HUNT343 Overall Notes

Lecture 1:

What is health and what is illness?

Community nutrition vs public health nutrition:

Public health nutrition is the application of nutrition and public health principles to design programs, systems, policies, and environments that aim to improve or maintain the optimal health of populations and targeted groups. Public health nutrition policies aim to reduce the gap between current eating habits/diets and dietary recommendations.

Community nutrition encompasses individual and interpersonal-level interventions that create changed in knowledge, attitudes, behaviour, and health outcomes among individuals, families, or small, targeted groups within a community setting.

Examples of nutrition public health initiatives; fortification of food such as iodised salt or cereal.

Analogy for public health system: a stream with different areas where things go wrong. Initiative would be to start from the top of the stream and ensure preventative measures, policies and plans are put into place so that things don’t occur further down.

Shifting our ways of thinking: what has happened overtime resulting in a shift in the way we think about things?

-            Foundation era (1700-1930) knowledge of food safety and sanitation

-            Nutrition deficiency era (1910-present) hunger and micronutrient deficiencies

-            Dietary excess and imbalance era (1940-2000) with an abundance of food came obesity and chronic diseases after the war (input > output).

-            Food system and sustainability era (1970-present) unsustainable foods and production/consumption.

SDG (Sustainable Developmental Goals)

Set 9 voluntary global NCD targets for 2025.

(1-9 goals)

Consider these targets from low risk to high risk on a pyramidal scheme targeting at different levels.

High risk; may be symptomatic or asymptomatic. Detectable signs but not full disease.

Individuals or groups whose risk is higher are at a selected level.

Low risk: general population where intervention is desirable for everyone in that group. i.e., fortification.

Public health approaches include socio-ecological, lifestyle and biological.

Socioecological:

-            How is a problem defined? Poor social and environmental circumstances e.g., food insecurity, inequity and non-sustainable food systems.

-            Intervention approach; promote food security for all as well as systems of sustainability.

-            Who is responsible? Government, civil society, food industry. Health professionals, organisations, media.

-            How outcomes are measured. Social equity in nutritional health profiles and secure and sustainable food systems.

Lifestyle:

-            The problem being populations lifestyle patterns and behaviour is not consistent with recommendations.

-            Focus of interventions by providing education and campaigns to shift population behaviours, as well as policy changes to make healthy choices easier.

-            In terms of responsibility health professionals, government, food industry as well as individuals within the population play a role in creating these lifestyle changes.

-            Looking at population’s dietary behaviour patterns in accordance with recommendations is a good way of assessing outcome measures.

Biological:

-            Given that an individual exceeds normal limits of food with excess intake in the less nutritional sector as well as having a genetic predisposition to diet-related diseases means one is more at risk to nutrition related issues.

-            Focus of intervention would be looking at production and consumption of functional food (containing healthy additives) products.

-            The responsibility for these interventions would be health professional organisations, manufactures of the products.

Two continuums that describe all public health interventions, with examples related to diet and obesity.

Ways of promoting health: govt related policies, nutrition education, mass communication, setting approach, micro-environments. By promoting health, it influences changes in behaviours, environments and communities.

Conclusion

1)       Public health nutrition has evolved with both public health and nutrition science.

2)       Public health problems can be tackled using a range of approached

3)       Definitions of health, approaches and guiding principles will shape applications.

Lecture 2:

Outline:

-            Introduction to the social determinants of health in NZ

-            What is the socioecological model

-            Applications of a socioecological approach.

Social inequities between and within countries cause numerous health issues within deprived countries. Life expectancy by deprivation shows a decrease in life expectancy with an increase in deprivation.    

Whitehall Study

-            Was a longitudinal study In London looking at cardiovascular and respiratory conditions. The higher the grade of employment the lower the risk of death from all causes including CVD and non-CVD.

Unavoidable determinants- genetic predisposition, age, climate

Avoidable determinants- factors which are avoidable are described as unjust, as we can change this.

“If systematic differences in health are avoidable through reasonable action, then their existence is unfair”.

