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On the day after the budget was released, we had the opportunity to listen to a panel of notable speakers who shared their perspectives on Budget 2023. The event was sponsored by the Child Poverty Action Group (CPAG), the Public Health Association New Zealand (PHANZ) Wellington branch, and the Social Justice Group of St Peter's on Willis, Te Aro, Wellington. Many speakers agreed on certain 'budget wins,' revealing that due to concerns about potential inflationary effects, most of the budget wins focused on investing in specific services to alleviate the cost of living instead of directly increasing incomes for those currently facing financial hardships. Some of the wins highlighted by the speakers this morning were:

• Removal of the $5 co-payment for all prescriptions.
• Extension of the 20-hour-a-week subsidy for early childhood education (ECE) to include children as young as two years old.
• Reduction in public transport fares for individuals aged 25 and under.
• Investment in disability services.
• Investment in Māori education.

Another moderate win was the extension of the Ka Ora Ka Ako Healthy School Lunches program, although an extension and expansion of the program would have been preferable. Huhana Lyndon from Ngātiwai Trust Board also emphasized how some of the 'wins,' such as reduced public transport fares and subsidised childcare for 2-year-olds, work well in urban areas but fail to make a meaningful impact on those living in rural regions due to a fundamental lack of infrastructure.

The panel also identified some key missed opportunities, including:

• The immediate need for assistance regarding the cost and need for adequate housing.
• Insufficient steps taken toward creating a fairer tax system, including the absence of a wealth tax.
• Limited investment in the health and well-being of Pacific communities.

We extend our sincere gratitude to all our speakers, those who attended and showed support both in person and online, as well as the organizing committee for hosting this valuable event. We will continue to examine the implications of this budget announcement on the public health sector and the well-being of the communities we serve.

You can read more about the impact of Budget 2023 and the forecast for our most vulnerable children and whanau by visiting the link to 'CPAG Budget Analysis - 18 May 2023 Budget Summary: Children need investment, not crumb' or the Child Poverty Report contained within Budget 2023.

Did you miss the event? You can watch recordings from all the speakers by visiting our Workshops and webinars webpage

Mis- or disinformation has fast become a major challenge in public health. Online mis- or disinformation can spread rapidly with just a few clicks and unfortunately can lodge itself deeper into someone's beliefs than the truth itself. Even with the best fact-checking processes or warning labels online, it can still be very hard to contain viral mis- and disinformation once it has spread.

So how can we protect ourselves and those we love from ‘falling down the rabbit hole’ in the first place? One evidence-based way, is to use the technique of ‘pre-bunking’ or ‘inoculation theory’.

Prebunking is the practice of building psychological resistance against online misinformation strategies before they are encountered. So for example, instead of believing a piece of misinformation online and then having it debunked or proven to be incorrect later on, pre-bunking helps you recognise misleading information when you first encounter it online.

While the ideas behind pre-bunking were developed more than a decade ago, recently published studies have shown the effectiveness of pre-bunking in the current ‘infodemic’ environment.

One of those studies from a group in Cambridge lead by Dr Sander van der Linden, Head of the Social Decision-Making Lab, uses the pandemic as an example in a game called GO VIRAL! Dr Sander van der Linden explains that "We are aiming to pre-emptively debunk, or pre-bunk, misinformation by exposing people to a mild dose of the methods used to disseminate fake news." So in this game, by positioning yourself as the person who spreads misinformation online, you get to learn about the common tactics employed by these people so when you come across these manipulation techniques online in your own everyday life you’ll be better able to see them for what they are.

“By using a simulated environment to show people how misinformation is produced, we can demystify it,” says Dr Jon Roozenbeek, co-developer of GO VIRAL! “The game empowers people with the tools they need to discern fact from fiction” and the inoculation effects appear to last up to several months.

Want to give GO VIRAL! a go? Do it yourself or even as a work team challenge to compare your scores afterwards. The higher the score, the better you are at using common manipulative techniques! Good luck!

Kawa in All Things

PHANZ Māori policy advisor Chris Webber provides a think piece to progress our application of kawa in public health. 

As we reap the fruits of embracing Māori engagement with public health, we should discover guidelines for our collective future - like ’ kawa in all things’, a pressing need in places where kaupapa Māori need to prevail. This universal principle for customary practice balances human behaviour with guidance drawn from realms of atua - often tied up in pūrākau (traditional stories) like our creation story or activities of the children of Ranginui and Papatuanuku.

