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Promoting Health in New Zealand

Prepared by the New Zealand Board of Health Committee on Health Promotion

The purpose of this document is to initiate discussion and action on those strategies that will best promote the health of New Zealanders.

The task of determining strategies is a major one calling for lengthy discussion by people in all walks of life and from the many cultures that make up New Zealand.

The greatest benefit for all is the central goal; and to achieve this priorities must be selected to enable action to proceed in a co-operative and effective way. The committee studied factors leading to a healthy existence and those that would produce the widest effect on increasing and maintaining the well-being of the population.

The proposals presented however are not exclusive and further key or core areas may arise as a result of discussion.

Please share this booklet with colleagues and friends.

Nau te rourou, naku te rourou, ka ora te

manuhiri

Your reactions would be welcomed by The Manager, Health Promotion Programme, Department of Health, P.O. Box 5013, Wellington.

Published by the New Zealand Board of Health May, 1988

Information Centre Ministry of Health Wellington 1

Contents·

Page

Foreword by the Governor-General 3

Introduction

A health policy with a New Zealand viewpoint 4

The basic prerequisites for community health 7

Promoting Health in New Zealand

1. Through structural and institutional change 9

2. By managing stress effectively 13

3. By encouraging self esteem 14

4. By fosterirg physical activity 16

5. By promoting sound nutrition 18

6. By reducing drug use 22

The Way Ahead He pekanga hou 25

Reference Material

Health promotion action guidelines, based on the Ottawa Charter, 1986 26

The Treaty of Waitangi 28

Index of Recommendations 30

Membership

New Zealand Board of Health Standing Committee on Health Promotion, 1985-88 32

2 0

, Foreword

GOVERNMENT HOUSE WELLINGTON NEW ZEAL.A:--JD

In this document, phrases like "community responsibility", "health promotion activities" and "frontline primary health care" keep recurring. The point is that we must promote health and keep people well. Too often issues are not tackled until disease and illness appear. By then it is too late.

There are all sorts of reasons why people get sick. The document's emphasis on positive health leads the writers to consider the effect which public policies on employment, education, housing, justice and the environment can have on our health.

Talk of public policies raises a heap of issues. Who makes these policies and how are they made? Does the body of policymakers reflect the social and ethnic mix of the people for whom they are making decisions?

The report places a great store by the Treaty of Waitangi and its relevance to the health of Maori people and perhaps others as well. Increasingly we are seeing that the Treaty is concerned not only with the allocation of resources and the ownership of assets but also the right of a culture to percolate to all corners of our society and there offer its view of the world.

The health of the Maori will improve if the Treaty is working creatively in the formation of policies and then the structures which will deliver those policies. I don't see the Treaty as a national prescription which automatically will guarantee good health. But it widens our understanding of health care and allows traditional experience and institutions such as whanau, hapu and iwi to be used creatively.

Once you introduce traditional concepts you are inviting people to accept responsibility for their own health and the health of others. Health is too important a matter to be left to the experts.

This is a tantalising document. Much of what it says needs amplifying. But as it is intended to promote discussion it is over to the reader to discuss and respond. Hopefully the long term result will be policies which will maintain health rather than rescue people from their sickness.

Governor-General

3

Introduction A health policy with a New Zealand viewpoint

Unuhia te rito 0 te harakeke kei hea te komako e ko? Kii mai koe ki ahau, he aha te mea nui 0 te ao? Maku e kii atu: he tangata, he tangata, he tangata.

What is the most important thing in the world? It is people, people, people.

Ranginui-e-tu-nei and Papa-tu-a-nuku lay embracing, their children between them in a world of darkness. After unsuccessful attempts

~ by his brothers, Tane-mahuta finally separated his parents, Rangi and Papa. Thus the children, the whanau, entered the world of light.

Enlightenment for the whanau and growth in well-being came with trial and struggle, pain and aroha. The central role of the whanau in serving the health care needs of its members is highlighted in this way.

Whanau

D The committee acknowledges the whanau as the functional unit within which individuals help themselves and others towards a healthy lifestyle.

Whanau, hapu and iwi are the functional units within society. They provide social structures to enable individuals to help themselves and others, towards a healthy existence.

The principle of community responsibility is paramount. Accountability comes through discussion and community decision-making which foster self esteem, confidence and well-being.

Whanau is a reality that encapsulates other realities. Some that are important to the promotion of health are:

W WHARE HOUSE. It shelters and unites; a symbol of MANA (prestige) and RANGATIRATANGA (leadership)

H HUI COLLECTIVE DISCUSSION. Gatherings held for the well­being of every member of the group, empowering all individuals.

A ARA WHANUI SPIRITUAL PATHWAY. This links past, present and future and signifies collective responsibility.

N NGATI TRIBAL IDENTITY AND SELF ESTEEM. This is gained through links with kindred WHANAU in an IWI (Tribal group)

A AWHINA SUPPORT. This is given in every conceivable circumstance.

U U-KAI-PO SUSTENANCE. The particular care for those at both ends of the age spectrum - the infant and KAUMATUA (elders) - and the weak in society.

