Role of central government
In 2000, while developing the New Zealand Health strategies there were several goals and objective set according to the degree of the enhancement of the health status of the population and thereby reduces the potential of health inequalities. One of the objectives focused by the Minister of Health and District Health Boards is to enhance the nutrition and reduce the obesity (King, 2000).
The Green Prescription Active Families programme (GRxAF) for the child and adolescent obesity was initiated by the sports and recreation to address the childhood obesity and other health related problems. The management of GRxAF was transferred to the Ministry of health in 2009. The Ministry of Health released multidisciplinary approach to tackle the childhood and adolescent obesity. This approach was to work along with Whanau/family to address food habits, activity and behavior (Anderson, Taylor, Grant, Fulton, & Hofman, 2015). Whanau Pakiri is a version of active families to intensively target obese Maori and Pacific children aged 5-16 in Taranaki (Ministry of Health New Zealand, 2015).
Later in 2015, the government launched the Childhood obesity plan to manage and prevent obesity in children and young people. The plan is to target the interventions of who are obese, to support those who are at increased risk of becoming obese and to make easy and healthy choices for all New Zealanders by partnerships. Through partnership with food and beverage industry was to commit and reduce the incidence of childhood obesity (Ministry of Health New Zealand, n.d.b).Weight Management in 2–5 Year Old was the priority of government to manage, monitor, and assess children who are overweight and obese (Ministry of Health New Zealand, 2016a).
Knowledge of governance and management
In particularly from the Treaty of Waitangi and Maori development the Government is seeking significant outcomes in whanau ora by advocating social justice, eliminating poverty, and in advancing the Maori culture, social, economic development. He Korowai Oranga is a policy statement in the Maori Health Strategy by the Ministry of Health (2002) and provides a framework for informing the weight management in Maori children and adult. The pathways to achieve by Whanau Ora are development of Hapu, Whanau, Iwi development, Maori participation in health and disability sector and to address the broader determinants of health (Ministry of Health New Zealand, 2016b).
Role of Maori in Health planning
Three strategies have been identified for the weight management in The Maori Health Strategy. First is to understand the lived realities of Maori and mana-enhancing relationships to develop the cultural competent sector. Second is ensuring effective health services are provided by non-Maori-led and Maori led providers for Maori. Third is to provide the ongoing development to the Maori-led providers and the M?ori workforce (Ministry of Health New Zealand, 2016b).
Specific health related issue
Obesity is the New Zealand leading risk factor for health loss. The definition of overweight and obesity has been changing over time. Although it can be defined as excess body fat, there is no cut-off point for excess body fat in children or adults (Sahoo, et, al., 2015). According to World health organisation the most widely used measurement for obesity is Body mass index (Flodmark, Lissau, Moreno, Pietrobelli, & Widhalm, 2004). The WHO defined obesity as equal to or greater than 30 in adults, for children under age 5 and between 5-19 years. Obesity is weight-for-height greater than 3 and 1 standard deviation above the WHO child growth standards median respectively (Flodmark, et, al., 2004).
The unhealthy diet, physical inactivity and excess weight contributed to early death, disability and illness in New Zealanders (Ministry of Health New Zealand, 2016a). A number of associated diseases to childhood obesity included diabetes type 2, cardiovascular disease, chronic pain, mental illnesses and dementia. In 2016, obesity projected to overtake tobacco which was the leading risk factor causing health loss (Ministry of Health New Zealand, 2016c). About one third obese preschool children remain obese as adults and about half of school age children will remain obese as adults (Anderson et al., 2015).
Worldwide obesity is tripled since, 1975 (Flodmark, et, al., 2004). In 21st century, Childhood obesity is one of the serious issues to the public health challenges. The problem is mainly raised in the low and middle income countries. Globally in 2016, close to 42 million under the age five are overweight, out of which 35 million are from developing countries. In 2016, 18% of children and adolescents aged 5-19 were obese (Sahoo, et, al., 2015). . In 2016, The USA ranked the first in obesity by prevalence of 41.8% and followed by New Zealand with 39.5% and Africa countries with 36% (World Health Organisation, 2018). In 2010, New Zealand ranked third highest out of 40 countries for child hood obesity and is rising. Nearly one third of New Zealand children are either obese or over weight (Ministry of Health New Zealand, 2016a).
