Global influences on milk purchasing in New Zealand – implications for health and inequalities

Background Economic changes and policy reforms, consistent with economic globalization, in New Zealand in the mid-1980s, combined with the recent global demand for dairy products, particularly from countries undergoing a 'nutrition transition', have created an environment where a proportion of the New Zealand population is now experiencing financial difficulty purchasing milk. This situation has the potential to adversely affect health. Discussion Similar to other developed nations, widening income disparities and health inequalities have resulted from economic globalization in New Zealand; with regard to nutrition, a proportion of the population now faces food poverty. Further, rates of overweight/obesity and chronic diseases have increased in recent decades, primarily affecting indigenous people and lower socio-economic groups. Economic globalization in New Zealand has changed the domestic milk supply with regard to the consumer and may shed light on the link between globalization, nutrition and health outcomes. This paper describes the economic changes in New Zealand, specifically in the dairy market and discusses how these changes have the potential to create inequalities and adverse health outcomes. The implications for the success of current policy addressing chronic health outcomes is discussed, alternative policy options such as subsidies, price controls or alteration of taxation of recommended foods relative to 'unhealthy' foods are presented and the need for further research is considered. Summary Changes in economic ideology in New Zealand have altered the focus of policy development, from social to commercial. To achieve equity in health and improve access to social determinants of health, such as healthy nutrition, policy-makers must give consideration to health outcomes when developing and implementing economic policy, both national and global.</p

Kids’ Digital Distractions: An observation study of recorded everyday screentime by 12-year-olds

The proliferation of personal information technology and online services have radically impacted how people spend their time and attention. With numerous possible targets of attention in the digital space, attention is more fragmented, distracted, and requires more effortful control. There is considerable concern in society of the ramifications, especially related to children. Notably, digital distractions can prevent the cognitive absorption during which learning and enjoyment takes place. While theories have identified a wide array of factors of distractions, we know little about how they play out in children’s actual day-to-day digital distractions. In this paper, we conduct a pilot study to shed more light on the nature and extent of children’s digital distractions. Building on the data collection project of Kids Online, with recorded screentime by 12-year-old students from schools in Wellington, New Zealand, we first develop a coding schema to identify behaviours that should allow us to evaluate proxies of distraction. Using this we report on the application use, frequency of attentional switching, and digital distraction of 17 participants. Our paper thus establishes a platform for further studies to examine the grounds of widely held concern, and to synthesize theory on the emergence and ramifications of everyday digital distraction

A walking stick in one hand and a chainsaw in the other: Patients’ perspectives of living with multimorbidity

AIMS: Multimorbidity is common, yet there are major gaps in research, particularly among younger and indigenous populations. This research aimed to understand patients’ perspectives of living with multimorbidity. METHODS: A qualitative study of 61 people living with multimorbidity, 27 of whom were Māori and a third aged under 65, from urban and rural regions in New Zealand. Six focus groups and 14 interviews were conducted, recorded, transcribed and analysed. RESULTS: For many participants, living with multimorbidity disrupted their ‘normal’ lives, posing challenges in everyday activities such as eating and toileting, working and managing medications. Dealing with the health system posed challenges such as accessing appointments and having enough time in consultations. Cultural competency, good communication and continuity of care from healthcare providers were all valued. Participants had many recommendations to improve management, including a professional single point of contact to coordinate all specialist care. CONCLUSIONS: Living with multimorbidity is often challenging requiring people to manage their conditions while continuing to live their lives. This research suggests changes are needed in the health system in New Zealand and elsewhere to better manage multimorbidity thus improving patient’s lives and reducing costs to the health sector and wider society

Tackling health inequalities: moving theory to action

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Patterns of sports sponsorship by gambling, alcohol and food companies: an Internet survey

