The Treaty of Waitangi and public health practice

PHA President Richard Egan and others examine the role of te Tiriti in New Zealand health promotion and practice.

It has been argued that in Aotearoa-New Zealand health promotion workers do better work among the well-off than among low income groups. Many health programmes have benefited the population as a whole while increasing the health disparity between rich and poor and between Māori and Pākehā.

In 1998, the Health Promotion Forum began consulting over the role of te Tiriti o Waitangi in health promotion practice. It was recommended te Tiriti should form the basis for all health promotion. But consultation revealed some health workers did not understand how to incorporate te Tiriti into their practice.

One of the main intentions of te Tiriti o Waitangi was to protect the wellbeing of the tangata whenua and each of the three treaty articles can be analysed for its health implications.

So in 2002, the booklet A Treaty Understanding of Hauora in Aotearoa-New Zealand (TUHA-NZ) was published. While it speaks to the way health promotion activities are formulated and carried out, it can apply equally well to the various forms of public health practice.

The following is largely drawn from TUHA-NZ:

One of the main intentions of te Tiriti o Waitangi was to protect the wellbeing of the tangata whenua and each of the three treaty articles can be analysed for its health implications.

Article One – Kawanatanga – achieving Māori participation in all aspects of health promotion

This implies meaningful Māori participation in all aspects of health practice including in management and other decision-making, prioritising, purchasing, planning, policy, implementing and evaluating services.

It envisages Māori actively managing and having input into Māori health priorities and action, where Māori world views and cultural values are influential, and where Māori are in the best position to advocate and strategise for Māori health advancement.

The issues for health workers to mull include:

• how to identify, establish and maintain appropriate and safe lines of communication with Māori
• how to facilitate equity of participation and resource management when there are competing needs
• how to strengthen Māori health systems and structures
• possible reasons Māori do not want to participate in resolving their own health issues
• how to ensure Māori are involved in all aspects of research about themselves.

Article Two – Tino Rangatiratanga – achieving the advancement of Māori health aspirations

The theories and beliefs that inform mainstream health practice do not necessarily work for indigenous populations. Māori health aspirations refer to the goals, desired outcomes, hopes, dreams and vision Māori have for their health.

Achieving Māori health aspirations is challenging, requiring ingenuity and innovative ways of carrying out health practice.

Achieving such aspirations means creating and resourcing opportunities for Māori to exercise control, authority and responsibility over Māori health. This includes resourcing and sustaining the ongoing development of Māori health promotion, providers and workforce.

Determining what Māori health aspirations are will need to be based in the realities of the people and communities for whom the health practitioner is working. Not all Māori aspirations are the same because Māori realities are different. Māori communities may have different priorities from each other and from those determined at a national level.

Achieving Māori health aspirations is challenging, requiring ingenuity and innovative ways of carrying out health practice. Whether or not a particular programme has been successful will depend not just on outcomes but on the relative degree of power and resources shared by its participants.

Article Three – Oritetanga – Undertake health practice which improves Māori health outcomes

Although an immediate goal is to reduce the health disparities between Māori and non-Māori, the continued improvement of Māori health status is the over-riding goal.

Te Tiriti and its articles are strongly associated with the determinants of health, and strategies to address the basic causes of poor health will need to be based on them. The treaty provides for good government and protection, for Māori self determination and control over their affairs and for equity with other Aotearoa-New Zealanders. All these elements affect health and wellbeing.

Equity of health outcomes is an important factor in the monitoring and evaluation of health services.

The Māori concept of health is holistic where good health is recognised as being dependent on a balance of factors affecting wellbeing.

Addressing the causes of poor health requires a willingness and ability to work with interest groups outside the health sector. For example if over-crowding and poor housing conditions increase the risk and spread of infectious diseases then it would be appropriate to address the issue of over-crowding and poor housing conditions in a related campaign or strategy. The creation and implementation of such a campaign might involve a collaboration of health, housing and cultural interests.

