20th IUHPE World Conference on Health Promotion, July 2010, Geneva, Switzerland Dr Heather Gifford Whakauae Research for Maori Health and Development Whanganui New Zealand

What is the story about? Te Kahui Whai Ora was a community-initiated, health promotion programme administered by an indigenous primary healthcare organisation; Te Oranganui Iwi Health Authority.

Why was the project conducted? Obesity, as defined by body mass index (BMI) ratio, is disproportionately prevalent in Māori; approximately 43% of Māori adults were obese in 2006/07 compared with 23% of New Zealand European and other adults. Among children aged 5–14 years in 2006/2007, the pattern of ethnic differences in the prevalence of obesity was similar to that of the population aged 15 years and over. Obesity in children increases the risk of adult obesity and can predict mortality and morbidity later in life.

The timeframe The pilot was developed in 2002 and was discontinued in June 2010.

Where was the project conducted? The Te Kahui Whaiora programme was based in the Castlecliff community of Whanganui; a high needs urban community with a large Māori population (36%).

Project aims The overall goal of TKW was to empower tamariki Māori (Māori children) and their whānau to make lifestyle changes that would lead to healthier, more active lifestyles through improved nutrition and increased physical activity.

People targeted by the project The focus of the programme was on so-called “at risk children”, not necessarily children who had been identified as being overweight or obese. The focus was on Māori. A whānau or family based approach was used.

People involved in the project The programme was an intersectoral initiative developed by the Whanganui Wellbeing forum; a local partnership with an interest in improving nutrition and physical activity at a population level. The group was formed to strengthen working relationships between key organisations in the region and to encourage sectors to work together to be effective in the community. Membership consisted of primary health care, public health, NGOs (Heart Foundation, Sport Whanganui) and local government.

What was done during the project? The pilot comprised a ten week programme delivering weekly “knowledge-building” workshops on healthy eating and healthy activity to children and their families. Utilising local resources (including local experts, amenities and settings) was a focus. At the end of the 10 weeks the children and their families planned, and participated in, a school holiday camp. These camps provided an opportunity for whānau to practice the skills they gained during the workshops; to discuss their ongoing needs and support requirements; and be introduced to more physical activities which they could participate in with their children.

What happened? Overall results from the impact evaluation indicate that the TKW programme both directly and indirectly benefitted families: directly in terms of improvements in family knowledge, understanding, skills and behaviour regarding nutrition and physical activity; and indirectly in terms of facilitating wider personal, social and community changes.

What worked well? The success of TKW is attributable to two key factors: designing a programme based on a sound understanding of the principles of Māori health promotion best practice and, in the delivery of the programme, ensuring these principles could be implemented in practice.

What worked well? Whānau confidently making changes to their lifestyles - such as food label reading and making better food choices at the supermarket. Effective referrals of tamariki into the programme through good partnerships. Strengthened whanau relationships as a result of being engaged in the programme. Emerging leadership and growing self esteem of some young graduates of the programme.

What did not work well? Complexity of the programme co-ordination role was not always matched by staff appointments and high turnover was initially a problem. Capacity issues with the provider, particularly in the area of report writing and managing some of the responsibilities of the programme. Various stresses working across intersectoral partnerships; communication, alignment of priorities, retention of partners, role confusion.

What did not work well? While whanau did participate, healthy nutrition and physical activity were not always priorities for families. Working collaboratively was a skill that had to be learnt for some partners. Turnover of staff both for partner agencies and provider; resulted in lack of continuity and loss of knowledge. Where funding was placed caused problems initially as partners were unsure about lines of accountability.

Suggestions to policy makers Both central government, through its Crown agencies, and local and regional governments, through the work of its councils have a role to play in developing safe, health-promoting environments. Central government have a responsibility to demonstrate and role-model leadership to the food industry, retailers and physical activity providers alike. Partnership approaches between local government, local communities, iwi and hapū to improve local infrastructure will contribute towards the creation of healthier environments

Suggestions to policy makers Ensure programmes which clearly demonstrate effectiveness and improvements in outcomes are moved out of pilot mode into a longer term funding environment. A longer term evidence-base to inform purchasing and best practice could be achieved by strengthening evaluation capacity within providers. Provider environments need to keep abreast of their communities changing needs and ensure that programmes are responsive to, and driven by, communities.

Suggestions to policy makers Review reporting requirements to ensure accountability but also reduce transaction costs to providers. The provider needs to ensure training and support is given to senior managers involved with the programme to ensure capacity in the areas of programme development and report writing is enhanced.

Suggestions to policy makers So what? It is through collective family efforts in conjunction with timely and appropriate stakeholders support that the prevalence of obesity will be reduced in our communities.