1
|
Gage R, Chambers T, Smith M, McKerchar C, Puloka V, Pearson A, Kawachi I, Signal L. Children's perspectives on the wicked problem of child poverty in Aotearoa New Zealand: a wearable camera study. N Z Med J 2022; 135:95-111. [PMID: 35999785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM Child poverty is a wicked problem and a key determinant of health, but research on child poverty has relied largely on self-report methods and reports from parents or caregivers. In this study we aimed to assess aspects of child poverty using data collected by children using wearable cameras. METHOD The Kids'Cam Project recruited 168 randomly selected children aged 11-13 from 16 randomly selected schools in the Wellington Region of Aotearoa New Zealand. Each child wore a wearable camera for four consecutive days, recording an image every seven seconds. We used negative binomial regression models to compare measures of household resources, harms, behaviours and built environment characteristics between children living in low socio-economic deprivation households (n=52) and children living in high socio-economic deprivation households (n=26). RESULTS Compared with children living in conditions of low socio-economic deprivation, children living in conditions of high socio-economic deprivation captured significantly fewer types of fruit (RR=0.46), vegetables (RR=0.25), educational materials (RR = 0.49) and physical activity equipment (RR = 0.66) on camera. However, they lived in homes with more structural deficiencies (RR=4.50) and mould (no mould was observed in low socio-economic deprivation households). They were also less likely to live in households with fixed heating (RR=0.27) and home computers (RR=0.45), and more likely to consume non-core food outside home (RR=1.94). CONCLUSIONS The children in this study show that children in poverty face disadvantages across many aspects of their lives. Comprehensive policies are urgently needed to address the complex problem of child poverty.
Collapse
Affiliation(s)
- Ryan Gage
- Department of Public Health, University of Otago, Wellington
| | - Tim Chambers
- Department of Public Health, University of Otago, Wellington
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington
| | | | - Viliami Puloka
- Department of Public Health, University of Otago, Wellington
| | - Amber Pearson
- Department of Geography, Environment and Spatial Sciences, Michigan State University
| | | | - Louise Signal
- Department of Public Health, University of Otago, Wellington
| |
Collapse
|
2
|
Gray L, MacDonald C, Puloka A, Bocock C, Gwyther R, Rushton A, Puloka V, Becker JS, Kvalsvig A, Baker MG. The lived experience of hotel isolation and quarantine at the Aotearoa New Zealand border for COVID-19: A qualitative descriptive study. Int J Disaster Risk Reduct 2022; 70:102779. [PMID: 36569446 PMCID: PMC9764876 DOI: 10.1016/j.ijdrr.2021.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 06/17/2023]
Abstract
Hotel-based Managed Isolation and Quarantine (MIQ) is a key public health intervention in Aotearoa New Zealand's (NZ) COVID-19 border control strategy for returning citizens and permanent residents. We aimed to investigate the experience of transiting through MIQ in NZ, to inform future refinements of this type of system. A qualitative thematic analysis method was utilised to explore experiences in depth with seventy-five individuals who had undergone MIQ in NZ between April 2020 and July 2021. Participants were interviewed by telephone or Zoom or completed an online qualitative questionnaire. Interviews were audio recorded, transcribed and coded; questionnaire responses were sorted and coded. All data were subjected to thematic analysis. Three main themes described the key elements of the participants' experience of MIQ that influenced their overall experiences: 1) The MIQ process, 2) MIQ Hotels, and 3) Individual experience. The variation in participants' overall experience of MIQ was strongly influenced by their perceptions of how well the MIQ process was managed (including communication, flexibility, and compliance with disease prevention and control measures); and the quality of the hotels they were allocated to (in particular hotel staff, meals and information). This valuable insight into the experience of individuals in NZ MIQ hotels can inform better planning, management and implementation of the MIQ process for NZ and adds to the literature of countries utilising such strategies to minimise the transmission of COVID-19, whilst protecting the wellbeing of those using the system.
