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Programme ProfilesEach year at ANA events and in our newsletter we profile successful nutrition and physical activity programmes from around the country. These profiles are included here. Hauora Tāne – Muriwhenua One Heart Many LivesANA Newsletter – December 2007 Hauora Tāne-Muriwhenua is part of the One Heart Many Lives Campaign in the Far North. Henare Anderson, Lisa Mc Nab, and Callie Corrigan of Te Hauora O Te Hiku O Te Ika, recently presented about this campaign to the National Nutrition and Physical Activity Hui in Turangawaewae. Hauora Tāne-Muriwhenua aims to increase awareness about the risk of cardiovascular disease among our whānau with a specific focus on Tāne Māori over the age of 35. Additional goals of the campaign are to:
From the initial planning stages of Hauora Tāne- Muriwhenua, Te Hauora o Te Hiku O Te Ika involved Tāne Māori from their community. "Tāne Māori were invited to a number of dinners to discuss issues around going to the doctor, communication from health professionals, what cardiovascular disease was and related topics," says Callie Corrigan. The sessions were led by Dr Lance O'Sullivan and Henare Anderson and provided a valuable foundation and ideas to progress the campaign. From these forums a number of tāne agreed to be a face for the campaign and the 'Brofiles' were born. The 'Brofiles' are a diverse group, different ages, occupations, iwi, and backgrounds. They shared their stories in a series of articles published in the local Northland Age. The articles also included information from Dr Lance O'Sullivan on cardiovascular disease and related lifestyle topics. The articles were a way of connecting the community to this important kaupapa, and Te Hauora O Te Hiku O Te Ika was awarded an Adult Education Award from Rural Education Adult Programme (REAP). A development from the campaign is the Heart Health WOF card. Following a screening examination, which includes checking blood pressure and cholesterol levels, an assessment of Red, Orange or Green is given. This provides an indication of cardiovascular disease risk and recommends time-frames for tāne to go and have a comprehensive heart health check from their GP or Nurse. Posters of the 'Brofiles' have also been produced to encourage other tāne Māori to look after themselves and get a heart health screen. The posters and information on cardiovascular disease have been collated into a heart health resource that will be distributed during the next stage of the campaign. Much remains to be done to achieve the goal of all our whānau having regular heart health screens, accessing the right medication and making healthy lifestyle choices. If you would like more information on the Hauora Tāne Muriwhenua – One Health Many Lives Campaign contact Te Hauora O Te Hiku O Te Ika on 09 408 4024. For information on the national One Heart Many Lives campaign contact PHARMAC on 04 460 4990 or 0800 660 050. The campaign website is www.oneheartmanylives.co.nz. Ūkaipo Kia Pai Te Tipu – Healthy Growing Breastfed PēpiANA Newsletter – December 2007 Tena Koutou Ūkaipo Kia Pai Te Tipu was an initiative developed in partnership with Toiora – Healthy Lifestyles and Manaaki Oranga corresponding with World Breastfeeding Week (1-8 August 2007). World Breastfeeding Week is an annual event aimed at raising the awareness of breastfeeding and increasing worldwide breastfeeding rates. This year World Breastfeeding Week focused on breastfeeding within the first hour of birth as the most vital step towards reducing infant and under-five mortality. Save ONE million babies – beginning with ONE action, ONE hour support and ONE message. Another of this year's themes was 'Skin-to-skin' highlighting the importance of immediate contact between mother and newborn. This direct contact allows instinctive behaviours to take over so the baby can feed when ready. Amazingly, a newborn will crawl towards the breast minutes after birth. Many of us know the benefits of breastfeeding, but were you aware that the nourishment received from colostrum will provide a baby with its first immunisation? Throughout the first hour their sucking reflex is at its strongest, so it helps them establish a proper latch on technique. Also skin-to-skin immediately following birth will keep baby warm and regulate their breathing and heart rate so they are calmer – especially after the ordeal they have just gone through! Toiora – Healthy Lifestyles and Manaaki Oranga Ltd wanted to create a Whānau Ora initiative using a photovoice display to raise awareness about the benefits of breastfeeding for Māori which included the following components:
