Sunday 17 March 2013

Legislation and policies in place to curb obesity in early childhood settings in Aotearoa, New Zealand

Developing my previous discussion, I have researched and examined legislation and government policies surrounding prevention and treatment of over-weight and obese children in Early Childhood Education Services (ECES) in New Zealand.

The Ministry of Health (2004) confirms that “...increased efforts to monitor and control childhood obesity are critical for the health of future generations of adults...”, thus demonstrating their concern for this social issue (p. 82). The Ministry of Health supports its concern by providing a background paper called Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0-2): A background paper (FNG) (2008), which is a legislative instrument under the Legislative Instruments Act 2003. This legislative instrument provides a policy base for implementing the three key messages of the Healthy Eating – Healthy Action: Oranga Kai – Oranga Pumau (HEHA): A strategic framework (Health Strategy), launched in 2003, which is also one of The Ministry of Health's (2003) responses to this social issue: obesity. McLean et al. agrees with this as they state that "New Zealand's response to the obesity epidemic has been The Healthy Eating-Healthy Action: Oranga Kai - Oranga Pumau Strategy to address growing concerns over poor eating habits, lack of physical activity, and the associated prevalence of obesity and increased risk of adverse health outcomes that result" (2009, p. 2). The three key messages, mentioned above, are: to improve nutrition, reduce obesity, and increase the level of physical activity and well-being for all (Minister of Health, 2000). This Health Strategy was set out as a guideline for everybody’s use: education institutions across the board, as well as private individuals (Healthy Eating Healthy Action, 2003). The HEHA, according to McLean et al. identifies the significance of "...reducing health inequalities and the Treaty of Waitangi, a treaty signed by Māori and the Crown in 1840..." (2009, p. 2). Deeply embedded in New Zealand health legislation, are the Treaty of Waitangi's principles of partnership, participation, and protection (Kingi, 2007; Ministry of Health, 2012). These New Zealand Health and Education Strategies, which include the FNG, focus on creating healthier environments in order to tackle the growing rate of overweight and obese infants and toddlers, using ECES as one of their main springboards in this endeavour (Ministry of Health, 2003b; Ministry of Health, 2004).

Under the HEHA Strategy, the ‘Mission-On’ campaign has been developed to help contribute to the implementation of this Health Strategy (Minister of Health, 2003). This campaign has one particular aim, which is “...to improve nutrition within early childhood environments...” (Minister of Health, 2003, p. 12). Mission-On is a joint campaign supported by the Ministries of Health, Education, Youth Development, and Sport New Zealand. The Ministry of Education has furthered this campaign, and set out the following guidelines – Food and Nutrition Guidelines for Healthy, Confident Kids’ which “...covers developing policies and procedures about food and beverages provided on site, and promotes consistent messages about healthy eating” (Ministry of Education, 2007). This was released into ECES in March 2007, thus giving advice on how to assist teachers to combat the level of overweight and obese children in ECES.

In addition to these policies and guidelines, the National Heart Foundation offers The Healthy Heart Award (HHA) for ECES, “...a free programme partially funded by the Ministry of Health ... assisting early childhood services in creating an environment that promotes healthy eating and physical activity to under 5s and their families” (National Heart Foundation, 2002, para. 1). The HHA was also promoted by Sport Hawke's Bay. This ‘Healthy Heart Award’ acts as a significant goal for most ECES as there are “...three levels of awards to recognise their achievements and seven criteria required to gain an award” (National Heart Foundation, 2002, para. 3). The ECES that I currently work for has utilised this programme, and has achieved the HHA. I, along with the rest of my colleagues, took part in implementing this programme into our curriculum. We achieved all levels, and met all seven criteria. We attained this HHA last year in 2012; I am extremely proud to have been a part of this accomplishment.

All aspects of ECES are close to my heart and I fully endorse and support the above policies and strategies the government has put in place to help eradicate the childhood overweight issue. I believe healthy eating and physical activity go a long way towards a strong mind and body, which prepares young children to be receptive to learning and intellectual growth. Ministry of Education (2007) supports this by stating that “Making connections with healthy food and nutrition choices affects aspects of the children’s learning and development, for example, by serving a balance of familiar and unfamiliar foods and establishing routines around mealtimes that encourage enjoyment” (para. 42).