In this instance, a health promoter may be able to:

• increase awareness about the relationship between housing conditions and health
• facilitate relationships between agencies toward more holistic strategies which seek to address the determinants of health
• advocate for research and health promotion activities which effectively relate to the community concerned.

Finally:

Health promoters need to identify achievable and appropriate objectives and strategies to undertake practice that will meet their obligations under te Tiriti. These objectives need to be specific, measurable, achievable, relevant and time-bound (SMART).

The Māori concept of health is holistic where good health is recognised as being dependent on a balance of factors affecting wellbeing: spiritual, mental, emotional, physical, whānau support, the environment and control over their own lives. Māori health therefore needs to be understood in the context of the social, economic and cultural position of Māori.

And the PHA?

Māori Caucus Member Peter Thomas says the PHA recognises the important place te Tiriti occupies in its organisational structure and planning.

Some NGOs, such as the PHA, recognise the value of having te Tiriti-based frameworks to establish or continue Māori health gain and development. In recent years, the PHA formulated a position which was submitted during the deletion of the Treaty principles in the Health and Disability Act. The PHA opposed the deletion as it would have had implications for our effort to eliminate inequalities and disparities.

Te Tiriti is a living document requiring ongoing definition and negotiation. It is as relevant today as it was in 1840.

Non-Māori organisations, or those who are not kaupapa Māori, require understanding and analysis of te Tiriti and how it could be reflected in their practice. This requires open forums at governance, management and other levels. This should be an inclusive process where everyone (te katoa) is part of an organisational Tiriti journey.

Organisations should not restrict or limit themselves to the one solution, but find varying solutions and strategies of implementation. Te Tiriti is a living document requiring ongoing definition and negotiation. It is as relevant today as it was in 1840, and we must continue to value it so organisations can establish a professional and competent organisational Tiriti culture.

The health workforce in Aoteraoa/New Zealand requires continued support to undergo Tiriti training to ensure that we are competent in our understanding of it and its application to our work. We need organisations that will support their staff in undergoing Tiriti training and recognise the special place te Tiriti has within the health sector.

Grant Berghan on Māori public health

Grant Berghan is the Chief Executive of Hauora.com and a specialist in the development of the Māori public health workforce. We asked him some questions about Māori public health.

These are difficult times for public health, but in adversity we're finding out what is really important to us. We're usually quite disparate as a sector but now we're connecting up and strengthening links because we realise that if we're going to get traction in this new environment, we need to work together.

How difficult is it for a public health practitioner to have a Treaty-based focus when the umbrella health sector culture is largely mono-culturally Pākehā?

It can be very difficult though not impossible. The work that a public health practitioner does has to be institutionally sanctioned and is therefore subject to the whims of our political masters. This is frustrating because the attitude of government waxes and wanes in relation to te Tiriti and we often end up defaulting to the goodwill or benevolence of our colleagues – an appeal to the social justice values that underpin much of what we do in public health.

But overall there is a growing critical mass of people who understand the value of te Tiriti. That's not to say everyone agrees with everything it implies, but there is a growing appreciation that it cannot be ignored.

Where does the Pākehā health practitioner fit in with 'by Māori for Māori'?

By Māori for Māori' is not only about improving access and services to Māori – it is also a reflection of mana motuhake or Māori self determination. Pākehā practitioners have a role to enable and support Māori to do it for ourselves. A Treaty-based focus does not mean they have to be Māori.

There are areas of tension within [Te Tiriti] that may never be resolved. So be it.

Are you ever dispirited that Treaty-based improvements in Māori health are taking too long?

There are times. Things could always be done better, faster and more effectively. But it does pay to also acknowledge and celebrate the successes that have been achieved. Although our gaze is often on the here and now, much of what we hope for will only be realised in the context of generations. That is the challenge, not to become too dispirited by the enduring nature of the work before us.

Te Tiriti is a good example of this. There are areas of tension within this document that may never be resolved. So be it. That should not stop us from living agreeably with each other with respect and mutual tolerance.

Te Tiriti speaks to us Māori of self determination, a universal right. The more I understand my need and right to who and what I am as a Māori, the more I appreciate the same thing for others. So maybe we will always disagree about some parts of te Tiriti, but education and training will help more and more people value it.