While developing our photovoice display, we were gifted a design developed by Mokoworx – Peter Elers that symbolises the importance of whānau, nutrition and health benefits connected to breastfeeding. The lower segment off the design shows pēpi being breastfed, the upper segment shows pēpi turned onto the shoulder being burped. We continued using the name 'Ūkaipo' which has been around for awhile, but added an extension given to us by Doreen Erueti 'Ūkaipo Kia Pai Te Tipu – Healthy, Growing Breastfed Pēpi'. Our vision is for the design is to become a visual connection pertaining to breastfeeding specific for Māori within Taranaki. Throughout World Breastfeeding Week our photovoice display was placed at different venues all over Taranaki to raise awareness around breastfeeding. Our local Māori radio station, Te Korimako o Taranaki, was happy to support the kaupapa. Kia tou ngā manaakitanga o to tātou Ariki ki runga kia tātou katoa. Supermarket Intervention Project – KawerauToi te Ora – Public Health is working with the Cancer Society, Kawerau PHO, and Māori provider Tuwharetoa ki Kawerau Hauora Trust to deliver a project with Kawerau New World. The aim is to improve family nutrition by increasing fruit and vegetable purchases made by mothers with young families. Project leader Richard Kavanagh says, "The project is based on a survey on mothers' knowledge, attitudes and barriers towards healthy eating, especially focusing on fruit and vegetables." The survey found parents are concerned about providing a range of fruit and vegetables to their children, but spending power often determines shopping choices. Parents also said their lack of knowledge on how to prepare fruit and vegetables and the fear their children won't accept them as key factors affecting how often they tried new fruit and vegetables. A 10-week intervention kicked off on 5 March at Kawerau New World. Each Wednesday and Thursday, healthy recipes using fruit and vegetables are available to sample with discounts offered on the key fruit and vegetables used. Laminated green feet with simple health messages have been placed on the floor of the aisles to remind people about fruit and vegetables and encourage them to try something different. This project also partners with the Cancer Society's LiveSmart campaign, which encourages people to make simple changes that add up to a healthier lifestyle. It also builds on a number of nutrition-based projects in Kawerau, including Fruit in Schools, a home gardening project by Tuwharetoa ki Kawerau Hauora and the planting of fruit trees in public domains by the City Council. For more information about the project please contact Richard Kavanagh: richard.kavanagh@bopdhb.govt.nz or phone 07 306 0701. Kai in the Yard – Māori Women's Welfare League'Kai in the Yard' is a national initiative of the Māori Women's Welfare League to assist whānau to re-establish vegetable gardens at home. It is carried out voluntarily by a number of different league branches around the country. Here the Arahi Branch of the League from South Invercargill shares its story. "We thought the Kai in the Yard project sounded like a practical way to assist whānau to grow their own vegetables at home. We also thought it was a good way to support healthy eating and reduce stress for people on tight budgets," say Arahi branch members Anne Fogarty and Jemma McArthur. Over the spring of 2005 branch members helped to plant four gardens for whānau needing assistance, for example families who had not gardened before, or older people no longer able to garden. A range of vegetables including potatoes, lettuce, silverbeet, spinach, yams and herbs, were planted. Many of the vegetables were planted in containers or polythene bags to make the plants more accessible and easier for people to weed. "The aim of the project is to encourage people to carry on with the garden, so it was positive to see the interest from whānau members, including teenagers," says Anne. The project breaks down some of barriers to starting a garden, such as the cost of seeds, plants, tools and whether a home has decent soil. It also addresses the problem of people living in rental accommodation who worry they may have to move once it is established." In 2006, the branch focused on working with Murihiku marae Te Kohanga Reo to establish a garden at the Kohanga with the involvement of tamariki, parents and staff. "We had a great planting day in November with a lot of help from the parents, and the Kohanga were able to get funding for the plants," said Jemma" The Māori Women's Welfare League – Te Roopu Wahine Māori Toko i te Ora, was founded in 1951 to support the welfare of Māori particularly women and children. The League has a number of different branches around New Zealand. For more information contact the National Office: 04 473 6451. Update on Mangere Healthy KaiANA Newsletter – December 2005 It is now two years since Mangere Healthy Kai was launched and things are changing at Mangere Town Centre. At a November stir-fry taste testing, held in support of Health Pacifica's and Turuki HealthCare's Diabetes Awareness Day, two retailers were given awards for their efforts to introduce new healthy food options. One of the retailers, Mr Liu, said his own health issue (a heart attack earlier this year) had enhanced his understanding of healthy eating. Mr Liu now sells sushi (a first for the Mangere Town Centre) and is using leaner meat in his stir-fries and low fat milk for beverages. A second retailer is grilling fish rather than frying, has ceased using MSG and is using less soy sauce. Three retailers gave their time to help with the stir-fry demonstrations. An external evaluation conducted in May showed the retailers believed in promoting healthy food, and that the programme enhanced their business through the increased promotion and media coverage of events. The retailers reported an increase in the sale of stir-fry, sandwiches, grilled fish