|PHA News Online — December 2010||Vol XIII, No 4|
The PHA would like to wish all its members and supporters a merry Christmas and a happy and healthy new year!
Te Tiriti o Waitangi and Pakeha Public Health Practice
I grew up in Invercargill and my ancestors originally came from the south of England and Scotland in the late nineteenth century. It was a bit of a culture shock for me coming to live in Northland. Thirty percent of our population are Māori. The inequalities are 'in your face' every single day. I am not just talking about the striking differences between Māori and European in our health statistics for diseases like rheumatic fever or meningococcal disease. Every day after parking my bicycle I need to walk past the community probation office whose clients are predominantly Māori.
What does the Treaty of Waitangi mean to me as a Pakeha public health doctor?
A large part of my job is tackling inequalities and therefore the Treaty of Waitangi is an essential part of everything I do. As a Pakeha, I knew about the 'when' and 'why' of the Treaty. However it was not until I came to Northland that I started to understand what it really means. For the Māori people I work with the Treaty means one thing above all others – self determination.
Self determination in everyday public health work
I am only a small cog in the health machine so there is little that I can do to settle land grievances or redress the injustices of the past. However self determination is not an unfamiliar concept for public health people who work with communities. The 1986 Ottawa Charter says, "Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities, their ownership and control of their own endeavours and destinies."
For the Māori people I work with the Treaty means one thing above all others — self determination.
I learned about the power of self determination with our Whangaroa rheumatic fever prevention project. In 2000 the small community of Whangaroa asked our service to help them with an important health problem affecting their children – rheumatic fever. We carried out a literature review, visited a large research project which was being carried out in Auckland at the time, and then went back to the community with some options. After discussion the community chose the option they wanted, we provided the Runanga with money to employ a community health worker, and we worked in partnership to tackle the problem. The last case of rheumatic fever in Whangaroa was eight days after the project started in 2002.
Partnership, participation, protection and "passion"
It was from the Whangaroa project that I learned there was another 'P' that can be added to what have been called the three 'P's of the Treaty of Waitangi. By empowering the Whangaroa community and allowing them to own and control the solution to their rheumatic fever problem they became passionate about getting rid of the disease. I believe that this is the real reason for the success of this project.
Over the years strong Māori women have told me many wise things,
Over the years strong Māori women have told me many wise things, most of which were uncomfortable to hear at the time. I remember one that is relevant to this discussion: "Dr Jarman, this issue of health inequalities is for you just a job. For us it's personal!"
The secret for successful health interventions with Māori is to tap into this passion and the pathway to do this is by applying the intent of the Treaty of Waitangi.
Achieving equity from the start in Aotearoa
Health professionals and many working with children and families feel deeply concerned about the continued poor state of child health in Aotearoa-New Zealand. There is concern about the seemingly low value placed on children and their carers. After many reports and calls to action there have been only small gains. The full impacts of the recession and changes in policy are still unfolding.
We have international support from the highest level — the World Health Organization is clear that one of the most important actions for improving health is to achieve equity starting antenatally through to age eight.
This year the Public Health Advisory Committee advised the Minister of Health on the steps to take to improve child health in its report The Best Start in Life.
Following discussions with concerned others, the PHA has identified the need for concerted action to make public support for children so strong that any government would agree. We need to contribute a loud, strong child health voice alongside the many other organisations advocating for children.
"Concerted, cohesive and sustained action will require the
combined efforts and leadership of many,
"The Best Start in Life provides the blueprint for action. Concerted, cohesive and sustained action will require the combined efforts and leadership of many, as well as the levers of political will and community action coming together," says Amanda D'Souza, a public health medicine specialist currently working as senior lecturer in the Paediatrics Department at the University of Otago.
"We already have existing rich networks of supporters, expertise and resources. A key task now is to win the hearts and minds of colleagues, community leaders, opinion-makers, politicians and the public. The challenge is to convey that child health and wellbeing, and the long-term consequences of a poor start to life, are issues that affect us all. Parents and families have a central role, but the issues and solutions reach much further," says Dr D'Souza.
We propose the following as a starting point for discussing what every New Zealander should know about early childhood:
Conference 2010 reflections
A big thank you for the scholarship to attend this conference in Ngaruawahia. I really loved the venue at Turangawaewae Marae – the atmosphere there was absolutely awesome!
I also enjoyed the keynote speakers, especially Dr Camara Jones on the first day on Achieving Health Equity and the tobacco sessions held throughout the day. My mahi is working in tobacco cessation so these sessions were very valuable.
