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Racism and government policies of colonisation and assimilation contribute to the disproportionate burden of disease carried by indigenous people globally. In colonial contexts such as Aotearoa New Zealand, these inequities are routinely monitored but governments believe economic growth and better lifestyles will resolve the issues. Stop Institutional Racism (STIR), a group of health activists, is challenging this dominant discourse and building a boutique social movement to transform racism within the New Zealand public health sector. Central to the work of STIR is partnership between indigenous and non-indigenous practitioners underpinned by Te Tiriti o Waitangi – the founding document of the colonial state of New Zealand. This paper reflects on STIR organisational processes and political achievements to date. We have worked towards mobilising the public health sector, re-energising the conversation around racism and strengthening the capacity and evidence base of the sector around key sites of racism and anti-racism praxis. This paper will be of interest to others within the global public health community who are looking for new collective ways to organise and challenge entrenched inequities. [ABSTRACT FROM PUBLISHER]

Sexuality education is a compulsory part of The New Zealand Curriculum for state-funded schools. In 2015, the Ministry of Education has published an updated revision of their official guidelines for schools on the teaching of sexuality education. This paper employs Foucauldian discourse analysis to argue that this policy document, Sexuality Education: A Guide for Principals, Boards of Trustees, and Teachers, reflects and reproduces particular ways of knowing which constrain possibilities for socially just sexuality education. These discourses include the adoption of an intellectual approach to teaching sexuality, the mandate to measure learning objectives, and a narrow emphasis on positive sexuality. Intentions for the curriculum to deliver a holistic, socio-ecological vision of sexual health as well as one which embeds Māori values are undermined by dominant understandings of individual action which shape approaches to both sexuality and pedagogy. Furthermore, the liberal recognition of cultural, ethnic, sexual and gender diversity in the curriculum unintentionally reinscribes an unmarked white, secular, heterosexuality as the norm. This paper reflexively critiques the discursive tensions that inhibit the realisation of sexuality education in schools which meets the needs of diverse students and offers it as a possible site for social justice. [ABSTRACT FROM AUTHOR]

Longitudinal research is needed to better understand the natural history of oral conditions and long-term health and social outcomes. Oral health data has been collected periodically in the Dunedin Multidisciplinary Health and Development Study for over 40 years. To date, 70+ peer-review articles on the Study's oral health-related findings have been published, providing insight into the natural history of oral conditions, risk factors, impacts on quality of life, and disparities in oral health. Some of these report new findings, while others build upon the existing body of evidence. This paper provides an overview of these findings and reflects on their public health implications and policy utility in New Zealand. [ABSTRACT FROM AUTHOR]

In this paper we consider what impact a biopolitics that creates a compliant self-governing weight-focused population has had on Māori health in Aotearoa/New Zealand. We frame this discussion with three vignettes that in different ways demonstrate the deleterious effects of the individualisation of health on Māori. We argue that the current biopolitics is best explained as 'the health of Maoris' not 'Māori Health'. To counter this current biopolitics we put forward an alternative epistemology, the 'Atua Matua' framework. This epistemology pays respect to a Māori view of health that is holistic, encompassing physical, emotional, spiritual, cultural and familial well-being and does not give ground to the requirement for individualism so prevalent in neoliberalism. Finally, we consider what this new epistemology might offer to the public health agendas in Aotearoa and other countries where indigenous populations suffer ill health disproportionately. Thus, our implications have potential not only for Māori health but human health in general. [ABSTRACT FROM AUTHOR]

Disparities in access to health care also extend to the end-of-life care. Despite the general principle that palliative care is equitably available for all in need, it remains underutilised by certain groups in the community. Ethnic minorities, older people and patients with non-cancer diseases are found to be at a greatest risk for underutilisation of palliative care. Barriers to access palliative care by these groups in the community are complex and often overlapping. To overcome these barriers, there is a need to take action on many fronts. This paper discusses these barriers and provides an overview of the strategies that have been implemented to address these issues. [ABSTRACT FROM AUTHOR]

Many western countries have experienced increased rates of youth suicide over recent years. This has been an issue of particular concern in New Zealand, since it had the highest rate of youth suicide among OECD countries in the mid-1990s. However, while attention is drawn to the now declining youth suicide rate by politicians and policy-makers, what is obscured is a cohort effect. In this paper we will argue that a cohort effect is clearly visible; suicide rates among 15-24 year olds came to the fore in the mid-1980s, peaking 10 years later, and were displaced by that among 25-35 year olds by the late-1990s. Further, this century has been characterised by the rise of suicide rates among 35-44 year olds. This effect correlates with a dramatic downturn in the New Zealand economy in a five-year period bracketing 1970. We argue for an increased focus on social and economic factors underlying suicide. [ABSTRACT FROM AUTHOR]

