Opinion: Health equity in older age

Source: Massey University

Associate Professor Mary Breheny discusses the findings of her team’s longitudinal research which shows that health in later life is closely related to childhood socioeconomic status.

By Associate Professor Mary Breheny

The media often focus on older people as a discrete group, whose needs must be balanced against the needs of younger groups. As a result, suggestions for healthy ageing tend to focus on promoting healthy choices among people who have already aged. But we know that there are marked differences in health and wellbeing among people of older age.

These differences do not just arise in later life; they reflect a life time of experiences. These may include health risks in younger years such as poor housing, workplace conditions, family experiences, and lack of access to resources and opportunities. Our research programme examines the differences between older people, based on their entire life experiences, rather than treating older people as if they were all the same.

Our longitudinal research shows five different profiles of wellbeing among older people over time. After following them for ten years, we found most older people (about two thirds of our sample) were in robust health or average good health. These groups were ageing well, maintaining good physical and mental health over time and remaining socially engaged. A smaller number experienced declining physical health whilst maintaining good social and mental health.

There were two groups who showed limitations in mental health and social wellbeing or vulnerable health across all domains. This represents a small but important group of older people with significant health limitations who tend to reach later life in poor health, rather than experiencing sharply declining health in old age. Taking this as a starting point, our research sought to uncover the specific lifetime and environmental factors that explain health differences in older age.

To answer questions about the factors which lead older people to reach later life in poor health, we used the Health, Work and Retirement longitudinal study of ageing. This includes life history data on childhood socioeconomic status, childhood health, and lifetime education and occupational status and health behaviours. These data are linked to our survey data which includes measures of quality of housing and neighbourhoods, as well as employment and living standards. Together, these data allow us to answer important questions on the factors which predict physical, mental and social health trajectories over time.

We found health in later life was significantly related to childhood socioeconomic status, which predicts standard of living in later life, and is strongly linked to physical and mental health. Later life living standards, satisfaction with housing, quality of neighbourhood, and social cohesion of neighbourhood – also influenced health and wellbeing. Even health behaviours, such as alcohol consumption, are best predicted by childhood family and socioeconomic factors. Once these health behaviour patterns are set early in life, they tend to persist over the life course.

Our research shows that the environments and health practices that influence healthy ageing generally reflect a lifetime of inequitable access to resources, rather than the result of individual abilities or choices. Policies to address this could focus on social and physical environments rather than suggestions for healthy activities in later life.

These research findings have important implications for public health and health promotion for older people. Current approaches neglect environmental effects across the life course on health and wellbeing for older people. Our research programme suggests that income support and housing are two of the most important areas for the health and wellbeing of older people. These provide clear opportunities for policy intervention, both to safeguard income support in later life and to ensure access to secure housing for older New Zealanders.

Recognising the factors that produce vulnerability shifts the focus from healthy behaviour in later life to environments that support health for all across the life course. These factors provide a clear focus for efforts to ensure health equity throughout the life course, and minimise the health disparities we see in later life in New Zealand.

Associate Professor Mary Breheny will present her findings at the IUHPE 23rd World Conference on Health Promotion in Rotorua from Sunday. This opinion peice was first published on the Health Central website.

Massey researchers to present at World Conference on Health Promotion

Source: Massey University

Felicity Ware from Te Pūtahi a Toi: School of Māori Knowledge, will have an exhibit at the World Conference on Health Promotion, and present on teaching whānau how to weave their own wahakura – woven harakeke basket for babies to sleep in.

Massey University staff and students will be well represented at the 23rd World Conference on Health Promotion, to be held in Rotorua from Sunday.

The theme for this year’s conference is Waiora: Promoting Planetary Health and Sustainable Development for All. The conference, which is run by the International Union for Health Promotion and Education (IUHPE), is held every three years, around the world. This is the first time New Zealand has hosted the conference, which will involve up to 3000 delegates from New Zealand, Australia, the Pacific Islands, the wider Asia-Pacific region, Europe, Americas, Middle East and Africa. The conference will have a strong indigenous component around Māori and Pasifika and will be the biggest event ever held in Rotorua.

The College of Health has more than 17 staff and PhD students presenting, including College of Health Pro Vice-Chancellor Professor Jane Mills.

