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Ngā mihi ki a koutou katoa,  

Welcome to policy spot 101.

What a pleasure to showcase the work of some of our members and supporters: and to provide a platform for debate. I had hoped the spot on Teen Vaping would prompt a rebuttal, and am pleased to publish just this, from Robert Beaglehole!

As ever, please continue to contribute to the debates, showcase your public health specialism or passion, and get involved with YOUR association.

To our members: Thank You, and keep up the good work! To our supporters and subscribers, please consider joining / re-subscribing to become members of the PHA. In these exciting times for public health, it is vital that we can demonstrate the depth and breadth of this important work, and add as many and diverse voices as possible to the submissions we make in support of reducing inequity and improving the health of all New Zealanders. 

Delighted to say we now have an Office Manager - much-needed support for all the back-office functions that keep the PHA afloat.

Mauri ora!

Ngā mihi mahana 
Leonie Walker 
PHANZ HQ Wellington 

Keep in touch by emailing grant@pha.org.nzleah@pha.org.nz, leonie@pha.org.nz

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In this week's PolicySpot:
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New Starter!

Meet our new Office Manager Nikita Kataria

Nikita has over 6 years of experience in the Insurance sector specialising in Finance, Operations, Marketing, and focussing on improving customer service. Her post-graduate study is in Marketing Management from the University of Auckland. Nikita has worked as a Quality Analyst and proceeded to develop her career with Public Health Association as an Office Manager. She has a core interest in contributing her skills, raise awareness and be a part of evolving Public Health Association. She said: " It gives me immense pleasure to be a part of such an exciting team".

You can contact Nikita by email at nikita@pha.org.nz 

 


 


Each fortnight, we will highlight hot policy topics, blogs or publications 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 

 
Guest topic:

World Breastfeeding Awareness week 2021
National Breastfeeding Strategy for New Zealand Aotearoa
Rautaki Whakamana Whāngote


 

Breastfeeding is established worldwide as a key public health measure that protects infant and maternal health thus reducing healthcare costs through decreased use of services.  Breastfeeding promotes health, prevents disease and helps contribute to reducing health inequities. Global public health policy therefore recommends exclusive breastfeeding for the first 6 months of life, continued alongside solid foods for as long as mother and infant desire.

The recent launch of the National Breastfeeding Strategy for New Zealand Aotearoa Rautaki Whakamana Whāngote by the Ministry of Health (MoH) recognises that increasing the exclusivity and duration of breastfeeding is a key determinant of public health and is one of the most significant and cost-effective ways to improve equity and increase the health and wellbeing of a population.   Further information from the MoH website and the National Breastfeeding Strategy for New Zealand Aotearoa states:

 In New Zealand Aotearoa only between 17 and 22 percent of children are exclusively breastfed to around six months (Ministry of Social Development 2018). Rates of exclusive breastfeeding are consistently lower for Māori and Pacific people.  Achieving ‘optimal infant feeding’ is a complex and multidimensional challenge that requires strong government leadership and coordination, and a holistic, whole-of-system approach.  Improving breastfeeding rates in New Zealand Aotearoa will directly contribute to:

·   achieving equitable health outcomes for Māori

·   improving overall population health outcomes

·   improving maternal and child mental wellbeing

·   reducing health costs through prevention of illness

·   sustainability and waste reduction

https://www.health.govt.nz/our-work/life-stages/breastfeeding/national-breastfeeding-strategy-new-zealand-aotearoa-rautaki-whakamana-whangote

Breastfeeding touches on social, economic, educational, institutional, and political spheres and the recent release of the National Breastfeeding Strategy for New Zealand Aotearoa makes this a timely topic for sharing
of information and viewpoints.

 

Cara Hafner, RN, IBCLC

Baby Friendly Advisor and Coordinator

New Zealand Breastfeeding Alliance

Right to Reply! 
The place of Vaping in Smoking Cessation

 Robert Beaglehole and Ruth Bonita, Emeritus Professors, University of Auckland

Tobacco harm reduction: the key to reaching Smokefree 2025
 
Aotearoa New Zealand is responding intelligently to the most critical tobacco policy discussion: the trade-off between supporting adult cigarette smokers to quit and the need to prevent young people from becoming cigarette smokers.
 
The aim, above all, is to reduce the enormous burden of premature death and disease caused by cigarette smoking. Nicotine-dependent cigarette smokers deserve dignity and empathy, not stigmatisation and punishment.
 
In New Zealand, 14 people die every day from tobacco-caused diseases, losing, on average, ten years of life compared with lifelong non-smokers.  The gap in life expectancy between Māori and other New Zealanders is seven years and cigarette smoking alone accounts for two of these years of life lost[i].  From this perspective, we mustn’t let the issue of vaping among young people distract from the pressing need to support adults to quit smoking.
 
