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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.

To suggest topics for inclusion, or to respond to the issues raised, please contact 

Covid-19 vaccination, medical ethics and freedom to dissent?

The Medical Council has come out strongly following widely reported evidence that a concerted campaign is set to undermine the vaccine roll out; warning that doctors spreading misinformation about the Covid-19 pandemic and the vaccination program could face professional sanctions including de-registration.

The Medical Council’s concerns about the harms of such misinformation are not without precedent.  Andrew Wakefield, a former physician and academic was struck off the British medical register due to his involvement in the Lancet MMR autism fraud, a 1998 study that falsely claimed a link between the measles, mumps, and rubella (MMR) vaccine and autism. He has subsequently become known for anti-vaccination activism. Publicity around the 1998 study caused a sharp decline in vaccination uptake, leading to a number of outbreaks of measles around the world. Wakefield has continued to defend his research and conclusions, saying there was no fraud, hoax or profit motive. In 2016, Wakefield directed the anti-vaccination film Vaxxed: From Cover-Up to Catastrophe, which was widely shown in parts of New Zealand –  and which was linked to a reduction in MMR vaccinations in the same areas: particularly in Northland and Golden Bay.

Kate Hannah, (disinformation) research fellow at the University of Auckland recently brought to the attention of the RNZGP an open letter signed by more than a dozen general practitioners sharing some of the same misleading claims around Pfizer's Covid-19 vaccine that were published and distributed by anti-vaccination and Covid-19 denial groups. The letter's contents have been confirmed by experts in the field as misinformation, or incomplete and taken out of context at best. Vaccinologist Helen Petousis –Harris has comprehensively answered these claims.

While healthy debate is essential, and doctors have an ethical duty to present their concerns if they have credible evidence of harm, it is surely in the public interest for these to be presented to credible academics and the Ministry of Health for evaluation with the rest of the scientific claims rather than risk harming public confidence in this vital work.

Balancing de-bunking misinformation with avoiding fuelling conspiracy theories is a difficult act: fortunately, a growing evidence base for how to do this effectively is emerging!
Michael Baker, a harm-reduction advocate, joins the Drug Foundation! 
During the time of alcohol prohibition in the U.S. (1920-1933), drinkers didn’t stop drinking because alcohol was illegal. They just bought their alcohol from different sources. Bootleggers and gangsters saw the profit to be made in black market alcohol and took advantage of an enormous untaxed business opportunity provided by Prohibition. Violent clashes between rival gangs vying for territory, and between the police and these gangs, turned into a low-grade, asymmetrical war, in which thousands of lives were lost” 

Sound familiar?  Taken further, Nixon’s War on Drugs, was a brilliant political move. It not only resulted in his landslide re-election in 1972, but also as an approach, it was copied all around the world. All too often, bad public policy is good politics.

Not only has drug use and deaths related to crime and violence across the world  continued to escalate, but new waves of harm from pharmaceutical and other synthetic products wreak harm; particularly in vulnerable communities.

The recent Cannabis legalisation debate provided a start for a more open and evidenced discussion. In calling for the funding currently spent on policing and incarcerating drug users to be available to empower community-based organisations, provide access to effective treatment for mental health and addictions, and a raft of health, social and other measures that could accompany the decriminalisation of drugs, provides a glimmer of hope to those who have been calling for such change.

Professor Michael Baker, known for his work on the Covid-19 response and establishment of the Needle Exchange Programme in NZ in the late 1980s, has just been appointed to the board of the NZ Drug Foundation. Baker’s decision to join to take up the role is warmly welcomed, bringing this respected public health expert, and his perspectives as a harm reduction proponent, into an arena where policy change is sorely needed.

The collective response to Covid-19, where the Government, the public, scientists, and science communicators firmly demonstrated the effectiveness of using evidence (often in the face of uncertainty, misinformation, political dissension, and fear) to inform public perceptions and influence health policy.

Let’s hope that in Aotearoa, drug policy development will “put science and evidence first, shed Nixon's shadow and re-write our drug laws based on public health principles at the core”.

Food insecurity in the land of plenty
Food insecurity is defined as a lack of assured access to sufficient nutritious food.  The 2019 study Household Food Insecurity Among Children in New Zealand identified that nearly a million children aged 0-14 in New Zealand experience severe to moderate food insecurity. The report highlighted the association between low socioeconomic position and household food insecurity.

The nutritional quality of food consumed in households (for example meeting fruit and vegetable guidelines, avoiding obesogenic fast foods and fizzy drinks) varied significantly, and lack of access to healthy food was strongly correlated with poverty, deprivation, housing insecurity, and being of Pacific and Māori ethnicity.

It confirmed that children in food-insecure households fare worse than children in food-secure households on indicators of health, development, and access to health services. Their parents were more likely to report psychological distress and, more specifically, stress related to parenting.

At the same time, there are rising levels of food waste. Up to 8.6 percent of all weekly food spend is ending up in landfills around the country, generating greenhouse gasses such as methane. Such gross waste and inequality could be constructed as a breach of human rights.

Taking a  Health in all policies. approach to food insecurity is especially important during a pandemic. Not only does a healthy diet play a vital role in supporting the immune system, but food supply chains may be disrupted, there may be a financial impact from insecure work, and access to healthy and affordable food options may not be available and accessible to all residents. Additionally, an economic downturn places more demand on food banks, community pantries and food rescue services. Longer-term, urban food growing and foraging (e.g. mahinga kai, growing at home, school, parks and community gardens) can be encouraged and supported to increase access, self-sufficiency and food sharing.

A recent study by McKerchar, Lacey & Signal, Ensuring the right to food for indigenous children examined food insecurity and obesity in tamariki Māori, taking a human rights and policy approach to tackling this long-standing and insidious issue. 
They concluded that “The right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ”.  

They advocate for:  1) a comprehensive policy response that supports children’s rights; 2) an end to child poverty;  3) food provision and healthy food policy in schools;  4) local government policy to promote healthy food availability, and 5) stronger Māori voices and values in decision-making.

In a country where food exports comprise over 65% of all merchandise exports, this timely and insightful study challenges us all to improve access to healthy food for all.

( Main Source: http:// )

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