Treaty of Waitangi

The committee recognises the Treaty of Waitangi and urges that all statutory and non-statutory agencies recognise the Treaty in policy and practice.

The interactive harmony of responsibility and accountability ensures the development of a stable New Zealand society and combats a sense of powerlessness that can only stunt growth.

"E tipu e rea i nga ra 0 to ao Ko to ringaringa ki nga rakau a te pakeha Hei oranga mo to tinana; Ko to ngakau ki nga taonga a 0 tupuna Hei tikitiki mo to mahuna Ko to wairua ki te Atua Nana hei nga mea katoa".

Grow, child, in the days of your world Your hand to the weapons of the pakeha As an existence for your body Your heart to the treasures of your ancestors As a topknot for your head, Your spirit to Almighty God Who is the giver of all things.

Sir Apirana Ngata

5

Maori models of well-being are rooted in the ancient wisdoms of our ancestors. They abide in the time~tested meridians of the old world and are the blueprints for future survival.

The principles of whanau, hapu and iwi are encapsulated in the spirit of the Treaty of Waitangi. It provides protection for the environment (lands, forests and fisheries) and our way of life (language, customs and other treasures).

In signing the Treaty of Waitangi, Maori people ceded kawanatanga (governorship) in return for the continued protection and rights to lands, forests, fisheries and other treasures. The Treaty also promised tino rangatiratanga (unqualified chieftainship) over these estates as well as the same rights and duties as the people of England.

Whakangarongaro he tangata, toitu he whenua People corne and go but the land remains.

Land is of extreme importance. It is our physical, spiritual and econoPlic base. It provides identity for whanau, and is a tangible link through time to the rhythm of ancestors, and thus reinforces the links with hapu and iwi.

Together with the estates of forestry, fisheries and other taonga it provides us with sustenance for whanau and visitors. The land in turn needs care, and the rituals and teachings handed down provide guidelines for environmental conservation.

Likewise land has economic power, not in terms of cash valuation, but rather in its sustaining ability and the mana associated with its guardianship. This guardia~ship is interwoven by whakapapa and hence returns us to the principles of the institutions of whanau, hapu and iwi.

The Treaty of Waitangi reinforces the inaliena.ble right to be Maori. It requires decisions to be made and solutions to be found that are in tune with cultural reality, and it protects the right to pursue well-being in all its dimensions.

Recognition of the Treaty must be seen as a prerequisite for health promotion in New Zealand.

6.

Introduction

The basic prerequisites for community health

In accord with the World Health Organisation Health for All strategy and the Ottawa Charter the committee places in the fore-front of its considered priorities a number of prerequisites for a community's health:

D That all government and community action should give priority to achieving the following basic conditions for health . - to safeguard peace and eliminate the fear of war - to ensure the same right to health for all people by the provision of equal

possibilities to develop and maintain health and by the reduction of social inequalities

- to satisfy people's basic needs for sufficient food, clean drinking water, suitable housing conditions, fundamental education and a useful occupation with an adequate income.

Housing

D That Government should act so that both public and private resources are allocated to ensure that all New Zealanders are adequately housed, in culturally appropriate accommodation at affordable cost and acceptable standard; and that this provision of housing be ensured and maintained as a matter of right for all New Zealanders.

Employment

Government should act to ensure

D That a prime result of economic policy is employment for all who seek it, at levels of remuneration which allow a lifestyle of security and dignity

D That employment opportunities be developed in regions and areas where this is desired by local communities because of close identification of people with places, especially tangata whenua

D That culturally appropriate training for employment be made available to those seeking it.

7

Removing sexism

Government should act to ensure

That barriers are removed and positive action is taken to enable women to achieve status, power and just recompense for the work they do.

That action be taken to ensure that positive images of women are presented by the media. Negative attitudes and stereotypes of women increase the likelihood of violence against women and girls.

Removing ageism

That positive views of ageing be promoted amongst all New Zealanders and that older people be recognised as a valuable resource in our community. Negative stereotypes and myths about older people should be identified and challenged.

Similarly, young people in our society should be recognised as the citizens of tomorrow. Their participation in planning, implementation and evaluation of health care is essential.

Removing institutional racism

That racial prejudice and attitudes which set up barriers to the equitable access and delivery of health services and impede the enjoyment of good health by all, should be recognised and removed.

8

Promoting health in New Zealand 1. Through structural and

institutional change

An improvement in the health of New Zealanders requires concerted action. An essential first step is the creation of new structures to facilitate the development and implementation of health promoting public policies.

In addition to the establishment of new structures, existing health promoting organisations and networks should be strengthened and co-ordination improved.

Tribal authorities are one such established network. They already provide extensive benefits to the communities they serve, and given the resources could further assist with the promotion of the health of Maori people.

To do both these things - to create new structures and to strengthen existing structures a commitment of funds is required.

Currently in New Zealand no structure exists which allows for a thorough review of the health implications of public policies. However, we recognise that all public policies do have an impact on health. Many actions taken by government and others beyond the health arena are important for the health of New Zealanders. The influence on health of public policies can be profound and obvious, as in the effect on the nature and quality of food, or the control of toxic substances. Others such as employment, education, income, housing, justice and the environment can be just as profound but less obvious.