I had to get over myself and my own cynicism in relation to Whānau Ora because I realised cynicism will kill it.

Whānau Ora seems to reflect what te Tiriti is about – what changes do you see coming?

There is good international evidence that to save money in health, there has to be a shift from focussing on the health sector alone to across-government action. At present, Whānau Ora is a policy shared by only the Ministries of Health, Social Development and Te Puni Kokiri.A good start but to succeed it must encompass the whole of government.

I had to get over myself and my own cynicism in relation to Whānau Ora because I realised cynicism will kill it. Whānau Ora needs committed and proactive champions and my friends and I are convinced it is not only good for Māori but holds some of the answers for the entire public sector.

The policy is hugely vulnerable to political whims. But if the Government and Cabinet and Treasury can get away from the idea that Whānau Ora is just the ticking off of an obligation under the National-Māori Party coalition agreement and a "thing for the Māoris", they would see the huge opportunities for the big gains it presents. It is an opportunity to improve the way that the state sector operates. And that has to mean better outcomes and lower costs for all New Zealanders.

Missing men – health workshop debates men's health problems and solutions

Dr Paul Callister is the Deputy Director of Victoria University's Institute of Policy Studies. In June the institute and the University of Otago, Wellington jointly hosted a men's health research and policy workshop.

It was one in a series of 'Missing men' workshops – small invite-only forums to engage with researchers and policy-makers. A variety of health specialists attended as did a member of the local chapter of Black Power and six Members of Parliament.

The aim of the workshop was to define where problems lie, explore gaps in information, highlight policies and programmes making a difference and identify some possible broad research and policy agendas.

What motivated you to hold such a forum?

I am responsible for running a three-year Foundation for Research, Science and Technology research project with the short title 'Missing men'. Part of this research focuses on men who are on the margins of work and family life, often poorly educated. There are clear links between some of the 'Missing men' issues we have been exploring and health status.

How important is it to address disparities in health outcomes between genders?

We need to look at disparities from a number of angles: ethnicity, gender, and socioeconomic class. My feeling was that gender had not had enough consideration. The forum was partly to ask and answer the question as to whether gender is important – and there was a mixture of views on this.

What, in your opinion, was the most important thing to come out of the workshop?

I thought it was the actual discussion rather than any specific outcome But a critical immediate issue is whether we need a male health policy like the new one in Australia – and again, opinions were divided.

Some are thinking about the benefits and disadvantages of developing a higher-level male health policy. One idea is that such a policy would signal an aspiration to improve outcomes. But what really matters is specific policies in areas of screening, targeting of health messages, funding and so on. This is where the debate divides – some at the forum argued that all health targeting should be based on need rather than gender (or ethnicity).

There was some debate as to whether there should be a Ministry of Men's Affairs, developing male-related policy but there was little support for this. But there is a question as to whether the Ministry of Women's Affairs needs to change to allow a more nuanced analysis of gender and advantage/disadvantage.

In concrete terms, what will be done with decisions made and lessons learned from the workshop?

There will be ongoing work in areas of specific male health like prostate cancer and an ongoing debate about an overall male health policy.

But I think one outcome will be that specific health delivery agencies, including NGOs, will think more carefully as to how they can best deliver health services for all their population groups and whether they need to do anything differently for men as a group, or for a specific sub groups of males.

John Waldon is the Health Research Council's Eru Pomare Post Doctoral Research Fellow in Māori Health at Massey University's Centre for Māori Health Research and Development. He is chair of the Central Districts branch. John attended the workshop, and gives his assessment of it.

Professor Tony Blakeley introduced a national overview that showed that, while life expectancy is narrowing between the genders and the ethnicities, Māori men on average live 12 years less than non-Māori women. Apart from this absolute statistic, Māori men on average live five years less than Māori women.

The gap in life expectancy between non Māori women and non Māori men is about three years. Virtually across the board – with the exceptions of lung, gall bladder and thyroid cancers – men fare worse in statistics of cancer incidence, CVD, injury and suicide.