Collapse
Affiliation(s)
- Lesley Gray
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | | | - Aivi Puloka
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
| | - Claudia Bocock
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
| | - Ruth Gwyther
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
| | - Ashleigh Rushton
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | - Viliami Puloka
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
| | - Julia S Becker
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | - Amanda Kvalsvig
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
| | - Michael G Baker
- University of Otago, Wellington, 6242, Aotearoa, New Zealand
| |
Collapse
|
3
|
Teng A, Puloka V, Signal L, Wilson N. Pacific countries lead the way on sugary drinks taxes: lessons for New Zealand. N Z Med J 2021; 134:137-140. [PMID: 34695085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Andrea Teng
- Senior Research Fellow, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Viliami Puloka
- Research Fellow, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Louise Signal
- Head of Department, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Professor, Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
4
|
Choi K, Giridharan N, Cartmell A, Lum D, Signal L, Puloka V, Crossin R, Gray L, Davies C, Baker M, Kvalsvig A. Life during lockdown: a qualitative study of low-income New Zealanders' experience during the COVID-19 pandemic. N Z Med J 2021; 134:52-67. [PMID: 34239145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM This research explores the experience of low-income New Zealanders during the COVID-19 pandemic lockdown and their advice to the Government about addressing future pandemics. New Zealand had a rapid and effective lockdown that meant the virtual elimination of community transmission. METHOD Twenty-seven semi-structured interviews were undertaken with low-income people in June-July 2020 immediately after lockdown was lifted. RESULTS Life during lockdown was challenging for study participants. They were fearful of the virus and experienced mental distress and isolation. Most participants felt safe at home and reported coping financially while still experiencing financial stress. Participants were resourceful and resilient. They coped with lockdown by using technology, self-help techniques and support from others. New Zealand's welfare state ensured participants had access to health services and welfare payments, but there were challenges. Welfare payments did not fully meet participants' needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government's response and advised the Government to take the same approach in the future. This is a particularly reassuring finding from some of the most vulnerable New Zealanders. CONCLUSIONS An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful lockdown for the low-income people in this study. Research of the experience of low-income people during pandemics is critical to ensuring inequities in pandemic impact are mitigated.
Collapse
Affiliation(s)
- Kimberley Choi
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Namratha Giridharan
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Abigail Cartmell
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dominique Lum
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Louise Signal
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Viliami Puloka
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, New Zealand
| | - Cheryl Davies
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand; Tu Kotahi Māori Asthma Trust, 7-9 Barnes Street, Seaview, Lower Hutt, Wellington, New Zealand
| | - Michael Baker
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Amanda Kvalsvig
- Health, Environment & Infection Research Unit (HEIRU), Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
5
|
Teng A, Snowdon W, Win Tin ST, Genç M, Na'ati E, Puloka V, Signal L, Wilson N. Progress in the Pacific on sugar-sweetened beverage taxes: a systematic review of policy changes from 2000 to 2019. Aust N Z J Public Health 2021; 45:376-384. [PMID: 34097355 DOI: 10.1111/1753-6405.13123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To systematically characterise sugar-sweetened beverage (SSB) tax policy changes in Pacific Island countries and territories (PICTs) from 2000 to 2019. METHODS Medline, Google Scholar, Pacific Islands Legal Information Institute database, Factiva and news and government websites were systematically searched up to October 2019. Information was extracted on the date and SSB tax level change, tax type, included beverages, and earmarking; and checked for consistency with local experts. RESULTS Three-quarters of PICTs had an SSB tax (n=16/21) and 11 of these were excise taxes that included both imported and locally produced beverages. The level of tax was over 20% in 14 jurisdictions. SSB tax was increased by more than 20 percentage points in eight PICTs. Most taxes were ad valorem or volumetric, three were earmarked and only two taxes targeted sugar-sweetened fruit juices. The majority of countries (14/21) had different tax rates for imported and locally produced beverages. CONCLUSIONS More than three-quarters of PICTs have SSB taxes. More than one-third increased these taxes since 2000 at an amount that is expected to reduce soft drink consumption. Implications for public health: Despite high-quality tax design elements in some PICTs, SSB control policies could generally be strengthened to improve health benefits, e.g. by targeting all SSBs and earmarking revenue for health.