Although young people are experimenting with vapes, the 2019 ASH Year 10 data found that very few non-smoking young people use vapes daily[ii]. Fortunately, there is no strong evidence that vaping is a gateway to smoking[iii], [iv]. In fact, there may be a gateway out of, or away from, smoking. Also, young people prone to cigarette smoking are the most likely non-smokers to vape - suggesting that vaping may be reducing risks for young people who would otherwise smoke cigarettes. Above all, it is highly unlikely that many young people today will go on to smoke cigarettes for the twenty years it takes to develop the ill effects of smoking. There are too many attractive alternatives and too many disincentives - from the price of cigarettes to stigmatisation - for this to happen. The 2020 vaping legislation and the forthcoming associated regulations, including the effective enforcement of the age limit on vape sales, will discourage teen vaping.
 
Although Aotearoa New Zealand is not on track to achieve the 2025 goal of an adult cigarette smoking prevalence of less than 5%, we are fortunate to have an Associate Minister of Health and a Government strongly committed to the goal. Achieving the goal requires at least 60,000 successful quits every year, up from the current level of about 15,000[v]. At the same time, we need to entrench the very low uptake of cigarette smoking by young people
 
Fortunately, we have a proven public health strategy – harm reduction - to accelerate progress towards the goal. Harm reduction is used widely, for example, seat belts to reduce injuries from car crashes and needle exchange programmes to reduce HIV infections. Since it is the smoke that kills, not the nicotine, tobacco harm reduction (THR) involves reducing the harm from burnt tobacco, through cigarette smoking cessation support, pharmaceutical nicotine replacement therapy (patches, lozenges etc.), and now from innovations in safer nicotine delivery with the availability of vapes, heat-not-burn products, snus, and oral nicotine pouches.
 
Reduced harm approaches to cigarettes help smokers transition away from cigarettes. In real-world conditions, monthly monitoring of smoking and vaping in the UK shows that vaping is the single most effective tool used by recent ex-smokers[vi]. Vaping has been the most significant contributor to the decline in cigarette smoking rates in the UK over the last eight years[vii]. Vaping has enormous potential to disrupt the cigarette market and is key to the tobacco harm reduction strategy.
 
Vapes and other cigarette alternatives are much, much less harmful than cigarettes.[viii] The suggestion that there are long-term effects of vaping on the respiratory and cardiovascular systems is incorrect[ix]. One of the early – and unfortunately influential - papers suggesting this possible adverse relationship, has since been retracted[x]. Vaping products are not only less harmful than cigarettes, they are also much cheaper.
 
The draft National Plan for Smokefree 2025 proposes interventions to address the accessibility, affordability and acceptability of cigarettes[xi]. The plan, which will be finalised later this year, is bold and ambitious.
 
But we don’t need to wait. ASH has proposed three immediate and related priorities:

  • a significant increase in mass marketing to encourage quitting;
  • increased support to communities to promote innovative interventions to support quitting; and
  • widespread and ongoing encouragement of cigarette smokers to switch to less harmful alternatives[xii].
 Urgent action by the Government and others on these easily implemented priorities will achieve fair and equitable results.  The cost of these immediate interventions will be minimal in both the political capital required, and in comparison to the over $1 billion tax revenue from cigarettes, most of which comes from poor people.

Tobacco harm reduction complements the Government’s plan to reach Smokefree 2025. It will also provide major health, economic and equity benefits to the whole country. The PHA must strongly support this public health goal; it is the critical issue on which the PHA can provide national leadership.
 
Robert Beaglehole and Ruth Bonita, Emeritus Professors, University of Auckland
PHA Public Health Champions 2010.
 

[i] Walsh M, Wright K. Ethnic inequities in life expectancy attributable to smoking. NZMJ 2020; 133: 28-38
 

[iii] Walker N, Parag V, Wong SF et al. Use of e-cigarettes and smoked tobacco in youth aged 14–15 years in New Zealand: findings from repeated cross-sectional studies (2014–19). Lancet Public Health. Open Access Published:January 22, 2020DOI:https://doi.org/10.1016/S2468-2667(19)30241-5

[iv] Chan GCK, Stjepanovic D, Lim C, et al. Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation. Addiction First published: 04 September 2020. https://doi.org/10.1111/add.15246

[vi]  https://docs.google.com/spreadsheets/d/1kApy_kp8vI1MXQ6IN6v6ZxZC82Xm7NjdabJHQxi_X-k/edit#gid=0

[vii] Levy DT, Sanchez-Romero LM, Li Y. England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England. Addiction. First published: 19 September 2020 https://doi.org/10.1111/add.15269