The health status of Māori men represents a breach of human rights because their health needs are being met differently to other New Zealanders.

Dr Rhys Jones, from Auckland University's Te Kupenga Hauora Māori, fleshed out some of these statistics with qualitative research. He talked about the gap between the genders being due to more than poor access to health services or poor outcomes due to needs not met by pharmaceuticals. It's also to do with the social milieu men are in, including their level of education and socioeconomic status. And beyond this, he says 'social injustice is killing Māori men on a grand scale'. The health status of Māori men represents a breach of human rights because their health needs are being met differently to other New Zealanders.

I think this is a fair inference from the interviews Rhys Jones conducted. I believe that in the same way that – based on interviews with the women concerned - the Cartwright enquiry led to sweeping changes to informed consent, any solutions to the inequity in the status of Māori men's health compared with other groups should be based on the views of those men who carry health inequalities: that is those men who have a disproportionate burden of health issues that are amenable to change (treatment) or prevention to reduce risk to the disadvantaged group.

Also from the University of Auckland, Professor Felicity Goodyear-Smith explored the assumption that men are the 'default' example in access to health services. It was noted there is, for instance, no Ministry of Men's Affairs nor men's health strategy. It has been women who have been seen to be disadvantaged. But Professor Goodyear-Smith challenged this perception noting that men figure far less in research.

Developing policies to deal with gender-specific conditions could have the unintended consequence of reducing services for other groups and so increase inequalities overall.

I agree that while gender analysis is useful to highlight relative differences and possibly their causes, it should not be solely relied upon to develop strategies. Developing policies to deal with gender-specific conditions could have the unintended consequence of reducing services for other groups and so increase inequalities overall.

Robust conversations are required on how to improve health outcomes for men and we should be wary of census-based research where the absence of low participation numbers of Māori males 15-25 years of age may result in incomplete base-line data.

There were a number of other excellent presentations during the forum. To learn more visit: http://ips.ac.nz/events/completed-activities/Missing%20men/Missing%20Men%20Workshops.html.

Post-budget breakfast speakers find little to celebrate

On 21 May more than a hundred people – a record attendance – packed into the St John's Church Conference Centre on an icy Wellington morning. This year the Children's Poverty Action Group (CPAG) co-hosted the breakfast with PHA Wellington.

Here is what the speakers had to say about Budget 2010:

Brenda Pilott is one of two National Secretaries of the Public Service Association (PSA). Prior to joining the PSA in 2004, she was a public servant for 11 years, working mainly in social policy.

This is a budget that favours the well-off over those on low and middle incomes. The winner is privatisation and commercialisation – for example extra funding for science goes straight into the pockets of the private sector at the same time as New Zealand is losing public sector scientists through CRI redundancies.

This is a slow starvation budget – departmental baselines have largely gone down or been frozen, with a promise of no relief for at least another four years.

There is $93m more for disability support services over the next four years but this funding is coming straight out of DHBs – robbing Peter to pay Paul. And we end up with neither public services nor community services being adequately funded. We're concerned that the Government is moving to contract out more public services because they see the community sector as a cheap option. This is hidden behind their rhetoric about communities. And it's very important this does not become a reality.

While on the face of it there is a bit more funding in the health sector, in reality we're just running up the down escalator – many DHBs have significant deficits and as far as we can see there's no money here to fix this.

My take on the Budget - low quality thinking, failed policies from the past, wrong priorities. Investing in tax cuts is the wrong priority. I'm scoring this Budget three out of 10.

David Grimmond works for Infometrics providing model development, customised forecasts and policy analysis. He has provided economic analysis on a wide range of topics for private business, non-profit organisations, central, and local government.

The Government appears to have been at pains to ensure that all but those who appear to be blatantly ripping the tax system off are not made worse off by the announced tax changes.

My assessment is that they have generally achieved this.

So what does the budget deliver?

