RHP&EO is the electronic journal of the International
Union for Health Promotion and Education
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Resources that have Influenced a Health Promoter from Aotearoa/New Zealandby Louise Signal, Otago University Signal, L. Resources that have Influenced a Health Promoter from Aotearoa/New Zealand, Reviews of Health Promotion and Education Online, 2002. URL: reviews/2002/1/index.htm. Where are we now ?A few words of introduction Since working in a maximum-security psychiatric hospital in Aotearoa/New Zealand at the age of 18, I have been acutely aware of social justice issues. At that time, I was planning to become a clinical psychologist. Subsequently, work as a nurse aide in a short-term psychiatric hospital convinced me that an individual approach to mental health was not enough. I realised that much of the stress that people endure in our society comes from social causes. I then turned to community psychology for a framework to address these issues. After a few years as a community worker, I accepted a position in the Ministry of Health where I began to understand the influence of public policy in our lives. It was at this point that I discovered health promotion. For me, health promotion captured my experience in working at the individual, community and policy levels. Health promotion acknowledges the complexity of human existence by providing meaningful solutions to our needs at a range of levels. My health promotion career has involved work in the Public Health Commission and the Ministry of Health as a health promotion advisor. It has also included PhD study in health promotion at the University in Toronto, in Canada. I am currently lecturing in health promotion at Otago University in Wellington, New Zealand. The Ottawa CharterWhen thinking about the resources that have influenced me most, I was struck once again by the contribution that Canada, and Canadians, have made to the development of health promotion internationally. The "Ottawa Charter for Health Promotion" (WHO et al, 1986) is the first resource I wish to highlight. I was working in the health promotion section of the New Zealand Department of Health in 1986 when it was developed. The Charter provided a real stick in the sand for the new public health. It was the first time that such a comprehensive approach to prevention had been articulated. It really resonated with us and has been extremely influential in framing health promotion in New Zealand since. Recently, I have heard New Zealanders say that it is outdated, that other documents - such as the "Jakarta Declaration", have superceded it. I defend the Charter as a seminal document in the field. The Charter not only defines health and health promotion, it outlines key roles health promoters fill and the major strategies we use. Furthermore, it calls for international action to promote health. There are changes that I would make to it, if given the opportunity. Spirituality, for example, is omitted from the definition of health and reorienting the health sector is written from the perspective of health promoters, not from the perspective of those many committed people in the health sector who are "reoriented" and wish to strengthen their work of "prevention in practice". However, for me, it remains the cornerstone of modern health promotion. Healthy Public PolicyTrevor Hancock, a British born Canadian, wrote a paper that greatly influenced me, "Beyond Health Care: From public health policy to healthy public policy" (Hancock, 1985). In articulating the difference between public health policy and healthy public policy, Trevor crystallised for me the challenge I had seen when I worked in the psychiatric unit, the need to address the broader causes of poor health.In 1988, I went to Canada to study healthy public policy. I went because of Canada's leadership in health promotion, and I was not disappointed. For five years I was based at the University of Toronto where I met, studied with and was befriended by many Canadians working in the field. My thesis was a process evaluation of the Premier's Council on Health Strategy, an innovative attempt by the Premier of Ontario to adopt a healthy public policy approach across his government. Premier Peterson brought eight cabinet ministers to the same table as leaders in the health sector, business and labour to address the health needs of the province. This occurred at a time of increasing fiscal pressure in the health system. As often happens in politics, this innovation was, I believe, two things at once: a genuine effort to understand how to take a healthy public policy approach, and an effort to contain costs. I have not been in a position to analyse to what extent this innovation made a difference to thinking about public policy making in Ontario, or to health outcomes. However, it was, in my view, a commendable effort to develop new institutional arrangements to improve health. A Strategic ApproachWhen I returned from Canada I worked in Aotearoa/New Zealand's short-lived Public Health Commission, another new government institution responsible for health promotion policy and purchasing. The Commission's work was framed by a strategic plan, "A Strategic Direction to Improve and Protect the Public Health" (Public Health Commission, 1994), and its companion document, "He Matariki: A Strategic Plan for Maori Public Health". These documents set out the goals and objectives for public health in Aotearoa/New Zealand and did so firmly based in a health promotion approach. Again, a Canadian had a role in this work. Terry Sullivan, the executive-director of the Premier's Council, was invited to New Zealand to advise on the establishment of the Commission and its strategic approach. Despite considerable reform in the health sector over the following decade, the "Strategic Direction" continued to frame much health promotion and public health practice in New Zealand for a number of years. Reflective PracticeIn my time as a health promotion policy maker, I was indebted to Fran Baum for a paper she wrote "The new public health: force for change or reaction?" (Baum, 1990). In this paper, Fran reminds us that there are contradictions inherent in health promotion. She argues "it only takes a slight re-jigging of the rhetoric for it to become reactionary rather than progressive" (1990, p. 149). The Ottawa Charter's support for enabling people to take control of their own health can, for example, be interpreted by conservative governments as justification for new right agendas of individual responsibility and withdrawal of state involvement in health promotion. Her paper helped me see these contradictions and provided advice about how to deal with them in my practice. Fran argues for self-reflection, for the need to:
Her message continues to be highly relevant today. Current developments in Aoteaora/New ZealandFinally, we have recently taken a considerable step forward in health promotion in Aotearoa/New Zealand with the development of "The TUHA-NZ Memorandum: a Treaty understanding of hauora [the Maori concept of health] in Aotearoa-New Zealand" (Health Promotion Forum, 2002). The Treaty of Waitangi is the founding document on this country. It is a Treaty signed in 1840 between the Crown and Maori, the indigenous people of this land, which sought to protect Maori from the result of colonisation. It guaranteed partnership between Maori and the Crown, promised to protect Maori interests and allow Maori the full expression of citizenship. Unfortunately, the Crown has failed to honour the Treaty and Maori continue to suffer considerable social and economic deprivation as a result. The challenge of honouring the Treaty remains. There has been unease in New Zealand about the relationship between the Treaty and health promotion for many years. Despite the acknowledgement in the Ottawa Charter that "health promotion strategies and programmes should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic systems", it has taken nearly 15 years for us to achieve this (WHO et al, 1986, p. 2). TUHA-NZ, symbolising the two hands of Treaty partnership, provides a way of operationalising the Treaty in our health promotion practice. It is part of a wider movement to articulate Maori approaches to health promotion, led by people such as Mason Durie, Papaarangi Reid and Mihi Ratima. TUHA-NZ may give inspiration to indigenous people, and those working for indigenous rights, to seek their own understanding of health promotion and to ensure that health promotion addresses their needs in culturally appropriate ways. In conclusionTo conclude, health promotion has much to contribute to addressing complex health issues in a comprehensive way. There is an increasing body of literature to support health promotion efforts. In this paper, I have highlighted a number of key issues through my selection of papers from this literature. They include: the value of the "Ottawa Charter" in defining health promotion; the importance of healthy public policy; the need for a strategic approach to health promotion; the importance of reflective practice and the on-going challenge of addressing the needs of indigenous people. Reference
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