The Health Gap- explained upstream causes of poor health

Causes/risk = intermediate

Life expectancy

Social Determinants of Health

What is considered a social determinant of health? 

·        Income 

·        Education 

·        Unemployment/job insecurity 

·        Working life conditions 

·        Food insecurity 

·        Housing, basic amenities 

·        Environment 

·        Early childhood development  

·        Social inclusion and non-discrimination 

·        Structural conflict 

·        Access to affordable health services 

-             The left shows structural determinants of health; Socioeconomical and political context is designed to include all the social and political mechanisms that generate social hierarchies (labor market, education system). 

-             Among these the biggest factor is wealth fare state and how we redistribute wealth within a society. Minister of Finance can have more impact on health then the Minister of Health, in terms of the way wealth is distributed within a country. 

-             Intermediary determinants are the box with material circumstance 

Having a good health system, and access can buffer these effects, as well as having access. 

·        All These factors impact on equity, health and wellbeing  

Socioeconomic position refers to the socially derived economic factors that influence what positions individuals or groups hold within the multiple stratified structure of society.

The three recommendations/commission on social determinants of health globally

1)     Improve daily living conditions

2)     Tackle inequitable distribution of power money and resources

3)     Measure and understand the problem and impact of action

Bronfenbrenner’s ecological systems theory

Lots of layers show how children and environments interact.

Microsystem- interpersonal interactions, home, siblings, caregivers, immediate environment 

Mesosystem- relationship between family, parents, other places e.g., daycare/school 

Exosystem- indirect environments, child isn't exposed to, but parents are in. Work, stress life, poor work life balance, indirect influence on the children. 

Macrosystem- social and cultural values 

Chronosystem-changes overtime, life course events, big events that occur in history (covid-19) 

* Indirect environments- busy parents not having much time for the kids 

Lecture 3: (Monday 22^nd July) Equity in Public Health

Differences in survival:

-            Regarding the Titanic survival was related to privilege which was related to social structures and values at the time.

-            Had difference in passage fares and difference between women and men.

We often relate differences in health outcomes to genetics factors, or levels of health risk to not accessing healthcare early enough, but it is also important to reflect on how society and structural factors external to the individual are playing a role.

Equality shows that everyone gets equal treatment, but the benefits may not be the same. Equity means that everybody gets the support that they need.

According to public health notes

Pathways to health inequities

Differential access to:

HEAT tool (Health, Equity, Assessment Tool)

-            Used in NZ and internationally

-            Has 4 stages, asks 10 questions

-            Potential of intervention to reduce inequities

These four stages of HEAT look like:

SIDS prevention campaign occurred in the 90s. there was a large disparity between Maori and non-Maori.

-            Modifiable risk factors (smoke-free pregnancy, separate beds, sleep position and breastfeeding).

-            Around early 2000’s there were informative educational campaigns about information of modifiable risk factors.

-            Resulted in a decline about 50% for NZ European SIDS

-            Cons of this campaign: Maori were not represented or involved in the campaign, was contextually and culturally insensitive. There were no changes to rates of smoking or breastfeeding.

Case study 1- breastfeeding

Had a target they wanted to reach, wasn’t working so went to literature and looked at what factors influence breastfeeding in a broader sense, especially for Maori. Understanding the role of whanau in maternity and infant care as well as exploring the pressures of having to return to work due to financial strains.

-            2002 baby friendly businesses

-            2016; 156 accredited sites

-            Retrospective case study

Stake holders- people who are working with and supporting people who are breastfeeding.

Outcomes for this campaign examples:

1.       Environmental support

2.       Support for parents and whanau

3.       Robust evidence base (exploring social, economic, and cultural influences that contribute to the feeding in NZ).

Strategies (same goal)

Universal- approach is for a whole population

Proportionate universalism- strategies proportionate to need

Wai 2575 Health services and Outcomes

-            Maori stance of health looking at recognising Maori political authority

Case study 2- Type 2 diabetes

Risk factors: weight, fibre, total and saturated fats, physical activity

Philadelphia Case Study (used an approach across 4 different areas shown above)

-            increased healthy option

-            decrease deterrents

-            increase resources

-            build community capacity

Manu Tu study

-            looking at people who have poorly controlled diabetes

-            RCT

Where to from here?

