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The Public Health Association of New Zealand beseeches the new Government to reverse their decision to repeal smokefree legislation. The move by the Government undermines decades of public health progress and poses a severe threat to the well-being of our communities, particularly our Māori and Pacific populations.

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In recognition of the profound impact of armed conflicts on global health, the Public Health Association of New Zealand asserts that the pursuit of peace is an urgent and imperative public health priority. Wars, with their indiscriminate nature, transcend borders and pose substantial threats to the well-being of populations, both human and environmental (1, 2).

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As we approach the upcoming election, the Public Health Association reaffirms its commitment to advancing public health priorities in Aotearoa New Zealand. Our nation's public health policies hold the power to shape the well-being of all New Zealanders, transcending political affiliations. The choices made at the ballot box will determine the future of public health in our country, and it is imperative that we address key election considerations in this context.

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The determinants of health are the range of factors that influence the health and well-being of individuals and populations. While many are familiar with the traditional determinants such as socioeconomic status, education, and healthcare access, there is another significant set of factors that shape health outcomes: the commercial determinants of health. In this blog, we will explore what the commercial determinants of health are and how they impact our well-being.

Defining the Commercial Determinants of Health

The commercial determinants of health refer to the actions and practices of commercial entities, such as industries and businesses, that have an influence on health outcomes. These determinants operate through various mechanisms, including the production, marketing, and distribution of goods and services, as well as through their impact on policy-making processes. The commercial determinants of health encompass a wide range of industries, including tobacco, alcohol, food and beverages, pharmaceuticals, and advertising.

Understanding Their Impact

Product Availability and Accessibility

The commercial determinants of health can significantly impact the availability and accessibility of goods and services that affect health outcomes. For instance, the availability of unhealthy food options, high-sugar beverages, and tobacco products in communities can contribute to poor dietary choices, obesity, and tobacco-related illnesses. Similarly, limited access to affordable and essential medications or healthcare services due to pricing practices can negatively impact health outcomes.

Marketing and Advertising Practices

Marketing and advertising play a central role in shaping consumer behavior and preferences. The commercial determinants of health heavily rely on marketing strategies to promote products and influence consumer choices. Aggressive marketing tactics employed by industries, particularly towards vulnerable populations like children and adolescents, can lead to the consumption of unhealthy products and contribute to the burden of non-communicable diseases. These marketing practices often prioritize profit over public health considerations.

Policy Influence

Powerful commercial entities have the potential to influence policy-making processes and regulations related to public health. Their lobbying efforts, financial contributions, and industry-funded research can shape policy decisions and hinder public health interventions. For example, tobacco companies have historically utilized their influence to impede tobacco control policies, delaying or diluting their implementation. Understanding the impact of industry influence on policy-making is essential for ensuring evidence-based and effective public health strategies.

Socioeconomic Inequalities

The commercial determinants of health are closely linked to socioeconomic factors and can exacerbate existing health inequalities. Commercial activities often target vulnerable populations, such as low-income communities, contributing to health disparities. Limited access to healthy food options, healthcare, and safe environments due to economic constraints perpetuates health inequities. Addressing these commercial determinants of health is vital for reducing health disparities and promoting health equity.

Environmental Impacts

Commercial activities can have adverse effects on the environment, which in turn impact public health. Industries that contribute to air and water pollution, deforestation, and climate change can lead to a range of health issues, including respiratory problems, infectious diseases, and increased vulnerability to extreme weather events. Addressing the commercial determinants of health requires considering the environmental impacts of industries and promoting sustainable practices that prioritize the health of both individuals and the planet.

Conclusion

Understanding and addressing the commercial determinants of health is crucial for improving population health outcomes in the modern day. The impact of industries on health extends beyond individual choices and behaviours. By recognizing the influence of commercial entities on product availability, marketing practices, policy-making, and socioeconomic inequalities, we can develop comprehensive public health strategies. Efforts to promote healthier products, responsible marketing practices, evidence-based policies, and health equity require collaboration among stakeholders, including public health professionals, policymakers, and commercial sectors. By tackling the commercial determinants of health, we can work towards a healthier society where the pursuit of profit aligns with (or is not deemed to be superior to) the promotion of public health.

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

Public health is the science and practice of protecting and improving the health of individuals and communities through organized efforts. It goes beyond individual health concerns and takes into account the social, economic, and environmental factors that influence health outcomes. The field of public health utilizes a multidisciplinary approach, drawing on knowledge and methods from various disciplines such as epidemiology, biostatistics, environmental health, health promotion, and policy.

Basics of Public Health

1. Disease Prevention and Control: Public health emphasizes preventing diseases and controlling their spread. This involves surveillance, outbreak investigations, vaccination campaigns, and implementing measures to reduce exposure to infectious agents.

2. Health Promotion and Education: Public health focuses on promoting healthy behaviors and educating communities about health risks and preventive measures. This includes initiatives to promote physical activity, healthy eating, smoking cessation, and safe sexual practices.

3. Environmental Health: Public health addresses the impact of environmental factors on health. This includes monitoring air and water quality, ensuring food safety, managing waste disposal, and mitigating environmental hazards.

4. Policy and Advocacy: Public health plays a vital role in advocating for policies that support health and well-being. It involves working with policymakers to develop evidence-based regulations, laws, and initiatives that protect public health and address health inequalities.

5. Data Analysis and Research: Public health relies on robust data collection, analysis, and research to inform decision-making and develop evidence-based interventions. This includes conducting epidemiological studies, analyzing health trends, and evaluating the effectiveness of public health programs.

A Brief History of Public Health

The roots of public health can be traced back to ancient civilizations where efforts were made to manage sanitation and prevent disease outbreaks. However, modern public health as we know it today emerged in the 19th century.

1. Sanitary Movement: In the 19th century, the Sanitary Movement led to significant advancements in public health. Public health pioneers like Edwin Chadwick and John Snow championed the importance of clean water, sanitation, and improved living conditions to combat diseases such as cholera.

2. Infectious Disease Control: The discovery of microorganisms and the development of vaccines and antibiotics revolutionized public health in the early 20th century. Landmark achievements include the eradication of smallpox and the development of vaccines for polio and other infectious diseases.

3. Health Promotion and Chronic Disease: With the epidemiological transition, the focus of public health expanded to include chronic diseases such as heart disease, cancer, and diabetes. Efforts shifted towards health promotion, risk factor reduction, and lifestyle interventions.

4. Global Health and Equity: Public health has increasingly embraced a global perspective, addressing health disparities and inequalities within and between countries. Initiatives such as the Millennium Development Goals and the Sustainable Development Goals have underscored the importance of addressing social determinants of health and achieving health equity.

Public health is an essential field that aims to protect and improve the health of communities and populations. Through disease prevention, health promotion, environmental health, policy advocacy, and research, public health professionals work tirelessly to safeguard the well-being of individuals and society as a whole. As we move forward, public health continues to evolve, adapting to new challenges, emerging diseases, and the changing needs of diverse communities. By recognizing the importance of public health and supporting its endeavors, we can build healthier communities and pave the way for a brighter future.

If you want to learn more about public health or hold an introductory 'Public Health 101' workshop at your workplace or in your community, feel free to get in contact.

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