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Racism and government policies of colonisation and assimilation contribute to the disproportionate burden of disease carried by indigenous people globally. In colonial contexts such as Aotearoa New Zealand, these inequities are routinely monitored but governments believe economic growth and better lifestyles will resolve the issues. Stop Institutional Racism (STIR), a group of health activists, is challenging this dominant discourse and building a boutique social movement to transform racism within the New Zealand public health sector. Central to the work of STIR is partnership between indigenous and non-indigenous practitioners underpinned by Te Tiriti o Waitangi – the founding document of the colonial state of New Zealand. This paper reflects on STIR organisational processes and political achievements to date. We have worked towards mobilising the public health sector, re-energising the conversation around racism and strengthening the capacity and evidence base of the sector around key sites of racism and anti-racism praxis. This paper will be of interest to others within the global public health community who are looking for new collective ways to organise and challenge entrenched inequities. [ABSTRACT FROM PUBLISHER]

Over recent decades, psychological health interventions have assumed a more prominent role in the conduct and regulation of daily life. Conceptualised in the critical social sciences as psychological governance, this development entails shaping the thoughts, feelings, and behaviours of individuals and populations to promote desired psychological states and conduct. In step with broader sociotechnical shifts, psychological governance is increasingly mobilised through digital technologies, such as smartphone apps. The COVID-19 pandemic marks a pivotal moment in the proliferation of digital mental wellbeing technologies. This paper examines the mental wellbeing app Mentemia, made available to the New Zealand public through government funding in the wake of COVID-19, exploring how Mentemia frames and addresses mental wellbeing in the context of the pandemic. Drawing from thematic analysis of within-app material and news media articles, we illustrate how Mentemia constructs mental wellbeing as a universal, everyday, and individual process and encourages users to engage with psychological intervention as a normalised component of daily life. We find that Mentemia's approach to framing and addressing mental wellbeing during COVID-19 aligns with prevailing discourses associated with the individualising and emancipatory values of contemporary neoliberalism which, in the context of psychological governance, presents as neuroliberalism. We highlight how Mentemia advances a particular understanding of psychological intervention to help remedy pandemic-related mental ill-health, illustrating the capacity for digital technologies to alter how mental wellbeing is experienced and acted on. [ABSTRACT FROM AUTHOR]

Recognition of the health effects of social isolation has led to the media framing it as a public health issue. In this paper, we examine how the media frame social isolation among older people and how the public respond to this framing. Using framing analysis, we analysed an online article, embedded video content and 369 comments posted in response to this article. The article used a recognisable public health framing to understand the causes of social isolation as structural, supported by a video which presented the private face of a public health problem. The online comments largely resisted this framing, arguing that social isolation reflected an individual deficit, best remedied through individual actions such as joining groups or having a positive attitude. Families were also viewed as responsible for the social lives of their members, and social isolation was attributed to neglectful families. Commenters also suggested that alleviating social isolation was the responsibility of neighbours and volunteers. These three arguments accounted for 88% of the comments. Much less commonly, social isolation was described as due to the march of Western civilisation. This analysis shows how the public are active in their response to, and largely rejection of, framing social isolation as a public health issue. Although the health impacts of social isolation were endorsed, this was insufficient for structural explanations to prevail. Public health campaigners need to understand how individualising accounts of health issues are used to undermine public health explanations so as to most effectively challenge them. [ABSTRACT FROM AUTHOR]

This paper explores whether industry self-regulation of food advertising to children protects child rights. The New Zealand Advertising Standards Authority (ASA) system is analysed with respect to the United Nations Convention on the Rights of the Child (UNCROC). Content analysis of data sources such as the ASA website and key documents is used. Eight decisions on public complaints about advertising are analysed. This research finds that implementation of the codes includes partial, unjustified and inconsistent decision making by the complaints board; failure to implement changes to codes; and failure to prevent unhealthy food advertisements being developed and aired. The ASA system is found to be reactive, to have limited sanctions, to provide little incentive for restraint by advertisers, and to lack independent monitoring. This analysis suggests the New Zealand advertising standards system does not protect the rights of children by failing to enact the spirit of UNCROC and specifically by not adequately addressing Articles 3, 6 and 13. Given the extent of the harm to children worldwide of unhealthy eating patterns, the evidence of the contribution of marketing to poor nutrition and the findings of this research, it is concluded that government regulation of marketing of food to children should be implemented globally. This would assist governments to reduce the effects of one of the key environmental contributors to unhealthy eating patterns and enable them to meet their obligations in international law to protect the rights of children. [ABSTRACT FROM AUTHOR]