• We will have a tax system that has reduced its reliance on personal income tax in favour of GST.
• The Government has tightened rules where there have been obvious signs of system abuse.
• In net terms households relying on wage income will be slightly better off.
• The average tax on wage income will fall by around 3 percent in most households. A positive impact, but not startling.
• Tax cuts are more generous to high income households, but the tax system will remain quite progressive, e.g. a household earning $120,000 will still pay four times the tax paid by a household earning $60,000.

Finally, the one way to reduce taxes is to reduce spending. This budget will see Government spending increase by $6bn in 2010/11 (from $64.8bn to $70.7bn), and increase from 34.2 percent of GDP to 34.7 percent. Such increases are not conducive to sustained reductions in taxes. The Government continues to hope for better times in the future, rather than making the tough decisions that will materially improve the quality of itsspending.

For these reasons I give this budget a C+.

Riripeti Haretuku is the Chair of Hauora.com, the national Māori Health workforce development organisation, and acting Chair of Te Whiringa Trust, the national body for Māori community health workforce development.

Ms Haretuku told the audience the 2010 Budget would have an immediate impact on children and vulnerable families who were already experiencing financial stress. An increase in GST would immediately affect the cost of food, clothing, and transport and tenants would also have to absorb higher rents.

"Māori children are more likely to die in utero and if they do draw breath, die of cot death. They are more likely to suffer a wide range of health issues and conditions, particularly respiratory conditions, which in turn means increased hospital stays, emergency department visits, middle ear infections. They are more likely to be born into poverty and into homes where multiple negative issues are present. In adolescence they are more likely to end up in Youth Court and if they become young adults are more likely to be incarcerated. The stark rise in suicide rates, family displacement and youth crime in recent years would indicate that existing conditions are likely to be exacerbated with the addition of more financial pressure.

"Will this year's budget change any of that? I suspect not. Our parents will continue to find it difficult to cope with paying the rent and continue to worry about putting food on the table. If they are unable to make ends meet it will be the children who will ultimately suffer. Māori community health workers will have to work harder as they try to find ways to unravel the complex issues associated with the needs and concerns of families.

"I am pleased the Whānau Ora initiative has been launched. This initiative will provide systems, processes, skills and capabilities that will at least create the mechanism through which the health and wellbeing of whānau can be monitored."

Jonathan Boston is the Director of the Institute of Policy Studies at Victoria University. He has published widely in the fields of public management, tertiary education, social policy, comparative government and New Zealand politics.

From a static perspective, the changes in this budget undoubtedly favour the well-off, but from a lifecycle perspective the implications are not quite so regressive. For instance, most people have relatively modest incomes when they are young and when they retire, but incomes above the average during the middle and latter years of their career. Accordingly, from a lifecycle perspective, tax changes of the kind announced in the budget will increase post-tax incomes in mid-life but bring little benefit during a person's early working life and/or their retirement.

Second, there are genuine issues concerning how to recruit and retain high-calibre staff within New Zealand, especially given the ease with which highly qualified New Zealanders can access the Australian labour market. The tax policy changes announced in the budget are clearly designed to help local employers recruit and retain talented staff. To what extent they are helpful remains to be seen.

Third, the changes in relation to the closing of tax loopholes and tax breaks on property investments are to be welcomed. I just wish that governments had had the courage to address such issues 15-20 years ago.

Fourth, I hope the Government is correct in its assessment that the revised tax structure will encourage the prudent use of resources and enhance the country's overall economic performance. But we cannot be totally confident about this. And any impact is likely to be relatively modest.

Mike Coleman chaired the breakfast forum. Now retired and undertaking a PhD in the Classics at Victoria University, Mike also works part time as Project Coordinator for Every Child Counts.

I see the budget as redistribution of wealth. Not to the poor, but to the rich. The fact that Paul Reynolds (CEO of Telecom) will be getting an extra $3000 a week indicates the sort of society we're becoming.

It's not good enough to say 'beneficiaries will be no worse off under this budget'. One in five of our children lives in deprivation and that is a national scandal. We will pay for that in the long term. Put aside the argument about equity and you still have a rationale for looking after New Zealand's most vulnerable. They will become adults, they will become more and more alienated and that will assuredly bring its own costs in the future.

