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Matheson A, Wehipeihana N, Gray R, Walton M, Uia T, Lindberg K, Shanthakumar M, Lopez MI, Reidy J, Firestone R, Ellison-Loschmann L. Building a systems-thinking community workforce to scale action on determinants of health in New Zealand. Health Place 2024; 87:103255. [PMID: 38710122 DOI: 10.1016/j.healthplace.2024.103255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
This article describes findings from the evaluation of Healthy Families NZ (HFNZ), an equity-driven, place-based community health initiative. Implemented in nine diverse communities across New Zealand, HFNZ aims to strengthen the systems that can improve health and well-being. Findings highlight local needs and priorities including the social mechanisms important for reorienting health and policy systems towards place-based communities. Lessons encompass the importance of local lived experience in putting evidence into practice; the strength of acting with systems in mind; the need for relational, learning, intentional, and well-resourced community organisation; examples of how to foster place-based 'community-up' leadership; and how to enable responsiveness between communities and local and national policy systems. A reconceptualisation of scaling in the context of complexity and systems change is offered, which recognises that relationships and agency are key to making progress on the determinants of health.
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Affiliation(s)
- Anna Matheson
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand.
| | - Nan Wehipeihana
- Weaving Insights, PO Box 147, Levin 5540, Horowhenua, New Zealand
| | - Rebecca Gray
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Mat Walton
- Institute of Environmental Science and Research Limited (ESR), Kenepuru Science Centre: 34 Kenepuru Drive, Kenepuru, Porirua 5022, PO Box 50348, Porirua 5240, New Zealand
| | - Tali Uia
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Kirstin Lindberg
- Environmental Health Intelligence New Zealand, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
| | - Mathu Shanthakumar
- Environmental Health Intelligence New Zealand, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
| | - Maite Irurzun Lopez
- Health Services Research Centre, Te Herenga Waka, Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Johanna Reidy
- School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn 6012, Wellington, New Zealand
| | - Riz Firestone
- Centre for Hauora and Health, Massey University, Wallace Street, Mount Cook, Wellington 6021, New Zealand
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Fredericks B, Bradfield A, Ward J, McAvoy S, Spierings S, Toth-Peter A, Combo T. Mapping pandemic responses in urban Indigenous Australia: Reflections on systems thinking and pandemic preparedness. Aust N Z J Public Health 2023; 47:100084. [PMID: 37806258 DOI: 10.1016/j.anzjph.2023.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES We investigate some of the strengths and challenges associated with Covid-19 responses in urban Indigenous communities in Brisbane, Australia. Our research reflects on the interconnected dynamics that impact health outcomes and mitigate or exacerbate the risk of Covid-19 spreading within urban Indigenous communities. METHODS Three systems thinking workshops were held in 2021 with Indigenous and non-Indigenous stakeholders (N15/workshop) from State and Federal services, along with Aboriginal Community Controlled Health Organisations. All worked in the urban Indigenous health sector. Stakeholders produced a Causal Loop Diagram (CLD) incorporating the critical feedbacks determining the dynamics influencing health outcomes. The aim of the research was to help stakeholders' build awareness of how the structure of the system influences health outcomes. RESULTS Stakeholders identified 6 key dynamics which have a negative or positive impact on mitigating risks of Covid-19 infection. By mapping these dynamics within a CLD, 7 intervention points were identified. CONCLUSIONS Systems thinking provides a useful tool in identifying the complexities associated with navigating health challenges, but further research is needed to develop frameworks that work in conjunction with Indigenous Australian methodologies. IMPLICATIONS FOR PUBLIC HEALTH Indigenous voices and communities must lie central to health responses/policies for Indigenous peoples. When systems thinking is done by or in collaboration with stakeholders it provides a visual language that can help design public health policy. What can be ascertained is that their effectiveness is predicated on systems thinking's integration with Indigenous methodologies that acknowledges Indigenous self-determination and challenges Eurocentric representations of health and Indigeneity.
