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    Māopoopo : a socio-cultural and collective understanding to improve wellbeing amongst Pacific people in Aotearoa/New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2021) Tuisano, Hana Salome
    The Aotearoa/New Zealand (NZ) healthcare system, has, like many other colonising ‘Western’ societies, placed a strong emphasis on biomedical models and the physical aspects of ‘disease’. Yet, it is the more encompassing and holistic worldviews of wellbeing that historically and currently resonate most strongly with Indigenous peoples. As a South Pacific country, there are many Pacific peoples who now live in Aotearoa/NZ with multiple generations having migrated from their island homelands over a period of some 80 years. However, there are significant health inequities among Pacific peoples compared with other ethnic groups in Aotearoa that have been ongoing for decades – notably those conditions related to non-communicable disease. This thesis explores the socio-cultural and historical perspectives of Pacific peoples in order to expand understanding about how they view health and wellbeing, an area about which relatively little is known. These understandings have the potential to lead to improved service delivery models and contribute to better health outcomes for Pacific peoples in Aotearoa/NZ. The overall objective of the study is to identify and articulate the values and principles that promote and enable Pacific peoples’ wellbeing and health in Aotearoa/NZ. The aims of the study are to: • draw on Tokelau knowledge of the cultural, historical, and social environment to better understand the influences on Pacific health and wellbeing • examine strategies of health empowerment and wellbeing among Pacific youth, and • examine service delivery models that can lead to improved Pacific health outcomes. The Tokelau worldview of māopoopo was used as an overall principle to inform all phases of this study. Conceptually, māopoopo serves as a cultural connector with people, a motivator of action, and informs principles that guide behaviour in practice. Māopoopo as a practice in action is to restore peace and wholeness and to inform future thinking (lumanaki), which includes an inseparable relationship with te fenua (land) e laga kita ko te fenua (to be determined to look after the land). Māopoopo as a metaphysical state is described in relation to levels of the individual (te tino), the family (Kāiga), the village (te Nuku). Semi-structured interviews and focus groups were carried out with a total of 37 participants including Tokelau elders, Tokelau community leaders, Tokelau adults, Pacific youth, and Pacific health and policy workers between July 2016 and January 2017. The data were analysed using thematic analysis and the emergent themes applied in relation to māopoopo. There were seven key themes identified from this research. The first theme, kāiga (family), was interrelated with the values of loto alofa (kindness), fai kāiga (family orientated), fakaaloalo (respect), loto maualalo (humility), and loto fehoahoani (helping others). The second theme, duty of care (tiute tautua), related to traditional knowledge and the intergenerational transfer of that knowledge, particularly in relation to culture, land, and language. Maintaining family relationships (loto fai kāiga) was the third identified theme and fundamentally underpins and is interrelated with all the first five themes identified. The fourth theme, interconnectedness (fehokotakiga), highlights the breadth of relationships between people and understandings of interdependence as opposed to independence. The fifth theme, spirituality (olaga faka-te-agaga), recognizes the centrality of the church in Pacific communities. Health advocacy was the sixth key theme with the final key theme being the impact of inequities on Pacific wellbeing. This thesis identifies Māopoopo as being an inclusive research approach that can have benefits for Pacific peoples while also having the potential to be developed within health policies to facilitate focus on collective action through effective cross-government and intersectoral approaches. In this way, it could be utilized to ensure effective approaches to collaboration between the health care system and the social, housing, employment, and education sectors. This work highlights the value and utility of applying Pacific understandings of wellbeing to support and empower communities through their active inclusion from the design through to the implementation of services. There is a great need for increased reciprocity in the relationships between government agencies and Pacific communities. There was recognition of the need for the application of cultural practices and concepts into service delivery for Pacific peoples, such as provision of on-site bilingual health workers, and it is therefore imperative that core health delivery services are brought closer into alignment with the realities of Pacific communities, for example, through active engagement with churches. There are significant gaps in health services for Pacific youth. This population group are an energetic group and, most importantly, the fastest growing population in Aotearoa. This current generation plays a significant role in terms of health advocacy, thus, to ensure relevant and effective impact within communities, they must be central players and key informers in the development of any interventions/strategies focussed on Pacific health and wellbeing. Further studies may well be useful to scope or investigate the healthcare services available for Pacific youth. Associated with the position and role of youth within Pacific communities, is the largely untapped potential to utilise the unique skills and knowledge available through intergenerational approaches where the grandparents are the educators in terms of the passing on of cultural knowledge and values. Health services can be made aware of this important pathway by which knowledge is transferred and of the critical role grandchildren could have to change their grandparents’ attitudes towards health.
