Beacon

Schools Project

Health Education
Level 8 Planning Guide
2006

Section 3
Units of work suitable for assessment with
AS 90709 Analyse an international health
issue

* The effect of colonisation on the health of

indigenous people – alcohol

* The effect of globalisation of food on the

incidence of diabetes, and on the health
of indigenous peoples

* HIV and AIDS

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 Achievement Standard

Subject Reference Health 3.2

Title Analyse an international health issue

Level 3 Credits 5 Assessment External

Subfield Health and Physical Education

Domain Health Education

Registration date 12 October 2005 Date version published 12 October 2005

This achievement standard involves explaining factors that contribute to an

international health issue, analysing the implications of the issue for people
who are affected and explaining recommendations for further action.

Achievement Criteria

Achievement Achievement with Merit Achievement with

Excellence

• Explain factors • Explain, in-depth, factors • Explain, comprehensively,

contributing to an contributing to an factors contributing to an
identified international identified international identified international
health issue. health issue. health issue.

• Analyse the implications • Analyse, in-depth, the • Analyse, perceptively, the

of this issue for people implications of this issue implications of this issue
who are affected. for people who are for people who are
affected. affected.

• Explain recommendations • Explain recommendations • Explain, comprehensively,

for future action, in terms
of this issue, that could
achieve a more equitable
outcome for people who
are affected.
for future action, in terms
of this issue, that could
achieve a more equitable
outcome for people who
are affected.
recommendations for
future action, in terms of
this issue, that could
achieve a more equitable
outcome for people who
are affected.

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Explanatory Notes

1 This achievement standard is derived from Health and Physical

Education in the New Zealand Curriculum, Learning Media, Ministry of
Education, 1999, pp. 28–29; Level 8 achievement objectives from
strands A, C and D.

2 Assessment will be consistent with, and reflect the underlying concepts

of, hauora, health promotion, a socio-ecological perspective and the
attitudes and values of:
• a positive and responsible attitude to the well-being of self
• respect for the rights of others
• care and concern for other people in the community
• social justice.

3 For an identified health issue the student must clearly state the health
topic being analysed as well as give examples of significant data to state
why it is a health issue.

4 For the purposes of this achievement standard, an international health

issue is one that impacts on a country other than New Zealand; or offers
comparison of New Zealand to at least one other country; or by its very
nature is international (like globalisation issues) although these will still
need to include discussion about countries other than, or as well as,
New Zealand.

5 Health topics could include:

• industrialisation and health in developing countries
• HIV, AIDS
• the interface between culture and gender
• sexual and reproductive health
• life expectancy and illnesses in a range of nations
• international profile of disease and immunisation
• international drug issues
• health and/or welfare systems in New Zealand and other countries
• colonisation and the health of indigenous people
• globalisation and health in developing and/or developed countries.

6 Factors contributing to an identified health issue refers to the

determinants of health relevant to the identified issue.

7 Explain means to give reasons and/or justify.

8 Analysis of implications will include as appropriate:

• identification of the significance or importance of implications,
• positive and/or negative factors
• short-term and/or long-term impacts,
and must address both personal and societal impacts.

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9 Explain in-depth means to present accurate and detailed supporting
evidence.

10 Analyse perceptively means to demonstrate understanding of the

underlying concepts of the curriculum and respond to them thoughtfully.

11 Comprehensive responses will require students to do one or more of the

following as relevant to the health issue and as required by the
assessment:
• explain relationships and/or interrelationships
• develop reasoned arguments
• explore the complexities of situations (including different
perspectives).

12 Equitable health outcomes must reflect the values of social justice

(fairness, inclusiveness, and non-discrimination). The recommendations
for action must be related to the factors that influence the health issue.

Year 13 students who have chosen to take health as a subject should be

attuned to the need for sensitivity in relation to health issues and should be
fully aware of additional support available to them if needed.

Teachers should inform students of the potential contexts for examining

issues, discuss with the class any potential sensitivities of particular issues
for students and negotiate which issues will be addressed.

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EFFECTS OF COLONISATION ON THE HEALTH
OF INDIGENOUS PEOPLE
Introduction

This unit of work is intended to be externally assessed by AS 3.2 – Analyse an

international health issue.

In order for student to grasp the impact of colonisation on indigenous people

they need to have an understanding of the term ‘colonisation’ and how it has
been, and still is, a major factor affecting indigenous people. Students also
need to have an understanding of the term ‘indigenous people’.