Because the health of New Zealanders can be affected by a wide range of public policies, there is a collective responsibility to examine policies from the public health perspective. In New Zealand, health promotion should be viewed from the whanau principle of community responsibility. This perspective ensures that the needs of one person are the concern of all within the community. It guarantees discussion and that decisions are made for whanau well-being and survival.

The development of health promotion in New Zealand therefore entails setting up and strengthening structures whicl1 will allow the assessment of the potential impact on health of a range of public policies and provide input to decision makers. It is, of course, the responsibility of government to then weigh up these positive or negative impacts on health when making policy decisions.

Funding

Department of Health Expenditure

CJ That Government be asked to identify the proportion of Vote:Health allocated to health promotion activities directly related to the six strategies which are the focus of this document. These are in harmony with the health promotion action guidelines of the Ottawa Charter 1986. (page 26).

That this proportion be increased annually to achieve at least 5% of Vote:Health by year 2000.

D That primary health care services of a disease prevention nature, such as blood pressure checks, should be funded separately from, and in addition to the proposed 5% for health promotion.

D That in view of the disadvantaged position of Maori people, an increase in the percentage of Vote:Health allocated to Maori health promotion initiatives is necessary.

Area Health Board Expenditure

D That area health boards be asked to identify that proportion of their budget allocated to health promotion activities.

D That area health boards assign 5% of their total budget to health promotion by the year 2000.

D That monies be specifically budgeted for Maori health promotion activities under Maori control.

Research Expenditure

That funds be allocated for research and development in order to ensure use of research findings in the development of health promoting policies and programmes and the use of appropriate and effective evaluation strategies in health promotion programmes.

Establishment of New Structures

Government Intersectorial Collaboration

That a government intersectorial group be established to consider the health consequences of policy and proposed legislation or regulations, and recommend to government, ways in which deleterious effects can be minimised and health promotional aspects maximised. Maori input must be ensured.

Non-Government Intersectorial Collaboration

That an independent body be established with responsibility for advocacy in the area of health promoting public policies. Support funding for this activity should allow autonomy of views and action.

The recent establishment of the New Zealand Health Association within the world-wide federation of Public Health Associations could fulfill this objective.

10

Research Structure

o That a multidisciplinary research group or groups be established to carry out research relevant to policy development and the development and evaluation of health promotion programmes.

That Maori participation be a significant part of the evaluation of Maori health programmes.

That a centre of excellence be established and funded to ensure research of international quality is carried out within New Zealand.

That area health board funding be assigned for research and evaluation specific to local programmes and concerns.

Strengthening and re-orienting existing organisations and structures

Department of Health

That within the Department of Health priority be given to adequate staffing and funding of the Health Promotion Programme.

That the concept of grants for programmes outside the department be endorsed.

N on-Government Organisations

That existing networks between health promotion organisations be strengthened and extended.

Regional and national forums along the lines of those previously held under the auspices of the. Medical Research Council should be re-convened with the object of establishing a national health promotion organisation.

Tribal Authorities

o That tribal authorities and other Maori networks - (such as the Maori Women's Welfare League, Women's Health League, Kohanga Reo, Matua Whangai, Kokiri Centres, Mana Enterprises and Maori Women's Development Trust) - be used as a conduit for resources for Maori health initiatives.

Cultural Sensitivity

That all health related services be culturally appropriate. This should be a mandatory responsibility of all health organisations.

11

Professional Training

D That the Department of Health's Workforce Development. Group, in co­operation with the Department of Education, take the initiative to investigate the means of training all health educators. All training should be culturally appropriate. An example is the Maori approach used by Te Wananga 0 Raukawa.

Self-help Support Schemes

D That the Department of Health continue to develop and support community-based endeavours.

Futher development of the 'Triple S' Scheme (Special Sessional Scheme) and the 'CHIFS' Scheme (Community Health Initiatives Funding Scheme) and similar endeavours is envisaged. Attention should be given to the difficulty that Maori groups have in accessing community health development funds.

Media Involvement in Health Promotion

D That the philosophy of the Broadcasting Corporation indicates responsibility for promotion of the health of New Zealanders by considering possible health consequences of all programmes and advertising.

D That a senior officer and advisory committee be established for both radio and television with responsibility for health promotion in both major cultures.

The committee views this as the first step towards meeting the health needs of all cultures.

Parenting Education

D That the Departments of Health and Education take the initiative to investigate the further development of parenting education.

The New Zealand Board of Health Child Health Committee in its recent report "Parenting" has given a valuable lead in this field.

The approach within the Maori community is likely to be different and therefore requires separate attention by Maori people.

12

Promoting Health in New Zealand

2. By managing stress effectively

Whaia e koe te iti kahurangi ki te tuohu koe me maunga teitei. If we seek inspiration, let it be from a lofty mountain.

Stress is a neutral environmental factor. Our bodies are equipped to cope with a degree of stress and indeed, some stress may be necessary in every-day life as a motivating force. However, health can be threatened when an individual encounters too many stressful situations in too short a space of time, though some of the effects of this unhealthy stress can be eased when the individual has coping mechanisms and strong societal support.