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Affiliation(s)
- Bronwyn Fredericks
- The University of Queensland Brisbane, QLD 4072, Australia; UQ Poche Centre Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland Brisbane, QLD 4072, Australia.
| | | | - James Ward
- UQ Poche Centre Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland Brisbane, QLD 4072, Australia
| | - Sue McAvoy
- Centre for the Business and Economics of Health, Faculty of Business, Economics and Law, The University of Queensland Brisbane, QLD 4072, Australia
| | - Shea Spierings
- UQ Poche Centre Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland Brisbane, QLD 4072, Australia
| | - Agnes Toth-Peter
- Australian Institute for Business and Economics, The University of Queensland Brisbane, QLD 4072, Australia
| | - Troy Combo
- UQ Poche Centre Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland Brisbane, QLD 4072, Australia
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Systems Mapping of the New Zealand Free and Healthy School Lunch Programme: Perspectives from Lunch Providers. Nutrients 2022; 14:nu14204336. [DOI: 10.3390/nu14204336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
As part of the COVID-19 economic recovery package, the Aotearoa New Zealand Government rolled out a universal free and healthy lunch programme to the 25% least advantaged schools nationwide. This study explored experiences of school lunch providers in the Hawke’s Bay region. The aim was to create a systems map identifying points of intervention through which the lunch programme could be improved to meet the goal of reducing child food insecurity. Twelve lunch providers were interviewed to generate casual loop diagrams which were examined and integrated to form a single systems map. Seven themes arose during analysis: teacher support, principal support, nutrition guidelines and government support, supply chain, ingredient suppliers, student feedback and food waste. Teacher support was important for getting students to try new foods and eat the nutritious lunches. Principal support was a strong theme impacting opportunities for broader student engagement. This study employed systems science to highlight the importance of support from different stakeholders within the lunch programme to achieve the goal of reduced child food insecurity. Further work is needed to ensure the programme meets the wider goals of the government and community, and to determine the potential broader benefits of the programme.
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Culture of Healthy Eating and Food Environments, Policies, and Practices in Regional New Zealand Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116729. [PMID: 35682307 PMCID: PMC9180331 DOI: 10.3390/ijerph19116729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 01/08/2023]
Abstract
The school food environment plays an important role in shaping students' dietary choices, which often influence future dietary behaviours. We surveyed primary and secondary schools in Hawke's Bay, New Zealand, to measure the comprehensiveness and strength of food policies, describe the culture of food provision, and identify barriers to improving school food environments. Fifty-one schools were included in the final analysis, with 58.8% having a food policy, most of which used a generic template. Schools with food policies and those participating in the free and healthy lunch programme were more likely to have a strong culture around healthy eating. Common barriers to healthy eating were food outlets near school and resistance from students. Secondary schools reported facing more barriers to implementing healthy eating cultures, were more likely to use food as classroom rewards and to sell food to students, most of which was unhealthy. Hawke's Bay schools participating in food provision programmes are successfully improving their food environments through improved culture and delivery of healthy food; however, more action is needed to strengthen the wording and guidance in food policies and reduce the provision of unhealthy food in schools before effective change can be achieved.
