Tim McCreanor

Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors

Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan–Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47). Conclusion Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer.

Race Talk and Common Sense: Patterns in Pakeha Discourse on Maori/Pakeha Relations in New Zealand

Discourse analysis of public submissions arising from an overt racial conflict in New Zealand in 1979 has yielded a number of patterns in the talk of Pakeha New Zealanders. An outline of two such patterns is presented and these are then drawn upon in the deconstruction of a piece of contemporary Pakeha discourse. This analysis is designed to shed some light on the significance of the patterns presented; their durability, their function, and their contribution to the apparent success of the sample discourse and their role in a broader Pakeha ideology of Maori/Pakeha relations in Aotearoa (New Zealand).

The impacts of a school closure on neighbourhood social cohesion: narratives from Invercargill, New Zealand.

We propose that, beyond their educational function, schools can serve as catalysts for community participation, social cohesion and the vitality of neighbourhoods. The paper explores the impacts of a school closure on families in an urban neighbourhood in Invercargill, New Zealand. The highest urban depopulation rate in the country has had implications for the viability of Invercargill schools. We present a qualitative study of narratives gathered during an interview-based study of the closure of Surrey Park School. Our analysis highlights the impact of school closure for low-income families and more generally reflects on the place of schools in contributing to social cohesion and the broadly defined health of a community.

Youth drinking cultures, social networking and alcohol marketing: implications for public health

Alcohol consumption and heavy drinking in young adults have been key concerns for public health. Alcohol marketing is an important factor in contributing to negative outcomes. The rapid growth in the use of new social networking technologies raises new issues regarding alcohol marketing, as well as potential impacts on alcohol cultures more generally. Young people, for example, routinely tell and re-tell drinking stories online, share images depicting drinking, and are exposed to often intensive and novel forms of alcohol marketing. In this paper, we critically review the research literature on (a) social networking technologies and alcohol marketing and (b) online alcohol content on social networks, and then consider implications for public health knowledge and research. We conclude that social networking systems are positive and pleasurable for young people, but are likely to contribute to pro-alcohol environments and encourage drinking. However, currently research is preliminary and descriptive, and we need innovative methods and detailed in-depth studies to gain greater understanding of young people’s mediated drinking cultures and commercial alcohol promotion.

Youth identity formation and contemporary alcohol marketing

This paper considers linkages between contemporary marketing theory and practice, and emerging conceptualizations of identity, to discuss implications for public health concerns over alcohol use among young people. Particular attention is paid to the theorizing of consumption as a component of youth identities and the ways in which developments of marketing praxis orients to such schemata. The authors’ analyses of exemplars of marketing materials in use in Aotearoa New Zealand, drawn from their research archive, emphasize the sophistication and power of such forms of marketing. They argue that public health policy and practice must respond to the interweaving of marketing and the self-making practices of young people to counter this complex threat to the health and well-being of young people.

Media, Racism and Public Health Psychology

International literature has established that racism contributes to ill-health of migrants, ethnic minorities and indigenous peoples. Racism generally negates wellbeing, adversely affecting physical and psychological health. Numerous studies have shown that media contribute marginalizing particular ethnic and cultural groups depicting them primarily as problems for and threats to the dominant. This articles frames media representations of, and their effect on, the indigenous Maori of Aotearoa, New Zealand within the ongoing processes of colonization. We argue that reflects the media contribution to maintenance and naturalisation of colonial relationships and seek to include critical media scholarship in a critical public health psychology.

Creating intoxigenic environments: marketing alcohol to young people in Aotearoa New Zealand.

Alcohol consumption among young people in New Zealand is on the rise. Given the broad array of acute and chronic harms that arise from this trend, it is a major cause for alarm and it is imperative that we improve our knowledge of key drivers of youth drinking. Changes wrought by the neoliberal political climate of deregulation that characterised the last two decades in many countries including Aotearoa (Aotearoa is a Maori name for New Zealand) New Zealand have transformed the availability of alcohol to young people. Commercial development of youth alcohol markets has seen the emergence of new environments, cultures and practices around drinking and intoxication but the ways in which these changes are interpreted and taken up are not well understood. This paper reports findings from a qualitative research project investigating the meaning-making practices of young people in New Zealand in response to alcohol marketing. Research data included group interviews with a range of Maori and Pakeha young people at three time periods. Thematic analyses of the youth data on usages of marketing materials indicate naturalisation of tropes of alcohol intoxication. We show how marketing is used and enjoyed in youth discourses creating and maintaining what we refer to as intoxigenic social environments. The implications are considered in light of the growing exposure of young people to alcohol marketing in a discussion of strategies to manage and mitigate its impacts on behaviour and consumption.

Consuming identities: alcohol marketing and the commodification of youth experience

Marketing has successfully used the postmodern turn in conceptualisations of the human subject and incorporated contemporary theorising of identities and self into its understanding of the key drivers of consumption. Such developments clearly converge in alcohol marketing practices that target young people, where commercialised youth identities available for consumption and engagement are a significant element. This article reports data from young people that reflect the uptake of such identities and considers the challenges that these developments represent for public health and the well-being of young people.

Insensitivity and Hypersensitivity: An Imbalance in Pakeha Accounts of Racial Conflict

In a plural society, the manner in which issues of race or ethnic relations are conceptualised is of considerable importance. So too are the processes by which such linguistic constructions are analysed. This article presents a detailed account of the analysis of one pattern observed in our analysis of submissions made to the Human Rights Commission (HRC) in 1979. The submission writers were explicitly asked to account for a physical confrontation between a group of Auckland University students performing a caricature of a Maori haka and a group of young Polynesians who objected to their performance. Sensitivity and related terms were used by 36 writers to accomplish various goals, particularly in attributing blame for the incident. The article describes the patterns of use and how they function for the writer.

The place of neighbourhood in social cohesion: insights from massey, West Auckland

Within public health discourse there is growing recognition that the social structures and ecology of neighbourhoods impact on health and wellbeing. A clearer understanding of the pathways through which this influence occurs will inform locality-based interventions to tackle inequalities. In this paper we report on an interview based study with parents of young children living in Massey, a suburban neighbourhood of metropolitan Auckland. Locational access to community resources is comparatively poor in Massey as measured by a community resource accessibility index. The findings provide insights into the impact of such access to services and amenities on neighbourhood social cohesion. We conclude by suggesting planning strategies for strengthening neighbourhood identification and attachment for this population group.