Australia, New Zealand and cultural diplomacy in the Cold War : an unanticipated consequence of the Colombo Plan

Considers the part planned, part accidental ventures in public diplomcy by Australia and New Zealand during the 1950s and 1960s, resulting from membership of the Colombo Plan for aid to South and Southeast Asia.

Health care and lost productivity costs of overweight and obesity in New Zealand

Objective: To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006.

Methods: A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA).

Results: Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA.

Conclusion: The cost burden of overweight and obesity in NZ is considerable.

Implications: Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs.

Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review

Background
The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). Triggered by a media report that traditional Samoan tattooing was causing NF, we conducted a chart review to investigate the role of this and other predisposing and precipitating factors and to document NF microbiology, complications and interventions in NZ.

Methods
We conducted a retrospective review of 299 hospital charts of patients discharged with NF diagnosis codes in eight hospitals in NZ between 2000 and 2006. We documented and compared by ethnicity the prevalence of predisposing and precipitating conditions, bacteria isolated, complications and interventions used.

Results
Out of 299 charts, 247 fulfilled the case definition. NF was most common in elderly males. Diabetes was the most frequent co-morbid condition, followed by obesity. Nearly a quarter of patients were taking non-steroidal anti-inflammatory drugs (NSAID). Traditional Samoan tattooing was an uncommon cause. Streptococcus pyogenes and Staphylococcus aureus were the two commonly isolated bacteria. Methicillin-resistant Staphylococcus aureus was implicated in a relatively small number of cases. Shock, renal failure, coagulation abnormality and multi-organ dysfunction were common complications. More than 90% of patients underwent surgical debridement, 56% were admitted to an intensive care unit (ICU) and slightly less than half of all patients had blood product transfusion. One in six NF cases had amputations and 23.5% died.

Conclusion
This chart review found that the highest proportion of NF cases was elderly males with co-morbidities, particularly diabetes and obesity. Tattooing was an uncommon precipitating event. The role of NSAID needs further exploration. NF is a serious disease with severe complications, high case fatality and considerable use of health care resources.

Understanding equity as an asset to national interest: developing a social contract analysis of policy

Alongside the influence of market-based reforms in education policy has been the growth of policy that has largely been overlooked – those that outline social contracts. This paper draws on policies that connect with equity as a way of illustrating this social contract turn in policy and develops a conceptualisation of social contracts as they apply to education policy. The argument provides three principles that underpin social contracts, including informed consent, negotiation and accountability. This paper applies these principles to three levels of social contract. At the first level are broad social contracts, which are associated with debates about the kinds of things that states should expect from its citizens, and the things that citizens could expect from governments and the state. The second level of social contract is an institutional or field-based social contract, which spells out the obligations and connections between a specific field and other fields. This level names a kind of social contract that is often exemplified in policies or statements by specific institutions. The third level of social contract deals with contract-like mechanisms embedded in fields that make tangible the obligations and expectations of citizens in fulfilling the expectations of fields.

Socio-economic inequalities in mortality persist into old age in New Zealand : study of all 65 years plus, 2001-04

A number of studies have explored the relationship between socioeconomic status (SES) and mortality, although these have mostly been based on the working age population, despite the fact that the burden of mortality is highest in older people. Using Poisson regression on linked New Zealand census and mortality data (2001 to 2004, 1.3 million person years) with a comprehensive set of socioeconomic indicators (education, income, car access, housing tenure, neighourhood deprivation) we examined the association of socioeconomic characteristics and older adult mortality (65+ years) in New Zealand. We found that socioeconomic mortality gradients persist into old age. Substantial relative risks of mortality were observed for all socioeconomic factors, except housing tenure. Most relative risk associations decreased in strength with aging (e.g. most deprived compared to least deprived rate ratio for males reducing from 1.40 (95% CI 1.28 to 1.53) for 65-74 year olds to 1.13 (1.00 to 1.28) for 85+ year olds), except for income and education among women where the rate ratios changed little with increasing age. This suggests individual level measures of SES are more closely related to mortality in older women than older men. Comparing across genders, the only statistically significantly different association between men and women was for a weaker association for women for car access.

Gender differences in financial barriers to primary health care in New Zealand

Gender differences in health status and use of health care services have been established in the developed world; less attention, however, has been paid to gender differences in financial barrier to primary health care. Such barrier, however, represent potentially avoidable mortality and morbidity. This paper aims to examine gender differences in financial barrier to primary health care in New Zealand.

Life and living in advanced age: a cohort study in New Zealand - Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

The number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.

Individual foraging site fidelity in lactating New Zealand fur seals : Continental shelf vs. oceanic habitats

Wide-ranging marine central place foragers often exhibit foraging site fidelity to oceanographic features over differing spatial scales (i.e., localized coastal upwellings and oceanic fronts). Few studies have tested how the degree of site fidelity to foraging areas varies in relation to the type of ocean features used. In order to determine how foraging site fidelity varied between continental shelf and oceanic foraging habitats, 31 lactating New Zealand fur seals (Arctocephalus australis forsteri1) were satellite tracked over consecutive foraging trips (14–108 d). Thirty-seven foraging trips were recorded from 11 females that foraged on the continental shelf, in a region associated with a coastal upwelling, while 65 foraging trips were recorded from 20 females that foraged in oceanic waters. There were no significant differences in the mean bearings (to maximum distance) of individual's consecutive foraging trips, suggesting individual fidelity to foraging areas. However, overlap in area and time spent in area varied considerably between continental shelf and oceanic foragers. Females that foraged on the continental shelf had significantly greater overlap in consecutive foraging trips when compared to females that foraged in oceanic waters (overlap in 5 × 5 km grid cells visited on consecutive trips 55.9%± 20.4% and 13.4%± 7.6%, respectively). Females that foraged on the continental shelf also spent significantly more time within the same grid cell than females that foraged in oceanic waters (maximum time spent in 5 × 5 km grid cells: 14%± 5% and 4%± 2%, respectively). This comparatively high foraging site fidelity may reflect the concentration of productivity associated with a coastal upwelling system, the Bonney Upwelling. Lower foraging site fidelity recorded by seals that foraged in oceanic waters implies a lower density/larger scale habitat, where prey are more dispersed or less predictable at fine scales, when compared to the continental shelf region.