This paper compares the ways in which governments in Canada and New Zealand have attempted to pursue reforms in two major health policy arenas - cost control and primary health care - in the period 1992-2005. The framework for comparison is drawn from the “modes of governance” literature that deals with hierarchies, markets, provider-based networks and communities as means of steering policy. Recent literature has argued that governments are increasingly mixing and matching different modes of governance. This comparison shows that governance versatility applies in New Zealand, but not Canada, and this is primarily attributable to the differences in health policy institutions. [ABSTRACT FROM AUTHOR]

From 0.1% of the total population in 1945 to 6.9% in 2006, Pacific peoples now resident in New Zealand highlight significant health policy and service delivery issues within an increasingly diverse society. Over the last decade, marked differences in the health status of Pacific New Zealanders and Palagi New Zealanders have been well documented, showing high levels of disparity and continuing negative trends. This paper provides a broad overview of the history of Pacific health and health initiatives in New Zealand from the 1940s through to the mid 2000s, highlighting the interface between Pacific peoples and the New Zealand health sector. While the New Zealand Government has become increasingly responsive to Pacific health needs, significant disparities remain between Pacific and Palagi populations. Furthermore, many of the encouraging health initiatives introduced in the past decade remain at risk due to a variety of factors, including a need to strengthen the Pacific health workforce and management expertise. [ABSTRACT FROM AUTHOR]

Ecosystem-based approaches to marine management, which integrate marine law and policy across sectors, communities, and scales, are increasingly advocated for in international policy debates and scholarly literature. We highlight critical and timely opportunities in Aotearoa New Zealand's evolving legal context to support an ecosystem-based approach across fisheries regulation, biodiversity conservation, environmental effects management, and Indigenous or customary rights. Given the scale of proposed law reform affecting the ocean in Aotearoa New Zealand, there are important global lessons to be elucidated from (and for) the Aotearoa New Zealand experience, revealing the potential for law to center the health of ocean ecosystems and related people in integrated marine decision making. [ABSTRACT FROM AUTHOR]

The Warnock Report has had a significant impact on regulatory developments in many jurisdictions including New Zealand. While New Zealand has adopted a different system than that in the United Kingdom the objectives are the same, namely to manage in a responsible way, the issues associated with regulation and reproductive choices. [ABSTRACT FROM AUTHOR]

This paper reviews the development of health impact assessment (HIA) in New Zealand to reveal factors which inhibited its effective institutionalisation until recently. It considers how differing views of HIA have affected the institutionalisation process, and assesses the longer-term prospects for HIA in policy- and project-level assessments. There is lack of a clear statutory mandate for considering health impacts under the Resource Management Act, although HIA and closely related health risk assessments have been carried out under other legislation, including the Biosecurity Act. Consequently, different understandings of the nature and purpose of HIA have developed, associated with different practitioner communities, often operating in isolation from other practitioners and the wider impact assessment community. The renewed effort to mobilise HIA has emphasised policy-level application in central government; the Ministry for Health now has an HIA Unit, and statutory recognition of the process is promised in the new Public Health Act. [ABSTRACT FROM AUTHOR]

This article provides an account of the role that agential realism might play in sex research, intersexuality and education, as well as the possibilities this opens up for research, institutions, policy, intersex communities and understandings of intersexuality. The account begins by addressing key issues in the field of sex research, intersexuality and education, then demonstrates how these may be read through an agential realist lens. This approach provides a more accountable means of thinking through matters of sexual difference and opens up more nuanced enquiry. Subsequently, the article speculates on what kinds of explorations of sex might emerge with future research and pedagogy, followed by an example of the ways in which this reading of sex has flow-on effects in relation to gender and sexuality, which are often taught alongside sexual difference. From consultations with members of the New Zealand intersex community, the article closes by discussing pertinent issues the community faces, which might be addressed in sex education. [ABSTRACT FROM AUTHOR]