Collapse
Affiliation(s)
- Andrea Teng
- Department of Public Health, University of Otago Wellington, New Zealand
| | - Wendy Snowdon
- Centre for Obesity Prevention, Deakin University, Victoria
| | | | - Murat Genç
- Otago Business School, University of Otago, New Zealand
| | | | - Viliami Puloka
- Department of Public Health, University of Otago Wellington, New Zealand
| | - Louise Signal
- Department of Public Health, University of Otago Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago Wellington, New Zealand
| |
Collapse
|
6
|
Tin STW, Na'ati E, Bertrand S, Fukofuka K, Vivili P, Soakai S, Puloka V, Passmore E. Assessing the Status of Diabetes Associations in the Pacific: A Starting Point for Strengthening Associations to Manage Diabetes. Hawaii J Health Soc Welf 2021; 80:68-72. [PMID: 33718880 PMCID: PMC7953240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aimed to assess the status of national diabetes associations in the Pacific Island Countries and Territories as a starting point for strengthening their development and effectiveness in the prevention and control of diabetes. This cross-sectional study was conducted in 21 Pacific Island Countries and Territories using a structured questionnaire that gathered information from national non-communicable diseases prevention and control focal persons on diabetes associations, organizational structure, funding sources, and ongoing activities to address diabetes. The overall status of national diabetes associations was assessed using standardized criteria. Of the 21 countries surveyed, 18 (86%) responded. Of these, 12 (67%; American Samoa, Northern Mariana Islands, Federated States of Micronesia, French Polynesia, Fiji, Guam, Nauru, Papua New Guinea, Marshall Islands, Solomon Islands, Tonga, and Vanuatu) have a national diabetes association. Half of the existing associations are fully functioning, while the remainder is either partially functioning or not functioning. Only 50% of existing associations have a regular funding source, and many lack clear visions and workable governance structures. This study fills a knowledge gap on the current status of associations and forms a baseline from which associations can be strengthened. It also draws attention to the need for Pacific leaders to invest and engage more in civil societies for better and effective diabetes care for all.
Collapse
Affiliation(s)
- Si Thu Win Tin
- Public Health Division, Pacific Community (SPC), Suva, Fiji (STWT, EN, KF, SS, EP)
| | - Elisiva Na'ati
- Public Health Division, Pacific Community (SPC), Suva, Fiji (STWT, EN, KF, SS, EP)
| | - Solene Bertrand
- Public Health Division, Pacific Community (SPC), Noumea, New Caledonia (SB, PV)
| | - Karen Fukofuka
- Public Health Division, Pacific Community (SPC), Suva, Fiji (STWT, EN, KF, SS, EP)
| | - Paula Vivili
- Public Health Division, Pacific Community (SPC), Noumea, New Caledonia (SB, PV)
| | - Sunia Soakai
- Public Health Division, Pacific Community (SPC), Suva, Fiji (STWT, EN, KF, SS, EP)
| | | | - Erin Passmore
- Public Health Division, Pacific Community (SPC), Suva, Fiji (STWT, EN, KF, SS, EP)
| |
Collapse
|
7
|
Gray L, Rose SB, Stanley J, Zhang J, Tassell-Matamua N, Puloka V, Kvalsvig A, Wiles S, Murton SA, Johnston DM, Becker JS, MacDonald C, Baker MG. Factors influencing individual ability to follow physical distancing recommendations in Aotearoa New Zealand during the COVID-19 pandemic: a population survey. J R Soc N Z 2021. [DOI: 10.1080/03036758.2021.1879179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sally B. Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Viliami Puloka
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Siouxsie Wiles
- Bioluminescent Superbugs Lab, Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Samantha A. Murton
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - David M. Johnston
- Joint Centre for Disaster Research, School of Psychology, Massey University, Wellington, New Zealand
| | - Julia S. Becker
- Joint Centre for Disaster Research, School of Psychology, Massey University, Wellington, New Zealand
| | | | - Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
8
|