This paper uses the concept of ‘ethicality’ to analyse focus-group conversations in New Zealand on biobanking and genetic testing. ‘Ethicality’ has been used by Arohia Durie, a Maori educationist, to highlight how ethical talk and practice is historically and socially positioned, situated within specific life-worlds, embedded within always partial communities, and articulated within individual life narratives. This situated ethicality is identified in the talk of Maori and non-Maori research participants. The authors (a moral philosopher, two sociologists and a kaupapa Maori social researcher) argue that serious consideration of ethicality presents significant challenges to the abstracted character of much expert ethical analysis, while also illustrating connections between ‘ethics talk’ and expert discourses. [ABSTRACT FROM AUTHOR]

In this paper we consider what impact a biopolitics that creates a compliant self-governing weight-focused population has had on Māori health in Aotearoa/New Zealand. We frame this discussion with three vignettes that in different ways demonstrate the deleterious effects of the individualisation of health on Māori. We argue that the current biopolitics is best explained as 'the health of Maoris' not 'Māori Health'. To counter this current biopolitics we put forward an alternative epistemology, the 'Atua Matua' framework. This epistemology pays respect to a Māori view of health that is holistic, encompassing physical, emotional, spiritual, cultural and familial well-being and does not give ground to the requirement for individualism so prevalent in neoliberalism. Finally, we consider what this new epistemology might offer to the public health agendas in Aotearoa and other countries where indigenous populations suffer ill health disproportionately. Thus, our implications have potential not only for Māori health but human health in general. [ABSTRACT FROM AUTHOR]

Unhealthy food environments are known to be major drivers of diet-related non-communicable diseases globally, and there is an imperative for major food companies to be publicly accountable for their actions to improve the healthiness of food environments. This paper examines the prevalence of publicly available policies and commitments of major packaged food and soft drink manufacturers, and fast-food restaurants in Australia, New Zealand and Fiji with respect to reducing food marketing to children and product (re)formulation. In each country, the most prominent companies in each sector were selected. Company policies, commitments and relevant industry initiatives were gleaned from company and industry association websites. In Australia and New Zealand, there are a higher proportion of companies with publicly available marketing and formulation policies than in Fiji. However, even in Australia, a large proportion of the most prominent food companies do not have publicly available policies. Where they exist, policies on food marketing to children generally focus on those aged less than 12, do not apply to all types of media, marketing channels and techniques, and do not provide transparency with respect to the products to which the policies apply. Product formulation policies, where they exist, focus mostly on salt reduction and changes to the make-up of overall product portfolios, and do not generally address saturated fat, added sugar and energy reduction. In the absence of strong policies and corresponding actions by the private sector, it is likely that government action (e.g. through co-regulation or legislation) will be needed to drive improved company performance. [ABSTRACT FROM AUTHOR]

In this paper, we examine how New Zealand children engage with public health agendas that seek to shape their understandings of health. We shed light on the ways children make sense of what they see, hear and come to know through public health ‘work’, and consider what effects this has for how they come to think of their ‘selves’ and relations with others. We pay attention to the way public health messages assemble, bolstered by dispositions, behaviours and ruminations expressed in schools, families and communities. Children’s talk exemplifies the sheer volume of public health missives saturating their worlds and the range of media used to reach into children’s lives. In many cases, children are ‘doing it for themselves’ in the sense that they are attempting to enact health imperatives about healthy eating, regular exercise and weight management. However, alongside the willingness of many to simply believe and enact health information, we draw attention to the capacity of some children to think through public health messages, negotiate and make sense of them in relation to their own lives. Despite the ubiquity and mantra-like quality of public health messages currently directed at children we contend they are variously interpreted and embedded in children’s lives. We regard the messiness and complexity of children’s engagement as affirmation that a critically informed variety of public health could provide opportunities for children to come to know health as more than simply eating the right foods and running a lot. [ABSTRACT FROM PUBLISHER]

A common aim of health and human service programmes is to improve the health status of marginalized groups. One such group is new migrants. This paper summarizes the results of a three-year study of a health and empowerment initiative undertaken with a low-income migrant community in Aotearoa/New Zealand (A/NZ), with subsequent interviews with community workers engaged with such communities in A/NZ and Canada, a country known for its open migration policies and programmes aimed at assisting new migrant communities. Subtle dynamics of identity, culture and power are demonstrated to play key roles in shaping new women migrant's empowerment experiences. The paradoxical nature of these dynamics has implications for those workers and agencies engaged in programs seeking to improve the capacities of such groups to act in empowered ways on conditions that influence their health. [ABSTRACT FROM AUTHOR]

