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Tēnā koutou katoa,

Each fortnight, we will highlight three hot policy topics related to public health in Aotearoa. Our aim will be to summarise the issues and stimulate debate and facilitate sharing of viewpoints from across the wide and diverse public health spectrum.

We particularly welcome contributions from our public health student members. Around 500 words, please. Editor's reserve the right to balance content  (two "guest spots" per edition) across different policy spots!

To suggest topics for inclusion, or to respond to the issues raised, please contact leonie@pha.org.nz 

 
Policy challenges of the digital divide in Aotearoa 

Every aspect of life in New Zealand is increasingly being digitalised, with data being generated by both government and non-governmental organisations that span education, income, employment, housing, benefits, migration, justice, and health. Additionally, goods and services from on line retail or banking to news, sources of vital advice and the very mechanisms of civic inclusion now rely on access to the internet. Differential access, affordability and digital literacy has exacerbated significant communication inequalities; differences in the generation, use, manipulation, and distribution of information can disadvantage the already vulnerable. 

A 2015 MBIE study found that internet access for both Māori and Pacifica was lower than for other groups in New Zealand. It also reported that those who rented a house or flat from HNZC or the local (social housing) equivalent had the lowest proportion of people with internet access; considerably lower than home-owners. Retirees (especially those over 75) and the disabled had the least access. The rural-urban divide has recently benefitted from the roll out of ultra-fast broad band, aided by funding from the government strategic priorities relating to the digital domain including internet access (Ministry of Business, Innovation & Employment & Stats NZ, 2019), though there have been arguments that wealthy farmers may have benefitted more than rural poor. 

In the health sphere, communication inequalities affect health-related outcomes. The social determinants of health (particularly education, housing and income) impact how people access, seek out, process, and use health-related information. Communication influences all aspects of health including prevention, diagnosis, treatment, survivorship, and end-of life care. While technological developments can bring significant advantages to patients, these advantages are primarily realized by those with greater resources, widening health disparities.  

Research suggests that community access, combined with point of use assistance where needed is an effective way of providing internet, computer and printer access to people in areas that might not be readily served. This could occur through installing additional computers in libraries and community centres and by providing free wireless internet in places like parks, buses, or churches. 

The recently published  The five point plan for digital inclusion, arguing for affordable, strengthened infrastructure, device access and provision through library internet services and using community services like Citizens Advice Bureau, providing support and digital skills teaching and longer term internet resilience could be a very useful and necessary initiative. 

Until the digital divide is addressed, those in public health and health communications must remember that those most reliant on high quality health messages and advice may be the least able to access sources that seem increasingly solely reliant on social media and the internet. 

Government to mandate folic acid in most bread-making flour to protect babies

Low folate levels in mothers cause neural tube defects that result in the death of babies, or life-long disability. New Zealand currently has around 10.6 neural tube defects per 10,000 births, compared to 8.7 in Australia, which mandated fortification in 2016. Cheaper white bread lacks folate, meaning poorer women, notably Māori and Pacifica women are at more risk of being folate deficient. 
 
In 2018 Sir Peter Gluckman and Royal Society Te Apārangi published a review of the health benefits and potential risks of adding folate (folic acid) to packaged bread to reduce the rate of neural tube birth defects in New Zealand. The evidence supported mandatory fortification.
 
Public opposition to the idea of large-scale mandatory fortification exists in NZ, representing a barrier to achieving the goals of folic acid fortification. Political discourse and media coverage have framed the debate around:

  • ethics (freedom of consumer choice, or opposition to “mass medication”),
  • necessity (is the government and the baking industry responsible for ensuring pregnant women get sufficient folic acid?) and
  • safety (concerns about adverse effects of dietary folic acid).
 Industry concerns over consumer reluctance, increased costs and loss of revenue represented a significant barrier to fortification when participation in the scheme was voluntary.