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    Health justice for all : the development of alternative health system capabilities in the conflict-affected context of Shan State, Myanmar : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Manawatū, New Zealand
    (Massey University, 2018) Bell, Sharon Margaret
    As the 2030 Agenda for Sustainable Development advances, it is vital to determine how conflict impacts on the achievement of the Sustainable Development Goals (SDGs) in conflict-affected contexts. The United Nations (UN) regards conflict as the leading risk to development progress as these contexts have high rates of poverty and limited access to crucial healthcare services. Shan State, Myanmar is one such context, facing a critical shortage in its health workforce, considered one of the building blocks of an effective health system. Approaches to building health workforce capabilities can meaningfully contribute towards meeting SDG 3 – ‘to ensure healthy lives and promote well-being for all at all ages’, and consequently, health justice for conflict-affected communities. This research aims to understand how the approaches taken by an international nongovernmental organisation (INGO) support the development of alternative health system capabilities in a conflict-affected context. A global development agenda of state- and peace-building has meant that INGOs have been criticised for undermining state legitimacy. Meanwhile, non-state armed groups (NSAGs) in areas like Shan State, Myanmar, have established alternative regimes which seek self-determination as well as attempting to provide for the social and economic wellbeing of their people. However, little is known about how a partnership between an INGO and a NSAG contributes toward enabling alternative health system development in these contexts. This research contributes to new ways of understanding this through the development of a capabilities framework for health system development in conflict-affected contexts. This was used to analyse findings from the qualitative case study of an INGO’s health workforce training programme on the Myanmar-Thailand border. The research found that a positive partnership between the INGO and the NSAG has played a crucial role in enabling the workforce capabilities of the alternative health system, leading to promising improvements in health outcomes in communities. However, the effectiveness of the programme is restricted by the INGO’s reliance on volunteerism for staffing, where expatriate medical volunteers are selected based on their availability, rather than the appropriate skills and experience for this context. The international aid community has also reduced its funding for cross-border development programmes in Myanmar which has constrained the activities of the INGO and the NSAG. For Myanmar to achieve health justice and SDG 3, supporting health system development that focuses on improving health outcomes needs to be a priority for the international community.
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    An examination of the influences on health development post conflict : Angola-- in the transition : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Palmerston North, Aotearoa, New Zealand
    (Massey University, 2005) Patterson, Laura
    This thesis examines the issues that influence health development post conflict. Its aim is to increase understanding of the current issues within the transitional post conflict phase through presenting the experiences of three communities in rural Angola. Having emerged from nearly 30 years of civil war, Angola remains in a challenging transitional period. This phase of rehabilitation, flanked by efforts of relief and development, is shown to be problematic. This thesis considers the process from conflict to peace and subsequent repatriation of population. It identifies the transitional phase between relief and development projects and the ambiguous linking of theory and practice within literature Discussion of appropriate health strategies for implementation shows the limitations of the primary health care (PHC) model. Concepts of community participation and empowerment are identified as difficult due to resettlement factors of time and planning. The methods of research include household surveys (181 completed), interviews, group discussions, and observations of three communities. Comparisons of the two groups of previously identified Internally Displaced People (IDPs) and Returned Refugees (RRs) are made throughout the thesis. A focus on the needs, wants, reality and use of health services reveals community participation and responsibility. The influences of identity (tribe, gender, IDP / RR) and past experiences of refuge, settlement, and education are recognised as impacting to varying degrees, knowledge, attitude and practice towards health services. The research concludes that the post conflict phase is impacted most strongly by community (identity), time and communication.