Students need to have an historical overview of the impact of alcohol on

indigenous people since colonisation.

Teaching needs to include:

• Definitions of ‘colonisation’ and ‘indigenous people’.
• Historical information and statistics of alcohol use and subsequent impacts
on the health of indigenous people (Maori and Aboriginal).

Useful Resources

Refer to Background Information found after the unit of work

Statistics:

Some statistical data has been included in the Beacon Schools Level 3 folder.
Other useful websites for statistics are:
www.aphru.ac.nz/whariki/publications (provides Maori health data and
information)
www.nzhis.govt.nz/topics/maorihealth.html (links to sites containing
statistics).
www.nzdf.org.nz
www.tpk.govt.nz/maori/health (Te Puni Kokiri)

Text:

Hutt, Marten (1999) Maori and Alcohol: A History. The Printing Press:
Wellington
This text can be purchased from Bennett’s Bookstores or by contacting ALAC.
$19.95

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Websites:
• www.alcohol.org.nz/maori/history
Provides a condensed version of Marten Hutt’s Maori and Alcohol: A
History.
• www.waipiro.org.nz
Provides access to Manaaki Tangata – Guidelines for the safe use of
alcohol.
• www.healthinfonet.ecu.edu.au
Provides a brief outline of the history of alcohol use by Australian
aboriginal people.
• www.nzhis.govt.nz/topics/maorihealth.html
Provides links to a number of Maori health sites.
• www.tpk.govt.nz/maori/health
Provides Maori health statistics and examines the correlation between
socio-economic factors and health.
• www.newhealth.govt.nz/toolkits/inequalities.htm
Gives information regarding the toolkits and provides the steps for
planning interventions and the intervention framework.

Other useful websites and resources:

www.nzdf.org.nz
www.alc.gov.au/publications
www.maorihealth.govt.nz
www.aphru.ac.nz/whariki/publications/waipiro.htm

• Index New Zealand – has access to a wide variety of articles regarding

Maori and alcohol.
• Whakatataka – the Maori Health Action Plan 2002 – 2005

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 Unit Outline: The Effect Of Colonisation On The Health Of
Indigenous Peoples (Alcohol and Maori and Aborigine)

Intended Processes/Activities/Strategies Assessment

A Learning Opportunities
O’s Outcomes
Students will Puzzle Activity (refer Beacon schools Diagnostic.
understand Level 2 A.S. 2.4) Clarifying key
8A4 the terms Using the puzzle pieces, students terms.
colonisation construct definitions.
and Discuss the key words/concepts that are
indigenous shared by the different
people. quotes/definitions.
Students will Students will use historical evidence to Formative
8A1 analyse the analyse drinking patterns of Maori and Students report
8A4 historical Aboriginals in the nineteenth and back to the
8C2 impact of twentieth centuries. class on their
alcohol use Complete Activity 4 in ‘Social Issues – findings.
on indigenous Alcohol’.
people and Using the research questions framed by
develop an the students in Activity 4: Each student
understanding select a research question to complete.
of the effects Possible resources: Maori and Alcohol:
on culture and A History and extracts with historical
identity, and information contained in the Beacon
the impact on Schools Level 3 folder.
well-being.
Students will Provide students with statistical data Formative.
8A1 evaluate data (both historical and current). In groups, Students
8D1 on the impact students analyse the impact of alcohol complete a
of alcohol use use on Maori and Aboriginal people. written account
on indigenous N.B. Statistical data and strategies for of their
people. evaluating data are included in the evaluation.
Beacon Schools Level 3 folder and
Social Issues – Alcohol, Activity 2.

8A1 Using the Revise the determinants of health (Social Summative.

8C2 historical Issues – Alcohol, Activity 5). Helps students
8D1 and In groups, students use the answers to prepare for
statistical the research questions to identify key assessment of
data determinants of health. For each Achievement
previously determinant they must give reasoned Standard 3.2.
analysed, arguments to support it being a key factor
students will and they must provide supporting
identify and evidence.
analyse the Groups report their findings to the class.
relationships Individuals write a brief report outlining
between key the relationships and interrelationships
determinants between the key determinants.
of health N.B. The photographs from Activity 5

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 and the could be replaced with appropriate photos
drinking of indigenous people (e.g. from Maori and
patterns of Alcohol: A History).
indigenous
people.