An integral part of colonisation is the suppression and marginalisation of indigenous knowledges. The indigenous health system within Aotearoa (New Zealand) was supplanted with a colonial infrastructure and praxis which has proven ineffective in addressing systemic health inequities created by the processes of colonisation. This novel study interrogates discursive representations of Māori (Indigenous peoples of Aotearoa) within colonial public health policy between 2006 and 2016. Colonial policy refers to generic or mainstream policy that are designed for 'all' New Zealanders. We utilised thematic analysis to examine 106 policies and, after excluding 13 ethnic specific policies, identified 68 policies containing no mention of Māori. The analysis highlights five themes relating to discursive representations of Māori. These were: i) silence about Māori health; ii) Māori as especially at risk; iii) Crown (lack of) responsiveness to te Tiriti o Waitangi obligations; iv) recognition of Māori philosophical approaches to service provision; and v) utilising mātauranga Māori (Māori knowledge). These findings suggest colonial policy presents a barrier to the pursuit of health equity and is poorly aligned to global Indigenous human rights declarations. Within the context of Aotearoa it echoes the sentiments of the key Waitangi Tribunal [WAI 2575] finding that health policy is contributing to health inequities and failing Māori. Health policy must be decolonised to better engage with human rights declarations and te Tiriti o Waitangi obligations in order to achieve health equity. [ABSTRACT FROM AUTHOR]

A range of barriers that impede collaborations between consumer researchers and other researchers have been identified, despite clear acknowledgement of the benefits of this approach in the literature. Recent research has questioned whether the costs of collaborative research outweigh the benefits. The overarching aim of the current study is to better understand non-consumer researchers' attitudes to, and issues concerning, engagement with consumer researchers. Non-consumer researchers from mental health disciplines were invited to participate in the cross-sectional Consumers as Researchers in Mental Health survey, and to respond to open-ended questions about their experiences of collaborative research with consumer researchers. The findings demonstrate a range of benefits associated with collaborations with consumer researchers – including increased relevance and credibility of research, and greater translation of research findings into changes in health policy, service, research and education. Collaborations were found to be varied and not limited by research design, decision-making styles, or research topic. Understanding these benefits within the context of identified barriers can make an important contribution to the proliferation of mental health consumer researcher roles. [ABSTRACT FROM AUTHOR]

Māori and Pasifika populations in New Zealand experience poorer health outcomes than other New Zealanders. These inequalities are a deeply entrenched injustice. This qualitative study explores the experiences of six Māori and Pasifika leaders on health policy-making advisory committees. All had extensive experience in the health system. They were recruited, provided semi-structured interviews, the data coded, and a thematic analysis undertaken. Our findings show that inequalities in the health system are reproduced in advisory committees. Participants noted their knowledge and interests were devalued and they experienced racism and tokenistic engagement. Some indicated it took considerable effort to establish credibility, be heard, have impact, and navigate advisory meetings, but even then their inputs were marginalised. Health policy advisory committees need deeper engagement and more genuine recognition of Māori and Pasifika knowledge. Māori and Pasifika leaders have constructive solutions for eliminating health inequities that could benefit all New Zealanders. [ABSTRACT FROM AUTHOR]

The article discusses the relation of mass media and public reactions to adverse drug reactions (ADR) to the medication Eltroxin (levothyroxine) in New Zealand from June 2008 to August 2009. Topics include statements by New Zealand government agencies related to public health, the importation of alternative drugs to treat hypothyroidism, and reforms related to drug safety and reporting.

It is widely recognized that chronic illnesses pose significant challenges for health care systems around the world. In response, most governments have set health policies in order to manage (or better, reduce) demand and improve the health of their populations. A discourse analysis of four policy documents that shape these strategies in New Zealand reveals that the policies construct the chronically ill as “others,” that is, as deviant or different from the “normal” population. The discourse further serves to blame the chronically ill both for being sick, and for placing a serious financial burden on society. We identify problems that arise from this discourse. They relate to (a) the fact that chronic illnesses are so prevalent, (b) the fallacy of categorizing all chronic illnesses as the same, (c) tensions between a blaming discourse and current clinical best practice directions, and (d) a lack of recognition of the wider social factors that impact on health. [ABSTRACT FROM PUBLISHER]