My highlight for the second day was Prof Fran Baum from Australia on Sustainable Development and Health Equity. The workshops run on the day that I attended on Whānau ora Community Development and Local Government were great as well.
I also enjoyed the dinners on both nights as well as the entertainment. I must say the meals we had there were awesome – a great big thank you to the caterers!
The third day highlight was our keynote speaker Shelly Campbell on Next Generation – Thinking on Health Collaboration" and what the future health system will look like. I thought her korero was well presented and she showed great insight into the future.
Overall the conference was well run and well organised. We couldn't do anything about the weather but inside was warm and cosy.
Once again thank you for the opportunity to attend.
Te Hauora O Te Hiku O Te Ika – Kaitaia
The first speaker who left an imprint in the sand for me was Hon Nanaia Mahuta, who opened the conference. She spoke about defining who we are, remembering where we have come from, where our tupuna have walked and moving forward. And the other speaker that most impressed me was Shelley Campbell who spoke about having influence without authority, being radical collaborators, being "authentic" with a moral compass, creating leaderful organisations, developing optimism, confidence, hope and resilience in others, seeing things as they are, learning agility with strong intelligence, reviewing each other and leaving a "legacy".
I also would like to acknowledge all the other great speakers and kaimahi who took the time to share with us, too many to mention, a lot of great mahi happening in our communities.
I enjoyed being a part of the PHA ceremonies and congratulate Professors Robert Beaglehole and Ruth Bonita, who were named the PHA Champions of 2010. I was very inspired listening to the great mahi they have accomplished and their 40-year marriage.
Congratulations also to the Honourable Tariana Turia on receiving the first new award, Tū Rangatira mo te Ora, to acknowledge and celebrate leadership in the development of Māori wellbeing. I believe she is a very deserving wahine toa for all the mahi she has achieved and is still accomplishing.
I also must acknowledge the PHA for providing the opportunity to attend the conference by accepting my application for the scholarship.
Mauri Ora, Kahu
Looking ahead to Conference 2011
PHA conference in 2011 – "Creating our future now" – will be hosted by the Canterbury-West Coast branch of the PHA and will be held at the University of Canterbury, 31 August – 2 September 2011.
The three themes for the conference are vision, sustainability and diversity. We want to explore our vision for our future, solutions we can find today that will help protect further generations, how we can build community resiliency and how we can positively embrace our diversity.
We are striving to live our values. We are planning in partnership with Kai Tahu and, as a first for the Public Health Association, we are working towards CarboNZero certification. We therefore ask you to consider the way you travel to the conference so that we can work towards reducing the impact of the conference on the environment.
We are excited about undertaking this challenge and look forward to bringing to you a series of stimulating international experts from our own Aotearoa, New Zealand! We will also be using innovative communication technology options to trial ways to share ideas during and after the conference, not only for the attendees, but also for the wider sector.
Not only is New Zealand a diverse country, ethnically, socially and geographically, the public health workforce is very diverse. To help us all get the best use of the conference time we will be using several different formats to present information, stimulate discussion, and build networks.
We look forward to welcoming you to Ōtautahi, Christchurch, in spring 2011 for the Public Health Association of New Zealand Conference.
PHO-based oral health promotion in Canterbury
"To assess an animal's overall condition, farmers look at its teeth. It really is no different from humans – although luckily if the teeth are bad, the outcome for humans is not as harsh as it is for animals!" says Louise Matson.
Louise and Nicola Wilmot have spent the last two years working doggedly on behalf of the primary health organisations in Canterbury to highlight the importance of good oral health to the fives-and-under, their parents and teenagers throughout the province.
The three-year project aims to increase awareness of what good oral health entails and the effects of bad oral health. It also aims to support stakeholders – such as general practices, Well Child/Tamariki Ora providers and early childhood education centres – to promote and improve oral health care.
"One of the major causes of poor oral health is a lack of awareness about how to avoid it."
"It is an important programme because in Canterbury nearly 50 percent of pre-schoolers, particularly Māori and Pacific children, have decayed, missing or filled teeth. And only 65 percent of adolescents make use of the free dental service," says Nicola.
The health promoters say one of the major causes of poor oral health is a lack of awareness about how to avoid it: not brushing teeth twice daily, poor diet, lack of fluoride, smoking and not making use of professional dental health care.
"And even though in New Zealand dental services are free to those 17-years and under, many don't bother or can't get to a dentist who offers the free service," they say.
"Poor dental health results in more than just toothache. It can lead to infection in the teeth and gums, difficulty in eating resulting in poor nutrition, problems with speech and crooked or crowded permanent teeth. Not surprisingly it is also associated with poor self esteem."