1.       Understand the risk factors for different groups and the root causes of inequities

2.       Use assessment tools and frameworks to do that

3.       Combining multi-level interventions

4.       Nutrition and social policy can work together

Lecture 4:

E-Reserve - required reading:

Reid, P. (2015). Promoting health equity. In S. L & M. Ratima (Eds.), Promoting Health in Aotearoa. Chapter 8.

1.       Who is Shariki Kumanyika and what does she research? Sharika Kumanyika is a research professor in the department of community health and prevention. Professor of epidemiology. She looks at social equity problems, focusing on prevention and management of obesity and diet related diseases, as well as solutions to social disparities. 

2.       Explain what WIC and SNAP programmes are in the United States

-            WIC; Women, Infants, and Children

-            SNAP; Supplement, Nutrition Assistant Program

3.       What might be some advantages and disadvantages of such programmes?

4.       What is targeted marketing?

-            Tarket marketing is marketing which is intentionally aimed at specific populations or demographic groups.

-            Possible solutions for target marketing include be aware, separate the effect of the marketing from the intent of the marketing.

5.       Are there any rules around marketing unhealthy foods to NZ children?

6.       What does Professor Shariki Kumanyika recommend for addressing obesity in the US? understand the food system is connected to other sources e.g., physical activity is connected to transport.

7.       What is meant by paternalism in public health? means that citizens deemed unfit to make their own decisions, so these decisions are made for them.

July 29^th Colonisation and Health

Indigenous people: 370 million, 70 countries, 5000 different indigenous people. 70% living in Asia.

                         Imperialism                                                                          Coloniality

                                        Colonisation                                                                Decolonisation                                       

In 2007 UN had Declaration of Rights of Indigenous Peoples

-            144 states in favour, 4 against (AUS, Canada, USA, New Zealand)

-            “Indigenous Peoples have an equal right to the highest attainable standard of physical and mental health”.

-            NZ did not sign this initially in 2007, in 2010 revisited it and signed

Whenua - Inheriting Privilege

-            By 1890, 90% of Ngai Tahu (people from the South Island) were landless. Either did not have any land, or enough for economic survival.

-            Video talks about Pakeha not having the tools to the now because we do not understand our history

-            Te Tiriti o Waitangi, about restoration of balance.

-            There is a whole loss of understanding, Maori ways of being in NZ. Pakeha can succeed in this society without the knowledge is how privilege works.

Common themes that occur with colonisation across all countries:

Disruption of:

Ø  Laws

Ø  Languages

Ø  Dress

Ø  Religion

Ø  Rituals

Ø  Healers

Ø  Dispossession of land

Ø  Socioeconomic and political marginalisation

Ø  Introduction of microorganisms (1918 flu in NZ, higher death rate in Maori > Pakeha, 8x greater)

Ø  Institutional racism

Life expectancy at Birth

-            Looking at life expectancy at birth across different countries, green is the difference between indigenous population and the rest of the population.

Infant Mortality (<12 months)

Similar trends in this graph as the one above.

For New Zealand there is a difference in life expectancy, infant mortality, maternal mortality rates, childhood obesity, childhood malnutrition.

Limitations to this data:

·       Lack of acknowledgement of some Indigenous peoples

·       Data completeness

·       Data availability

·       Data quality

Colonisation

Contemporary Coloniality

Poverty Spiral – For NZ, check website

Cut of lots of social welfare in NZ causing huge rise in healthcare insecurity.

Pathway to health inequities

Differential access to:

Impact of Urbanisation

-            High energy, fat, salt

-            Low fibre

-            Decreased physical activity

Understanding of obesity (qualitative paper/more in-depth research)

1.       Health and wellbeing

2.       What obesity is to them, contributors and inhibitors. Feelings and knowledge around body weight.

3.       Health and well-being in relation to their own customs and worldview

4.       Utopian world incorporating their health concepts

Themes from this qualitative study:

(+) holistic health incorporating Indigenous customs and worldviews

(+) relationships and social connectedness ‘Kotahitanga’

(-) Historical trauma and the effects of colonisation

(-) biomedical model of caloric restriction, diet and exercise was non-relatable, and culturally insensitive

Relationship between chronic stress and obesity

Author proposing that in people with obesity this system does not work so well, lots of resistance to that. More susceptibility to depression and anxiety.