This small, exploratory study, conducted in Auckland, New Zealand, followed on from an earlier review and sought the opinions of young people from diverse communities as to how their voices might be located in public health policy. A focus group was undertaken with 6 youth involving participatory research methods of mind mapping and ranking. Participants created two key themes to direct their mind mapping activity: “a beautiful world to speak in” and “a difficult world to speak in.” Each theme was broken down into 3 sub-themes reflecting participants’ perceptions of having or not having their voices heard. On the one hand, participants appreciated the open environment for communication in the New Zealand context. Yet, concurrently, societal power relationships which unfairly privilege one group over another were identified as limiting youth voice. The study informs the design of a larger participatory research project focused on youth leadership and public health policy in New Zealand and the Pacific Region. [ABSTRACT FROM AUTHOR]

The AUDIT-C screening measure for hazardous and heavy episodic drinking was included in a 2006 postal survey of a representative population sample of New Zealanders aged 55-70 years (N = 6642) funded by the Health Research Council of New Zealand. Results from logistic regressions showed that New Zealand Europeans and Māori, males, those with higher incomes, and those with a good standard of living were significantly more likely to drink hazardously. Heavy episodic drinking was more likely among men, Māori, and those with secondary or no school qualifications. The findings warrant further research into alcohol consumption among older people as this cohort moves into retirement. [ABSTRACT FROM AUTHOR]

Both New Zealand and Sweden have health and disability policies that promote recreational exercise within society for people with disability. Despite these policies, levels of physical activity by people with disability in these countries are low. Physiotherapists are equipped to assist people with disabling conditions into physical activity. This qualitative study explored the perspectives and experiences of physiotherapists in New Zealand and Sweden toward promoting physically active recreation for adults with chronic neurological conditions. Nine physiotherapists who worked with adults with neurological disability in a range of long-term rehabilitation and community (home) health services were interviewed and the data analysed for themes. The physiotherapists described innovative and resourceful expertise to assist patients to be physically active. However, they perceived a lack of support for their work from within the health system and a lack of knowledge of disability issues within the recreational arena, both of which they perceived hindered their promotion of physical activity for people with neurological disability. Physiotherapists feel unable to fully support health and disability policies for the promotion of physically active recreation for people with neurological conditions, because of perceived constraints from within the recreational arena and their own health systems. If these constraints were addressed, then physiotherapists could be better agents to promote physical activity for people with neurological conditions. [ABSTRACT FROM AUTHOR]

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While there is a need for more detailed information on health inequality to guide public health policy, the most complete and easily available data remain those in mortality tables. We investigate, via a comparative analysis of data from new Zealand on Māori and non-Māori mortality, whether more detailed information than raw life expectancy may be extracted from the mortality tables. Given a parametric distribution for the mortality capable of fitting irregularities in mortality table data, the curvature of the survival and hazard rates can identify changes in mortality rates, such as infant and late-life adult mortality, which allows for straightforward comparisons between the two sub-populations. Our results identify an exogenous effect in earlier mortality among Māori, which correlates well with many published observations of health and health-care inequalities between Māori and non-Māori. This "proof of concept" for our method of analysis indicates that examination of bulk data such as those in mortality tables has a potential role in the design of more detailed studies involving causes of mortality. [ABSTRACT FROM AUTHOR]

The concept of the hollow state has been proposed as a general framework for public sector restructuring, with New Zealand seen as a leader in reforming social and welfare services, including mental health. This article reports on documentary and interview research into the provision of community-based mental health services in terms of hollow state characteristics: privatization, decentralization and flexibilization. The evidence suggests that privatization occurred only at the margins, that decentralization led to significant regional differences in contractual arrangements and services and that flexibilization brought mixed blessings to the agencies involved. Consistent with findings from elsewhere related to hollow state mechanisms, performance assessment and accountability became more difficult. It is concluded that such frameworks are not appropriate for sectors such as mental health where there is high uncertainty and vulnerable service recipients. Recent policy changes suggest a retreat from privatization and flexibilization, and the emergence of a new balance between centralized and decentralized decision making. [ABSTRACT FROM AUTHOR]

Contemporary health sector reform is frequently underpinned by market-influenced public policy "prescriptions." Such prescriptions provide details of what policies ought to look like, but little by way of how they should be implemented. This article compares the experience of New Zealand and Hong Kong, two locations in which recent health reforms were based upon the policy prescription. Where the respective health policies bear similarities, implementation styles differ with interesting consequences. New Zealand's apparent "success" in implementation may ultimately prove counterproductive; it seems more likely that Hong Kong, whose implementation success has been, to date, moderate, will achieve objectives of providing a better public health service. [ABSTRACT FROM AUTHOR]