    The concept of kawa is understood in traditional Māori settings and governs 'organised efforts of society' there - like how activity is conducted on the marae and which tikanga are applied in what order during protocols like powhiri. As space is found for Māori expression in wider public health settings, so too can the guidance of kawa be applied. For PHANZ, this includes a Tiriti-inspired 50% Māori on our governance committee to open space for new growth and enlightenment - a bit like the kawa of powhiri on marae or kawa of new harakeke shoots emerging safely between the parents and grandparents in the domain of Tane. The template of ‘what to do' is sacred or tapu, not to be corrupted by vagaries of human minds, egos and politics other than applying local tikanga for ‘how to do it’. In some regions the words are interchangeable (tikanga/kawa) but the eternal principles remain. 

    So which kawa applies where? On the marae, the war-like domain of Tumatauenga in front of the meeting house permits fiery korero, whilst inside more peaceful korero prevails as the domain of Rongo. What workplace wouldn’t benefit from such separations and dedications of space? As a musician, the performers ‘green room’ helps settle and prepare for a stage performance, helping the right spirit carry in the music. At very least, a karakia helps create space for minds to settle and tune into the task at hand to with the intention to achieving the desired outcomes.

To answer the question - keep asking the question, and be listening for the answer - not just from the human mind, or the one, but from collective wisdom of community from whence the kawa resides. Find the ‘carriers of the kawa’, the whakahaere, or create space for them to surface. Kaumatua with the knowledge may be in short supply, but younger leaders may be picking it up and being recognised amongst others as individuals or in a collective caucus.

Aronui-Tikanga-Kaupapa

Drawing from Royal's (2004) explanation for ‘organic arising’ of tikanga, a tool for understanding human behaviour can be applied and used to refine what kawa will be maintained by whom. A person or group's world view (aronui) relates to their selected ground or subject (ka-u-papa) from which understanding of correct actions arise (tikanga) pertaining to that kaupapa or world view. A group cultivating gardens on dry ground will develop different water tikanga from a group cultivating gardens on wetlands - the kawa for garden growth will be achieved by each using different sets of tikanga around water transport or drainage by those ‘whakahaere’ or leaders whose kawa is to know what the plants need to grow. By extension, someone growing hydroponics in their back room needs the same kawa of getting correct requirements for plants to grow, but will do it differently - the set of new tikanga becomes the kawa that is maintained.

    The same is needed in many contemporary spaces Māori are operating in, but then become frustrated or burnt out when generic systems don’t accommodate sufficient tikanga and kawa - let alone have adequate ‘whakahaere’ to apply it. In generic spaces like government agencies, this shouldn't be left solely to government or departmental managers that change with the times. It needs to be enshrined in more than just policy or Tiriti principle interpretations. My aspiration to assist organised efforts of society, is all Māori who work in government space must be valued, respected, cared for and protected - like in the pūrākau about Rata who took a tree from the forest without proper acknowledgement, so the forest took the tree back. We often say this when we hand over someone in a whakatau, but sadly learn sometime later they felt used, abused and burnt out before leaving. The whakahaere of this kawa should help correct things.

    A final seed to plant here - Te Kawa Tapu a Hine. From our pūrākau, our taha wahine (female aspect) is central from coming into the world via te whare tangata and exiting the world via Hine-nui-te-po. However some might say the male energy of Tumatauenga has dominated in the world which now needs healing from domains of Rongo and the female energies. Just one way to look at things, but tied up by the concept of ’Te Kawa Tapu a Hine’ - the need for sacred healing and protective protocols in the world, in our policies, amongst people, for the planet. We are looking for ways to lock this into the work we do.

    Pehea ou whakaaro - what do you think? Engage in our monthly 2nd Friday Kai Tahi zoom sessions to discuss the five elements around our kawa discussions and find ways to progress kawa in your space.

 Reference

Royal, T.A. (2004). An Organic Arising: An Interpretation of Tikanga based upon Māori Creation Traditions. Published in Tikanga Rangahau Matauranga Tuku Iho - Traditioinal Knowledge and Research Ethics Conference 2004. Nga Pae o te Maramatanga. Auckand.

 

A potential emerging issue?

Leptospirosis is an infectious disease caused by the bacteria leptospires which are usually found in animals such as rats, dogs, cattle, and pigs. This disease is found worldwide and can affect both animals and humans. In an RNZ article published in February 2023, the Auckland Regional Public Health Service (ARPHS) has noted an increase in leptospirosis cases across the region which could be linked to the larger rainfall events and the resulting flooding.

How is Leptospirosis transmitted?