Some sectors of the community have more stressful events per year than others. Those who attain power in the community may suffer stress from the responsibility that comes with that power.

But those who never attain power still suffer the stresses that corne with the needs of survival. For these people, unhealthy stress may manifest itself in a loss of self esteem and a sense of "powerlessness".

Particular groups liable to suffer in this way are the unemployed, adolescents, the culturally dislocated, those caring for dependants in the horne, and young women in the horne.

We firmly believe that priority should be given to fostering health promoting strategies for these people.

Furthermore, a disproportionately high percentage of each of these groups is Maori and thus they must be considered as a priority group.

[ Public Policy

That public policy at all levels of government, recognise the importance of the prerequisites for health (refer page 7) and pursue the policies that alleviate powerlessness by developing the social circumstances which enable individuals and communities to improve their quality of life.

Enabling Support Networks

That whanau, family and societal support structures for all be strengthened using community health development and traditional Maori methods.

Raising Awareness of Stress Management

That initiatives be taken by government and community organisations to raise the awareness and the understanding of stress and the possible ways in which coping skills can be used to alleviate stress, especially for those most commonly placed in stressful situations critical to survival.

13

Promoting Health in New Zealand

3. By encouraging self esteem

Self esteem is an essential factor for physical, mental, and social health. Neglectful, self­destructive, and sOcially harmful health behaviours can result from its absence.

Self esteem may not be recognised or explicitly expressed by individuals. For example,in a happy carefree childhood it might be experienced simply as the absence of negative feelings about oneself. But nonetheless, it is a prerequisite for optimal development and coping, and for life-long zestful enjoyment -of experience.

Self esteem can be influenced by events and circumstances in the development of the individual from foetal stages through birth and onwards through life.

Parents have a particularly important role in this development of self esteem.

Partnering skills especially should be recognised as contributing to the development of self esteem, not only for the couple, but also for their children and family.

The family and in some cultures the extended family network is a significant setting for the development of self esteem; and appreciation of differing family patterns should be fostered through education.

Fundamental to national efforts towards better parenting is the fostering of the aim of 'every child a wanted child' as the optimal start to the development of self esteem within a nurturing and caring environment.

Parenting and Partnering

That parenting skills be given increasing recognition and emphasis in New Zealand, through formal education, informal adult learning, and by increased awareness on the part of the mass media.

That basic partnering skills be included in formal parenting education schemes, especially at the later secondary levels.

14

[ Child Development

That child development be given optimum conditions throughout society, including full practical State support for the nurturing roles of parents and families, by increased societal resources to meet the real human needs of all children, parents, and families, to assist carers and professionals involved in the development of children and young people.

It should be noted that basic to these societal supports are:

adequate income employment for all who seek it adequate housing for all access to health services without financial barriers recognition of whanau and cultural identity appropriate education for all special supports such as home aid and alternative care schemes freedom from discrimination because of gender, age, marital status, race and culture, disability and socio-economic status.

Commitment cto $crutiny

An explicit part of this focus on societal influences on self esteem is the understanding that the economic, political and social structures of New Zealand are to be constantly reviewed in terms of how they serve, or do not serve, the fullest development of human potential and health of all New Zealanders, including the self esteem of individuals. There can be no real commitment to safeguarding, maintaining, or advancing the health of New Zealanders without this overall scrutiny of the human results of our national life.

15

Promoting Health in New Zealand

4. By fostering physical activity

Raising the level of physical activity undertaken by New Zealanders could have a beneficial effect on the health and well-being of the nation. It is considered that a co-ordinated and directed effort to enhance physical activity will prociuce widespread benefit. For this reason strong support is given to the recommendations contained in The Prevention of Cardicroascular Disease report and the general thrust of the recommendations of the Hillary Commission for Recreation and Sport's report The Cost of Doing Nothing.

Further, it is considered that physical activity should be recommended for its potential benefit to a sense of general well-being, to mental health, to individual self esteem and to family and social interaction of a positive kind seen to take place within a whanau based ethos.

Support in the Area of Physical Activity for the Heartbeat New Zealand Team.

That an Active Life Task Force be established by the Department of Health to complement and support the Heartbeat New Zealand Team proposed in The Prevention of Cardiovascular Disease report. The task force should view physical activity in the broadest sense by encouraging more widespread "participation in life", and by increasing the general level of involvement in all forms of life-enhancing activity. The physical, mental, cultural, aesthetic, expressive and social components should be included.

This Task Force to be formed by representation from the ­

Ministry of Women's Affairs QE II Arts Council including the Maori and South Pacific Arts Council Royal New Zealand College of General Practitioners Fitness-Health Industry Sports Medicine Foundation New Zealand Fitness Accreditation Council Broadcasting Corporation of New Zealand National Heart Foundation of New Zealand Hillary Commission for Recreation and Sport Department of Health Department of Education

c:::::J That doctors be encouraged to prescribe physical activity where it is deemed to be appropriate as a treatment.