However, an Examination of barriers and enablers to uptake of folic acid fortification of bread in New Zealand found that consumer reluctance (mainly centered on folate being an artificial or processed additive) was relatively minor. As folate is not mandated in organic and wholegrain bread, wealthier consumers may choose alternatives.
 
In mandating fortification, science and health equity have been chosen over industry concerns.

FSANZ: Food irradiation extended in Aotearoa

In November 2019, FSANZ  received an application (A1193) to extend the current irradiation permissions in the Code to include all fresh fruit and vegetables as a phytosanitary measure. This has now been approved. Food irradiation, most commonly gamma radiation,  is a technique used to kill insects and harmful bacteria in food. Irradiation can also be used to slow down the ripening of food and stop food from sprouting to extend its shelf life. This can protect the biosecurity in particular for fruit growers, and reduce the need for higher use of pesticides.

Extending the shelf-life of food reduces food waste, and may also, therefore, reduce the costs of fresh fruits and vegetables. It is most commonly used for high value, imported, and perishable crops such as tropical fruits, persimmons, tomatoes and capsicums, berry fruits and now a range of other specific fruit and vegetables (apple, apricot, cherry, nectarine, peach, plum, honeydew, rockmelon, squash, strawberry, grapes, zucchini).

There were numerous early surveys of consumer acceptance of food irradiation. Many of these indicated consumer oppositions or reluctance to purchase irradiated foods, including a 2002 study of New Zealand and Australian consumers (Gamble 2002). Some of the studies indicated that consumers may be more concerned about chemical residues from pesticides than irradiation. More informed concerns include the loss of nutrients (natural decline) due to the longer storage of irradiated foods and possible radiolytic by-products formed during irradiation. FSANZ has examined these concerns (and many others) and concluded that “that phytosanitary doses of irradiation do not pose a nutritional risk to the Australian and New Zealand populations.”

Labeling of food as irradiated is still mandated by FSANZ, so as with fortified bread, wealthier consumers can choose organic and non-irradiated but more expensive produce.
Questioning transgender womens' participation in sports
causes real harm to all.
The selection of Lauren Hubbard, the first openly transgender athlete ever to compete at the Olympics,  generated a fierce debate on gender, sexism, and sport. To her supporters, the 43-year-old's selection is a decades-in-the-making milestone that exemplifies the Olympic spirit of inclusion and could inspire transgender athletes who are underrepresented in sport at all levels. Others, including some other athletes (none of whom are privy to her personal journey), have been vocal and hateful in their responses.

The IOC rules -- agreed on in 2003 and known as the Stockholm consensus -- allowed transgender women and men to compete in the Olympics, as long as they had "surgical anatomical changes" (including having their testes or ovaries removed), obtained legal recognition of their assigned sex, and underwent hormone therapy for sufficient time to "minimize gender-related advantages." 

 Kristen Worley became the first athlete to undergo an Olympic gender verification process when she tried to represent Canada in track cycling at the 2008 Olympics in Beijing, with devastating results. Scared and traumatized after the years-long processes and invasive intimate examinations, she quit, losing her career, health, and wellbeing. "When you're violated in that way ... you never forget it. You just learn how to manage it," she told CNN in a Zoom interview. The way her gender identity was publicly discussed destroyed her: "It made me feel like I was less than half a human being."

While participation in elite sport is the pinnacle of achievement for a tiny few, such debate can also sow division and have a chilling effect on participation for all. Acceptance of womens' participation in sport, with the resulting physical, emotional and psychosocial benefits that follow, has been hard-won, and we are still very far away from equality in sport. 

Racism, sexism, misogyny and homophobia are rife in sport at all levels. Insistence on the depiction of "ideal' feminine bodies (especially the insidious effects of sports sponsorship and their PR / image manipulation) can lead to body dysmorphia, anorexia, damage self-esteem and can deter girls and young women in particular from pursuing sports. Stoking fears that they might get swept into questions of sexual or gender identity will not help. 

People transition to truly be themselves and to make themselves feel comfortable, not to take advantage in a sport. They have a passion to compete and play. They certainly do not deserve the hate. 

 






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