pacific health providers. Many of them were consciously based on the Declaration's principles, and were established as community trusts, with staff employed on salaries.
Dr Neuwelt says the achievements of those third sector health providers, along with the primary care reforms in the UK, underpinned the New Zealand Government's decision, 23 years after Alma-Ata, to roll out the Primary Health Care Strategy in 2001. The Strategy called for the establishment of not-for-profit primary health organisations (PHOs), funded using a population-based funding formula, and involving communities in their governance.
The first PHOs were established in 2002 and there are now over 80, some catering for an enrolled population of 6,000; others for a population of nearly 600,000.
"The smaller ones have tended to emerge from third sector health providers and they generally mirror Alma-Ata in their responsiveness to the needs of the community around them," Dr Neuwelt says.
"They are flexible, taking medical services out to marae or in a mobile van and holding health promotion classes on local community venues. Genuine community involvement means they are sensitive to the needs of the most vulnerable in their area. For example, they often consciously employ Māori and Pacific staff, and make use of interpreters for working with new migrants."
On the other hand, the larger PHOs have generally grown from general practitioner-dominated and -owned practices.
"It's pretty much business as usual with those PHOs. The Primary Health Care Strategy has delivered cheaper general practice visits and that's great but in most other ways, health care is delivered by those PHOs as it was before 2001. That means the majority of New Zealanders are not fully benefiting from the goals of the Strategy.
"Many of the larger PHOs have developed quite innovative health promotion programmes, but their clinical services remain unchanged. Māori and Pacific peoples still attend clinics that are not necessarily culturally responsive, services are still doctor-focused rather than being delivered by teams including nurses and community health workers, and patients sometimes travel a long way to see a doctor. There is little attempt to take a health promotion approach to the delivery of all PHO services, including clinical."
Dr Neuwelt says a critical difference between the two types of PHO is that on the smaller boards, the community representatives will generally have real input into decision-making, whereas the community representation on some of the largest PHO boards is not much more than consumer representation, with little impact on improving the community responsiveness of PHO services .
"Community representatives reflect collective concerns, such as equity and value of health services for taxpayers' money, whereas consumer representatives are primarily interested in improving the services that they themselves access. 'Community representatives' on large PHO boards are often frustrated at their inability to have an impact on decision-making as well as their inability to truly represent the views of very large population groups."
Pat Neuwelt says the Primary Health Care Strategy has a long way to go before it reflects more closely the principles of Alma-Ata.
"In many areas it hasn't met its promise of involving and enabling communities, nor in building a team approach to the planning and delivery of services.
"It's not acceptable that vulnerable people, such as youth, people on low incomes, Māori and some ethnic minority groups are still missing out on basic health care. While going to the doctor is much cheaper, in some PHO areas, it's still not as cheap as the Government had hoped, funds often being put instead into general practices.
"There needs to be a much bigger shift to focus on the needs of the most vulnerable. If the focus is on the most vulnerable, everybody's needs are met because there is clear evidence that a more equitable society is a healthier society.
"In 2001 those of us in public health argued that PHOs offered an opportunity for public health involvement and change. I think that opportunity still exists, we still have potential for gains to be made and it's important we make a contribution.
"The Declaration continues to call for all primary health care actors to work towards improving people's access to the determinants of good health – such as appropriate housing, access to meaningful work, opportunities for quality education. It raises questions for us in Aotearoa about how PHOs and how we as health workers can collectively improve health equity in New Zealand."
To view the Alma-Ata Declaration on Primary Health Care visit www.who.int/hpr/NPH/docs/declaration_almaata.pdf.
Pat Neuwelt is a general practitioner and public health physician, and a senior lecturer in public health at the University of Auckland's School of Population Health. She has worked in primary care with disadvantaged communities in both Canada and New Zealand. Pat is the author of the Community Participation Toolkit – A resource for primary health organisations published from her PhD research on that topic.
PHA concerned over cancellation of primary health care conference
National Executive Officer, Dr Gay Keating, has written to the Minister of Health, expressing her concern at the cancellation of the primary health care conference which was to have been held this month in Wellington.
In her letter, Dr Keating has pointed out that primary care is about far more than doctors and she has asked for a meeting with Tony Ryall to discuss how effective primary care can reduce avoidable hospital admissions.
The PHA strongly believes primary care should be the focus of the health system, and used as the Primary Health Care Strategy envisages – to treat conditions early could substantially reduce costly hospital stays. This means of course more money for things like surgery for those on waiting lists.
"While hospital admissions for treatable conditions have reduced for Pakeha, the numbers remain unchanged for Māori and Pacific people. This means a renewed focus on the ability of primary health care to reduce inequalities is urgently needed.
