Papers by David Tipene-Leach
Food ethics, Jun 28, 2023
Māori (Indigenous people of New Zealand (NZ)) suffer food insecurity disproportionately in New Ze... more Māori (Indigenous people of New Zealand (NZ)) suffer food insecurity disproportionately in New Zealand. Some research suggests that Māori value mātauranga Māori (traditional Māori knowledge) when it comes to the collection, preparation and eating of kai (food). This study explores the connections between mātauranga Māori and kai in regional NZ schools for potential pathways to impact food security for children. Semi-structured interviews were undertaken with five primary school principals in the Hawke's Bay region. Principals were purposively selected on commitments to proactively incorporating mātauranga Māori into their school environment. Reflective thematic analysis was used to analyse the data. Three main themes were identified: teaching and learning around mātauranga Māori and kai; environmental sustainability and the sustainability of kai initiatives; and school values. A strong emphasis was placed on the learning of traditional Māori values around kai and the whenua (land) and the sustainability of teaching programs. School values were invariably bound in Te Ao Māori (a Māori worldview) however, schools felt challenged in aligning their values and their mātauranga Māori-bound teaching practices with the current food provision programme in their schools (Ka Ora, Ka Ako). The programme's strict nutritional guidelines appeared to challenge traditional Māori approaches to kai. Schools remain an ideal environment for the incorporation of mātauranga Māori to support food security and food education, and future work should explore a demonstration project that incorporates the knowledge gained in this study and ways to integrate mātauranga Māori into Ka Ora, Ka Ako.
The New Zealand Medical Journal, Feb 19, 2010
The editorial in the 11 December 2009 issue NZMJ 1 suggests that the Ministry of Health has taken... more The editorial in the 11 December 2009 issue NZMJ 1 suggests that the Ministry of Health has taken a “softly-softly approach” to the prevention of SIDS and that a “different, stronger and no nonsense approach” should be taken. Ed Mitchell and Coroner Evans advise parents not to bed-share with infants at all for the first 6 months of life. I am proposing a different approach to this message that will allow bedsharing yet mitigate much of the risk for this group of mainly Māori infants who continue to die of SIDS.
Journal of primary health care, 2018
Maori priMary health care treasures Pounamu (greenstone) is the most precious of stones to māori.... more Maori priMary health care treasures Pounamu (greenstone) is the most precious of stones to māori. 'ahakoa he iti, he pounamu' (Although it is small, it is valuable
International Journal for Equity in Health, May 22, 2019
Background: The prevalence of smoking during pregnancy among indigenous women approaches 50% and ... more Background: The prevalence of smoking during pregnancy among indigenous women approaches 50% and is associated with sudden infant death, pregnancy loss, preterm delivery, low birth weight, and anatomical deformity. This study aims to synthesise qualitative studies by reporting experiences, perceptions, and values of smoking cessation among pregnant indigenous women to inform potential interventions. Method: A highly-sensitive search of MEDLINE, Embase, PsychINFO, and CINAHL, in conjunction with analysis of Google Scholar and reference lists of related studies was conducted in March 2018. We utilised two methods (thematic synthesis and an indigenous Māori analytical framework) in parallel to analyse data. Completeness of reporting in studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) framework. Results: We included seven studies from Australia and New Zealand involving 250 indigenous women. Three themes were identified. Realising well-being and creating agency included giving the best start to baby, pride in being a healthy mum, female role models, and family support. Understanding the drivers for smoking included the impact of stress and chaos that hindered prioritisation of self-care, the social acceptability of smoking, guilt and feeling judged, and inadequate information about the risks of smoking. Indigenous women strongly preferred culturally responsive approaches to smoking cessation, placing value on programs designed specifically for and by indigenous people, that were accessible, and provided an alternative to smoking. Conclusion: Future interventions and smoking cessation programmes might be more effective and acceptable to indigenous women and families when they harness self-agency and the desire for a healthy baby, recognise the high value of indigenous peer involvement, and embed a social focus in place of smoking as a way to maintain community support and relationships. Development and evaluation of smoking cessation programs for pregnant indigenous women and families is warranted.