and fruit and vegetables since the beginning of the programme. While shopper surveys show good awareness of the programme, the evaluation revealed that some consumers were confused by the signage and more work needed to be done to get the programme messages across. In response the Working Group has developed a resource with photos of the healthy choices to place at point of sale and has held a community consultation meeting. A resource has also been developed for health workers to use with their patients and workshops to explain the resource and the Healthy Kai programme. Agencies participating in Mangere Healthy Kai are Health Pacifica, Turuki HealthCare, Mangere Community Health Trust, Auckland Regional Public Health Service, New Zealand National Heart Foundation and ProCare Network Manukau. Ngati and Healthy Diabetes Prevention ProjectAt the ANA forum in Northland 2004 Helen Pahau, from Ngati Porou Hauora, presented about the Ngati and Healthy Prevention Diabetes Project. Ngati Porou Hauora covers the East Coast area of the North Island. The project is a collaboration between Ngati Porou Hauora and the Edgar National Centre for Diabetes Research, University of Otago. Its objective is to "Develop and evaluate a community intervention to reduce the prevalence of insulin resistance, Impaired Glucose Tolerance/IFG and type 2 diabetes in a Māori population". The study's design consists of three components:
The pre and post intervention surveys are being used by the researchers to evaluate the effectiveness of the two-year intervention. A process evaluation is also being done. The pre-intervention survey brought up some alarming results. Of the 247 Māori randomly surveyed, 22 (8.9%) had known diabetes. However, a further 11 people (4.5%) were identified as having diabetes. Eleven people (4.5%) had impaired Glucose Tolerance, and 91 people (36.8%) were identified as insulin resistant. More than 50% were either at risk of developing diabetes or already had it. The study is now in its invention phase focusing on the community as well as individuals identified as high risk. The community programme is being run once a month in the East Coast communities of Uawa, Tokomaru Bay, Ruatoria and Matakaoa, for a two year period. The programme consists of:
The resources used in the programme, such as food diariess and suggested food changes sheets, are constantly evaluated and modified to suit the community's needs. Changes encouraged include having breakfast, changing preparation methods to reduce fat, increasing the use of vegetables, increasing water consumption and reducing soft drinks. As part of a structural strategy, Helen is trying to make healthier foods such as brown bread easier for people to access in remote rural communities. Exercises unique to the East Coast environment are also encouraged, such as gathering food from the sea, and bush. Funding and support for the programme has come from a number of sources:
The programme also relies on the time and resources from the staff of Ngati Porou Hauora, the University of Otago, as well as the support of the wider Ngati Porou whānau. The recent signing of a memorandum of understanding by the University of Otago with Ngati Porou Hauora has strengthened this link. Te Whai Matauranga o te Ahua Noho – Diabetes Prevention ProgrammeAt the Wellington forum 2004 Eleanor Murphy presented about Te Whai Matauranga o te Ahua Noho, a lifestyle intervention aimed at decreasing the risk of type 2 diabetes for Māori in Otepoti (Dunedin). Based on a clinical trial called the 'Insulin Resistance Study' at the Department of Human Nutrition, University of Otago, Te Whai is a community based 12 month intervention programme based in the Otago District Health Board Lifestyle Unit.
During the initial consultation with participants their readiness for change is established along with their medical history and risk status. The participant also completes a four-day food record and dietary changes are encouraged for the participant and their entire whānau.
The emphasis is always on long term gradual changes rather than a short term diet focus. Dietary changes encouraged include eating more fruit and vegetables, eating kai moana (seafood) one to two times a week if possible, removing fat from meat, eating legumes (e.g. lentils and chickpeas) one to two times a week, learning about low GI and low fat dairy foods, and aiming for heart healthy fats from nuts and seeds.
Participants and their whānau learn how to make these changes through monthly 'Healthy Kai sessions'. The programme offers supermarket tours and other services on request.
It also encourages physical activity, tailoring exercise goals so that activities are offered for groups and individuals in a safe, supportive and enjoyable environment. The emphasis is always on fun for the whole whānau, performing exercise safely (intensity and type) and helping people develop a 'habit' of physical activity for life.
The programme has had some stunning results both clinically and in terms of weight loss. One man went from 145kg to 109kg over the 12 month period.
In her presentation Eleanor emphasised that other measures are important for participants such as being able to cut your own toe nails, reducing your anti depressant medication and feeling good about yourself.