On the same morning, 110 people also braved terrible weather to attend the Child Poverty Action Group (CPAG) Post-Budget Breakfast in Auckland. Economist Dr Susan St John gave her assessments of the 2010 budget.

"This budget is a very significant shift away from progressive taxation and has serious implications for our children. It is a huge gamble for New Zealand as it is by no means clear that the global economic crisis is over. This is the very time we should be committing to make sure children are protected and the welfare state strengthened, but that is not the focus of this budget.

"Despite some strong improvement in our export earnings and current account, this budget projects an increasing net overseas debt as a proportion of GDP. We are one of the most seriously indebted countries in the OECD and sit uncomfortably between Greece and Iceland on some international comparisons. This is no time for a budget to be cutting the top tax rate. Once it is cut and GST has gone up – we have not got the choices to deal with the next economic recession.

Awards go to public health stalwarts

Dr Susan St John, Associate Professor in Economics and co-Director of the Retirement Policy and Research Centre at Auckland University was made a Companion of the Queens Service Order for services to social policy in the Queen's Birthday Honours in June.

As a researcher and commentator on child and family poverty issues and founding member of the Child Poverty Action Group (CPAG), Dr St John has an extensive track record of articles and presentations, including co-authoring CPAG's cornerstone 2008 report Left Behind: How social and income inequalities damage NZ children.

Dr St John's tireless concern for the wellbeing of the nation's most vulnerable children led to the formation of CPAG in the early 1990s. She has remained on the Management Committee and has been the CPAG Economics Spokesperson since that time.

CPAG says the award is very well-deserved and recognises the important policy work Dr St John has done in areas outside child poverty including retirement policy, taxation and ACC.

Dr St John says her award is an acknowledgement of the importance of the work of CPAG.

Professor Neil Pearce of Massey University's Centre for Public Health Research has been honoured with a lifetime achievement award for services to occupational health.

The noted epidemiologist leads one of the largest health studies in the world into asthma, involving more than a million children at more than 280 health centres in 100 countries. He has also led investigations that discovered meat workers, pulp and paper workers and farmers were at greater risk from certain forms of cancer.

The award recognised Professor Pearce's leadership over five years of the National Health and Safety Advisory Committee, citing his major contribution in placing occupational health firmly on New Zealand's research and policy agenda.

The award citation states that, under Professor Pearce's leadership, the Committee identified the risks of respiratory disease and causal exposures in welders, farmers, mussel openers, hairdressers, asbestos workers, saw mill workers and plywood workers and recommended safety improvements.

The annual awards are organised by Thomson Reuters, publishers of Safeguard magazine and Professor Pearce received his at the New Zealand Workplace Health and Safety Awards in Auckland in June.

Professor Pearce has also won $1.19m in Health Research Council funding over three years for research assessing whether occupational solvent exposure in spray painters is associated with neurological disorders.

From an Eritrean refugee camp to public health work in Palmerston North

It's a story of determination and triumph.

Mona Andreas, originally from war-torn Eritrea, graduated in May with a Massey University Bachelor of Health Sciences after arriving in New Zealand as a refugee just seven years ago. Now he has a 10-month contract as a Technical Health Protection Officer at Palmerston North Hospital.

Mona's duties involve following up on disease notifications and helping health protection officers with issues such as making asbestos checks on buildings and checking for the potential existence of mosquitoes accidentally flown in from overseas to Ohakea Air Force base.

After fleeing Eritrea, in the northeast of Africa, for its comparably stable neighbour, Ethiopia, in 1998, Mr Andreas worked as a Health Assistant in a refugee camp. It gave him first-hand knowledge of the dangers of disease arising from a lack of basic living standards.

When he arrived in New Zealand as a refugee in 2003, he thought of training as a nurse but found the language barrier too difficult.

'While we studied English at school in Eritrea, it is not practised much and is therefore difficult to speak. So when I arrived I had limited English. It was only through part-time study, other students at Massey and my church group that I picked it up.'