Research shows that there may be many barriers to participation of ECES in the recommendations of those legislative instruments (Dowman, 2006). Since 2005, Sport Hawke's Bay has offered many different programmes, including the HHA, mentioned above, in Hawke's Bay ECES. An evaluation conducted in 2008 showed that "...in the 34 ECES surveyed, the programmes were linked, well suited to their needs, and were running successfully" (Mara, Ashcroft, Stockdale-Frost, & Karekare, 2008, para. 1).

However, in 2009, Sport Hawke's Bay noted that many ECES, including Ngā Kōhanga Reo, did not choose to take part in the HHA programme offered. Sport Hawke’s Bay’s Mara et al. conducted an evaluation, in 2010, to find answers to why ECES were not participating. This evaluation examined the factors that inhibited ECES' involvement in the programmes, in other words, barriers.

Some of the barriers to participation in the HHA I have identified include: socio-economic factors, lack of literacy, cultural inequities, language differences, lack of motivation, and, most importantly, lack of structure in curriculum planning. These barriers would therefore impact on both ECES and parents. Furthermore, the challenge by ECES to achieve the Award could be seen as a competition between the different ECES within a community. Instead of a celebration of accomplishment, a divide could be established causing further unnecessary rivalry.

Results of the 2010 evaluation, mentioned above, demonstrated that although there were many barriers to participation, ECES involved in the HHA increased from 34 in 2008 to 65 in 2010 that implemented the HHA (Mara, Ashcroft, Stockdale-Frost, & Karekare, 2010). The following are the barriers that were identified in the 2010 evaluation: "...[ECES] believing that they are already including key components of healthy eating and active movement within their curriculum, [seeing] no need for taking up the [HHA] programme; that the amount of documentation required by the HHA is viewed as onerous and acts as a deterrent to completing the programmes; that some Ngā Kōhanga Reo would like to be able to report within their own kaupapa frameworks, including in Te Reo Māori and, the need to have recognition and support for this point of difference for Ngā Kōhanga Reo by Sport Hawke's Bay and the National Heart Foundation" (Mara, Ashcroft, Stockdale-Frost, & Karekare, 2010, para. 4). It is of interest to me, that my observations about barriers to participation are parallel with the results of the evaluation.

Within the HHA, there are key strands that link into the New Zealand early childhood curriculum (ECC) – Te Whāriki’s (Ministry of Education, 1996) key principles; illustrated in the special woven mat (Heart Foundation, n.d.).
These four principles of Te Whāriki (Ministry of Education, 1996) underpin practices in ECES and provide a basis for including food and nutrition guidelines, thus supporting those legislative instruments above.

Te Whāriki – The Early Childhood Curriculum
Four broad principles are at the centre of Te Whāriki, the ECC:
  • Empowerment – the ECC empowers the child to learn and grow
-Connecting with the Learning and Teaching strand
  • Holistic Development – the ECC reflects the holistic way children learn and grow
-Connecting with the Governance and Management strand
  • Family and Community – the wider world of family and community is an integral part of the ECC
-Connects with the Collaboration strand
  • Relationships – children learn through responsive and reciprocal relationships with people, places, and things.
-Connects with the Professional Development strand

These principles of Te Whāriki (Ministry of Education, 1996) link into the strands of the HHA, produced by the National Heart Foundation, therefore suggesting that the HHA has been carefully designed in order to work in with the New Zealand ECC, which supports the implementation of the HHA.

Moreover, Te Whāriki’s first goal of the Well-being strand of the curriculum states that “Children [must] experience an environment where their health is promoted” (Ministry of Education, 1996,  p. 15). This goal provides a context in which children can develop a disposition to make health-related choices, including those of food selection and physical activity, provided to them by their ECES, which have been supplied by the Ministry of Education and Ministry of Health.

In regards to the HEHA, Labour politician Annette King, Minister of Health (2002), stated that she was certain that the implementation of the policy HEHA would have a positive effect on the health of New Zealanders, both adults and children. My analysis of this HEHA policy draws to the conclusion that, although the policies named are exemplary, where human-beings are involved, there may always be challenges and contradictions. This reminds me of the saying by John Lydgate (1370-1451) "you can't please everybody all of the time". Perhaps to countermand my sentiment, Bronwen King, a Christchurch public health nutritionist  would say, in support of these policies, that within ECES, “Education settings provide numerous and diverse opportunities for children and young people to make decisions about food, so it is important that these environments are structured to promote healthy eating” (2010, para. 17). 