The programme has successfully completed three years supporting participants and their whānau to make life-long lifestyle changes. For more information contact Eleanor Murphy: eleanorm@healthotago.co.nz. 10,000 Steps Northland10,000 Steps Northland is New Zealand's first 'whole of Northland' health promotion physical activity project funded by SPARC through the Active Communities Scheme. This is a creative approach to the problem of inactivity. The concept of the project is to encourage Northlanders to walk at least 10,000 steps over the course of the day. People are encouraged to start out slowly and gradually increase activity over time. Small increases in daily activity can have a big impact on health. Many can reach 10,000 steps a day by adding a 30-minute walk -– an inexpensive way to accumulate the activity you need. Project partnersThe 10,000 Steps Northland project involves the Far North, Kaipara and Whangarei District Councils, the Northland District Health Board, Manaia Health PHO, Hauora Whanui, Northland Health, Auckland University of Technology, SPARC (Sport and Recreation New Zealand) and Sport Northland. The Launch of 10,000 Steps NorthlandThe project was launched during the week starting Monday 22 November 2004 in five areas throughout Northland (Kaitaia, Kerikeri, Kaikohe, Dargaville and Whangarei). More than 1,000 people turned up to the launches over the course of the week which started at 10.00am. The concept of 10,000 steps was explained and an easy 900-1500 step walk followed. Everyone who participated received a ticket to go into a spot prize draw. The launch strolls did not take a lot of time and showed people what they could do during a break or while they are waiting for someone. Resources/WebsiteSome resources have been produced for the project including stickers, posters, t-shirts, drink bottles, hats. At the project's website (www.10000stepsnorthland.co.nz) people can download maps, newsletters, physical activity tips, step logs, order pedometers, ask questions, access walking club contacts, and find up and coming fun run and walking events. Every second month some new strands will be introduced to the project to keep awareness and interest high. Gardening in Pacific Island Preschool CentresKasalanaita Puniani presented an innovative programme to promote better eating choices in Pacific Island early childhood centres at the ANA 2003 Regional Forums in Christchurch, Rotorua, and Whangarei. Auckland Regional Public Health Promotion and the Auckland Regional Council have been helping South Auckland communities create vegetable and fruit gardens in Pacific early childhood centres. The gardening programme began in September 2001 involving the Samoan, Tongan, Niuean, Tokelauan, and Cook Island communities. It involves workshops with the centres, demonstrations and prizes for gardens. A factor in the programmes success has been the input of Steve Benham from the Auckland Regional Council's Botanic Gardens who shared his gardening skills in the workshop sessions with parents and teachers. Everything from soil preparation to seed selection, sowing, watering, harvesting, tools, safety and composting was covered. The evaluations and associated prizes for the best gardens have been a good way to maintain the early childhood centres' interest in the programme. The gardens have proven a practical way to increase nutritious food choices and provide regular physical activity. Produce from the gardens has become part of the children's lunchtime diets, and is also circulated within communities. The vegetable gardens have also become a useful focus for educational activities such as literacy, numeracy and the sciences. The School Food Programme – Heart FoundationThe School Food Programme is a well-established national initiative of the Heart Foundation. The programme uses a 'whole of school' approach towards healthy eating and focuses on four key areas:
Food ChoiceThis focuses on the development of a food and nutrition policy and the provision of healthy food via the existing school food service, thoughit is not necessary for schools to have a food service to participate. Schools may include strategies in their food and nutrition policy such as encouraging students to be responsible for their health and make healthy food choices and ensuring the tuck-shop offers a variety of healthy, affordable foods. Nutrition EducationThis area is directly linked to the implementation of the Health and Physical Education Curriculum and cross-curricula learning opportunities. For example, students might learn about how to read nutritional panels in class. They then identify items in the canteen that are high in salt, fat or sugar and create strategies for replacing these items over a period of time. Promoting Healthy FoodsThis area encourages schools to promote healthy food choices to students, staff, family/whānau and caregivers. For example, schools might display posters of healthy foods, display healthy foods at the top of the menu or competitively price healthier options. Community Health PromotionThe involvement of parents, whānau, caregivers and the wider community influences the outcomes of nutrition education. This key area motivates schools to initiate activities that promote nutrition to the wider school community. For instance, schools may hold fundraising galas where the food sold has an international theme as well as being healthy, or include lunchbox tips in the weekly newsletter. Heartbeat AwardsOnce a school has begun making positive changes in its nutrition environment, it is able apply for a School Food Programme Heartbeat award. The Award gives schools recognition for their commitment towards fostering a healthy nutrition environment. Heartbeat Awards are available at four levels: Heartbeat, Bronze, Silver and Gold. Each level recognises an increasingly comprehensive nutrition environment and a Gold Award demonstrates that a school has achieved extremely high standards in their nutrition environment. Every school is required to achieve a Heartbeat and/or Bronze Heartbeat before progressing to a Silver or Gold Award. Programme OutcomesProgramme evaluations have shown a number of positive outcomes, including increased student participation in food nutrition activities, positive changes in food sales (reduced sales of high fat, high sugar and high salt foods and increased sales of healthier alternatives), increased healthy options in the food service and perceived positive behavioural changes amongst students. Many schools say the improvements made to their food service have been financially rewarding, either causing cost efficiencies and/or increases in sales.
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