Te Pae Mahutonga

-            Importance of cultural identity, participation, and environment, how they are all linked to health.

Food Sovereignty- Empowering people, as individuals and as groups, to make their own choices about the food they eat, where it comes from, how it is produced and their relationship to its production.

12 projects to improve indigenous health

-            Human rights, freedoms, healing, full participation, self-determination etc. by tackling these we can make differences in terms of indigenous health.

July 30^th Reading papers and interpretating evidence.

-            Systematic reviews, meta-analysis located at the top of the pyramid of hierarchy or research designs, (backed up and constructed by taking individual studies that address the same question)

-            Systematic review may or may not include a meta-analysis

-            Studies with sample sizes that are too small have confidence intervals which can be wide. Pooling data in meta-analysis allows for an increase in precision of results.

-            Meta-analysis can also be used when different studies give conflicting results

-            Publication bias: studies with positive effect or larger than average is more likely to be published.

-            Funnel plot, Forest plot

-            Heterogeneity vs homogeneity?

-            Cochran’s Q test

August 5^th Interactive Lecture

1.       What wider factors are discussed as playing a role? 

·       Supermarket access, economic, ads and media, policy, income, advertising.

2.       Diet plays a big role in how heavy you are, studies find cutting number of calories ingested=weight loss 

• Lack of exercise, exercise is important for overall health, reducing CVD and NCD 

• Healthy food is more expensive 

• Link between financial stress and obesity 

3.       Do you think we have food deserts in New Zealand? 

• Yes, Porirua Wellington 

Food desert: areas where poverty don't have access to supermarket, lack of fresh healthy foods 

• Food deserts are rarely in the places with highest obesity (USA research) 

• opt for good containing more energy (increase in calories) 

“Food Swamps” an area that has more access to less nutritious foods than nutrient dense foods.

Alternatives

-            food swamps: area that has more access to less nutritious foods than nutrient-dense foods.

-            food oases: an area with greater access to supermarkets and vegetable shops.

-            food mirages: grocery stores are plentiful, but prices are beyond the means of low-income households.

-            food haven: a place where there is a wide variety of food that’s easily available.

“a space or place where people have high availability of healthy food and beverages that are accessible, convenient, affordable, and desirable”.

Food outlet classifications:

1.       Windows of opportunity discussed in the webinar

2.       Advantages of a longitudinal study? can track changes overtime with the same group of people. Stronger source of evidence.

3.       Do you think NZ faces a similar issue relating to the physical environment? Dairies close to houses, advertising, safety when it comes to walking to school. In order to change this decrease exposure to advertising or have a safer walking environment.

4.       What were the unintended effects of changes to the 2007 food advertising rules to children in England?

6^th August Communication (related to Assignment 1)

Models of Science Communication

Deficit model

Sender -> receiver (inadequate knowledge)

-            Problematic because there is a lot of people, a lot of noise outside of this

Dialogue and Participation approach

Science communication as a two-way street. Receiver <- > sender

-            E.g., working with a client, assessing their information, tailoring your message and ideas to fit within that.

A lot of science communication and what is out there is confusing

#1 identify your audience

·       Who are the, why should they care about the issue, what is the context?

#2 focus your message

·       What do you want your key points to be?

·       What do you want the audience to come away with?

·       Three key points

Consider filling in the gaps, background information, what other information is out there.

Step 1: communication objective

Step 2: target audience

Step 3: key messages (with supporting facts)

Step 4: restate key message

#3 tell your story

·       Communicating science through stories and narratives. (not limited to fiction, improves comprehension, generates more interest and engagement).

ABT: And, But, Therefore

-            And the beginning

-            But … the middle

-            Therefore ... the end

Ethical issues- comprehension or persuasion? Meanings implicit rather than explicit. And for the plot what gets left out?

