Healthy Eating Healthy Action (HEHA)

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1 Healthy Eating Healthy Action (HEHA) a national strategy to reduce obesity and improve nutrition in New Zealand Rachael McLean

2 Overview Background: - obesity and chronic disease in New Zealand HEHA- a national strategy- development and implementation Evaluating HEHA- lessons learned.

3 Aotearoa / New Zealand Mixed member proportional electoral system NZ Population by Ethnicity (Census 2006) European (64%) Māori (14%) Pacific Peoples (6%) Asian (8%) Other Ethnicity(7%)

4 Age standardised obesity prevalence (%) Male Female

5 Age standardised rates % Prevalence of obesity, adults 15+ yrs, 2006/07 NZHS Men Women Total Maori Pacific Asian European/Other

6 Age standardised rates % Prevalence of obesity, children 2-14 yrs, 2006/07 NZH S Boys Girls Total M aori Pacific As ian European/Other

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9 CVD mortality rates by ethnicity, 1-74 yrs (Age standardised, deaths per 100,000) Blakely et al. NZ Census Mortality Study. Available

10 All-cancer mortality rates by ethnicity, 1-74 yrs (Age standardised, deaths per 100,000) Blakely et al. NZ Census Mortality Study. Available

11 Life expectancy in years 85 Life expectancy Non-Mäori (SNZ) Male Mäori (SNZ) Male Mäori (NZMCS) Male Māori (MoH latest) Male Non-Mäori (SNZ) Female Mäori (SNZ) Female Mäori (NZMCS) Female Māori (MoH latest) Female Blakely et al. NZ Census Mortality Study. Available

12 Government Response 2002 February Release of Healthy Action Healthy Eating Oranga Pumau Oranga Kai: A Draft for Consultation 2003 March Release of Healthy Eating Healthy Action Oranga Kai Oranga Pumau: A Strategic Framework 2003 and Healthy Eating Healthy Action Oranga Kai Oranga Pumau: A Background June Release of Healthy Eating Healthy Action Oranga Kai Oranga Pumau: Implementation Plan: July Tripartite Agreement signed between the Ministry of Health, Ministry of Education and SPARC (ended in 2007) 2006 June Permanent HEHA Project Team at Ministry of Health in place Health Select Committee Inquiry into Obesity and Type 2 Diabetes in New Zealand

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14 Healthy Eating- Healthy Action Oranga Kai Oranga Pumau HEHA is the Ministry of Health s strategic approach to improving nutrition, increasing physical activity and achieving a healthy weight for all New Zealanders. HEHA Vision: An environment and society where individuals, families and whānau, and communities are supported to eat well, live physically active lives, and attain and maintain a healthy body weight.

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16 HEHA Infrastructure

17 Examples: Social Marketing District Health Board- Lets Beat Diabetes Community/ DHB- Ngati & Healthy Schools Workplace

18 Social Marketing Feeding our futures -advertisements encouraging parents to eat and cook with their children and promote water and milk instead of sugar-loaded drinks. Youth-focused websites to promote healthy eating and physical activity Sponsorship of television and radio programmes that promote healthy choices Sport & Recreation New Zealand (SPARC)

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20 Let s Beat Diabetes (LBD): Counties Manukau DHB

21 LBD Action Areas Supporting Community Leadership & Action Promoting Behaviour Change through Social Marketing Supporting a Healthy Environment through a Food Industry Accord Developing a Schools Accord Supporting Primary Care-based Prevention and Early Intervention Improving Service Integration and Care for Advanced Disease

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23 Swap 2 win

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26 Food Industry Supermarket initiatives, cooking demonstrations, promotion of fruit and vegetables (5+ a day) McDonald s Sprite zero

27 Community- Ngati & Healthy

28 Intervention Population-based approach Community buy-in and ownership of the programme components considered important Kaiawhina critical link between the health professional/research team and the community Baseline 2003 survey informed the 3 key messages: (i) Increase consumption of fruit and vegetables (ii) Increase consumption of wholegrain foods (iii) Increase exercise levels Community initiatives were designed to support the 3 messages at all levels in the community.

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31 Age-specific prevalence of glucose metabolism disorders in Maori (Tipene-Leach et al, NZMJ, 2004)

32 Insulin resistance prevalence (%) by sex and age group (Coppell et al, Diab Res Clin Pract, 2009)

33 Ngati & Healthy: Conclusions Participation in a community diabetes prevention intervention appeared to reduce prevalence of insulin resistance after 2 years in those with the highest level of participation, and overall diabetes prevalence was static. The future challenge is to embed and sustain the intervention across the entire community.

34 Food Industry Group Food Industry Accord September 2004 Mission to do all that is possible to encourage all sectors of the food industry to create commercially successful products and service that will make a positive contribution to the health of New Zealanders Advertising- self regulation around children s food Reformulation and development of new products CHIP and PIE groups Sponsorship voluntary agreement to stop selling full sugar carbonated soft drinks in New Zealand schools from December 2009, vending machines to remain. Lack of independent evaluation Food Industry Initiatives

35 Schools: Mission On National Administration Guideline (NAG) 5 promote healthy food and nutrition for all students; and Where food and beverages are sold on school premises, make only healthy options available. Nutrition guidelines Identified foods that were not recommended, for limited provision, appropriate for everyday consumption Fruit in Schools provision of fruit to children in low decile schools, promotion of healthy eating, physical activity, sun protection, smokefree Nutrition fund

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37 Workplace Healthier vending machines Active friendly workplaces Occupational safety and health focus on nutrition and physical activity

38 Election 2008

39 Change of Government November February Removal of NAG 5 clause iii ( where food and beverages are sold on school premises, make only healthy options available ) June Mission-On programmes discontinued Funding for District Coordinators, Mission-On and Feeding our Futures ends. Public Health Unit baseline nutrition/physical activity funding, DHB evaluation budget, HRC research partnership funding all reduced. Nutrition Fund merged with Community Action Project funding. Fruit in Schools downgraded November National HEHA Strategy Evaluation contract terminated early

40 National HEHA Strategy Evaluation Consortium of Researchers: University of Otago, Victoria University of Wellington, Auckland University of Technology (AUT) Stocktake of HEHA Initiatives (>1200) Implementation- interviews with key personnel (Māori and Pacific) Value for money Outcomes- Nutrition and PA survey; National Health & Nutrition surveys

41 Evaluation: some findings Lack of sustainability (including Evaluation itself) Stocktake (>1200 initatives) Wide range Large number local programmes underpinned by strong national programmes Effectively reach Māori and Pacific, less coverage for Asian/South Asian PA > Nutrition programmes

42 Evaluation: some findings Implementation: Generally positive about strategy and early outcomes Inter-governmental collaboration initially difficult Tension between top down and bottom up Pacific policy makers- consulted late Concern about withdrawal of programmes and funding -potential damage to future community working relationships

43 Evaluation- some findings Outcomes- not formally assessed Value for money >$328 million between Little security of funding Informants believed HEHA would deliver value for money in long-term

44 Acknowledgements Ministry of Health Consortium: University of Otago- Prof Jim Mann, Prof Janet Hoek AUT- Prof Grant Schofield VUW Assoc. Prof Jackie Cumming Whakauae Research Services Dr Heather Gifford