Dr Victoria Chinn will present her research, entitled Women unveiling their health potential: A way forward for empowering health promotion interventions.

“Health promotion adopts a positive, holistic, participatory and empowerment focused approach to health, yet many women’s health programmes set weight-loss as the primary goal for success, which has not only proven to be largely ineffectivebut also damaging to women’s health,” Dr Chinn says.

“This study introduces a health programme that aligns to the values of health promotion and with prospects to create sustainable change conducive to women’s health. The programme, Next Level Health, applies participatory methods for women to determine their own goals across six key health areas: physical activity, sleep, nutrition, eating behaviour, stress management and self-care, with the core aim of gaining more control over their health.”

Sixty women took part in the programme, which ran over a six-month period, and included a twelve-month follow up. Each month the participants met to reflect on the goals they had set, and to set new ones, with the aim to progress their self-defined goals by the end of the programme. Data was collected via a series of questionnaires at the beginning of the programme, at six months and at 12 months.

“Women progressed across an average of 29 levels, out of a possible 36, and significantly gained greater control over their health. The programme enabled women to create health routines in their everyday lives; broaden their health perspective to consider physical, mental and social dimensions as relevant to their health; improve their functional, interactional and critical health literacy; and more fully realise their potential for health in a process of self-actualisation,” Dr Chinn says.

“These findings suggest a holistic approach to health may be more effective for sustainable behaviour change focused on a balance of positive health behaviours rather than a weight-loss focused approach.”

Felicity Ware, Ngāpuhi, a lecturer from Massey’s Te Pūtahi a Toi: School of Māori Knowledge, will have an exhibit at the conference, and present on teaching whānau how to weave their own wahakura – woven harakeke basket for sleeping baby (pēpi).

“Wahakura are individual hand-made safe sleep spaces for pēpi woven out of harakeke, using the tradition of rāranga [weaving]. They were developed as a contemporary kaupapa Māori innovation to safe co-sleeping, particularly for Māori who have a disproportionately high rate of Sudden Unexpected Death in Infancy [SUDI]. Wahakura also promote bonding, responsive parenting, breastfeeding and smokefree environments,” she says.

“Wahakura embody the significant connection between the Pā Harakeke [plantation] as a model of whānau development and te whare tapu o te tangata [womb]. The atua Hineteiwaiwa, goddess of female arts, presides over both, strengthening the link between harakeke, weaving, wahakura, and raising tamariki [children]. Wahakura have their own mana [spiritual vitality] and mauri [physical vitality] inherited from Papatūānuku, Hineteiwaiwa and the whānau and weavers involved,” Ms Ware says.

“Teaching whānau how to make their own wahakura is empowering them to literally and symbolically create their own pathways to wellbeing. It contributes to the revitalisation of Māori culture, positive cultural identity, and mana motuhake/rangatiratanga [self-determination], especially important for Māori who have been displaced or marginalised.”

The waikawa weaving style was developed as the most simplest version in order to teach those new to weaving how to create their own, she says. “Wahakura take about two full days to make from harvest to finish for a new weaver. Once dried, quality assured and fitted with a breathable mattress, a cotton sheet and a natural fibre blanket, wahakura are safe to sleep babies from newborn until about four to six months, and can be re-used as long as they meet quality standards.”

Massey University staff and students presenting at the conference:

Associate Professor Mary Breheny – Importance of early lives to inequalities in older age (research presentation)

Dr Victoria Chinn – Women unveiling their health potential: A way forward for empowering health promotion interventions (research presentation)

Dr Beven Erueti – Wairuatanga:  Integrating the fourth article of Te Tiriti o Waitangi into health promotion and health education (workshop)

Dr Geoff Kira – “Sometimes I just didn’t have the money”: Removing the barriers to consuming more fruit and vegetables. An exploratory study (research presentation), and Promoting Indigenous food sovereignty for enhancing food security, nutrition and health equity (symposium)

Professor Marlena Kruger – Dietary patterns associated with adiposity and bone mineral densityin older urban black South African women (research presentation)

Adjunct Dr Mat Walton – Implementing a health promotion initiative to achieve systems change: lessons from evaluation of Healthy Families NZ (research presentation) and Using Developmental Evaluation to inform systems change for health (oral presentation)

Professor Jane Mills – What can we do to address health challenges faced by communities? (sub-plenary session)