What do you hope to do in public health/health protection in the long term?

I hope to continue working for public health and maintain the job so I will develop my knowledge into a higher level to protect public health.

Do you think of one day returning to Eritrea to use your skills there?

I would really like to go back to Eritrea one day and help my people with my skills. However I cannot go back at the moment as the Eritrean Government is a dictatorship. I am really happy here and I want to continue working for New Zealand.

What is your greatest satisfaction in your current role?

I am really satisfied with the whole area of my work at the public health unit. The best things to have at the workplace are a good environment (nice, supportive and helpful people) and I have all of this at the public health unit. I can't ask for anything more than this. I am really glad working for them. Hunting mossies is my favourite part!

Have you been in New Zealand long enough to comment on what you think might be the country's greatest public health challenges?

This is difficult question but to my understanding, the greatest public health challenges would be smoking, obesity, cancer, heart disease, nutrition and in general managing health inequality between Pacific and other New Zealanders. The other challenging thing would be managing newly emerging diseases.

Are you married, do you have children?

I am not married but I have a lovely son called Matiu.

What do you enjoy most about living in NZ?

The freedom is the greatest thing to have but you have really nice people in New Zealand. And I enjoy the nature of New Zealand – all green all over the country – and the whole water body.

How do you manage in the Palmerston North cold?!!

Yes, over the last couple of weeks I have noticed that Palmerston North is getting cooler, and now I am worried knowing that it is going to get colder than this!

Heroes of public health

This is our third instalment in a series of profiles of pioneers whom present day public health folk regard as heroes of public health practice.

Ann Shaw, Public Health Champion for 2005 pays tribute to some of her own champions.

My champions in public health share a common theme of being able to see the interdependence of living and the widest dimensions of health.

Beatrice Salmon

Beatrice Salmon was an exceptional public health practitioner and educator. Her influence, support and ability to encourage nurses to see health beyond the narrow medical scope of practice can be seen across community health, social welfare, law, education and politics from the 1960s until today.

Bea trained in New Plymouth and worked as a public health nurse in the central North Island (there is still a fishing pool named after her near Turangi) before attending McGill University , Montreal, obtaining a Bachelor of Nursing in 1961. She worked for the World Health Organization as a nurse educator in Ghana from 1963 to 1965 and, returning to work at McGill, she also attained a Master of Science Degree in 1967.

She then returned to New Zealand as the Principal of the Post-Graduate School for Nurses [later renamed School of Advanced Nursing Studies], Wellington. Subsequently she was a foundation member of the Bailey Trust which established Victoria University's nursing programme.

Bea assisted in launching a new era where health became everybody's business.

This humble, private woman was able to inspire nurses to think, analyse evidence, make decisions and take responsibility for them, have an ethical understanding of the widest dimensions of health, to read widely and understand political strategies and the importance of ongoing education for life and of the interdependence of life and the environment.

Bea held international positions in the International Council of Nurses and the World Health Organization, but was also aware of and held in high regard the solutions coming from New Zealand communities to their own health issues. She inspired many ordinary people to achieve far greater goals than they would have because she had faith in their ability.

By widening the horizons of learning and communicating the possibilities of what the new public health could do beyond the confines of a pure medical model Bea assisted in launching a new era where health became everybody's business.

Rene Dubos

I first came across the biologist Rene Dubos' writings in 1969. His book, The Mirage of Health was a refreshing new philosophy at a time when technology was going to be the ultimate weapon against ill health.

He clearly identified the complex make-up of the illness/wellness continuum and the importance of the prevention of ill health.

"The most disturbing aspect is that human beings are so adaptable. They can become adjusted to conditions and habits that will eventually destroy the values most characteristic of human life."
– Rene Dubos

His explanation about the interdependence of all living things, our environment and the universe and the determinants of health and disease highlight the interdependence of factors in health and the importance of adaptation. He comments that "the most disturbing aspect of the problem is paradoxically that human beings are so adaptable. They can become adjusted to conditions and habits that will eventually destroy the values most characteristic of human life."