Louise and Nicola have visited all 125 general practices in Canterbury to promote oral health and provide resources. They are in the middle of visiting all 460 early childhood education centres in the region. They have placed oral health information on websites and in community newspapers as well as sending twice-yearly newsletters, new resources and updated dentist lists to all stakeholders. They have held stalls at various event days and in shopping malls, and they provide resources to libraries, churches, sports, youth and community groups. They have constantly promoted how 0-17-year-olds can make use of free oral health services.
After consulting with the Community Dental Service, Louise and Nicola developed simple resources on how to make use of free dental care and how to brush teeth. They created a tooth brushing chart that was translated into Māori and Samoan and proved very popular. It's currently being translated into other languages including Chinese. Following requests from youth group leaders, Nicola and Louise also created colourful wallet cards promoting oral health for adolescents.
"But the most useful resources have been toothbrushes and toothpaste. We've distributed more than 15,000 toothbrushes throughout Canterbury and we also provided brushes to all the welfare centres following the Christchurch earthquake."
Nicola and Louise also promote the new Ministry of Health website: www.letstalkteeth.co.nz and the freephone number 0800 TALK TEETH (0800 825 583).
Heroes of public health
As a schoolboy I was interested in history and social studies. As those interests evolved and intertwined the focus came to be on the social history of health and disease. In particular I remember reading avidly the works of Henry E Sigerist an American physician and social historian who, in the 1930s and 1940s, wrote extensively on the history and sociology of medicine.
Given the broad sweep of my interests I was somewhat disappointed in my undergraduate medical education, which at that time was narrowly focused on the biological manifestations of disease rather than the broader determinants of health and wellbeing.
My early training in internal medicine took me to Cornwall Hospital in Auckland, which is now gone. In those days it was a very large geriatric hospital. There, under the guidance of doctors Ron Barker, Peter Loten and James Newman, I came to appreciate the importance of social and cultural influences in the lives and health of older people. It was then that I decided to return to Dunedin to train and explore career possibilities in the practice of public health.
The next career twist came in 1969 when the then Director General of Health, D P Kennedy, invited me to join the Department of Health in Wellington in a new role he had created in health service evaluation. At that time health sector evaluation was in its infancy. Few people understood what evaluation was about and the available tools were limited. Many colleagues tended to see evaluation as unhelpful, potentially intrusive, and damaging within their spheres of influence and authority.
"I was somewhat disappointed in my undergraduate medical
education, which at that
My first substantial evaluation effort was a survey of maternal and child health services in the Greater Wellington Region. The findings brought me face to face with health equity and social justice issues in the way that health resources are allocated and used. In writing up this project I became interested in the work of a British general practice researcher Dr Julian Tudor Hart who first demonstrated and publicised what came to be called "the inverse care law of health care delivery". Simply stated the law postulates that the availability of health services is inversely related to the needs for care. Insights from this study continue to influence my thinking and practice.
About this time I became associated with Dr Ian Prior's work at the Epidemiology Unit at Wellington Hospital – the precursor of the present Department of Public Health at the Wellington Medical School. Ian's influence and his extraordinary network of contacts both within and beyond New Zealand enabled me to broaden and deepen my understanding of public health issues and practice.
A career highlight came in September 1978 when, as part of a small New Zealand delegation, I attended the conference at Alma Ata where the World Health Organization launched its global "Health for All" strategy based on primary health care. For me this was a revelation. It fitted well with my previous reflective thinking about health and disease, and set a direction for the rest of my working life.
Along the way, both in New Zealand and internationally, I have had the good fortune to meet and work with many people, great and small, who have informed and guided my journey – too many to mention here. I am grateful to each and every one of them.
Professor George Salmond was the PHA's joint Public Health Champion 2001. Find out more.
Public Health Champions 2010
Robert Beaglehole and Ruth Bonita
Ruth and Robert have been involved in public health for more than 40 years, both in New Zealand and internationally. They have authored, together and separately, a large number of scientific papers and books on public health including Basic Epidemiology which they co-authored with New Zealand public health practitioner, Tord Kjellstrom.
In announcing Ruth and Robert as Public Health Champions for 2010, the PHA president Richard Egan said: "For more than four decades they have brought insight and intellect, passion and dedication to public health, and people around the world are better off, in very tangible ways, because of them."