MAI journal, Jun 29, 2021
Interviews with stakeholders in deprived Hawke's Bay schools early in the COVID-19 lockdown docum... more Interviews with stakeholders in deprived Hawke's Bay schools early in the COVID-19 lockdown documented exacerbated food insecurity among school whänau. Our enquiry highlights the support role played by well-informed teacher aides and school-whänau networks, which were easily and inexpensively resourced, intuitive, proactive and collaborative, ensuring whänau access to appropriate support according to need. We expect our findings to further inform such initiatives in any further lockdown. Additionally, we posit that such school-based operations could become the nexus of a primary foodsecurity hub, alongside the Lunches in Schools programme, working in a tailor-made fashion bespoke to whänau without a charity or welfare label. Given the recent well-resourced COVID-19-related investment into the business world and the ongoing lack of progress in the reduction of child poverty, in the post-COVID-19-lockdown environment, simple structural rearrangements for the chronically food insecure are likely to become politically acceptable to the nation.
PubMed, Mar 9, 2018
Māori demand on New Zealand mental health services is out of proportion to the size of the Māori ... more Māori demand on New Zealand mental health services is out of proportion to the size of the Māori population, and the psychiatric service response is limited by lack of capacity. But there is also an inherent lack of capability, that is, the ability of a Western paradigm psychiatric service to meet the needs of an indigenous community. The Mahi a Atua narratives-based programme established in the primary mental healthcare services of the Tairāwhiti/Gisborne area has created a new approach to psychiatric assessment, diagnosis and therapy that is appropriate, but not confined, to the Māori community.
PubMed, Feb 27, 1991
This paper investigates the differential between Maori and European coronary heart disease mortal... more This paper investigates the differential between Maori and European coronary heart disease mortality in Auckland by analysing data from an Auckland register of coronary heart disease. The age standardised coronary heart disease mortality rate for Maori men is 1.6 times higher than for European men, and the rate for Maori women is 4.2 times higher than that of European women. Maori mortality is disproportionately high for women, and for the younger age groups. Maori and European who died of definite myocardial infarction in Auckland between 1983-86 showed little difference in severity of coronary artery occlusion at post mortem, and the likelihood of cardiomyopathy contributing a major part to Maori heart disease mortality is small.
PubMed, Mar 8, 1996
Aims: This study compares recent coronary heart disease morbidity and mortality rates and ten yea... more Aims: This study compares recent coronary heart disease morbidity and mortality rates and ten year trends for Maori, Pacific Islands people and Europeans living in New Zealand. Methods: Fatal coronary heart disease rates (mortality) and nonfatal hospitalisation rates for myocardial infarctions (morbidity) from 1983-92 were assessed and compared for males and females in each ethnic group, aged 35 to 64 years, using data from the Auckland Region Coronary or Stroke Study (ARCOS), a community-based coronary heart disease surveillance programme. Results: The recent 1990-2 mean coronary heart disease mortality rate for Maori men (232/100 000) was almost double the rate for Pacific Islands men (135/100 000 p=0.008) and more than double the rate for European men (103/100 000 p=0.001). Maori women had a three-fold higher mean mortality rate (85/100 000) than European women (25/100 000 p=0.02). The morality rate for Pacific Islands women (42/100 000) was midway between the other ethnic groups. Over the decade 1983-92 coronary heart disease mortality rates have decreased significantly by approximately 5% per year for European men and women. Rates for Maori and Pacific Islands people also appear to have fallen although the precision of these estimates are low. Morbidity rates in 1990-2 were similar among men in all three ethnic groups. Among women, morbidity was approximately half the male rates and there were no clear differences between the ethnic groups. Between 1983 and 1992 morbidity rates declined significantly for European men (p=0.008) and women (p=0.02) by approximately 5% per year. Among Maori and Pacific Islands people the trends were variable. Conclusion: Maori men and women continue to experience more than double the coronary heart disease mortality rates than Europeans. Mortality rates for Pacific Islands people are intermediate between Maori and European. Both coronary heart disease mortality and morbidity rates are declining in Europeans; there appears to have been a decline in coronary heart disease mortality for Maori and Pacific Islands groups but not in morbidity rates which may have increased. Given the trend towards a decline in coronary heart disease mortality for Maori and Pacific Islands people, the most likely explanation for the apparent increase in morbidity is improved access to secondary health care services and greater awareness of coronary health disease symptoms.