16

Development of Protocols for Training in Activity Prescription

That medical schools, the post graduate affairs departments of medical schools, the Faculty of Physical Education, the comprehensive nursing schools, the Sports Medicine Foundation and other health professionals, together with accredited fitness health centres, co-operatively develop protocols for the training of staff and students involved in the prescription of physical activity.

Accreditation of the Activity Industry I.

That the accreditation of individuals and organisations providing commercial physical activity programmes be stringently controlled by the New Zealand Fitness Accreditation Council to ensure the exercise and physical activity prescribed is appropriate and well supervised to produce maximum benefit.

Access to Physical Activity Opportunities

CJ That the Department of Health commission an investigation into the access of all sectors of society to facilities which provide the opportunity for advice and the practice of beneficial activity and exercise.

Access must include aspects of cost, convenience, transport, social setting, as well as proximity, especially where the work-place is not involved. Access must also include non­physical, or attitudinal and value aspects. These can be ethnic or socio-cultural feelings of belonging to a place, activity or programme. It may be that the non-exercise interests are more effective initiators of exercise than an explicit narrower focus on fitness.

Access should include consideration of age group, lifestyle, peer and reference groups, and physical disability.

17

Promoting Health in New Zealand

5. By promoting sound nutrition

The major goals for nutrition are: the adoption of healthy eating practices and the improvement of the nutritional health of New Zealanders of all ages and cultural backgrounds. To achieve these goals, the skills and knowledge which allow New Zealanders to make healthy food choices must be fostered, the availability of food supplies that promote health be increased, and the development of a social environment that nurtures and enhances the desire for healthy eating be of central concern.

The Promotion of the Knowledge which allows New Zealanders to make Skilful and Healthy Food Choices.

[ Education and Nutrition

The Prevention of Cardiovascular Disease report draws attention to the relationship between diet, lifestyle and cardiovascular disease. Diet and lifestyle issues also affect other diseases. It is essential that nutrition education is up to date and health promoting : research and curriculum review processes are necessary for this to occur.

That all New Zealanders have the right to education on food and nutrition.

That initiatives involving schools, community and cultural groups be carried out concurrently in order to reach the whole population. Inter­agency efforts must be endorsed and supported.

Training in Nutrition

That training in food and nutrition for teachers at all levels and for front line primary health care professionals, including nurses, general practitioners, community health workers and others be fully implemented. More community based nutrition specialists are needed. New courses must be provided to meet these needs.

18

The Availability of Food Supplies which Promote Health

I The Food Industry

c::::J That the highest priority be given by the primary and secondary food industries to produce food and food products in keeping with New Zealand's nutritional guidelines. For example, the New Zealand Vegetable Growers' Federation and the Fruit Industry should be encouraged to continue to market their fresh produce as today's health foods.

Protection and Maintenance of Food Sources

We are concerned that no authoritative body nor any commercial enterprise has a particular interest in the protection and maintenance of traditional food sources for New Zealanders, for exampk traditional sources of seafood, seed production and distribution. It is essential to ensure the survival of as wide a range as possible of edible flora and fauna.

Food Production Quality

Priority should be given to encouraging an approach to food production and food processing that preserves ecological balance. An increasing number of New Zealanders want to see a reduction in the use of chemicals of all kinds, during food production and processing.

c::::J That publicity be given to the fact that all consumers may make submissions to the Foods Standards Committee which has statutory responsibility for the control of the use of chemicals in food processing.

c::::J That the Department of Health take a positive and unequivocal role in maintaining food quality in New Zealand.

The Development of a Social Environment that nurtures and enhances the desire for Healthy Eating

I Early Life ~utrition I

The importance of breast feeding, particularly in the first weeks and months of life cannot be over-emphasised.

That efforts be made to increase the nation's understanding of the importance of breast feeding and to increase the social acceptability of mothers breast feeding wherever and whenever the need arises.

Adequate child care facilities close to the work place for mothers and adequate maternity leave' provisions are also essential to achieve this priority. : '

That more research be carried out into the effects of the use of infant formulae on the later development of food intolerances.

19

[!OOd Standards in Schools \

The food available to children and young adults at school should be consistent with the highest standards of nutrition.

That school environmental reports carried out by the Department of Health be extended to gather information about food in schools

That research be carried out into the ways and means by which some schools have successfully implemented high nutritional standards in food available in school shops, boarding school meals and on other eating occasions

c::J That the findings of this research be published and made available to teachers, school committees, school boards, residential school managements and other interested groups.

The Needs of the Elderly

That promotion of food suitable to meet the special nutritional needs of the older population be actioned.

c::J That due consideration be given to the dental health needs of the elderly.

Advertising

A high percentage of TV advertising targeted at children and young people promotes food products commonly referred to as 'junk foods'. Research evidence indicates that the concern about such advertising is well founded. Children's food choices can be biased.

===:J That action be taken to ensure advertising does not make implicit health. claims to children and other audiences, and mislead children in particular into believing that certain high energy, low nutrient density food products are good for them.

Multi-sectorial Task Force

That a multi-sectorial Nutrition Task Force be funded for an initial period of five years, responsible directly to the Prime Minister.