Each already had distinguished careers in research and teaching in New Zealand when in 1999, Ruth was appointed as a Director of Noncommunicable Disease Surveillance at the World Health Organization in Geneva. Subsequently, in 2004, Robert was appointed as Director of the WHO Department of Chronic Disease and Health Promotion. He developed an integrated approach to the prevention and control of chronic diseases and led the development of the Bangkok Charter on Health Promotion.
"But the major thrust of our work is keeping attention
focussed on the potential of
Ruth and Robert returned to New Zealand in 2007 and were appointed to honorary positions at the University of Auckland as Emeritus Professors. Since their return, they have maintained a blistering pace of teaching, consulting, mentoring, and engagement with advocacy and policy.
They teach at summer schools in Europe and serve on several scientific advisory boards. Robert has coordinated three series of articles in the medical journal, The Lancet, which have made an impact on public health thinking around the globe.
"But the major thrust of our work is keeping attention focussed on the potential of prevention of chronic diseases in low and middle income countries," says Ruth.
"We both remain passionate about the power of public health measures to improve health. Simple and well-known interventions are often all that are needed to avoid large numbers of premature deaths", she says.
In New Zealand, Robert chairs the Smokefree Coalition and Ruth has come full circle – from her initial research on stroke in Auckland - to becoming involved locally with the Stroke Organisation of New Zealand and as a representative on the Board of the World Stroke Organisation.
"We were thrilled when we heard that we had been proposed as joint Public Health Champions for 2010. We enjoy working closely together, but recognition of our work is not often a joint one," Robert says. The other joint recognition that they have received was in 2006 when they were both made Officers of the New Zealand Order of Merit for services to medicine.
"One of the most pressing issues in New Zealand public health is tobacco
One of their new interests is the development of the Ian and Elespie Prior Policy Centre for Health and Wellbeing. "Currently, the main focus in health and health policy is on individual and clinical health service interventions. Population-wide health activities are under-appreciated and under-funded and have not contributed their full potential," says Robert.
"The Prior Policy Centre is an independent action group to develop and disseminate research and policy for public discussion on the role of health and social interventions in promoting and improving the health and wellbeing of all people."
"One of the most pressing issues in New Zealand public health is tobacco control. I believe a smokefree New Zealand by 2020 is achievable – and we are making progress toward that goal."
He says on the global public health front, there is steady progress.
"In September 2011 the United Nations will host a high-level meeting on chronic diseases. A meeting at this level is unprecedented and indicates how nations around the world are beginning to recognise the power of public health."
The couple, who live in Devonport, have a son Rob, a daughter Anna, and three grandsons, Eli, Sol, and Thomas, spread from Nelson to Edinburgh.
By a waterfall in Hawai'i — Reflections on the 6th Healing our Spirit Worldwide Gathering
It's not every conference where you can sit in a tropical pool under a waterfall, talking to a health promoter from the Yukon about youth development, or where the event opens with kaumātua from many nations arriving on traditional Pacific voyaging waka.
Healing our Spirit Worldwide, an indigenous movement focusing on health, healing, and addictions, has developed its own flavour. Each Gathering brings together community health workers, elders, academic researchers, youth, and traditional healers.
Among more than 2,000 delegates at the Honolulu gathering were several hundred from Aotearoa New Zealand.
Our representatives included Minister Tariana Turia, who spoke to the Gathering about the annual Tira Hoe Waka, in which descendants of the Whanganui awa reconnect with the river and with each other. Many presenters described successful interventions which reconnect people in need of healing with their cultural base: from men's bush camps in central Australia, to working with horses on the Canadian plains, to the hula schools of Hawai'i.
As an indigenous researcher and policy worker, the Gathering was exciting on many levels. There was practical discussion about how to measure and share good indigenous public health practice (a project the PHA is working on for Aotearoa New Zealand). There was the opportunity to present my own research (on Māori women, alcohol and pregnancy) and to get feedback, including some tough questions from internationally respected researchers and practitioners. It was also cool to see presentations by our own public health workers and researchers (including many PHA members) being so well received.
"Underpinning all the Gatherings is the shared understanding that the teaching of our elders is of value today and tomorrow, and that 'culture 'is not just a frill or an optional extra."
There's always interest in how successful Māori are in running and governing their own health services, as well as in innovative projects such as the Street by Street project, which reduced alcohol-related harm and community violence in a neighbourhood.
Among my strongest memories is that of the faces of Māori tāne when faced with a menu featuring spam burgers, the 'pig plate', and enormous servings. As they said, marae food doesn't look like this anymore, and "maybe it would be good to bring HEHA to Hawai'i!"