Acta Paediatrica, Aug 1, 1993
Sudden infant death syndrome (SIDS or cot death) is the major cause of post-neonatal death in ind... more Sudden infant death syndrome (SIDS or cot death) is the major cause of post-neonatal death in industrialized countries. The search for a physiological mechanism for SIDS has continued for many years but without success. The observations that mortality from SIDS differs between countries ( I ) and that it appears to change with time has led to speculation that infant care practices or lifestyles might be causally related to SIDS. In the last two years, there have been exciting development from epidemiological studies in New Zealand (national) (2, 3), Australia (Tasmania) (4, 5 ) and the UK (Avon county) (6, 7), which have identified potentially modifiable risk factors in parents' child-care practices. In N Z and Avon, a high SIDS mortality rate (NZ 1985 4.1/1000 live births and Avon 3.7/1000) was the impetus for an epidemiological study. The findings in N Z and Avon have formed the basis of the national campaigns in NZ and the UK, which have targeted information at parents about chiid-care practices. In N Z (population 3 million), the New Zealand Cot Death Study (NZCDS) was a three-year (1987-90) multicentre prospective case-control study which covered 78% of all births in the country. In the study there were 485 cot deaths, which were compared to 1800 control infants randomly sampled and matched for postnatal age. Comprehensive information was collected form obstetric and community nursing records and from interviews with the parents. Participation rates were high. In the first year of the study, comparison of 162 cases and 589 controls revealed three major risk factors which were amenable to modification (2): ( I ) prone sleeping (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 2.3, 5.5); (2) maternal smoking (OR = 3.0,95% CI = 2.0,4.5); and (3) not breast feeding
Kidney medicine, Nov 1, 2019
Community house hemodialysis is a submodality of home hemodialysis that enables patients to perfo... more Community house hemodialysis is a submodality of home hemodialysis that enables patients to perform hemodialysis independent of nursing or medical supervision in a shared house. This study describes the perspectives and experiences of patients using community house hemodialysis in New Zealand to explore ways this dialysis modality may support the wider delivery of independent hemodialysis care. Study Design: Qualitative semi-structured indepth interview study. Setting & Participants: 25 patients who had experienced community house hemodialysis. Participants were asked about why they chose community house hemodialysis and their experiences and perspectives of this. Analytical Approach: Thematic analysis using an inductive approach. Complete author and article information provided before references.
Acta Paediatrica, Jul 18, 2016
Postneonatal mortality rates changed very little from 2000 until recently. There has been a decre... more Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths. Methods: The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs). Results: Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for M aori and in regions with the most intensive programmes. Conclusion: The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees.
Nutrients, Oct 17, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of the Royal Society of New Zealand
Diabetes Research and Clinical Practice, Aug 1, 2009
We describe changes in markers and prevalence of glucose metabolism disorders following a 2-year ... more We describe changes in markers and prevalence of glucose metabolism disorders following a 2-year community-wide intervention aimed at reducing insulin resistance (IR) prevalence in a high risk community. Surveys were undertaken before and 2 years after implementation of a community developed and led diabetes prevention program. Proportions and means were calculated and compared by sex and age groups: 25-49 years and 50+ years. A process evaluation contributed to interpretation of results. Response rates were around 50% and demographic characteristics similar in both surveys. Overall, IR prevalence decreased markedly from 35.5% to 25.4% (p = 0.003). Most changes were observed amongst 25-49 years old women for whom there was a significant change in prevalences of IR and glucose metabolism disorders (p = 0.015), largely due to reduced IR prevalence (38.2-25.6%). In 2006, 60.3% achieved minimum recommended exercise levels and 65.4% ate wholegrain bread compared with 45.1% (p = 0.002) and 42.2% (p = 0.044), respectively, in 2003. Participation in a community diabetes prevention intervention appeared to reduce IR prevalence after 2 years in those with the highest level of participation and most marked lifestyle changes.
The strict nationwide Covid-19 lockdown that began in March 2020 in Aotearoa New Zealand required... more The strict nationwide Covid-19 lockdown that began in March 2020 in Aotearoa New Zealand required staff from tertiary education institutions to immediately adapt and move their teaching and professional activities online, as well as maintain social contact remotely. The aim of our study was to explore the impact of the lockdown and restrictions on working life and personal wellbeing for staff at five Institutes of Technology and Polytechnics (ITPs) across Te Pūkenga national network. Participants were invited to complete an online survey at five time points, corresponding to different alert levels and decreasing social restrictions. They responded to questions about changes to work and personal life, activities to maintain wellbeing, adequacy and trustworthiness of information sources, and provided qualitative comment. Overall, 2250 responses were collected from 1240 individuals over the five time points. They show that participants made higher levels of adjustments in their working lives than in their personal lives or their efforts to maintain social contact. Levels of adjustment decreased over time, despite an increase in alert level (increased social restrictions) in September 2020. Attention to wellbeing also dropped off over time, with an increasing proportion of staff becoming at risk of poor wellbeing (below the cutoff of the WHO-5 depression index). Qualitative comments show innovative and creative ways of maintaining wellbeing despite the requirements for considerable adjustments to participants' daily working and personal lives.