BACKGROUND: Sports sponsorship is a significant marketing tool. As such, it can promote products that pose risks to health (eg, high fat and high sugar foods) or it can promote health-supporting products (eg, sporting equipment and services). However, there is a lack of data on the proportion of sponsorship associated with "unhealthy" and "healthy" products and no methodology for systematically assessing it. This research aimed to explore this proportion with an Internet survey of sports sponsorship in the New Zealand setting. METHODS: A search methodology was developed to identify Internet-based evidence of sports sponsorship at the national level and at the regional and club level in one specific region (Wellington). The top eight sports for 5-17-year-olds were selected and products and services of sponsors were classified in terms of potential public health impact (using a conservative approach). RESULTS: Sponsorship of these popular sports was common at the national, regional and club levels (640 sponsors listed on 107 websites overall). Sports sponsorship associated with sponsors' products classified as "unhealthy" (eg, food high in fat and sugar, gambling and alcohol) were over twice as common as sponsorship associated with sponsors' products classified as "healthy" (32.7% (95% CI = 29.1, 36.5) versus 15.5% (95% CI = 12.8, 18.6) respectively). "Gambling" was the most common specific type of sponsorship (18.8%) followed by alcohol (11.3%). There were significantly more "alcohol" sponsors for rugby, compared to all the other sports collectively (rate ratio (RR) = 2.47; 95% CI = 1.60, 3.79), and for top male sports compared to female (RR = 1.83; 95% CI = 1.05, 3.18). Also there was significantly more "unhealthy food" sponsorship for touch rugby and for "junior" teams/clubs compared to other sports collectively (RR = 6.54; 95% CI = 2.07, 20.69; and RR = 14.72, 95% CI = 6.22, 34.8; respectively). A validation study gave an inter-rater reliability for number of sponsors of 95% (n = 87 sponsors), and an inter-rater reliability of classification and categorisation of 100%. CONCLUSION: This study found that the sponsorship of popular sports for young people is dominated by "unhealthy" sponsorship (ie, predominantly gambling, alcohol and unhealthy food) relative to "healthy" sponsorship. Governments may need to consider regulations that limit unhealthy sponsorship and/or adopt alternative funding mechanisms for supporting popular sports

The politics of health promotion: insights from political theory.

SUMMARY Health promotion is inherently political. Not only is it largely funded by government, but the very nature of the enterprise requires shifts in power. Political theory has much to contribute to an understanding of the politics of health promotion. In this paper three key political theories are explained and their insights for health promotion explored. They are then applied to the development of a National Drug Policy in New Zealand. The theoriesÐpluralist interest group theory, the new institutionalism and neo-Marxist theoryÐare each at a different level of analysis. The significance of interests, institutional factors and class as political influences on health promotion are discussed. It is concluded that to ensure good practice health promotion practitioners need to be aware of these influences on their work. They need to strategise to ensure support from key interests, build capacity for health promotion into their institutions and recognise the macro-political context within which they work in order to influence it

Using Continuous Glucose Monitoring Data and Detrended Fluctuation Analysis to Determine Patient Condition: A Review.

Patients admitted to critical care often experience dysglycemia and high levels of insulin resistance, various intensive insulin therapy protocols and methods have attempted to safely normalize blood glucose (BG) levels. Continuous glucose monitoring (CGM) devices allow glycemic dynamics to be captured much more frequently (every 2-5 minutes) than traditional measures of blood glucose and have begun to be used in critical care patients and neonates to help monitor dysglycemia. In an attempt to obtain a better insight relating biomedical signals and patient status, some researchers have turned toward advanced time series analysis methods. In particular, Detrended Fluctuation Analysis (DFA) has been a topic of many recent studies in to glycemic dynamics. DFA investigates the "complexity" of a signal, how one point in time changes relative to its neighboring points, and DFA has been applied to signals like the inter-beat-interval of human heartbeat to differentiate healthy and pathological conditions. Analyzing the glucose metabolic system with such signal processing tools as DFA has been enabled by the emergence of high quality CGM devices. However, there are several inconsistencies within the published work applying DFA to CGM signals. Therefore, this article presents a review and a "how-to" tutorial of DFA, and in particular its application to CGM signals to ensure the methods used to determine complexity are used correctly and so that any relationship between complexity and patient outcome is robust

International trade and investment law: a new framework for public health and the common good