Much of my learning came from just sitting and talking with people from so many different nations. The Gathering provided the perfect setting for this in 'Aunt Betty's garden'. A group of Hawai'ian women elders turned the convention centre's shady courtyard into a relaxation space where, as well as sharing work talk, you could learn to string lei, listen to the aunties playing Hawai'ian music, or be introduced to hula. Underpinning all the Gatherings is the shared understanding that the teaching of our elders is of value today and tomorrow, and that 'culture 'is not just a frill or an optional extra, but an integral part of health practice.
The next Gathering will be in Australia in 2013. You can see find out more about the movement, and the Healing Our Spirit Worldwide Covenant, at http://www.hosw.com/.
Agencies for Nutrition Action Conference 2011
The conference will be held 3-4 May 2011, at the Rendezvous Hotel, Auckland, and plenary sessions and social events are almost confirmed. An excellent programme means the conference is gearing up to be the most anticipated event of the 2011 calendar for those with an interest in nutrition and/or physical activity.
An updated version of the conference programme and abstract submission guidelines are now available at www.ana.org.nz/conference11/. There you can also download copies of our regular conference e-updates. These contain the latest speaker announcements
Early bird registrations remain open, register today to take advantage of this great rate!
For more information on any aspect of the conference contact Julia Lyon on firstname.lastname@example.org or 04 499 6365.
Council comings and goings
Also leaving the council is Suaree Borell who has finished her two-year term as Pacific Caucus Representative. Suaree has been an excellent council member with her honest and astute approach; we will miss her greatly. Ramona Taitia is taking over from Suaree and we warmly welcome her to council, thank you Ramona for taking on this responsibility.
Martin Witt is replacing Vivien Daley as the Canterbury representative on council. You are most welcome Martin and thank you for stepping up into the role. Vivien will still very much be around however – she is a prime organiser for next year's PHA conference in July! Thank you Vivien for all your hard work and input into council deliberations as a long standing member and Vice President.
Finally Michael Bradfield has resigned as council representative for Otago-Southland, and has been replaced by Jean Simpson. Callie Corrigan has resigned as council representative for Te Tai Tokerau and has not yet been replaced.. Thank you Michael and Sallie for flying the PHA flag in your areas and we wish you well.
Around the branches
The Central Districts Branch held a post-conference meeting on 13 October that featured excellent feedback from members who attended the conference. We are finding this year that having café breakfast meetings really suits those who are currently attending meetings.
Central Districts changed its plans about distributing public health information to local body candidates because of the short time between closure of candidacy and postal voting starting. Instead we contacted the successful candidates by mail, providing them with PHA and general public health information along with a congratulatory letter. We also enclosed an invitation to join the PHA, but unfortunately to date we have had no takers.
I am representing the PHA in the working party looking at health promoters forming an association. This group has had its third meeting and will present the completed process to the Health Promotion Forum Symposium in July next year.
The PHA commissioned a paper on Māori public health and its relationship with local government that also contributed to Keriata Stewart's presentation at conference – Don't just tick the box: Putting public health into local government elections.
Before the local government elections, a range of information concerning public health in councils and in District Health Boards was collected and uploaded to the PHA website. Also, for the first time the PHA tried using Facebook as an approach to getting information out. We have decided Facebook is a useful additional approach that is worth using for specific campaigns, but we will not be maintaining continuing presence there on a week-to-week basis.
Building on the work of the WHO Commission on Social Determinants of Health, the PHA commissioned a paper on early childhood development and how supporting it can promote equity. This led to the presentation at conference by Gay Keating and Amanda D'Souza, How New Zealand can achieve equity from the start. The focus of the paper is the reduction of inequalities, noting that the major health inequality is for Māori.
National Office has initiated a Ministry of Health project, building on work in health promotion and primary care. The PHA is doing some preliminary scoping of the project and members who would like to nominate people to join the advisory group are encouraged to contact Gay Keating: 04 472 3060.
In the media
To draw public attention towards the importance of public health in local body and DHB elections, the PHA produced a letter to the editor, an opinion piece and a media release. The opinion piece and letter to the editor were submitted to a wide range of daily and community papers in the name of local PHA members.
The media release was used five times and the opinion piece was printed in full in three major daily newspapers. The letter to the editor was highly successful, being printed 19 times.
Three general releases and 13 topical media releases were sent out during the course of the conference. This year, with the conference being located at Turangawaewae, six releases were written specifically with a Māori focus. There was also a media release sent out regarding the Public Health Champions, and one for the Tū Rangatira mo te Ora tohu for Hon Tariana Turia.
Other media activity
PHA media releases are archived online at www.pha.org.nz/keydocs.html#mediareleases.