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McKelvie-Sebileau P, Gerritsen S, Swinburn B, D’Souza E, Tipene-Leach D. Nourishing Hawke’s Bay: He wairua tō te kai – food security, health behaviours and wellbeing in children in regional New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2064519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pippa McKelvie-Sebileau
- School of Population Health, University of Auckland, Auckland, New Zealand
- Research and Innovation Centre, Eastern Institute of Technology, Napier, New Zealand
| | - Sarah Gerritsen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Erica D’Souza
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - David Tipene-Leach
- Research and Innovation Centre, Eastern Institute of Technology, Napier, New Zealand
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McKelvie-Sebileau P, Rees D, Tipene-Leach D, D’Souza E, Swinburn B, Gerritsen S. Community Co-Design of Regional Actions for Children's Nutritional Health Combining Indigenous Knowledge and Systems Thinking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4936. [PMID: 35564331 PMCID: PMC9106006 DOI: 10.3390/ijerph19094936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Children's nutrition is highly influenced by community-level deprivation and socioeconomic inequalities and the health outcomes associated, such as childhood obesity, continue to widen. Systems Thinking using community-based system dynamics (CBSD) approaches can build community capacity, develop new knowledge and increase commitments to health improvement at the community level. We applied the formal structure and resources of a Group Model Building (GMB) approach, embedded within an Indigenous worldview to engage a high deprivation, high Indigenous population regional community in New Zealand to improve children's nutrition. Three GMB workshops were held and the youth and adult participants created two systems map of the drivers and feedback loops of poor nutrition in the community. Māori Indigenous knowledge (mātauranga) and approaches (tikanga) were prioritized to ensure cultural safety of participants and to encourage identification of interventions that take into account social and cultural environmental factors. While the adult-constructed map focused more on the influence of societal factors such as cost of housing, financial literacy in communities, and social security, the youth-constructed map placed more emphasis on individual-environment factors such as the influence of marketing by the fast-food industry and mental wellbeing. Ten prioritized community-proposed interventions such as increasing cultural connections in schools, are presented with the feasibility and likely impact for change of each intervention rated by community leaders. The combination of community-based system dynamics methods of group model building and a mātauranga Māori worldview is a novel Indigenous systems approach that engages participants and highlights cultural and family issues in the systems maps, acknowledging the ongoing impact of historical colonization in our communities.
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Affiliation(s)
- Pippa McKelvie-Sebileau
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - David Rees
- Synergia Consulting Ltd., Auckland 1011, New Zealand;
| | - David Tipene-Leach
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - Erica D’Souza
- School of Future Environments, AUT University, Auckland 1141, New Zealand;
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
| | - Sarah Gerritsen
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
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McKelvie-Sebileau P, D’Souza E, Tipene-Leach D, Swinburn B, Gerritsen S. Healthy Food Environments in Early Learning Services: An Analysis of Manager Survey Responses, Menus and Policies in Regional New Zealand Early Childhood Education and Care Centres. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084709. [PMID: 35457573 PMCID: PMC9028152 DOI: 10.3390/ijerph19084709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 12/04/2022]
Abstract
Healthy food environments in early childhood play an important role in establishing health-promoting nutritional behaviours for later life. We surveyed Early Learning Services (ELS) in the Hawke’s Bay region of New Zealand and describe common barriers and facilitators to providing a healthy food environment, through descriptive survey analysis and thematic analysis of open-ended questions. We used a policy analysis tool to assess the strength and comprehensiveness of the individual centre’s nutrition policies and we report on the healthiness of menus provided daily in the centres. Sixty-two centres participated and 96.7% had policies on nutrition compared to 86.7% with policies on drinks. Of the 14 full policies provided for analysis, identified strengths were providing timelines for review and encouraging role modelling by teachers. The main weaknesses were communication with parents and staff, lack of nutrition training for staff and absence of policies for special occasion and fundraising food. With regard to practices in the ELS, food for celebrations was more likely to be healthy when provided by the centre rather than brought from home. Food used in fundraising was more likely to be unhealthy than healthy, though <20% of centres reported using food in fundraising. Only 40% of menus analysed met the national guidelines by not including any ‘red’ (unhealthy) items. Centre Managers considered the biggest barriers to improving food environments to be a lack of parental support and concerns about food-related choking. These results highlight the need for future focus in three areas: policies for water and milk-only, celebration and fundraising food; increased nutrition-focused professional learning and development for teachers; and communication between the centre and parents, as a crucial pathway to improved nutrition for children attending NZ early childhood education and care centres.
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Affiliation(s)
- Pippa McKelvie-Sebileau
- School of Population Health, University of Auckland, Auckland 1145, New Zealand; (B.S.); (S.G.)
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
- Correspondence: ; Tel.: +64-6-830-1787
| | - Erica D’Souza
- School of Future Environments, AUT University, Auckland 1010, New Zealand;
| | - David Tipene-Leach
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland 1145, New Zealand; (B.S.); (S.G.)
| | - Sarah Gerritsen
- School of Population Health, University of Auckland, Auckland 1145, New Zealand; (B.S.); (S.G.)
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