Christine Roseveare – Engaging public health students with equity: An innovative approach from an on-line New Zealand undergraduate course (oral presentation)

Sudesh Sharma and Associate Professor Rachel Page – Tobacco and alcohol use are playing critical role in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective (research presentation) and Health and social system challenges to tackle social determinants of non-communicable diseases in Nepal: a systems analysis (research presentation)

Dr Christina Severinsen and Angelique Reweti – Wai ora: Connecting tangata (people), hauora (health), and taiao (environment) through participation in waka ama (film screening and research presentation)

Professor Christine Stephens – The importance of housing to health: A Capabilities Approach to unequal trajectories of healthy ageing (research presentation)

Dr Agnes Szabo – Alcohol use across the life course: Influences on health in old adulthood (research presentation)

Dr Agnes Szabo, Associate Professor Mary Breheny and Professor Christine Stephens – Environments for health equity in older age: Taking a life course perspective (symposium) and Advocating for health equity (moderated discussion)

Chris Vogliano – Can leveraging agrobiodiverse food systems help reverse the rise of malnutrition while providing climate change resilience in Pacific Small Island Developing States? (research presentation)

Felicity Ware – Wahakura (art) and Wahakura wānanga (weaving workshop – oral presentation)

Health by Design: new public lecture series at Massey

Source: Massey University

The first Health by Design public lecture will be held on the Manawatū campus next month, focusing on Prevention through Design.

Associate Professor Ian Laird, School of Health Sciences.

In the first of a series of public lectures, entitled Health by Design, Associate Professor Ian Laird will speak about Prevention through Design (PtD) – the integration of hazard analysis and risk assessment methods early in the design and engineering stages so that risks of injury or illness are prevented.

“Designing out hazards is seen as one of the most effective means of preventing occupational injuries, illnesses and fatalities,” Dr Laird says.

“It’s a transdisciplinary process and although this concept is well known, there hasn’t yet been a concerted effort to achieve broad implementation of it, particularly in relation to noise exposure and prevention of noise induced hearing loss.”

Dr Laird says some PtD principles have been successfully applied to noise reduction in the construction and mining industry but have not yet been applied extensively within the agricultural sector. “The research I will discuss utilises PtD principles and applies them to control noise exposures commonly experienced in agriculture.”

His presentation examines two New Zealand-based case studies which highlight how the acoustic assessment methodologies can be used to inform and drive the PtD process.

“The first focuses on an all-terrain vehicle extensively used in farming operations here and internationally. The second case study involves sheep shearing equipment. Noise sources are identified and, in both cases, the PtD process is illustrated to design out the excessive noise,” he says.

Dr Laird is an Associate Professor in Occupational Health and Safety in the Centre for Ergonomics, Occupational Safety and Health, School of Health Sciences, Massey University. He has a Master of Science in Occupational Hygiene from the London School of Hygiene and Tropical Medicine, University of London, and a PhD in Physiology from Massey University. Dr Laird was a member of the Occupational Health Advisory Group that advised the Worksafe NZ Board on occupational health. He is a Fulbright Senior Scholar and visiting scientist at the Harvard School of Public Health.

Event details

Time: 5pm start with networking, drinks and nibbles. Event concludes approximately 6.30pm

Date: April 4

Location: Japan Lecture Theatre, University House, Main Drive, Massey University, Palmerston North

Click here to register and for more information about the Health by Design public lecture series.

Massey professor named Senior New Zealander of the Year

Source: Massey University

Professor Bill Glass from the Centre for Public Health Research.

Professor Bill Glass from the Centre for Public Health Research has been named Metlifecare Senior New Zealander of the Year in the 2019 Kiwibank New Zealanders of the Year awards.

Professor Glass has, throughout his long and distinguished career, considerably advanced occupational medicine, workers’ health, and policy development in New Zealand, through original research, his work as an occupational physician, and his long involvement with WorkSafe.

One of the major successes of his career was the creation of the Asbestos Exposure Register. His efforts have resulted in better health outcomes for countless workers by not only highlighting the dangers posed by substances like asbestos, lead and silica, but also by offering solutions to reduce exposure.

College of Health Pro Vice-Chancellor Professor Jane Mills congratulated Professor Glass.