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    Health and development in Vietnam : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University
    (Massey University, 1996) Altmann, Maria
    This research investigates the current situation of Vietnamese people's health and development, with a particular focus on the wellbeing of Vietnamese women. Its central question is the impact of the political and economic reforms in Vietnam from 1986 onward, which reinstated the "family economy" and a number of free market principles within the country's socialist framework. It is based on a combination of field observations from an investigative visit to Vietnam in April 1994 and literature reviews covering concepts of development, Vietnamese culture, history, politics and economics. Wherever possible, Vietnamese sources (in English translation) have been incorporated. The first substantive chapter explores the connection between health, development and the environment, estabishing the interrelationship between the wellbeing of marginalised groups within a society and the meaning behind sustainable human development. The concept of wellbeing is argued as encompassing values of self-determination, while the concept of provision for sustainable livelihood is highlighted as a means to intercept the cycles of poverty and disease. A brief insight into aspects of Vietnamese cultural and social history up to the end of the colonial period is then offered, focusing on the organisation of the traditional village, so as to sign-post key aspects of culture and social organisation which have continued to influence the development of Vietnamese society. The following chapter gives the background to the process of political and economic reform in Vietnam from reunification in 1976 following the end of the Vietnam War identifying the ideological changes involved and outlining the macroeconomic impact of the reforms. The goals of current Vietnamese social policy are also considered. The final two chapters present data and analysis on the current state of Vietnamese people's wellbeing, identifying where possible the effects of recent policy changes. Topics covered are population, gender discrimination and the status of women, household poverty, education, employment, water supply and sanitation, women's health, child wellbeing, and the structure and operation of the Vietnamese health care system. The main findings are that the reforms have increased resource disparities between different groups in Vietnam and that the less advantaged, including a large proportion of Vietnamese women, face a serious decline in wellbeing unless changes occur in priorities for development.
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    Whakaoranga whānau : a whānau resilience framework : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2014) Waiti, Jordan Te Aramoana McPherson
    This research explored the capacity of whanau (family, extended family) to overcome adversity, flourish and enjoy better health and well-being. While external factors, internal dynamics, and financial pressures often constrain capacity, whanau have nevertheless demonstrated an innate ability to respond to these challenges – to make use of limited resources, and to react in positive and innovative ways. Three key objectives were identified to help seek and understand Maori notions of whanau resilience and how they are utilised by whanau for positive growth and development. The three objectives were: 1. To identify resilience mechanisms which exist within whanau; 2. To consider the cultural underpinnings of resilience; and 3. To construct an evidenced based framework for resilient whanau. A thematic analysis detailed the components of a Whanau Resilience Framework. The framework consists of four resilience platforms: (1) Whanaungatanga (networks and relationships); (2) Pukenga (skills and abilities); (3) Tikanga (values and beliefs); and (4) Tuakiri-a-Maori (cultural identity). This thesis highlights both the synergies and dissonance between Maori and non-Maori perspectives of resilience and how cultural factors might best guide Maori and whanau development. Insofar as this framework exhibits similar resilence strategies to other populations, it is at the micro-level where there are differences between Maori and other cultures or populations.
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    Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial
    (BioMed Central, 2009-06-28) Wall, Martin; Hayes, Richard; Moore, Derek; Petticrew, Mark; Clow, Angela; Schmidt, Elena; Draper, Alizon; Lock, Karen; Lynch, Rebecca; Renton, Adrian
    Background: In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach. The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services. Methods/Design: The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact. The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated. Discussion: The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation. Trial Registration: Current Controlled Trials ISRCTN68175121
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    Media, racism and public health psychology
    (SAGE Publications, 2006) Nairn R; Pega F; McCreanor T; Rankine J; Barnes A
    International literature has established that racism contributes to ill-health of migrants, ethnic minorities and indigenous peoples. Racism generally negates wellbeing, adversely affecting physical and psychological health. Numerous studies have shown that media contribute marginalizing particular ethnic and cultural groups depicting them primarily as problems for and threats to the dominant. This articles frames media representations of, and their effect on, the indigenous Maori of Aotearoa, New Zealand within the ongoing processes of colonization. We argue that reflects the media contribution to maintenance and naturalisation of colonial relationships and seek to include critical media scholarship in a critical public health psychology.
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    Consuming identities: alcohol marketing and the commodification of youth experience
    (Informa Healthcare, 2005-12) McCreanor, Tim; Moewaka Barnes, Helen; Gregory, Mandi; Kaiwai, Hector; Borell, Suaree
    Marketing has successfully used the postmodern turn in conceptualisations of the human subject and incorporated contemporary theorising of identities and self into its understanding of the key drivers of consumption. Such developments clearly converge in alcohol marketing practices that target young people where commercialized youth identities available for consumption and engagement are a significant element. This paper reports data from young people that reflect the uptake of such identities and considers the challenges that these developments represent for public health and the wellbeing of young people.
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    Youth identity formation and contemporary alcohol marketing
    (Taylor & Francis, 2005) McCreanor TN; Greenaway A; Moewaka Barnes HE; Borell SS; Gregory MJ
    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. © 2005 Taylor & Francis.