This paper considers linkages between contemporary marketing theory and practice, and emerging conceptualizations of identity, to discuss implications for public health concerns over alcohol use among young people. Particular attention is paid to the theorizing of consumption as a component of youth identities and the ways in which developments of marketing praxis orients to such schemata. The authors’ analyses of exemplars of marketing materials in use in Aotearoa New Zealand, drawn from their research archive, emphasize the sophistication and power of such forms of marketing. They argue that public health policy and practice must respond to the interweaving of marketing and the self-making practices of young people to counter this complex threat to the health and well-being of young people. [ABSTRACT FROM AUTHOR]

In New Zealand child health nurses are employed by a voluntary organization called the Royal New Zealand Plunket Society (RNZPS) and are called Plunket nurses. These nurses primarily work in the community with the parents of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices generally carried out in the context of a relationship between the nurse and the mother. However, there are suggestions in the literature that historically the nurse's surveillance role has conflicting objectives, as she is at the same time an inspector and family friend. The purpose of this paper is to examine the discourses of scientific mothercraft and their implications for the nurse-mother relationship, drawing on the author's recent research into surveillance and the exercise of power in the child health nursing context. The application of Foucauldian discourse analysis to the texts generated by interviews with five New Zealand child health nurses confirms that this paradoxical role has never been fully resolved. [ABSTRACT FROM AUTHOR]

Healthy Food Guide (HFG) has been a hugely successful magazine, both dominating the health magazine market and becoming deeply imbedded within the public health discourse, sanctioned and legitimated through a range of State apparatuses. Central to this has been an ability to differentiate itself from 'restrictive diet programs' and other forms of 'misleading' health advice, which they claim, unlike their magazine, are ungrounded in the latest scientific evidence. Through a qualitative analysis of the lead article in every issue of HFG from 2005 to 2017, we question its endorsement by New Zealand public health agencies, arguing that it acquires revenue through the intensification of health anxiety within its target readership. It does this through constructing its ideal reader as a health entrepreneur within the discourse of new public health, able to collect the right information to make the appropriate consumer choices, within a risk-saturated marketplace. A key contribution of this article is bringing a Lacanian psychoanalytic theory to the broad area of public health, which has been so far under-applied. By linking Lacanian theory to the health entrepreneur, we developed that concept by foregrounding the roles of desire and anxiety in healthism discourse. We argue that the consumer of HFG is bound to its libidinal economy in a relation of domination, whereby they are given the task of allaying anxiety through the collection of data on their bodies, information which only produces more anxiety. [ABSTRACT FROM AUTHOR]

An integral part of colonisation is the suppression and marginalisation of indigenous knowledges. The indigenous health system within Aotearoa (New Zealand) was supplanted with a colonial infrastructure and praxis which has proven ineffective in addressing systemic health inequities created by the processes of colonisation. This novel study interrogates discursive representations of Māori (Indigenous peoples of Aotearoa) within colonial public health policy between 2006 and 2016. Colonial policy refers to generic or mainstream policy that are designed for 'all' New Zealanders. We utilised thematic analysis to examine 106 policies and, after excluding 13 ethnic specific policies, identified 68 policies containing no mention of Māori. The analysis highlights five themes relating to discursive representations of Māori. These were: i) silence about Māori health; ii) Māori as especially at risk; iii) Crown (lack of) responsiveness to te Tiriti o Waitangi obligations; iv) recognition of Māori philosophical approaches to service provision; and v) utilising mātauranga Māori (Māori knowledge). These findings suggest colonial policy presents a barrier to the pursuit of health equity and is poorly aligned to global Indigenous human rights declarations. Within the context of Aotearoa it echoes the sentiments of the key Waitangi Tribunal [WAI 2575] finding that health policy is contributing to health inequities and failing Māori. Health policy must be decolonised to better engage with human rights declarations and te Tiriti o Waitangi obligations in order to achieve health equity. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the association between caregiver experiences of racial discrimination and physical and emotional health outcomes for their children and to explore potential pathway variables in this relation. We analysed data from two instances of the New Zealand Health Survey that provide nationally representative data for children and adults, with high response rates for each of the major ethnic groupings (Indigenous Māori, Pacific, Asian, and European/Other). Questionnaires from the primary caregiver and their child (5 to 14 years) were linked to create n = 2,958 child-primary caregiver dyads in the 2006/07 Survey and n = 2,632 dyads in the 2011/12 Survey. Children whose caregivers reported any experience of racial discrimination had poorer mental health, self-esteem, and behaviour scores on the CHQ PF-28 scale, even after adjustment for caregiver sociodemographic variables. Multivariable models identified a worsening in child emotional health as the number of reported racism experiences increased. Caregiver experiences of racism were not associated with medicated asthma in their children. Multivariable models suggest that caregiver psychological distress may be a pathway linking vicarious racism to poorer child emotional health. [ABSTRACT FROM AUTHOR]

The article discusses the relation of mass media and public reactions to adverse drug reactions (ADR) to the medication Eltroxin (levothyroxine) in New Zealand from June 2008 to August 2009. Topics include statements by New Zealand government agencies related to public health, the importation of alternative drugs to treat hypothyroidism, and reforms related to drug safety and reporting.