“Congratulations Bill on receiving this well-deserved recognition of your major contribution to New Zealand in the field of occupational health. We are very proud that you have chosen to continue your research in the Centre for Public Health Research. Your leadership and mentoring is much appreciated by all at Massey and we thank you for your local contribution to our research culture.”

The awards recognise those aged 67 and over who are making a positive contribution to New Zealand. Mental health advocate, comedian and TV personality Mike King was named New Zealander of the Year for shining a light on the effects and impacts of mental health, particularly among Māori and young people.

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Mastering sports event management

Source: Massey University

Amanda Isada, Masters in Sport Management graduate and business administration manager at Volleyball New Zealand.

A year ago, Amanda Isada was completing her Masters in Sport Management undertaking a professional practice placement with Harbour Sport and Harbour Volleyball in Auckland. Next month, she will manage the 51st Volleyball New Zealand Secondary School Championships held at the Central Energy Trust Arena Manawatu and Massey University – a role she picked up as a direct result of her Work-Integrated Learning (WIL) experience.

The business administration manager for Volleyball New Zealand says the WIL placement was very rewarding. “I learnt so much about community sports, marketing, communications and event management. Not only did I learn about the organisation, but I learned about myself as well. How I work with others, what part of the industry I want to pursue, what type of people I would want to work for and with. I was able to contribute to the organisations, and there was never a dull moment.”

Professor Andy Martin from the School of Sport, Exercise and Nutrition supervises the WIL placements. His recent research focused on how to enhance supervision and student WIL experiences. The research, funded by Ako Aotearoa, was undertaken in conjunction with colleagues from Auckland University of Technology, University of Waikato, the New Zealand Council for Educational Research, and Malcolm Rees, manager of Massey’s Student Survey and Evaluation Unit.

Professor Martin’s findings highlighted that workplace supervisor support in setting expectations and engaging in the initial planning and organising were important factors in effective management of the WIL placement. “The workplace supervisor role then moved beyond providing the student direction and feedback to more of a mentoring role. This role provided them with professional development and continued to be valuable into the future,” he says.

Ms Isada’s experience reinforces these findings. “My mentors and colleagues were very supportive in every way. I learned so much from them and talked to them about various things happening in sports around North Harbour, Auckland and the country. My colleagues gave me advice in terms of personal growth; my mentors helped my professional growth. The culture is great and gave me an understanding of the kind of environment I would want to work in, the kind of people I want to work with, and the kind of person I should be as well.”

Professor Martin says, “The student focus on setting clear expectations for themselves and the placement, and making the most of the WIL experience is important in enhancing the development of Massey graduate’s employability characteristics, such as of self-management, effective communication and leadership.”

Next month’s national volleyball tournament will be supported by current Massey sport development students who will be helping at the event in volunteer roles.

 “The new sport development majorwithin the revised Bachelor of Sport and Exercise will help prepare students for work in the varied and growing area of sport development by providing knowledge in topics such as sport organisational structure and function, event and facility management and sport coaching, along with sociological, performance and business issues linked to sport,” Professor Martin says.

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Ka Mate – a commodity to trade or taonga to treasure?

Source: Massey University

“We can’t continue to turn a blind eye to the disrespectful ways that haka are used for commercial purposes,” Jeremy Hapeta says.

As we approach the ninth Rugby World Cup, hosted by Japan in September-November later this year, Massey University researchers are recommending more protections for the use of haka in marketing, both here and overseas.

Lead researcher Jeremy Hapeta, (Ngāti Raukawa Ngāti Huia, Ngāti Pareraukawa), and colleagues Dr Farah Palmer, (Ngāti Maniapoto, Waikato) and Dr Yusuke Kuroda, carried out a literature review which drew upon existing research, legislation and recent marketing campaigns. Additionally, the study involved interviews with pukengā (experts) to gather pūrākau (narratives) from their informed perspectives and reflections of the commercialisation of this particular Māori ritual in sport.

Ka Mate, composed by Ngāti Toa chief Te Rauparaha, has received global exposure due mostly to its adoption as a pre-match ritual by the All Blacks. Increasingly, the two entities have become symbols of New Zealand national identity and pride, but not without controversy and debate.

“Haka can be used for celebrations, protests, acknowledgement and an expression of identity that may align with nationality, ethnicity, sub-culture, a movement or a brand,” Mr Hapeta says. “The benefits of pūrākau embedded within ngā taonga tuku iho [cultural treasures] such as haka however, tend to be absent in sport marketing.”