Leptospirosis is transmitted to humans through contact with the urine of infected animals or contaminated water and soil. Even a splash or fine spray of urine or indirect contact with urine-contaminated water can spread large numbers of leptospires. Infection generally occurs through cuts and cracks in the skin or through the mucous membranes of the eyes, nose, or mouth. The bacteria thrive in moist or wet conditions and can survive for several weeks in groundwater and moist soil.

In New Zealand, the disease is commonly associated with working in high-risk occupations involving animals or animal products such as farming, meat processing and veterinary work or involving frequently contaminated environments such as those experienced by forestry or sewer workers.

In 2019, there were 82 cases of leptospirosis across New Zealand with the majority of cases related to occupations with exposure to animals (see report for more Leptospirosis statistics).

What are the signs and symptoms for diagnosis?

Leptospirosis can affect both animals and humans, and the severity of the disease can range from mild flu-like symptoms to severe illness and even death. Symptoms typically appear within 2 to 14 days after infection and include fever, headache, muscle aches, nausea, vomiting, diarrhoea, and a rash. In severe cases, the disease can cause organ failure (liver, lung, kidney), bleeding, and meningitis.

Diagnosis of leptospirosis can be challenging as the symptoms can mimic other diseases such as influenza. The diagnosis of leptospirosis is typically based on clinical signs and symptoms, laboratory testing, and a history of exposure to potential sources of the bacteria. Laboratory-based tests such as blood tests are used to detect antibodies to Leptospire bacteria to confirm the diagnosis.

How can we prevent it?

Prevention and control of leptospirosis are primarily focused on reducing the exposure of humans to infected animals and avoiding contact with contaminated water or soil.

In the workplace, personal protective equipment must be worn (gloves, boots, protective suits or clothing, anti-splash goggles, etc). Vaccination is also an effective way to prevent Leptospirosis. In New Zealand, a vaccine is available for cattle, and farmers are encouraged to vaccinate their herds to reduce the risk of transmission to humans.

In the event of a wound, wash thoroughly with clean water and soap, disinfect with an antiseptic solution, and protect any cuts and grazes with waterproof covering.

To reduce the risk of leptospirosis, it is important to take precautions such as avoiding swimming or wading in potentially contaminated water such as lakes, rivers, and streams, particularly after heavy rains (water quality and safety hazards information available on safeswim.org.nz)

Public health significance?

In New Zealand, leptospirosis is listed as a notifiable infectious disease under the Health Act 1956, which means that medical practitioners must notify any suspected cases to the local medical officer of health as soon as possible. Leptospirosis is also regarded as a significant hazard under the Health and Safety in Employment (HSE) Act 1992. Employers should report cases of leptospirosis as a Notifiable Occupational Disease (NOD) to WorkSafe New Zealand. Early notification of cases helps to ensure that appropriate public health measures are taken to prevent the spread of the disease and appropriate data collection and analysis procedures are in place to prevent future outbreaks of similar circumstances.

Given the likelihood of further severe weather events in New Zealand, knowledge gained from previous outbreaks is important for preventative and protective measures for the future. For example, if there were more lepsopirosis cases in Auckland because of the flooding then an awareness campaign on how to hygenically navigate floodwaters (i.e., avoid where possible, no swimming or playing in floodwater notices) and how to hygenically navigate the resultant clean up (e.g., wear gloves, cover any cuts or grazes) would be important to implement.  

Increased awareness of the disease and its potential consequences is essential to ensure the continued health and safety of both humans and animals in New Zealand.

If you suspect that you have been exposed to leptospirosis, it is important to seek medical attention within 24 hours to get tested. Treatment with antibiotics is effective if started early, and early diagnosis can help prevent severe complications.

Article written by: Véronique Nuns 

REFERENCES

Public Health Surveillance: Notifiable diseases in New Zealand: Annual Report 2019

https://surv.esr.cri.nz/PDF_surveillance/AnnualRpt/AnnualSurv/2019/2019AnnualNDReport_FINAL.pdf

Public Health Surveillance: Annual Notifiable Disease Tables (by year)

https://surv.esr.cri.nz/surveillance/annual_diseasetables.php

Ministry of Health: Leptospirosis

https://www.health.govt.nz/our-work/diseases-and-conditions/communicable-disease-control-manual/leptospirosis

LEPTOSPIROSIS: Information for medical providers

https://www.healthnavigator.org.nz/media/7635/wks-6-leptospirosis-medical-providers.pdf

Leptospirosis: Good practice guidelines

https://www.healthnavigator.org.nz/media/7636/wks-4-leptospirosis-prevention-and-control.pdf