[viii] McNeill et al, E-cigarettes: an evidence update – A report commissioned by Public Health
England, Public Health England, August 2015

[ix] Critcher CR, Siegel M. Re-examining the Association Between E-Cigarette Use and Myocardial Infarction: A cautionary Tale. Am J Prev Med July 22, 2021 DOI:https://doi.org/10.1016/j.amepre.2021.05.003

[x] Retraction to: electronic cigarette use and myocardial infarction among adults in the U.S. Population Assessment of Tobacco and Health [retraction of: J Am Heart Assoc. 2019;8(12):e012317].
J Am Heart Assoc. 2020; 9e014519https://doi.org/10.1161/JAHA.119.014519
 
[xi] https://www.health.govt.nz/publication/proposals-smokefree-aotearoa-2025-action-plan

 

 

Member paper spotlight: 
COVID-19 and Indigenous knowledge and leadership: (Re)centring public health curricula to address inequities

Authors: Christina SeverinsenFelicity WareHeather CameLinda Murray            

Conclusion: 

In Aotearoa New Zealand, those working in public health must recognise Māori as Tāngata Whenua (Indigenous people of the land), and acknowledge Te Tiriti o Waitangi responsibilities, working to eliminate ethnic health inequities. The COVID-19 pandemic response has provided discussion about how we can ensure our public health actions and outcomes reflect the realities and aspirations of Māori. Like the Ottawa Charter, which is about the relationships between individuals, communities and governments, Te Tiriti o Waitangi is also about relationships, especially the Crown's relationship with Māori, the balance between state control and autonomy, and the opportunity for cooperative action so that mutual collective benefits might be realised.

Will our current health promotion pedagogies equip us with a workforce competent in decolonisation, able to support meaningful relationships with communities and Indigenous peoples, and ready to do political and anti-racism work? The challenge for us as teachers is to disrupt the longstanding traditions of public health that focus on Eurocentric methodologies and that limit our ability to achieve equity. We must have courageous conversations with each other and our students about how racism and colonisation continue to shape both our past and present.

 

 
Recent Submissions and 
Consultations open:

 Joint Venture Family Violence Sexual Violence Consultation  Submitted 29 June 2021


Resource Management Act 

Natural and Built Environments Bill: Submitted 02.08.21

A high-level overview of the key differences between the RMA and the proposed NBA (and Spatial Planning and Climate Change Adaptation Acts) is available on the Ministry for the Environment’s website.

 

[RMA Consultation with Tangata Whenua guidance]

 
Hepatitis Action Plan Launched

Amid this Covid -19 Pandemic, it is sometimes easy to forget the other viral pandemics that kill millions of people. Hepatitis C is a blood-borne virus that attacks the liver and can lead to cancer. It is very pleasing to see that the Ministry of Health has responded to the WHO call to action. 

The World Health Organization estimates there are 71 million people affected by hepatitis C around the world. For more details refer to their Hepatitis C factsheet.

Hepatitis C affects approximately 45,000 New Zealanders but because symptoms often don’t show for many years, thousands may be unaware they have it. Hepatitis C is the leading cause of liver transplantation and the second leading cause of liver cancer in New Zealand. It is estimated around 1,000 people currently contract the virus every year, and more than 200 die from it.

The recent development of a highly effective, direct-acting antiviral treatment for hepatitis C provides New Zealand with an opportunity to eliminate hepatitis C as a major public health threat. Since February 2019, around 4,500 New Zealanders with hepatitis C have been treated with Maviret, a new treatment funded by PHARMAC.

The Action Plan has been developed in collaboration with a working group made of representatives from DHBs, primary health organisations, government agencies, laboratories, public health services, needle exchange services, community alcohol and other drug services, addiction services, consumer representatives, the hepatitis C health workforce (including hospital specialists, general practitioners and nurses), the Māori and Pacific workforce, and other national and non-governmental organisations.

The Action Plan was launched and published on World Hepatitis Day, 28 July 2021.

PHA@AUT:Critical te Tiriti analysis:
A tool to strengthen te Tiriti compliance workshops - NEW DATE!
(Photo credit Leah Bain)

Critical te Tiriti analysis: A tool to strengthen te Tiriti compliance August 16th 2021 

Critical te Tiriti analysis: A tool to strengthen te Tiriti compliance interactive workshops led by Assoc Prof Jacquie Kidd and Dr Heather Came have been wildly popular selling out in record times. A second workshop was then offered which has also sold out in quick succession. 

We are proud the highlight both these workshops and the CTA tool developed by Prof Tim McCreanor and Dr Heather Came to inform the development of policy, review policy/curriculum/competencies, analysis qualitative research data to check te Tiriti compliance. Ka mau te wehi!
Have an event to share? Send the details through to leah@pha.org.nz and we'll feature it here. 






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