PHA Conference 08 reflections
Wellington Branch awarded two people scholarships to attend the 2008 PHA Conference. Here they look back at their experience at Waitangi.
Shirley Simmonds (Ngāti Raukawa ki Waikato, Ngāti Tūwharetoa)
At the Eru Pōmare Māori Health Research Centre in Wellington, our research aims to improve Māori health and achieve equitable health outcomes. As a researcher with the Centre, this is the framework I have in mind when attending any hui, and therefore, also my first ever Public Health Association conference.
How appropriate that the conference was held at Waitangi. Māori have a right to good health and healthy conditions, a right conferred by the Treaty of Waitangi with its guarantee of equity. Good quality statistical data is vital for monitoring disparities in health and ensuring the Crown upholds its obligation to Māori. Often we can feel bombarded by negative statistics portraying the poor health status of Māori, and I was reminded of the power of the spoken word – if we hear something often enough, it can become normalised.
However, by virtue of location, we are also reminded of the need to frame disparities in a historical context to understand how they are generated and maintained in order to find appropriate interventions at a societal level. This steers us away from a victim-blaming, individualistic approach to inequities.
Appropriate use of statistical data can provide a powerful advocacy tool at a systems and policy level. Statistics can reveal who gets what and how much, and who is being privileged by our health system. Gaining an understanding of how quantitative data is generated and how it can be effectively utilised allows us to go beyond mere description of disparities. Instead we are able to decide how we wish to be represented, we achieve a greater sense of ownership of the data and are further empowered to effect positive change and eliminate disparities in the health system.
I am extremely grateful to the PHA committee for providing the opportunity to attend what was a diverse and vibrant conference. The strong Māori presence, high level of involvement from local organisations, and wide range of attendees provided a forum for a rich knowledge base and wealth of expertise to come together.
Ngā mihi nui ki a koutou katoa.
The 2008 conference, held at Waitangi, had a potent Māori flavour, including harmonious waiata sung before and after plenary speakers. As a Pakeha I felt at a distinct disadvantage not knowing more than a few Māori words of the speeches and jokes we were exposed to. I was impressed by the warm welcome given to me, arriving late at the powhiri on Tuesday in time to be given a meal.
Wednesday started with Malcolm Peri, who has been described as a 'provocative Māori thinker'. Malcolm argued that we can't separate tapu from noa, they are intertwined. Dr Colin Tukuitonga talked about the challenges of public health, including individualism vs collectivism and the market vs the state. As he put it, "I'd rather the state be my nanny than the market". He described self-regulation as "foxes in charge of the henhouse". Professor John Raeburn pointed out how the size of inequity is the biggest predictor of public health. Dr Kawshi De Silva emphasised how culture and health are strongly linked and that the health of migrants often deteriorates after their move to New Zealand.
There were many interesting workshops, but what stood out for me was Donna Frost's account of a pilot programme for Māori and Pacific parents to learn about nutrition and activity. She explained it was vital to validate cultures to bring about any level of change, which means that you can't say a food is bad when people love it. People are more important than any programme, she emphasised, and deliberately involved the whole family in the programme. Her impact and the success of her programme were illustrated when she described how she had eight families in the first session but by the fourth session this had mushroomed to 48!
Te Tai Tokerau Branch and ROK Management Solutions together produced a memorable and thought-provoking conference, set in the picturesque surroundings of Copthorne Hotel.
What's happening with the Public Health Bill?
The Public Health Bill has been considered by Select Committee. Its report is available here.
The Bill, with the changes recommended by the majority of Select Committee, will be discussed in Parliament as a committee (second reading) and if agreed it goes through a final reading and a vote to pass it. It is possible for changes to be made to the Bill at either of these readings.
What happens now to the Public Health Bill will be decided by the new government.
What did the Health Select Committee say?
The Select Committee report recommends that Parliament pass the Bill with some changes.
The major additions recommended by Select Committee are to:
The Public Health Association is very pleased with these recommendations as the majority of these issues are ones that the PHA had advocated for in our submission.
Minority opinions within Health Select Committee
There is a minority opinion from New Zealand National Party members opposing regulation or codes of practice on non-communicable diseases (Part 3.3), the provision of statistical information by private providers (Part 2.1) the possible costs associated with Public Health Risk Management Plans (Part 6.5) and inclusion of reference to the Treaty of Waitangi.
The opposition of the New Zealand National Party members of the Select Committee to regulatory powers for risk factors for non-communicable disease is consistent with the position taken on the Select Committee Inquiry into Obesity and Type II Diabetes.
The Green Party also adopted a minority position. They consider that emergency powers to detain unvaccinated people who are considered to pose a risk to public health (e.g. 266 (j) (ii)) could be used to violate civil rights.
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