RNZ article 24/02/2023 Salmonella and leptospirosis thriving in pot-cyclone conditions

https://www.rnz.co.nz/news/national/484818/salmonella-and-leptospirosis-thriving-in-post-cyclone-conditions

RNZ article 21/02/2023 Rise in leptospirosis cases could be linked to flooding

https://www.rnz.co.nz/news/ldr/484620/rise-in-leptospirosis-cases-could-be-linked-to-flooding

Asian and other ethnic populations account for a significant proportion of Aotearoa’s population (more than 18% as at Census 2018; almost one in five now) and these populations are also increasing at a fast pace. Although some Asian and ethnic groups have higher life expectancy at birth, lower rate of infant mortality and lower mortality rates for some conditions, we must acknowledge these groups are extremely diverse in culture, language, health status, settlement history, and unmet health needs. We will have to develop systematic rather than ‘piecemeal’ national health strategy and implementation plans at regional/district level for Asian and ethnic communities to maintain the outstanding results and to address those areas where issues exist already or are emerging particularly for some Asian and ethnic sub-groups, former refugees and asylum seekers. It is highly recommended to apply an (vertical) equity lens to Asian and ethnic populations, to understand the unique health needs of these sub-populations and proportionate investment of resources via Asian and ethnic health research, to set up dedicated regional/district level Asian and ethnic health divisions with commissioning powers and empower community organisations for better health outcomes, patient experiences and well-being.

Over the past 2 years, there have been a couple of milestone statements published/released by the Asian caucus of the Public Health Association (PHA) NZ or core members of the Asian caucus, as follows:

Recommendations on the health system reform from the Asian Caucus of the PHA (https://lnkd.in/gg4W-64C)
 
Statement on the health system reform for Asian and ethnic communities (https://lnkd.in/dJBkSC4w)

Pae Ora: ensuring a healthy future for all – including Asian and Ethnic minorities
(https://lnkd.in/e58_CVur)

This petition is built on the previous work of the PHA, academics and community organisations, requesting that "the House of Representatives urge Te Whatu Ora – Health New Zealand to develop a national, entity-level policy/strategy and regional/district implementation plans to improve the health and well-being of Asian and other ethnic minority population groups". 

You can sign the petition here - closes June 10 2023

Nominations are now open for our 2022 Public Health Champions. If you have an individual or group that you wish to nominate, you can do so by completing the form below and sending it back to National Office via email. There are four awards on offer; the Public Health Champion Award, the Pasifika Public Health Award, the Tū Rangatira mō te Ora Award, and our new Asian and Ethnic Peoples Public Health Award. Nominations will remain open until the 11th November 2022, 5pm. You can find an honours list of our previous winners on our website and the nomination form here

Recently, CAHRE held a panel discussion on Pae Ora and Ethnic Minority Health at its National Symposium. The session led to a passionate and wide-ranging discussion involving conference attendees that included health practitioners, service managers, academics, researchers, representatives from government and non-government sectors and communities.

Mr Grant Berghan (previous CEO) and Dr Lifeng Zhou (Asian caucus chair) were among the panellists of the 2022 CAHRE Symposium and Associate Prof Roshini Peiris-John (Asian caucus member) facilitated the panel discussion. 

In the document attached, key points from the panel discussion reflecting the views of the panellists and delegates that attended the conference are summarised to facilitate appropriate government responsiveness to the health needs of this population in Aotearoa New Zealand.

To date, the document has been sent to the nation’s top health leaders including some ministers and MPs related. Hon Andrew Little’s office has indicated that the Minister has noted our concerns and asked the MoH to provide a formal response.

You can read the document here: Ensuring a healthy future for Asian and Ethnic minorities.pdf

From July 2023, the primary test for cervical screening will change to a human papillomavirus (HPV) test, with the option of self-testing. The current cytology-based test has served New Zealand well for over 20 years and played a huge role in reducing cervical cancer mortality. Why is HPV testing going to a be a better primary screening test? How will it will find more pre-cancers and prevent more cases of cervical cancer? Will the self-testing option lead to greater participation in the screening pathway? What consideration has been given to equity and Te Tiriti obligations? And how is the transition being planned and organised?

Find out how and why we are transitioning to HPV Primary Screening in July 2023 by reading the full overview here.

PHANZ thanks the HPV cervical screening team for sharing their knowledge and insight on this issue. If you have any questions from the article you can contact the HPV Primary Screening Project, National Cervical Screening Programme via email HPVSCreen@health.govt.nz

Grant Berghan (Ngāpuhi, Ngāti Wai, Te Rarawa) has announced his resignation as CEO of the Public Health Association of NZ. (PHANZ)

Grant who joined PHANZ as CEO in October 2020 said it was with regret that he was stepping down, as he had loved working for and  with PHANZ during what had been a particularly busy time in our   health sector.