PubMed, Dec 17, 2021
Aims: Choosing Wisely seeks to prevent harm by reducing the number of unnecessary tests, treatmen... more Aims: Choosing Wisely seeks to prevent harm by reducing the number of unnecessary tests, treatments and procedures, and by promoting shared decision-making. This article scopes perspectives of Māori patients/consumers and Māori health practitioners around Choosing Wisely and explores shared decision-making between Māori and their medical practitioners. Methods: Eight Māori consumers and seven Māori health practitioners participated in a qualitative, semi-structured, in-depth interview study with an inductive thematic analysis. Results: Participant feedback spanned issues from lack of Māori participation in programme governance through to practical issues like meaningful and literacy-appropriate health messaging, traversing consumer, practitioner, organisational and health-system aspects. Feedback further focused on the patient having trust in the practitioner, a sense of autonomy and the availability of advocacy and support in the consultation. Conclusions: Despite a late campaign collaboration with Māori, Choosing Wisely New Zealand is the first of the international programmes to acknowledge the possibility that their initiative might increase inequity for Indigenous populations. This enquiry highlights the need to consult Māori early and to infuse Treaty principles and Māori knowledge and custom at every stage of the programme.
PubMed, May 1, 2015
Aims: The wahakura (flax bassinet) is presently being distributed as a safe infant sleeping devic... more Aims: The wahakura (flax bassinet) is presently being distributed as a safe infant sleeping device amongst New Zealand Māori, where sudden unexpected deaths in infancy (SUDI) rates are high. It is promoted as mitigating bedsharing risk by providing a separate infant sleeping surface. This study aimed to understand exactly what factors determine the apparent acceptability of the wahakura as an infant sleeping device to Māori mothers and other key Māori community stakeholders. Methods: The qualitative study used face-to-face, semi-structured interviews, following Māori cultural protocols, to explore the experiences and views of 12 Māori mothers and 10 key informants who had wahakura experience. We employed purposeful sampling of participants and thematic analysis of data. Results: The practical appeal of the wahakura related to its portability, the enabling of bedsharing and easier breastfeeding. Considerable cultural and spiritual appeal was related to its native flax composition and traditional origin. Health professionals found it useful to engage Māori women antenatally. Conclusions: The study affirmed the acceptance of the wahakura as a culturally initiated endeavour, meaningfully engaging Māori mothers and families in SUDI risk mitigation. It has the potential to capitalise on the benefits of bedsharing to enhance infant wellbeing while also safeguarding them from harm.
PubMed, Aug 2, 2013
Recent research and policy around sudden unexpected death in infancy (SUDI) have emphasised the p... more Recent research and policy around sudden unexpected death in infancy (SUDI) have emphasised the place of safe sleeping practices within SUDI prevention strategies. Maori SUDI prevention workers have focussed on innovations around the safe sleep environment for some time now, as they have grappled with difficult to change and disproportionately high Maori SUDI rates. The wahakura (a flax bassinet modelled on a traditional Maori infant sleeping item) was developed in 2006 aiming to mitigate some of the risks of bedsharing with vulnerable infants, in particular infants exposed to maternal smoking in pregnancy. Early wahakura projects in Gisborne and Hawke's Bay showed high acceptability, effectiveness as an infant health promotion vehicle but difficulty maintaining a low/no cost supply for vulnerable families. The Hawke's Bay project revealed two pathways forward: the need for robust research to ensure the safety of the wahakura and the exploration of financially viable and more readily available alternatives. Work on both pathways is currently in progress around the country, signalling New Zealand's ongoing contribution to SUDI prevention and its potential contribution to knowledge and practices applicable to indigenous and other marginalised communities worldwide.
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Papers by David Tipene-Leach