Māori and Pacific Peoples experience a disproportionate burden of alcohol-related harm relative to other ethnic groups, yet little is known about the context in which this drinking occurs. Few studies have explored how and why young Māori and Pacific women drink. Therefore, this article aims to develop a more nuanced and detailed account of Māori and Pacific young women’s drinking practices. The following article reports on an ethnographic study of young Māori and Pacific women aged 18–30. Five Māori participants and six Pacific participants were selected and asked to become researchers within their social groups. Nine female researchers also became participants in the study, accompanying recruited participants to drinking occasions and events. Participants were each given a ‘drinking diary’ to document drinking occasions, which formed the data-set for the project. Three levels of thematic analysis were undertaken. The first noted broad themes with the second and third levels exploring more nuanced themes and identifying intersections across themes. The study demonstrated that Māori and Pacific young women’s engagement with New Zealand’s culture of intoxication is complex: Māori and Pacific women drink for pleasure or to achieve a ‘buzz’ and to be social. Drinking practices are deeply affected by ethnic and peer group collectives (‘the girls’), traditions and expectations. Harm reduction initiatives need to take account of the many pathways specific to how Māori and Pacific young women engage with alcohol use. Additionally, the wider context in which alcohol-related harm occurs needs to be considered in policy and harm reduction debates. [ABSTRACT FROM PUBLISHER]

Public health medicine is distinct in two ways from most other forms of medical specialisation; firstly, it is predominantly non-clinical and secondly, its concern is with populations, rather than the more common individual physician–patient encounter. In spite of recent attempts to ‘mainstream’ public health approaches into medical training and practice, it remains a relatively low prestige medical specialty. In the face of the centrality of all things clinical in medical training, the identity work needed to think beyond this and into population health approaches is significant. In the face of public health physicians’ subaltern position within medicine, this research investigates the identity work doctors did as they made the transition into public health medicine and how they understood their positioning once they were within the specialty. The inductive thematic analysis conducted on the qualitative interview data generated for this research elicited three key themes of relevance for the 19 public health physicians in New Zealand who were interviewed. The calling into question of biomedical identities was evident and concomitant with this was a sense of loss of the satisfactions of clinical medicine including contact with patients and the ability to solve discrete clinical problems. The final theme revolved around how public health physician identities were felt by the participants to be discredited. Lack of attention to the identity work required to think beyond the individual in health terms may contribute to a slow pace of change. [ABSTRACT FROM PUBLISHER]

Concern for the creep of surveillance and control into the everyday lives of citizens has revived contemporary debates over the politics of health promotion. We examined how political changes have impacted on the work of health promoters through qualitative research with individuals working in the health promotion sector. Interviews and focus groups were undertaken between January 2008 and March 2009. Caught in a neoliberally influenced drive to increase the efficiency of the health sector, health promotion in New Zealand has been subject to considerable changes in the funding and provision of services. Characterised by a growth in limited-term contracts with constrained budgets, health promoters have responded to fiscal limitations by pooling resources. We find that rather than being uncritical agents of the government’s health promotion agenda, health promoters often became advocates of the community’s agenda, occupying a ‘grey space’ where the demands of contracts create tension with their commitments to communities. Any portrayal of health promotion must acknowledge the contested nature of the spaces of governance health promoters occupy and resist reducing them to uncritical agents of the state. [ABSTRACT FROM PUBLISHER]

A wide variety of health promotion strategies are employed which are designed to educate members of the public with the ultimate goal of gradual general cultural change and individual behaviour change. The object is a closer alignment of individual and population health-related behaviours with 'ideal' notions of what a healthy citizen might be. These campaigns are not taken up in any straightforward way, but people negotiate the messages in complex and sometimes contradictory ways. Drawing on data generated in focus groups, this article explores this complexity by addressing the themes of resistance, denial and othering. This article also identifies an unintended consequence that may arise from processes of othering that may serve to reinforce stigmatisation and inequality rather than mitigating it. [ABSTRACT FROM AUTHOR]