“Not only have we contended with Covid-19, but we have been part   of the most significant health reform process this country has seen   in the past 30 years,” said Grant whose last day with PHANZ is on  August 26.

 “I realised that, as the health reforms became a reality on July 1st, 2022, the timing is perfect for me to relinquish the role to a new person, who can support the organisation with fresh energy and ideas in this new environment.

“I wish to thank you all for your support to me over the past two years. I particularly want to thank the Executive Council of the PHANZ, and the staff of our national office for their service and commitment to our work despite the challenges.

“Without you there is nothing. I have been threatening to semi-retire for several years now. This is the first step on that journey. I wish you all the very best for the future.

"Mauri ora ki a tatou katoa.”

PHANZ Executive Council co-presidents Gail Duncan and Nari Faiers thanked Grant for his service saying he had “brought vision and connected the PHANZ during the challenging times of Covid-19 lockdowns, and positioning of public health in terms of the Health and Disability Review and representation of Māori interests". 

The co-presidents said Grant's first action as CEO was to embark on a national road trip from Kaitaia to Invercargill to meet face-to-face with PHANZ members across the branches and with graduates of a Māori leadership programme to seek feedback from PHANZ members on how PHANZ could be relevant in a post-Covid environment, and to understand public health issues in each town/city and generate interest and registration with PHANZ. 

"He has ensured ongoing PHANZ office staffing; including policy advisors, project management, communications, and office management and engaged regularly with PHANZ branch chairs. Grant spoke at the World Health Promotion Conference in December 2021 and has co-hosted the CPAG Post Budget Breakfast events, most recently in May 2022," they said.

“He has led and developed an updated membership drive and Te Tiriti-focused communication plan. This year Grant led PHANZ into the new public health-shared service across Health New Zealand and the Māori Health Authority with expectation of improved outcomes for Māori, Pasifika and disabled people being the prime focus.

We wholeheartedly thank Grant for preparing and motivating the PHA to amplify public health influence across the whole of government and community and exploit the synergy that lies at the intersection of Māori health (hauroa aa iwi) and public health (hauroa aa iwi).”

Te Kōkī refers to the bird song chorus when manu of all kinds gather at dawn to sing and kōrero together.  When they stop singing there is an immediate silence and they flit back to their various places of mahi and habitation until the next kōkī.    

Te Kōkī Hauora is the name given to the gathering of manu hauora to kōrero and meet (online and kānohi ki te kānohi – face to face).  In this context, the network refers specifically to Māori working within mainstream Public Health Units (PHU’s) throughout Aotearoa

Te Kōkī Hauora (Māori Public Health Network) was established in June 2020, from the increasing pressures that Māori workforce within Public Health Units were experiencing. Covid19 exacerbated inequities and institutional failures that already existed within Public Health services. Therefore, there is some urgency to support the Māori workforce to minimise future workforce turnover and to prepare the sector for ongoing and future public health challenges. The roopu focused on their immediate need to;

• Have a safe place to kōrero with other Māori experiencing the same issues

• Providing collegial and cultural support 

• Sharing intelligence from across hapori Māori, and lessons learnt 

• Discussing Public Health issues that required attention whilst dealing with a pandemic

As a response to the challenges of inequities and growing pressures on Māori workforce an opportunity was sought to collaborate with Waikato DHB, Māori Health Equity Directorate and the MOH, Māori Health Directorate to host a Public Health symposium. The aim of the day was to explore effective ways of sharing Māori Covid19 learning and practises to strengthen our public health response. The outcome of this symposium can be found here.  Te Ao Hou Symposium report. 

The roopu continued to hui online and after the completion of a SWOT analysis in June 2021, it was agreed to approach Public Health Association to umbrella the roopu moving forward. TKH sought this support due to the high level of trust and confidence that they had in Grant Berghan and Leah Bain. Since then, PHA have advocated the needs of TKH and have worked with Ministry of Health to acknowledge that even though there has been effort made to build Māori workforce and increase their participation in decision-making and service delivery, more needs to be done to create these conditions for change. 

Te Kōkī Hauora will be hosted by the Public Health Association on the 26 August, in Rotorua at the Hikitia te Wairua waananga. The waananga will be an opportunity to validate the experiences of the past, but most importantly for Te Kōkī Hauora  whānau to reconnect, and establish tools to build resiliency as individuals and roopu hauora.