#4 The mechanics

-            Podcasting (variation in sound, speed, tone, person?) be descriptive

Potential software; garage band, audacity

-            Video (vlog, voice over animation, recorded presentation, interview) for videos can speed up.

Potential software; windows video editor, iMovie

-            Article: Plan, use paragraphs (one idea per paragraph), be descriptive, edit and write

e.g., healthy food, Heart foundation, NZ listener, the conversation

#5 test your message (with target audience for feedback)

#6 read, listen, and watch.

12^th August

·       Introduction to household food insecurity and its measurement

·       Who is food insecure in Aotearoa?

·       Health and nutrition implications in adults

FAO (Food and Agriculture Organisation) definition

“Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy lifestyle”.

Food Insecurity

Household food insecurity is the inadequate or insecure access to food due to financial constraints. A state of being without reliable access to a sufficient quantity of affordable, nutritious, sustainably source, culturally appropriate food. This includes the right to self-determine how you access food.

Root causes of systemic ongoing food insecurity (inequality, racism, colonisation, gender disparities).

For example: inadequate income, maternal hardship, health/disability impacts on nutrition, limited accessibility to healthy food outlets, emergency housing (poor storage, cooking facilities) and high costs of house.

Traditional response has been use of food parcels, food banks, and community meals, until 2020 this has been funded through the community and philanthropy. Largely community responding to the community and focusing on addressing the immediate needs, but not the systemic problems.

Temporary food insecurity

Is the limited or uncertain availability of nutritionally adequate and safe foods or limited ability to acquire personally acceptable foods that meet cultural needs in a socially acceptable way.

Brief short-term causation

-            Shocks/disasters (economic, health, natural)

-            Response is usually government – Civil Defence

-            Personal shocks with temporary consequences not lasting more than 12 weeks (health, loss of income, change of circumstances).

Food Related Poverty

“People living in food poverty have an income or expenditure that is less than the amount needed to consistently afford a basket of food with minimum recommended nutritional intake”.

-            This looks like single earning parents, high rent and inadequate protections for renters, benefit rates and minimum wage being inadequate to meet household costs, reliance on bought food and reduce variety, quantity, quality of food.

Food Dependency

“Food is not accessible to all, creating the need for ongoing financial and other support for people to consume good food”.

-            This looks like regular use of foodbanks, wider whanau reliance.

Food Security

All people at all times have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active healthy lifestyle.

-            Not just about food but also, adequate housing and income, access to land and knowledge to grow kai.

Food sovereignty

The right of people to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their rights to define their own food and agriculture systems.

-            Intrinsically linked to land sovereignty. In NZ linked to honouring Te Tiriti o Waitangi

Other terminology:

Discourse on household food insecurity

Survival

Parents have primary responsibility for providing for children, but states must assist parents and others responsible for the child to implement this. (UN)

-            Need water, warmth, and food

Measurement of Food Insecurity

·       USDA Household food insecurity tool (used the most)

·       FAO Food Insecurity Experience Sale (FIES)

·       Sustainable Dev’t Goal Indicator

·       NZ Household Food Insecurity Scale

·       Other measures: foodbank

NZ indicator Statements

-            NZ questionnaire came about through focus groups of low-income whanau

-            Developed the questions & pre-tested (300 people) rather than the individual

NZ Household Food Insecurity scale questions:

From questionnaires and survey’s common themes show stress occurring for social occasions such as birthdays, relying on others and when food runs out, they eat less

International Comparison:

Annual Health Survey- Households with children

Graphs shows trend overtime in NZ

When comparing item responses for 2002 Children’s Nutritional Survey and 2015/16 New Zealand Health Survey for households with children for each question there is not a huge shift in terms of the way people are responding, and prevalence of affirmative response for each question.

Food Insecurity in NZ

Nutrition and Health Impacts

Usual daily intake of selected nutrients by food security status for females, NZANS08/9

Micronutrient stats indicative of lower fresh fruit and vegetables. Differences in terms of lactose intake, calcium. Increase intake of saturated fats (processed source of meat).