Mr Hapeta would like New Zealand Rugby (NZR) to play a leading role in guiding global corporations and sponsors in relation to accessing and attributing the haka to the appropriate iwi and people.

“We can’t continue to turn a blind eye to the disrespectful ways that haka are used for commercial purposes. While the NZR appear to be responding with the establishment of a kaitiaki group for haka within the All Blacks, a pūkenga for the Māori All Blacks and organisation, the adoption of a Respect and Inclusion programme, and a cultural subcommittee of the New Zealand Māori Rugby Board, more still needs to be done to protect the mana of the haka as a taonga.”

The researchers spoke with members of three iwi who are closely associated with Ka Mate, namely Ngāti Toa, Ngāti Raukawa and Ngāti Tūwharetoa, as well as critically reviewing literature and legislation from a kaupapa Māori perspective.

“The kōrerorero [discussions] were guided by open-ended questions related to: how mātauranga [knowledge] of haka were handed on to these experts, how Māori and wider New Zealand society are passing on knowledge of haka today, their aspirations for this knowledge to be handed on to future generations and finally the use of haka in sport marketing,” Mr Hapeta says.

“Haka, especially Ka Mate, have been associated with global brands and corporations aligned with rugby teams and events. Our review explored sport marketing, focusing on Ka Mate and the All Blacks, alongside contemporary use, and misuse of Ka Mate, by transnational agencies and sponsors.”

WAI 262 and the Haka Ka Mate Attribution Act

In 1991, six tribes took a major claim to the Waitangi Tribunal, in regards to the indigenous flora and fauna and Māori cultural intellectual property. It is within the claim, commonly known as WAI 262, that Ngāti Toa sought to cease the exploitation and regain some control over Ka Mate.

Findings and recommendations from the WAI 262 report set a precedent, and it was closely followed by the Haka Ka Mate Attribution Act. The Government acknowledged the importance of Ka Mate to Ngāti Toa and passed legislation requiring attribution to Ngāti Toa, including commercial uses of Ka Mate.

“It’s important to note that the Act is New Zealand-based legislation and doesn’t apply offshore,” Mr Hapeta adds. “Our research identified three haka representations that came after the Act, and did not attribute the haka to Ngāti Toa, which was deeply disappointing.”

Jacomo’s “Hakarena” campaign

In a pre-tournament Rugby World Cup (RWC) 2015 promotion, former English rugby captain Matt Dawson featured, along with several support actors, in an online video for British men’s clothing brand Jacomo, that parodied Ka Mate. They blended music and moves from the hit Spanish dance song Macarena with Ka Mate lyrics and gestures to create a hybrid dance called the “Hakarena”.

At the time, Ngāti Toa executive director Sir Matiu Rei said: “This video is disrespectful and belittling to our cultural performance, the All Blacks and Māori people … I feel for New Zealanders, not just Māori, I feel sorry for anyone who has to watch it.”

Heineken’s “Fight or Flight” competition

Heineken were a major sponsor of the 2015 RWC hosted by England. The company produced a promotional video, using customers in a Dublin bottle store. The clip showed customers flipping a coin for a chance to win tickets to the RWC final. Following the coin toss, they were surprised by three actors (who appeared to be of Māori heritage), who performed a generic haka. The actors then challenged the customers to perform their best haka to win the tickets – resulting in amateur performances of Ka Mate.

“Whether intentional or not, the use of haka for commercial gain, performed with little understanding of the nuances and meanings of this cultural ritual, and distributed to the public without appropriate acknowledgement, disrespects the intended spirit of the WAI 262 and the Act,” Mr Hapeta says.

Wozniaki’s haka lesson

The most recent example of strategic haka use by sport sponsors was at the 2016 ASB Classic in Auckland. Organisers secured several high-profile All Blacks who provided top international women’s tennis star Caroline Wozniaki with a personal haka lesson. This story was covered by New Zealand media, appearing on the national 6pm news bulletin.

“In the footage, Wozniaki was encouraged to poke out her tongue during the performance – a practice inconsistent with tikanga Māori [customs], because wāhine [women] do not normally protrude their tongue,” Mr Hapeta says.