Gray L, MacDonald C, Tassell-Matamua N, Stanley J, Kvalsvig A, Zhang J, Murton S, Wiles S, Puloka V, Becker J, Johnston D, Baker MG. Wearing one for the team: views and attitudes to face covering in New Zealand/Aotearoa during COVID-19 Alert Level 4 lockdown. J Prim Health Care 2020; 12:199-206. [PMID: 32988441 DOI: 10.1071/hc20089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Mass masking is emerging as a key non-pharmaceutical intervention for reducing community spread of COVID-19. However, although hand washing, social distancing and bubble living have been widely adopted by the 'team of 5 million', mass masking has not been socialised to the general population. AIM To identify factors associated with face masking in New Zealand during COVID-19 Alert Level 4 lockdown to inform strategies to socialise and support mass masking. METHODS A quantitative online survey conducted in New Zealand during April 2020 invited residents aged ≥18 years to complete a questionnaire. Questions about face masking were included in the survey. The sample was drawn from a commissioned research panel survey, with boosted sampling for Māori and Pacific participants. Responses were weighted to reflect the New Zealand population for all analyses. RESULTS A total of 1015 individuals participated. Self-reported beliefs were strongly related to behaviours, with respondents viewing face masking measures as 'somewhat' or 'very' effective in preventing them from contracting COVID-19 more likely to report having worn a face mask than respondents who viewed them as 'not at all' effective. The strongest barriers to face mask use included beliefs that there was a mask shortage and that the needs of others were greater than their own. DISCUSSION Highlighting the efficacy of and dispelling myths about the relative efficacy of mask types and socialising people to the purpose of mass masking will contribute to community protective actions of mask wearing in the New Zealand response to COVID-19.
Collapse
Affiliation(s)
- Lesley Gray
- University of Otago, PO Box 7343, Wellington, New Zealand
| | - Carol MacDonald
- Independent Researcher, 6a Mahunga Drive, Masterton, New Zealand
| | | | - James Stanley
- University of Otago, PO Box 7343, Wellington, New Zealand
| | | | - Jane Zhang
- University of Otago, PO Box 7343, Wellington, New Zealand
| | | | - Siouxsie Wiles
- Bioluminescent Superbugs Lab, University of Auckland, Auckland, New Zealand
| | - Viliami Puloka
- University of Otago, PO Box 7343, Wellington, New Zealand
| | - Julia Becker
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | - David Johnston
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | | |
Collapse
|
9
|
Teng A, Puloka V, Genç M, Filimoehala O, Latu C, Lolomana'ia M, Osornprasop S, Signal L, Wilson N. Sweetened beverage taxes and changes in beverage price, imports and manufacturing: interrupted time series analysis in a middle-income country. Int J Behav Nutr Phys Act 2020; 17:90. [PMID: 32646500 PMCID: PMC7350205 DOI: 10.1186/s12966-020-00980-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/05/2020] [Indexed: 01/07/2023] Open
Abstract
Background The Pacific Island nation of Tonga (a middle-income country) introduced a sweetened beverage tax of T$0.50/L in 2013, with this increasing further in 2016 (to T$1.00/L), and in 2017 (T$1.50/L; US$0.02/oz). Given the potential importance of such types of fiscal intervention for preventing chronic disease, we aimed to evaluate the impact of these tax changes in Tonga. Methods Interrupted time series analysis was used to examine monthly import volumes and quarterly price and manufacturing 1 year after each tax change, compared with a counterfactual based on existing trends. Autocorrelation was adjusted for when present, and adjustments were made for changes in GDP per capita, visitor numbers, season and T$/US$ exchange rate. Results In the year after the 2013, 2016 and 2017 tax increases, the price of an indicator soft drink increased by 16.8% (95%CI: 6.3 to 29.6), 3.7% (− 0.6 to 8.3) and 17.6% (6.0 to 32.0) respectively. Imports of sweetened beverages decreased with changes of − 10.4% (− 23.6 to 9.0), − 30.3% (− 38.8 to − 20.5) and − 62.5% (− 73.1 to − 43.4) respectively. Juice imports changed by − 54.2% (− 93.2 to − 1.1), and sachet drinks by − 15.5% (− 67.8 to 88.3) after the 2017 tax increase. Tonga water bottling (T$) increased in value by 143% (69 to 334) after the 2016 tax increase and soft drink manufacturing increased by 20% (2 to 46, albeit 5% market share). Conclusions Consistent with international evaluations of sugar-sweetened beverage taxes, the taxes in Tonga were associated with increased prices, decreased taxed beverages imports, and increased locally bottled water.