Abstract Background International trade and investment agreements can have positive outcomes, but also have negative consequences that affect global health and influence fundamental health determinants: poverty, inequality and the environment. This article proposes principles and strategies for designing future international law to attain health and common good objectives. Argument Basic principles are needed for international trade and investment agreements that are consistent with the common good, public health, and human rights. These principles should reflect the importance of reducing inequalities, along with social and environmental sustainability. Economic growth should be recognised as a means to common good objectives, rather than an end in itself. Our favoured approach is both radical and comprehensive: we describe what this approach would include and outline the strategies for its implementation, the processes and capacity building necessary for its achievement, and related governance and corporate issues. The comprehensive approach includes significant changes to current models for trade and investment agreements, in particular (i) health, social and environmental objectives would be recognised as legitimate in their own right and implemented accordingly; (ii) changes to dispute-resolution processes, both state-to-state and investor-state; (iii) greater deference to international legal frameworks for health, environmental protection, and human rights; (iv) greater coherence across the international law framework; (v) limitations on investor privileges, and (vi) enforceable corporate responsibilities for contributing to health, environmental, human rights and other common good objectives. We also identify some limited changes that could be considered as an alternative to the proposed comprehensive approach. Future research is needed to develop a range of model treaties, and on the means by which such treaties and reforms might be achieved. Such research would focus also on complementary institutional reforms relevant to the United Nations and other international agencies. Advocacy by a range of communities is needed for effective change. Reform will require informed debate, determined engagement with decision-makers and stakeholders, and some agreement across health, social and environmental sectors on alternatives. Conclusions Current frameworks of international law that govern trade and economic development need radical change, in relation to treaty processes, content, and contexts, to better attain public health objectives

Submissions to the Australian and New Zealand Review of Food Labelling Law and Policy support traffic light nutrition labelling

Abstract Objective: Food labels to support healthier choices are an important potential intervention for improving population health by reducing obesity and diet‐related disease. This study examines the use of research evidence about traffic light nutrition labelling in submissions to the Review of Food Labelling Law and Policy conducted in Australia and New Zealand. Methods: Content analysis of final submissions to the Review and a literature review of documents reporting research evidence about traffic light labelling. Results: Sixty‐two submitters to the Review were categorised as ‘supporters’ of traffic light labelling and 29 as ‘opponents’. Supporters focused on studies showing traffic light labels were better than other systems at helping consumers identify healthier food options. Opponents cited evidence that traffic light labels were no better than other systems in this respect and noted a lack of evidence that they led to changes in food consumption. A literature review demonstrated that, as a group, submitters had drawn attention to most of the relevant research evidence on traffic light labelling. Both supporters and opponents were, however, selective in their use of evidence. Conclusions: The weight of evidence suggested that traffic light labelling has strengths in helping consumers to identify healthier food options. Further research would be valuable in informing the development of an interpretive front‐of‐pack labelling system. Implications: The findings have significant implications for the development of front‐of‐pack nutrition labelling currently being considered in Australia and New Zealand

Continuous Glucose Monitoring: Using CGM to Guide Insulin Therapy Virtual Trials Results

Continuous glucose monitoring (CGM) devices can measure blood glucose levels through interstitial measurements almost continuously (1-5min sampling period). However, they are not as accurate as glucose readings from blood measurements. The relation between tissue and blood glucose is dynamic and the sensor signal can degrade over time. In addition, CGM readings contains high frequency noise and can drift between measurements. However, maintaining continuous glucose monitoring has the potential to improve the level of glycemic control achieved and reduce nurse workload. For this purpose, a simple model was designed and tested to see the effect of inherent CGM error on the insulin therapy protocol, STAR (Stochastic TARgeted). An error model was generated from 9 patients that had one Guardian Real-Time CGM device (Medtronic Minimed, Northridge, CA, USA) inserted into their abdomen as part of an observation trial assesing the accuracy of CGM measurements compared to a blood gas analyser and glucometer readings. A resulting error model was then used to simulate the outcomes if the STAR protocol was guided by CGM values on 183 virtual patients. CGM alarms for hyper- and hypo-glycaemic region were included to improve patient safety acting as 'guardrails'. The STAR CGM protocol gave good performance and reduced workload by ~50%, reducing the number of measurements per day per patient from 13 to 7. The number of hypoglycaemic events increased compared to the current STAR from 0.03% <2.2mmol/L to 0.32%. However, in comparison to other published protocols it is still a very low level of hypoglycaemia and less than clinically acceptable value of 5% <4.0mmol/L. More importantly this study shows great promise for the future of CGM and their use in clinic. With the a newer generation of sensors, specifically designed for the ICU, promising less noise and drift suggesting that a reduced nurse workload without compromising safety or performance is with in reach