“This scenario demonstrated an example of corporate sponsors dislocating a distinctive local ritual from its cultural meaning. Despite this happening in New Zealand, where the Act applies, there was no verbal or written attribution to Ngāti Toa or Te Rauparaha in the news story.”

The paper, entitled KA MATE: A commodity to trade or taonga to treasure? was published in the MAI Journal last year.

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Opinion: If we legalise cannabis we must keep business at bay

Source: Massey University

The age at which people start regular cannabis use is a likely predictor of harm, Professor Sally Casswell says.

Professor Sally Casswell from the SHORE & Whāriki
Research Centre.

By Professor Sally Casswell

We must beware of extreme ideological positions in our cannabis discussion. In particular it would be good to acknowledge the “war on drugs” is not a particularly relevant concept. In fact we are moving towards decriminalisation of cannabis use in New Zealand due to police discretionary practices.

Ministry of Justice figures for 2017/18 show three people were imprisoned for cannabis possession and it is very likely they had an extensive conviction history — legalising cannabis possession will not reduce incarceration. But this is not to argue against an informed debate on cannabis in New Zealand, including the possibility of legalisation.

Cannabis use does not inevitably result in harm for the individual user, nor is it risk-free. Looking at the emerging evidence from the United States where several states have legalised cannabis, often allowing profit-making industries to take control, it is very likely that if we follow suit, thereby increasing availability and normalising use, we will experience more harm.

A recent review of US data has drawn attention to increases in cannabis potency, prenatal and unintentional childhood exposure and, in adults, an increase in cannabis use, fatal vehicle crashes, cannabis-related emergency room visits, and cannabis use disorder (which includes dependence and harms such as social and interpersonal problems and neglect of major roles in order to use).

About one in five lifetime users met criteria for cannabis use disorder.

The age at which people start regular cannabis use is a likely predictor of harm. The Christchurch longitudinal study found those who began using cannabis at earlier ages were at increased risk of adverse outcomes including lower levels of educational attainment, welfare dependence and unemployment and psychotic symptomatology.

A major US study has been launched which, over 10 years, will clarify the effects of adolescent cannabis use on cognitive abilities. In the meantime the precautionary principle would suggest working hard to limit young people’s access to cannabis products.

What we learn from our experience with alcohol is that purchase age matters. The reduction of the purchase age from 20 to 18 increased access to 16 and 17-year-olds as friends who can purchase tend to supply large amounts to their slightly younger friends.

In regulated drug markets keeping purchase age high is a very effective way to reduce harm. However, it is necessary that the illicit market is gradually curtailed, which can be achieved through enforcement in combination with the convenience of the legal market.

Public ownership of supply and restriction of use to private settings is feasible for New Zealand. Again, learning from alcohol, retail in public ownership shows better outcomes compared with retail in private, for-profit, sales outlets.

Well managed publicly owned stores control the access of young people, hours of sale, facilitate minimum pricing (the money goes to the Government and can be used to respond to increased harm), and control the type of products sold, packaging and promotion.

In a legalised market, potency and the nature of the products available are important considerations. Legalised cannabis products will not be mainly plant material. A range of products are being developed by the transnational corporations, including beverages and edibles.

As others have said, we need to keep the industry at bay and our experience with tobacco and alcohol reinforces this. However, this will be difficult given the extent to which the alcohol transnational corporations have bought into the giant medicinal cannabis producers and are seeing major business opportunities. Heineken has a cannabis-infused “beer” — “Hi-fi Hops” on the market in California.

The producers of medicinal cannabis are anticipating huge expansion based on widespread personal use. Retail in public ownership would provide one layer of protection and avoid the problems we see with alcohol where more deprived neighbourhoods have been unable to prevent the imposition of a disproportionate number of alcohol outlets or reduce trading hours.

In Canada, which recently legalised cannabis, all provinces, including those keeping retail in public ownership, allow online purchase. This, with adequate age ID on delivery, is likely to be a popular mode here, if allowed, and is feasible in a public ownership model.

As a colleague commented in a recent hui, it could be the saving of NZ Post!

If we do decide to legalise use of cannabis caution is needed. A model of retail in public ownership with a limited number of carefully managed cannabis-specific outlets, with or without the possibility of growing a limited amount of plant material, should be discussed.