Membership of the task force should include people from a wide· variety of government and non-government groups involved in food and nutrition. The sectors of interest from which membership could be drawn include Government Departments of Trade and Industry, Conservation, Agriculture and Fisheries, Health, Education, Consumer Affairs, representatives from food production and processing, wholesale and retail distributors, marketing and the media, Maori organisations, people with expertise in nutrition and social science.

20

The task force would address the issues o~ concern outlined, and recommend strategies for action. These would include encouragement of industry initiatives in addition to recommendations to the Prime Minister for policy development.

A primary issue of concern would be the cost of an ample range of standard foods to the consumer, especially the low income or socially disadvantaged; and food prices should be regularly scrutinised so that there are no economic barriers to healthy nutrition.

The Nutrition Task Force would consult widely and have as its focus a holistic approach to nutrition. It would advise the Prime Minister on goals and strategies for the attainment of these priorities in the next 5-10 years. In so doing it should consider:

= initiating research about New Zealanders' food intake, eating patterns and updating information on nutrient intakes= ways in which social and other barriers to healthy nutrition practices can be overcome= a review of the nutritional goals and guidelines for New Zealanders= the promotion of the nutritional goals and guidelines

c:::::::J ways Of providing resources and appropriate training for the task of delivering nutrition education to the community. People involved should include . community health workers, nurses, health educators, teachers, nutritionists, pharmacists, fitness consultants, dentists, as well as dietitians and doctors

= ways of providing resources including finance, information, and consultancy services that should be available to support community initiatives in nutrition education= strategies to ensure the survival of edible flora and fauna

= plan strategies to relate the New Zealand nutritional guidelines to primary and secondary food industries = the initiation of a Commission of Enquiry 'Planning for Food Production and Processing in the Year 2000'=the role played by the media in influencing the perception and use of foods = updating 'Recommendations for selected nutrient intake levels of New Zealanders' published in 1983.

= a review of current resources and strategies available, their utilisation and potential to promote nutritional goals and guidelines. This should include the five major health promotion action guidelines of the Ottawa Charter (see page 26) as ways of enacting nutrition education initiatives across the country

the .use of community development models for the attainment of the above priorities.

Food Standards Committee

That the Food Standards Committee be required to make it easier for the consumer to benefit from information on food labelling and food processing.

21

Promoting Health in New Zealand

6. By reducing drug use

Drugs in particular circumstances have beneficial effects. However, a major goal for health promotion in this area is the reduction in the per capita use of drugs and medicines.

This heading of "drugs and medicines" includes alcohol, tobacco, cannabis and other illicit recreational drugs, solvents, prescription drugs and over-the-counter medicines.

The aim is to reduce both demand and supply. A variety of strategies will be needed to achieve this for both legal and illegal drugs.

Alcohol and tobacco are the two drugs which do the most harm in our society. There should be however a reduction in the demand for prescribed drugs as welL Prescribed drugs should be used only for those conditions for which there is no viable alternative.

Excessive and inappropriate pharmaceutical advertising plays a role in the unacceptable high level of drug usage by some groups.

Growing pressures on the consumer by health product manufacturers have led to a readiness to pop pills as a means of maintaining sound health. There is a need to raise awareness of the fact that self-prescribed medication is rarely necessary and that positive alternatives can often be used.

Increased understanding and support for policies which control both supply and demand for alcohol and tobacco are needed; These include controls on the availability and circumstances of sale of alcohol and tobacco, the promotion of their use and taxation policies. Other compensatory strategies include community development and the development of personal and interpersonal skills relevant to the situations in which drugs are used.

Dissemination of Information

C That alcohol and tobacco policies and their likely effects be the subject of media coverage and other means of dissemination.

I Reducing Alcohol Abuse

Avoiding Drunkenness and heavy regular use of Alcohol

That social marketing by health promotion qgencies and controls on promotions by the alcohol industry be directed to the benefits of avoiding drunkenness and heavy regular use of alcohoL

That the use of macho behaviour and mateship to market alcohol be countered by health promotion strategies.

22

The Role of ALAe

That in recognition of the major problems associated with alcohol abuse there should be no dilution of the energy and resources available to deal with these problems. In this respect, the role of ALAC (AlCoholic Liquor Advisory Council) should not be extended to deal with other forms of drug abuse.

Promotion of Non-Smoking

The promotion of non-smoking behaviour and its benefits to health need continuous and vigorous support.

D That increased resources be made available to existing organisations to achieve the following two non-smoking objectives:

Abolition of Tobacco Advertising

c::::::J That social marketing, health education and restrictions on tobacco industry advertising be pursued with the aim of making New Zealand, by the year 2000, a smoke-free society in which there is no smoking in enclosed public places and no promotion of tobacco products.

Implementation of Non-Smoking Goals

D That the goals and recommendations of the 1985 Advisory Committee on Smoking and Health be implemented.

Funding and Role of the Interdepartmental Committee on Substance Abuse

That adequate funding be made available to the Interdepartmental Committee on Substance Abuse to enable its community based work to be effective.