Food is a flexible expenditure; more likely to compromise food when other bills need to be paid.

Pilot study looked at what happens across the pay cycle for intake of different food groups and nutrients. Comparing women to children.

*In Canada 1 in 8 adults are food insecure, 1/3 of hospitalisations are from food insecure households. Having a toll on people’s mental health.

Prevalence of Obesity by Food Insecurity in Females

Prevalence of Type 2 Diabetes by Household Food Insecurity, (NHANES 1999-2002)

CVD proposed mechanisms

What can we do?

-            Awareness, empathy, practical help, advocation

13^th August- Interactive Lecture

1.       Define household food insecurity and differentiate it from related concepts

Household food insecurity is the state in which members of a household lack consistent access to sufficient, safe, and nutritious food necessary for an active and healthy life. It involves uncertainty about the ability to obtain food and can range from worrying about running out of food to experiencing hunger due to insufficient food intake.

-            Related concepts; hunger, malnutrition, poverty, undernutrition

2.       Identify and explain the short-term and long-term consequences of food insecurity on individuals, families and communities.

Short term consequences:

-            On individuals: Physical health, mental health

-            On families: parental stress, child development

-            On communities: social strain, economic impact

Long term consequences:

-            On individuals: Chronic health conditions, mental health issues, persistent anxiety/depression

-            On families: intergenerational impact, family instability

-            On communities: public health burden, economic decline, social inequity.

From podcast:

1.       Who is Valerie Tarasuk?

-            Researcher in the field of nutrition, leads PROOF (Food Insecurity Policy Research)

2.       Have a look at the USDA food insecurity measurement- how does this differ to the NZ question?

-            USDA measures food insecurity using a detailed survey module. USDA is more nuanced, and NZ uses more direct questions.

3.       What does Tarasuk discuss as being different in low-income countries compared to high income countries? Food insecurity, drivers of food insecurity, health impacts, policy and intervention approaches, role of food systems.

4.       What charitable aid can NZers access with regard to food? Foodbanks, food rescues, community pantries and programs, as well as school food programs.

5.       What are your views on the role of food rescue in solving the food insecurity issue?

6.       What about community gardens? Community gardens are a powerful tool in addressing food insecurity, and they offer a range of benefits that go beyond simply providing food.

Rebekah Graham article

Agree or disagree with views in this article?

Lecture 11: 19^th August Nutrition in school settings

School milk 1937-67

John Keys 2013 food in schools

New Brighton Catholic School 2016

Recent history – NZ Schools

From 2003-08 there were guidelines and regulations about what could be sold in canteens, fundraising etc. in 2009 change in government, all administration guidelines were removed so schools no longer had to comply with regulations. Became more of an opt in approach.

Paternalism/Nanny State

-            People criticising the role that the state has. Cartoon shows a small girl receiving an apple from the woman at the tuckshop, interrupted by a man wheeling a wheelbarrow full of’ fatty profit pies; ‘hospital fries’ etc. he tells the girl not to listen to nanny but to let the market mollycoddle her instead. Refers to legislation that will require schools to sell only healthy food.

Intervention ladder- Different approaches that can be taken in terms of interventions.

Eliminate choice

Guide choice through disincentives

Guide choice through incentives

Guide choice through changing the default policy

Enable choice

Provide information

Do nothing or monitor

Universal and free school meals

-            Some countries how free school meals for entire population; Finland, Sweden, India, Estonia, South Korea, England (for infants).

-            41% of primary children

-            61% in high income countries,18% in low-income countries

International look on where in the world there are regulations around what happens in schools. Regulations around foods and beverages in schools (vendors, tuck shops).

Currently in NZ if in Ka Ora Aka program can operate a school canteen

Child wellbeing and youth strategy

·       Children and young people are loved, safe and nurtured

·       Children and young people have what they need

·       Children and young people are happy and healthy

·       Children and young people are learning and developing

·       Children and young people are accepted, respected and connected

·       children and young people are involved and empowered.

Child Poverty Related Indicator

data from 2015 showing percent of households from children where the report of running out of food often or sometimes occurs

Children’s Nutrition Survey

children living in households with low food security did have a compromise nutrient intake compared to children in food secure group.