If we do legalise, there will be an increase in some harms and we need to take the opportunity of regulating to minimise this.

Cannabis regulation should be stricter than tobacco control, which is an attempt to deal retrospectively with the harm a legal, heavily promoted product produced. It should certainly not look anything like our loosely regulated alcohol market.

Professor Sally Casswell is the Co-Director of the SHORE and Whāriki Research Centre in Auckland. This commentary was first published in the New Zealand Herald.

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Gaps in health professionals’ knowledge about HPV and cervical screening

Source: Massey University

In a new study, less than 10 per cent of all health professionals surveyed could correctly answer all questions about the current cervical screening guidelines, which have been in place since 2008.

The first New Zealand study of health professionals’ knowledge and understanding about the human papillomavirus (HPV) has identified significant gaps, particularly about the role of HPV testing in the New Zealand National Cervical Screening Programme.

The study, which was recently published in the journal PLOS ONE, surveyed 230 practice nurses, smear takers and other clinical and laboratory staff via a cross-sectional survey, between April 2016 and July 2017.

Dr Collette Bromhead, from Massey University’s School of Health Sciences, led the research and says while the mean scores on the general HPV knowledge questions were high (13.2 out of 15), only 25.2 per cent of respondents scored 100 per cent.

“Only 63.7 per cent of respondents agreed or strongly agreed they were adequately informed about HPV, which is a concern. There were significant gaps in knowledge and more education is required to ensure misinformation and stigma do not inadvertently result from interactions between health professionals and patients,” Dr Bromhead says.

HPV is responsible for 99.7 per cent of cases of cervical cancer, along with some head and neck, penal and anal cancers. There are approximately 150 new diagnoses and 50 deaths from cervical cancer in New Zealand each year.

“In addition, there are longstanding ethnic inequalities in cervical cancer incidence and mortality, and cervical cancer screening coverage remains low for Māori and Pacific women,” Dr Bromhead says.

“Worryingly, 13 per cent of respondents either believed HPV causes HIV/AIDS or were unclear that it did not,” she says.

Previous studies have highlighted that the public are generally not well informed about HPV and its impact on health, and the sexually transmitted nature of HPV may bring a stigma to its diagnosis. “Therefore a lack of knowledge among health professionals is worrying for its impact on women’s engagement with cervical screening,” Dr Bromhead says.

“Most concerning was the finding that less than 10 per cent of all health professionals surveyed could correctly answer all questions about the current cervical screening guidelines, which have been in place since 2008,” Dr Bromhead says. “Our analyses showed that this knowledge could be predicted by the number of years since training took place. We need to ensure career-long learning about HPV is integrated into routine practice for smear takers, nurses, GPs, colposcopists, gynaecologists and other specialists taking care of women’s health.”

Respondents also provided suggestions for how training might be improved. “They wanted regular updates, more training sessions, and several health professionals felt that online training or online resources such as research, frequently asked questions and updates would be useful. With a change to HPV primary screening coming, we hope this work will provide a baseline from which various agencies can build robust continuing medical education programmes for all levels of healthcare providers involved in the screening pathway,” Dr Bromhead says.

The paper, entitled ‘Knowledge, attitudes and awareness of the human papillomavirus among health professionals in New Zealand’, was written by Dr Collette Bromhead, School of Health Sciences, Massey University; with Dr Hayley Denison and Professor Jeroen Douwes, Centre for Public Health Research, Massey University; Dr Susan Sherman, School of Psychology, Keele University, United Kingdom; Dr Karen Bartholomew, Waitemata District Health Board; Hersha Patel, Department of Gynaecology, University Hospitals Leicester, United Kingdom; and Dr Esther Moss, Leicester Cancer Research Centre, University of Leicester, United Kingdom.

Study shows strong support for community and non-profit approaches to cannabis reform

Source: Massey University

“Our findings indicate significant support for non-commercial and community-managed approaches to cannabis regulation, as opposed to profit-driven commercial markets,” Dr Marta Rychert says.

Dr Rychert, SHORE & Whāriki Research Centre.

New research indicates significant support for non-commercial and community-managed approaches to regulate cannabis, with home-growing and a community trust approach among preferred options.

The latest research bulletin from the SHORE & Whāriki Research Centre presents preliminary findings from a Massey University pilot study investigating the potential options for regulating recreational cannabis.