Collapse
Affiliation(s)
- Andrea Teng
- University of Otago Wellington, PO Box 7343, Wellington, New Zealand.
| | - Viliami Puloka
- University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Murat Genç
- University of Otago, Dunedin, New Zealand
| | | | | | | | | | - Louise Signal
- University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Nick Wilson
- University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| |
Collapse
|
10
|
O'Toole C, Gage R, McKerchar C, Puloka V, McLean R, Signal L. Is snacking the new eating norm for New Zealand children? An urgent call for research. N Z Med J 2020; 133:131-132. [PMID: 32595230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Christy O'Toole
- House Surgeon, Capital & Coast and Hutt Valley District Health Board, Wellington
| | - Ryan Gage
- Research Fellow, Department of Public Health, University of Otago, Wellington
| | - Christina McKerchar
- Lecturer, Department of Population Health, University of Otago, Christchurch
| | - Viliami Puloka
- Research Fellow, Department of Public Health, University of Otago, Wellington
| | - Rachael McLean
- Associate Professor, Department of Preventive and Social Medicine, University of Otago, Dunedin
| | - Louise Signal
- Professor, Department of Public Health, University of Otago, Wellington
| |
Collapse
|
11
|
Abstract
The 2019 IUHPE Global Health Promotion Conference held in Rotorua New Zealand, provided an unparalleled opportunity to demonstrate the contribution of health promotion to the achievement of planetary health and sustainable development. This brief conference report outlines the intent of the two conference statements and calls for action by health promoters at all levels to integrate these principles into their everyday work.
Collapse
Affiliation(s)
- Sione Tu'itahi
- Health Promotion Forum of New Zealand, Runanga Whakapiki Ake i te Hauora o Aotearoa, Auckland, New Zealand
| | - Melissa Stoneham
- Public Health Advocacy Institute Western Australia, Curtin University, Bentley, Perth Western Australia, Australia
| | | | - Trevor Simpson
- Health Promotion Forum of New Zealand, Auckland, New Zealand
| | - Louise Signal
- Health Promotion and Policy Research Unit, University of Otago, Wellington, New Zealand
| | - Viliami Puloka
- Pacific Portfolio, Health Promotion Forum of New Zealand, Runanga Whakapiki Ake i te Hauora o Aotearoa, Auckland, New Zealand
| |
Collapse
|
12
|
Sarfati D, Dyer R, Sam FAL, Barton M, Bray F, Buadromo E, Ekeroma A, Foliaki S, Fong J, Herman J, Huggins L, Maoate K, Meredith I, Mola G, Palafox N, Puloka V, Shin HR, Skeen J, Snowdon W, Tafuna'i M, Teng A, Watters D, Vivili P. Cancer control in the Pacific: big challenges facing small island states. Lancet Oncol 2019; 20:e475-e492. [PMID: 31395476 PMCID: PMC7746436 DOI: 10.1016/s1470-2045(19)30400-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 01/03/2023]
Abstract
This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.
Collapse
Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Filipina Amosa-Lei Sam
- Pathology Department, Tupua Tamasese Meaole Hospital, Private Bag National Health Services, Apia, Samoa
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Eka Buadromo
- Pathology Department, Vaiola Hospital, Nuku'alofa, Tonga
| | - Alec Ekeroma
- Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa; Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - James Fong
- Obstetrics and Gynaecology Unit, Colonial War Memorial Hospital, Ministry of Health, Suva, Fiji; Department of Obstetrics and Gynaecology, Fiji National University, Suva, Fiji
| | | | - Linda Huggins
- Palliative Care Services, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Kiki Maoate
- Department of Paediatric Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Ineke Meredith
- Department of Surgery, Capital; Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand
| | - Glen Mola
- Department of Obstetrics, Gynaecology and Reproductive Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea; School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Viliami Puloka
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand; Health Promotion Forum of New Zealand, Auckland, New Zealand
| | - Hai-Rim Shin
- Non-communicable Disease and Health Promotion, Western Pacific Regional Office, World Health Organization, Manila, Philippines
| | - Jane Skeen
- Starship Blood and Cancer Centre, Starship Children's Health, Auckland, New Zealand
| | - Wendy Snowdon
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Malama Tafuna'i
- Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa
| | - Andrea Teng
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - David Watters
- Deakin University and Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Paula Vivili
- Public Health Division, Pacific Community, Noumea, New Caledonia
| |
Collapse
|
13
|
Veatupu L, Puloka V, Smith M, McKerchar C, Signal L. Me'akai in Tonga: Exploring the Nature and Context of the Food Tongan Children Eat in Ha'apai Using Wearable Cameras. Int J Environ Res Public Health 2019; 16:ijerph16101681. [PMID: 31091717 PMCID: PMC6572351 DOI: 10.3390/ijerph16101681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022]
Abstract
Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me’akai (food) consumed by Tongan children in Ha’apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids’Cam Tonga project. Images were analysed to assess the participants’ food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.