According to international studies children 9 to 16 years are aware of household food insecurity this can impact on them emotionally, cognitively, and physically. These children may have to take responsibility, we can participate in adult strategies, initiate strategies and generate resources.

Child development; impact of food security on cognitive function and behaviour for a child during development.

Early child longitudinal kindergarten cohort- Longitudinal study

Looking at what happens in terms of academic performance overtime.

-            Looked at children who were food secure > insecure

-            Food insecure to secure

-            Persistent food security

Results:

-            Persistent food insecurity compared to persistent food insecurity meant greater increase in BMI overtime. No difference in changes in maths, but in terms of reading girls had a smaller increase.

-            Transitioning to food insecurity means girls and boys had a smaller increase in reading and math scores overtime.

Socioecological model

·       individual (biological, cognition, lifestyle, demographics)

·       social (peers, family, staff)

·       physical (surrounding food environments, school food access to, school rule)

·       macro levels (legislations, guidelines, education, social norms, laws, cost of food).

Ka Ora, Ka Ako

Ora – to be a live, well, safe, cured, recovered, healthy, fit, healed

Ako – to learn, study, instruct, teach, advise

Aims to improve:

·       food security

·       wellbeing and overall health

·       school attendance

·       support child development and learning

·       behaviour, concentration and school achievement

·       financial hardship for families

currently: over 1000 schools in NZ take part in this, eligible schools are based on equity index.

-            Different models; external models, Iwi/Hapu model, head school model, or internal model.

Nutrition and Food Standards: Strict guidelines that specify what can and cannot be in the school meal, this differs depending on the year group that the meals are given to.

·       Other guidelines: traffic light system (green, amber, red), health starts >=3

Ka Ora, Ka Ako evaluation

Food, wellbeing and attendance

Aim: assess the impact of Ka Ora, Ka Ako programme on secondary akonga wellbeing as well as the impact of the programme on attendance among all age groups.

The distribution of secondary schools and kura across equity index

-            If above 461, eligible as a school to take part in the program

-            Got schools to take part just below and above equity area

-            Underestimates the effect of school lunches on participating school who are more disadvantaged.

Overview of the quality of evidence in the evaluation.

-            Ministry administrative data 73-81 schools and kura

-            Survey of secondary akonga, 10,694 (of 224,454)

-            Case study interviews, 8 schools and kura (of 981)

·       Students in the programme more likely to report enough food in schools

·       Students not in the programme- more fruit and vegetables at home

·       Higher scores across mental wellbeing, physical, school, emotional, and social functioning. Overall health quality of life.

·       Students who were more food insecure, school lunches had a greater effect across all aspects.

·       No impact on attendance

Nutrient Evaluation

Aims: determine the contribution Ka Ora, Ka Ako lunch meals to the daily nutrient requirements of students (assessed against Australia/NZ Nutrient reference values. Also compare nutritional values of this program to international lunch program nutrient standards.

-            Took a recipe provided by the schools, analysed it and programmed into food works. Most of meals were below 1/3 of daily energy requirements. Fibre, riboflavin, vitamin C, calcium, iron.

Impact Evaluation

-            Finance and stress; nutritional practice & knowledge; wellbeing and engagement

-            (+) Opportunities for learning, improved food security.

-            (-) Loss of agency, lack of knowledge, food waste.

Unintended consequences

School canteens open at morning tea had unhealthy foods, diversion of resources and time. Student tended to leave school grounds.

Systematic Review- overview around universal meals.

-            Improvement in diet quality

-            Mixed results in attendance

-            Academic performance little to no effect

-            BMI no association

What is missing?

1)       Effect on academic outcomes

2)       Measurement of food waste

3)       Attendance (post covid)

4)       Improved understanding of nutrition

5)       Reduced hunger

6)       Intake data

Summary – over a short period of time Ka Ora, Ka Ako is making a positive contribution to diet quality, overall school food environment, community and whanau and health and wellbeing. Qualitative data also suggests learner outcomes.

Tuesday 20^th August- Interactive Lecture