Ministry of Education (2007) supports the implementation of the FNG stated above, and suggests that “Teachers and educators in early childhood education services play an important role in fostering knowledge and understanding about healthy food and nutrition and in providing opportunities for children to make healthy choices, therefore the implementation of the Food and Nutrition Guidelines is necessary” (para. 30). 

I surmise that after this examination and critique, ECES should embrace the above government guidelines and legislative instruments, to provide an environment where children can learn how to stay healthy, to develop self-help, self-care skills, which result in self-confidence and good self-esteem (Te Whāriki, Ministry of Education, 1996). Children can therefore develop working theories about nutrition; for example, they may begin to develop skills in food preparation, to develop knowledge of healthy food choices, and to understand the cultural importance of certain foods. Te Whāriki recognizes that the child’s learning environment extends far beyond the ECES, therefore it is important for ECES to provide healthy guidelines, which will effect a child's thinking about healthy eating and physical activity, both now and in the future (Ministry of Education, 1996).

Please watch this space for the following blog post which will be discussing the effects of television and food advertising on childhood obesity.

References:

Dowman, M. (2006). Factors influencing participation and success in the healthy heart award programme. Retrieved from http://www.otago.ac.nz/christchurch/research/publichealth/theses/otago013145.html 
Heart Foundation. (n.d.). Te Whāriki. Retrieved from http://www.heartfoundation.org.nz/uploads/4._Te_Whariki.jpg
King, B. (2010). Healthy eating in our schools – are we doing enough? Retrieved from http://www.sciencemediacentre.co.nz/2010/01/27/healthy-eating-in-our-schools-are-we-doing-enough/ 
Kingi, T. (2007). The Treaty of Waitangi: A framework for Māori health development. New Zealand Journal of Occupational Therapy, 54(1), 4-10. Retrieved from CINAHL Plus database.
Mara, D., Ashcroft, J., Stockdale-Frost, A., & Karekare, M. (2010). An evaluation of the extent to which early childhood centres in Hawkes Bay engage with Hawkes Bay Heart Foundation Healthy Heart Award and SPARC Active Movement Programmes in 2010. Retrieved from http://www.srknowledge.org.nz/research-completed/an-evaluation-of-the-extent-to-which-early-childhood-centres-in-hawkes-bay-engage-with-hawkes-bay-heart-foundation-healthy-heart-award-and-sparc-active-movement-programmes-in-2010/ 
McLean, R. M., Hoek, J. A., Buckley, S., Croxson, B., Cumming, J., Ehau, T. H., . . . Schofield, G. (2009). "Healthy eating – healthy action": Evaluating New Zealand's obesity prevention strategy. BMC Public Health, 9(1), 452-452. doi: 10.1186/1471-2458-9-452
Ministry of Education. (1996). Te Whāriki: He Whāriki Mātauranga mō ngā Mokopuna o Aotearoa/Early Childhood Curriculum. Wellington, New Zealand: Learning Media.
Ministry of Education. (2007). Food and nutrition for healthy, confident kids. Wellington, New Zealand: Learning Media.
Minister of Health. (2000). The New Zealand health strategy. Wellington, New Zealand: Minister of Health.
Minister of Health. (2002). Healthy heart award for early childhood centres. Retrieved from http://www.beehive.govt.nz/node/14569
Minister of Health. (2003). Health eating – healthy action: Oranga kai – Oranga pumau: A strategic framework. Wellington, New Zealand: Minister of Health.
Ministry of Health. (2003b). NZ food, NZ children: Key results of the 2002 national children’s nutrition survey. Wellington, New Zealand: Ministry of Health.
Ministry of Health. (2004). Tracking the obesity epidemic: New Zealand 1977-2003. Wellington, New Zealand: Ministry of Health.
Ministry of Health. (2008). Food and nutrition guidelines for healthy infants and toddlers (aged 0-2 years): A background paper. Retrieved from http://www.health.govt.nz/publication/food-and-nutrition-guidelines-healthy-infants-and-toddlers-aged-0-2-background-paper-partially 
National Heart Foundation. (2002). The healthy heart award. Retrieved from http://www.heartfoundation.org.nz/programmes-resources/schools-and-eces/healthy-heart-award