The prevalence for the childhood obesity that is children between age 2-14 years who are obese, or with a BMI equivalent to adult BMI greater than 30, according to DHBs the highest prevalence is at the Whaganui DHB, 2nd at the Taranaki DHB and third prevalence is at the Counties Manakau. The least prevalence is at the Nelson Marlborough. Depending on the Ethnicity the European/other remain the highest followed by Pacific (29.5 %), Maori (15.9%) and then Asian (6.7%) (Ministry of Health New Zealand, 2018). The childhood obesity rates have risen from 9% in 2006 to 11% in 2013 (Sharpe, & Bradbury, 2015).
Rates of obesity in pacific adult are five times higher and four times higher in children than non-pacific. While among Maori the rate of obesity are three times higher in adults and two times higher in children than non-Maori (Sharpe, & Bradbury, 2015). When the gender comparisons between the Maori, the girls were most deprived with 16.1% and boys were deprived of 15.7%. When childhood obesity is compared between the age groups of 5-9 remained the highest followed by 10-14 and then 2-4 (Ministry of Health New Zealand, 2018)
Strategies and policies
The childhood obesity plan was launched by the government in October 2015 to prevent and manage obesity. The main initiative was to partner with the food and beverage industry for the contribution of reducing the incidence of childhood obesity. The partnership resulted in the health kid’s industry pledge (Ministry of Health New Zealand, n.d.b). The means were committed from the pledge to provide easy access to children and their families to healthy options, to enhance the labeling for the healthy choices by including healthy star from government, support advertising, sponsorship and marketing of healthy nutrition, support particularly Maori and address the differences in outcomes of health. The Ministry also held forum with other government agencies including Ministry of Education, Sport NZ, Health Promotion Agency and the Education Review Office (Ministry of Health New Zealand, n.d.a).
The targeted initiatives were that to identify the obese children and Before Scholl Check programme will be offered to ensure sustained and positive health effects. In addition Before Scholl Check programme will have enhanced access to physical activity and nutrition programmes (Ministry of Health New Zealand, n.d.a).
Wh?nau Ora and Healthier Families NZ policies are a starting point to address obesity. In 2010, Whanau Ora concept was implemented by the government as a holistic approach to strengthen the concept of Healthy Eating Health Action strategy. The HEHA strategy considered all the three principles of Treaty of Waitangi; partnership: working together with Hapu, whanau, iwi, Participation: involving M?ori at all levels of heath and disability sector, Protection: ensuring same level of health for Maori and non-Maori. The strategy main focus was on environmental change, which is education at schools and workplace. Additionally the government also launched the Healthy Families NZ policy to address the preventable chronic diseases including obesity. Hence, it is recommended to incorporate such HEHA strategy with holistic approach of Whanau Ora and Healthy Families NZ policy the childhood obesity can be improved especially in Maori (Theodore, McLean, ; TeMorenga, 2015).
Second recommendation is attempt comprehended lifestyle intervention programme which are more likely to be accepted by Maori Community which was implemented in Dunedin hospital. This programme mainly focused on dietary programmes, exercise programmes, cultural programmes such as kapahaka (traditional dance and song) and waka ama (canoe paddling). This is recommending so that the traditions and cultures are protection and respected (Murphy, et, al., 2003).
Third is to by partnership with various advertising and marketing companies to the decrease exposure of foods which are high fat in content, sugary/soft drinks and low nutrition content products. Thereby, help in reducing the childhood obesity by increasing the exposure for healthy food (Eagle, Bulmer, DeBruin, ; Kitchen, 2004).