Collapse
Affiliation(s)
- Loma Veatupu
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Viliami Puloka
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Moira Smith
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Christina McKerchar
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Louise Signal
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| |
Collapse
|
14
|
Robinson A, Hulme-Moir S, Puloka V, Smith M, Stanley J, Signal L. Housing as a Determinant of Tongan Children's Health: Innovative Methodology Using Wearable Cameras. Int J Environ Res Public Health 2017; 14:E1170. [PMID: 28976919 PMCID: PMC5664671 DOI: 10.3390/ijerph14101170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 11/17/2022]
Abstract
Housing is a significant determinant of health, particularly in developing countries such as Tonga. Currently, very little is known about the quality of the housing in Tonga, as is the case with many developing countries, nor about the interaction between children and the home environment. This study aimed to identify the nature and extent of health risk factors and behaviours in Tongan houses from a child's perspective. An innovative methodology was used, Kids'Cam Tonga. Seventy-two Class 6 children (10 to 13-year-olds) were randomly selected from 12 randomly selected schools in Tongatapu, the main island. Each participating child wore a wearable camera on lanyards around their neck. The device automatically took wide-angled, 136° images of the child's perspective every seven seconds. The children were instructed to wear the camera all day from Friday morning to Sunday evening, inclusive. The analysis showed that the majority of Tongan children in the study live in houses that have structural deficiencies and hazards, including water damage (42%), mould (36%), and electrical (89%) and burn risk factors (28%). The findings suggest that improvements to the housing stock may reduce the associated health burden and increase buildings' resilience to natural hazards. A collaborative approach between communities, community leaders, government and non-governmental organisations (NGOs) is urgently needed. This research methodology may be of value to other developing countries.
Collapse
Affiliation(s)
- Andrew Robinson
- Health Promotion & Policy Research Unit, University of Otago, 6242 Wellington, New Zealand.
| | - Sarah Hulme-Moir
- Health Promotion & Policy Research Unit, University of Otago, 6242 Wellington, New Zealand.
| | - Viliami Puloka
- Health Promotion & Policy Research Unit, University of Otago, 6242 Wellington, New Zealand.
| | - Moira Smith
- Health Promotion & Policy Research Unit, University of Otago, 6242 Wellington, New Zealand.
| | - James Stanley
- Health Promotion & Policy Research Unit, University of Otago, 6242 Wellington, New Zealand.
| | - Louise Signal
- Health Promotion & Policy Research Unit, University of Otago, 6242 Wellington, New Zealand.
| |
Collapse
|
15
|
Lower T, Nauan B, Abel M, Ake M, Puloka V, Tiban K. Curbing the tide--non-communicable disease in the Pacific. Pac Health Dialog 2005; 12:61-64. [PMID: 18181495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper assesses the introduction of several small-scale sentinel data surveillance approaches. These data assist with improving the understanding of casual factors related to the development of NCDs at the local level in the Pacific and the design of subsequent interventions. While individually the data may be of limited value due to methodological considerations, their conjoint use provides a reasonably strong database upon which to base interventions. Within the highly resource constrained environment of the Pacific, such approaches are feasible and practical, while also ensuring that local data to develop local solutions, are available to inform evidence based decision making.
Collapse
Affiliation(s)
- Tony Lower
- Secretariat of the Pacific Community, Noumea.
| | | | | | | | | | | |
Collapse
|