That the role of this committee be extended to enable it to ascertain the usage patterns and beliefs about illicit drugs in the New Zealand population.

That the level of awareness be raised of the likelihood of apprehension and of the consequences of supplying illicit drugs.

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Information, Training in the Use 'of Prescription Drugs and Alternatives

That specialist publications and education courses be used to inform the medical professional about the appropriate use of drugs and alternatives to drug use.

Redudionof Inappropriate Prescribing

C That the Department of Health implement an effective policy to reduce inappropriate prescription of drugs.

Information on Alternatives to Drug Use

C That a variety of strategies be used to inform the general public on the appropriate use of drugs and the available alternatives to drug use.

Pharmaceutical Advertising

C That Part 4 of the Medicines Act be re-written to limit and control the nature and extent of advertising of pharmaceutical products .

.Preventive P.rogrammes

C That resources be made available to support the development of programmes designed to enhance self esteem. Examples of such programmes are Maramatanga, Outward Bound, and Reaching Out, which help to reduce the demand for drugs.

Education on Over-the-Counter Medicines

That health promotion agencies seek to reduce the inappropriate use of over-the-counter medicines and food supplements.

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The way ahead He pekanga hou

The New Zealand Board of Health Standing Committee on Health Promotion, in determining health promotion priorities for New Zealand, endorses the aim of the 1977 30th World Health Assembly of the World Health Organisation - that by the year 2000 all people of the world should have reached a state of health that enables them to live socially and economically productive lives.

Further, the committee endorses the definition of Health Promotion formulated in the Charter of the first International Conference on Health Promotion held in Ottawa, November 1986:

"Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physcial, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being"

The committee's responsibility is to promulgate good health strategies of benefit to all New Zealanders. However; current health statistics for Maori and Pacific Island people demonstrate that the health status of both communities warrants particular national concern. If improvement is to occur the committee considers that a health delivery system which is culturally valid, and in many cases is already active in these communities, is the most appropriate way to promote health.

When these concerns especially for the health of the Maori are addressed, our country would more readily achieve the World Health Organisation's target of 'Health for All by the Year 2000'.

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Reference material 1. Health promotion action guidelines from the Ottawa Charter, 1986.

Building Healthy Public Policy

Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health . Health promotion policy combines diverse but complementary approaches including legislation, fiscal measures, taxation and organisational change. It is co-ordinated action that leads to health, income and social policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments. Health promotion policy requires the identification of barriers to the adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice for policy makers as well.

Creating Supportive Environments

Our societies are complex and inter-related. Health cannot be separated from other goals. The inextricable links between people and their environment constitutes the basis for a socio­ecological approach to health. The overall guiding principle for the world, nations; regions and communities alike, is the need to encourage reciprocal maintenance - to take care of each other, our communities and our natural environment. The conservation of natural resources throughout the world should be emphasised as a global responsibility. Changing patterns of life, work and leisure have a significant impact on health. Work and leisure should be a source of health for people. The way society organises work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable. Systematic assessment of the health impact of a rapidly changing environment - particularly in areas of technology, work, energy production and urbanisation ­is essential and must be followed by action to ensure positive benefit to the health of the

(') public. The protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy.

rengthening Community Action

promotion works through concrete and effective community action in setting priorities, decisions, planning strategies and implementing them to achieve better health. At the

heart of this process is the empowerment of communities, with the ownership and control of their own endeavours and destinies. Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support.

Developing Personal Skills

Health promotion supports personal and social development through providing information, education for health and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Enabling people to learn throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essentiaL This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves.

Re-orienting Health Services

The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments, They must work together towards a health care system which contributes to the pursuit of health. The role of the health sector must move increasingly in a health promotion direction, beyond its responSibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components. Re-orienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organisation of health services, which re-focuses on the total needs of the individual as a whole person.

The Ottawa Charter was developed at the first International Conference on Health Promotion held inOttawa in 1986 under the auspices of the World Health Organisation.

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Reference material

2. The Treaty of Waitangi

Maori Version

Ko te tuatahi Ko nga Rangatira 0 te Wakaminenga, me nga Rangatira katoa, hoki, kihai i uru ki taua Wakaminenga, ka tuku rawa atu ki te Kuini 0 Ingarangi ake tonu atu te Kawanatanga katoa 0 0 ratou wenua.

Ko te tuarua Ko te Kuini 0 Ingarangi ka wakarite ka wakaae ki nga Rangatira, ki nga Hapu, ki nga tangata katoa 0 Nu Tirani, te tino rangatiratanga 0 0 ratou wenua 0 ratou kainga me 0 ratou taonga katoa. Otiia ko nga Rangatira 0

te Wakaminenga me nga Rangatira katoa atu, ka tuku ki te Kuini te hokonga 0 era wahi wenua e pai ai te tangata nona te wenua, ki te ritenga 0 te utu e wakaritea ai e ratou ko te kai hoko e meatia nei e te Kuini hei kai hoko mona.

Ko te tuatoru Hei wakaritenga mai hoki tenei mo te wakaaetanga ki te Kawanatanga 0 te Kuini. Ka tiakina e te Kuini 0 Ingarangi nga· tangata maori katoa 0 Nu Tirani. Ka tukua ki a ratou nga tikanga katoa rite tahi ke ana mea ki nga tangata 0 Ingarangi.