The New Zealand government intends to conduct a national referendum on the personal use of cannabis at next year’s general election, signalling the potential for a major change in policy.

Dr Marta Rychert says international drug policy experts have pointed out there is a range of reform options for cannabis, including many alternatives to profit-driven commercial markets. However, there is little existing research on different approaches including public opinion on reform options, and this reduces the likelihood they will be seriously considered by policymakers.

“Our online survey asked people living in West Auckland and Invercargill about their support for using an­­ alcohol trust model to regulate legal cannabis. These two areas of the country are among a handful of districts that currently have experience with the retail sale of alcohol via community-owned entities, called licensing trusts.

“Our research shows the community trust model was the fourth most preferred option for cannabis reform [11 per cent], with growing your own cannabis plants for personal use the most popular option [27 per cent],” Dr Rychert says.

This was followed by restricted availability via pharmacies or under doctor’s supervision (17 per cent) and a commercial profit-driven market similar to alcohol (12 per cent). Overall, 62 per cent of respondents chose some form of “middle-ground” cannabis law regime as their preferred option for reform.

“Our findings indicate significant support for non-commercial and community-managed approaches to cannabis regulation, as opposed to profit-driven commercial markets. The distribution of profits from cannabis sales back to local communities was the most valued element of applying the trust model for legal cannabis, followed by the increased ability to restrict cannabis sales and availability, and control of the cannabis industry.

“Application of the community trust model for legal cannabis should take into account public opposition to monopoly market regimes. These concerns could be addressed by allowing multiple trusts to work in the same district,” Dr Rychert says.

The anonymous online survey was promoted via a targeted Facebook campaign in September and October 2018. A total of 2,379 people completed the survey. Sixty-five per cent of respondents were from West Auckland, and 35 per cent from Invercargill.

This research bulletin was co-authored by Dr Rychert, with Associate Professor Chris Wilkins, Dr Jose Romeo and Thomas Graydon-Guy from the SHORE & Whāriki Research Centre.

Read the research bulletin here.

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Public health researcher in top 1 per cent of cited scientists

Source: Massey University

Professor John Potter has been recognised as one of the worlds most cited scientists over the last decade.

Professor John Potter, from Massey University’s Centre for Public Health Research, has been named as one of only 16 New Zealand scientists listed in the top one per cent of most cited scientists in the world.

The prestigious list of academics compiled by Clarivate Analytics recognises world-class scientists who have demonstrated significant influence through publication of multiple, highly cited papers during the last decade.

Professor Potter’s career has focused on nutrition, other environmental and host factors, and genetics in the aetiology (cause of disease or condition), pathobiology (the biology of disease), and early detection of cancers and other chronic diseases. International recognition includes being awarded the American Association for Cancer Research Award for Research Excellence in Cancer Epidemiology and Prevention in 2009, and the 2012 Medal of Honour from the International Agency for Research on Cancer. He has authored or co-authored more than 700 scientific papers, chapters and books.

“Being awarded this latest honour speaks to the quality of all my colleagues with whom I have worked with for many decades  – they do great work,” Professor Potter says.

He was drawn to his area of research after undertaking the first population-based case-control study of the causes of colorectal cancer undertaken anywhere in the world.

“That all began in Australia because I had one of the 20th century’s best scientists, the late Professor Tony McMichael, as my mentor. I worked with Tony for about 10 years and we continued to collaborate on understanding nutrition and cancer for several decades after that. I spent a lot of my subsequent career in the United States, where I worked further on colorectal and other cancers – environmental factors, genetics, prevention, and early detection.

“More recently, I have been worrying more about the way in which we are changing the environment, the climate, and our living spaces and the impact that these changes have on our health, and on the health of the planet.”

Professor Potter says he is most proud of the work his former students are doing.

“The best times in my life have been around watching my former students, former post-docs, and junior colleagues flourish and contribute strongly to what we know. Just this month, one of my former PhD students became the director of one of the cancer centres in the United States. I am so proud of them all.”

Professor Potter began his role at Massey in 2010 based in Wellington. He was also Chief Science Advisor for the Ministry of Health between January 2016 and January 2019. He is Senior Advisor at the Fred Hutchinson Cancer Research Center and Professor Emeritus of Epidemiology, University of Washington, both in Seattle, United States.