Even in the 1960s Dubos was able to see that while the prevention of disease was able to be achieved at low cost, therapeutic medicine would increasingly involve the use of expensive techniques, equipment and supplies.

He recognised that both are important and health cannot be viewed in silos. He stated that 'a true picture of man cannot come from a study of his components; the past , like the mind, disappears when the organism is taken apart.

I wonder what he would think of the many silos of health care that have developed over the years!

Mandy Ruru

Mandy is a retired New Zealand nurse who in the 1950s was the youngest ward sister in Wellington hospital. Ever practicable she taught me as a junior nurse how to poach 35 eggs in a pan without breaking a yolk! (Those were the days when patients supplied their own egg for breakfast and the nurse cooked them!)

After working in public health in Vietnam Mandy married and became a public health nurse in Gisborne, and ending some 40 years later as a child health expert whose role required three people to replace her!

Mandy understood how to empower families. She would move heaven and earth to help them, but they also had to pull their weight.

Mandy understood how to empower families. She would move heaven and earth to help them, but they also had to pull their weight. Inter-sector working came naturally to her. There have been many parents, grandparents, lawyers, judges, teachers, principals, police officers and doctors who found themselves being 're-oriented' to become whānau-centred. (Whānau Ora is not a new concept). She would remove all bureaucracy for her families but they had to take their own responsibility too.

When cot deaths were high in Tairawhiti she persuaded local trusts and key local citizens to pay for new monitors which were used with great success.

From the late 60s to the 90s, Mandy led the Public Health Nursing Service in the Gisborne district in helping the paediatrician Dr Frankish pioneer the long term use of penicillin to prevent complications of rheumatic fever or a recurrence of the disease.

For 20 years Mandy and the other nurses, each month, tracked down their patients, whether at school or in factories or out in the bush to give them their penicillin injections. As the children grew and moved away, the nurses would arrange for a local nurse in the children's – now young adults – new area to give them the injection.

Mandy (as did many other public health nurses of her era) used her influence to work with families in the widest roles possible. She could not be confined to a health silo or restricted to a job description, to the annoyance of the new kind of managers who could only sanction work being done if it was spelled out beforehand in the contract.

Her legacy lies in the many educated, healthy families and competent health providers who she has assisted or for whom she was a role model.

Ann Shaw
Public Health Champion, 2005

National Office roundup

It has been a busy last few months for Head Office, with Gay back at the helm and everything in full swing.

Activities have been heavily focused on the impending Conference and associated matters like sponsorship. And then there's all the financials and reports etc for the AGM!

We have been active in the media, carrying out a number of small media campaigns:

• supporting tobacco tax increases
• opposing public health staffing cuts
• supporting the removal of GST from healthy food

We are also working on a strategy to increase the attention given to public health issues during local body and DHB elections later this year. We will work with the branches to achieve this in the weeks prior to the elections.

We're pleased to have launched (during Māori Language Week) Kawerongo Hiko, our new monthly e-bulletin for Māori public health workers. You can sign up for this, by the way, at www.pha.org.nz/ksignup.html.

Other National Office activities over the last few months include:

• Submission on the Local Government Act 2002 Amendment Bill 2010
• Preparation of a scoping paper for effective public health interventions in New Zealand project
• Development of a code of public health ethics which is now in final draft stages
• Oral hearing for Māori smokefree submission and immunisation submission
• An article for the Public Health Association of Australia about the campaign to remove GST from healthy food in New Zealand.

In the media

It has also been an extremely busy time media wise, with the PHA, and Gay in particular, receiving a high profile across the country.

Note: The PHA has a government contract to encourage and facilitate informed debate on effective public health approaches. However, a lot of our public face in the media comes from advocacy which is not funded under that contract. Instead it depends on members and fundraising. Remember, the PHA only exists because of members' support! Please consider making a donation (however small) to help maintain the PHA's independent profile.

Media activity

PHA media releases are archived online at www.pha.org.nz/keydocs.html#mediareleases.