English Version Article the First The Chiefs of the Confederation of the United Tribes of New Zealand and the separate and independent Chiefs who have not become members of the Confederation cede to Her Majesty the Queen of England absolutely and without reservation all the rights and powers of Sovereignty which the said Confederation or Individual Chiefs respectively exercise or possess, or may be supposed to exercise or to possess over their respective Territories as the sole Sovereigns thereof.

Article the Second Her Majesty the Queen of England confirms and guarantees to the Chiefs and Tribes of New Zealand and to the respective families and individuals thereof the full exclusive and undisturbed possession of their Lands and Estates Forests Fisheries and other properties which they may collectively or individually possess so long as it is their wish and desire to retain the same in their possession; but the Chiefs of the United Tribes and the individual Chiefs yield to Her Majesty the exclusive right of Preemption over such lands as the proprietors thereof may be disposed to alienate at such prices as may be agreed upon between the respective Proprietors and persons appointed by Her Majesty to treat with them in that behalf.

Article the Third In consideration thereof Her Majesty the Queen of England extends to the Natives of New Zealand Her royal protection and imparts to them all the Rights and Privileges of British Subjects.

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Translation of Maori Version (Professor H Kawharu)

The first The Chiefs of the Confederation and all the Chiefs who have not joined that Confederation give absolutely to the Queen of England for ever the complete government over their land.

The second The Queen of England agrees to protect the Chiefs, the Subtribes and all the people of New Zealand in the unqualified exercise of their chieftainship over their lands, villages and all their treasures. But on the other hand the Chiefs of the Confederation and all the Chiefs will sell land to the Queen at a price agreed to by the person owning it and by the person buying it (the latter being) appointed by the Queen as her purchase agent.

The third For this agreed arrangement therefore concerning the Government of the Queen, the Queen of England will protect all the ordinary people of New Zealand and will give them the same rights and duties of citizenship as the people of England.

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Index of Recommendations

Introduction A health policy with a New Zealand Viewpoint

Whanau Treaty of Waitangi

The basic prerequisites for community health Housing Employment Removing Sexism Removing Ageism Removing Institutional Racism

Promoting Health in New Zealand 1. Through structural and institutional change

Department of Health Expenditure Area Health Board Expenditure Research Expenditure Government Intersectorial Collaboration Non-Government Intersectorial Collaboration Department of Health Non-Government Organisations Tribal Authorities Cultural Sensitivity Professional Training Self-Help Support Schemes Media Involvement in Health Promotion Parenting Education

Promoting Health in New Zealand 2. By managing stress effectively

Public Policy Enabling Support Networks Raising Awareness of Stress Management

Promoting Health in New Zealand 3. By encouraging self esteem

Parenting and Partnering Child Development Commitment to scrutiny

Page

4

7

9

13

14

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Promoting Health in New Zealand 4. By fostering physical activity 16

Support in the Area of Physical Activity for the Heartbeat Team Development of Protocols for Training in Activity Prescription Accreditation of the Activity Industry Access to Physical Activity Opportunities

Promoting Health in New Zealand 5. By promoting sound nutrition 18

Education in Nutrition Training and Nutrition The Food Industry Protection and Maintenance of Food Sources Food Production Quality Early Life Nutrition Food Standards in Schools The Needs of the Elderly Advertising Multi-sectorial Task Force Foods Standards Committee

Promoting Health in New Zealand 6. By reducing drug use 22

Dissemination of Information Avoiding Drunkenness and Heavy Regular Use of Alcohol The Role of ALAC Promotion of Non-Smoking Abolition of Toacco Advertising Implementation of Non-Smoking Goals Funding and Role of the Interdepartmental Committee on Substance Abuse Information, Training on the Use of Prescription Drugs and Alternatives Reduction of Inappropriate Prescribing Information on Alternatives to Drug Use Pharmaceutical Advertising Preventative Programmes Education on Over-the-Counter Medicines

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Members of the Board of Health Standing Committee on Health Promotion, 1985-88

Present members

Dr Philip Barham Dr Sally Casswell Mrs Louise Croot Dr Barbara Guthrie Mr Tom Hutchins Mrs Bette Kill (Health Department Advisor) Dr John Mcleod Mr Peter McQueen (Chairperson) Mrs Erihapeti Murchie Mr Andrew Perkins (Secretary) Dr Paparangi Reid

Past members contributed in varying degrees to the contents and views expressed in this document. We are grateful for their participation and continuing interest.

Past Members

Mr Nelson Speirs (NZBOH representative) to 1987 Dr Diana Mason to 1987 Dr Larry Peters (Ex officio MRC ) to 1987 Mrs Myra Graham to 1986 Dr John Holden (Health Department Advisor) to 1986 Prof Ted Glynn to 1986 Mr Peter Bryant to 1986

Designed by Ian Cheeseman Te~t edited bv Alan TrusseIJ~Cull{"n Printed by Maxwell Printing Company Limited

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