8A3 Students Students examine and discuss possible Formative.

examine ethical dilemmas, both from a historical Observations of
ethical and contemporary perspective. discussions.
issues Provide students with cards of possible
arising from situations and assign them roles, e.g.
the use of Minister of Maori Affairs (2004),
alcohol by Kaumatua (1867), etc.
indigenous
people.
8C1 Students will Students explore the impact on Formative.
8C2 critically individuals and groups. The following can Observation of
8A4 analyse the be provided: the previous determinants Continuing
impact on of health information; personal stories; Story.
relationships quotes from speeches at
and the seminars/forums, etc.
implications Students categorise impacts into
for positive/negative and short/long term.
individuals Students could make a Continuing Story
and groups. (refer Beacon Schools Level 2, 2.4) or
could write a historical diary from the
viewpoint of differing generations.
8D1 Students will Students use the information previously Summative.
8D2 establish gathered to develop recommendations for Helps students
and justify equitable outcomes (this could be started prepare for
priorities for by doing a brainstorm of issues needing assessment of
strategies to to be addressed). Achievement
bring about standard 3.2.
equitable
outcomes for
indigenous
people.

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 Background Information
Determinants
The factual information provided should give students an understanding of the
impact of alcohol use on the health of indigenous people. From this, students
should be able to identify the factors contributing to this health issue.

Some Contributing Factors:

Maori Aboriginal
Determinant
Treaty of Waitangi 1838 – 1908, laws
Political Land Wars prohibiting the sale or
Oppression supply of alcohol to
Constitutional standing indigenous people
(later amendment to
apply to ‘full descent’
and ‘mixed descent’).
Police patrolling of
indigenous
settlements.
Prohibition of
consumption in
Western Australia until
1964; on supply in
South Australia. Until
1967.
Restrictions on
possession and
consumption on
reserves and missions
until 1970’s.
Alienation from land Dispossession of their
Environmental Urbanisation land.
Forced dislocation
equalled social
disruption.
Poor response to
environmental health
issues, e.g. waste
disposal, sanitation.
Maori economy Rum became an object
Economic collapsed of currency, e.g. New
NZ recession South Wales.
Alcohol as payment for
work, sex, etc.
Large amounts of
money spent on
alcohol – supported
economy.

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Culture Tino rangatiratanga Destruction of
(self-determination) traditional culture and
Lack of understanding influence.
between cultures Introduction of alcohol
Breakdown in traditional use into traditional
way of life and social indigenous life.
mores. Alcohol-induced
Disparities between prostitution having a
dominant culture and harmful effect on child
minority culture. rearing patterns.
Beginnings of the Maori
Warden scheme.
Social:
Social Gradient Low incomes; poor Decline in living
housing. standards.

Work conditions Lack of cultural

understanding.

Unemployment Urbanisation; high

unemployment (2001 High unemployment
census – 28% (e.g. Queensland,
unemployed). 1994, 33%)
Social exclusion High welfare
Discrimination (e.g. dependency.
1847 sale of Spirits
Ordinance) Discrimination.
Stereotyping – ‘native Alcohol-induced
inferiority’. prostitution accelerated
the birth rate of mixed
descent children –
many faced rejection
Social support from their European
fathers.
Isolation from whanau, High imprisonment
iwi, hapu. rates.
Addiction
Increased family
Heavy drinking patterns conflicts.
Lifestyle of many alcohol users. ‘Stolen generation’ –
impact on health.
Drug use – alcohol use
entrenched.

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Implications for individuals and groups

1. Maori

Individuals:

Factor Effects
Physical Health Many short and long-term alcohol related problems.
Injuries resulting from alcohol use.
Disability/death Resulting from alcohol resulted harm, e.g. drunk driving.
Mental Health Significant mental health problems, e.g. depression,
anxiety.
Financial Cost of alcohol.
Social Alienation from society; lifestyle choices resulting from
colonisation, e.g. urbanisation and dislocation from iwi,
hapu, whanau.
Family Conflict, violence, disruption.
Friendships Arguments, fights.
Cultural Inclusion of alcohol in traditional ceremonies/meetings,
loss of contact with traditional values and social support of
the marae.
Work Opportunities lost; absenteeism; work output affected;
unemployment.
Stress In personal relationships.
Early sexual Unprotected sex while under the influence of alcohol.
intercourse
Violence Domestic; involvement in crime; imprisonment.

The factors interrelate and affect individuals’ hauora/well-being.

Families/whanau, friends, communities are affected as a result of the
interrelationships.
Aboriginal:
Factor Effects
Physical Long-term alcohol related harm, e.g. cirrhosis of the liver,
stroke, and suicide. High rates of injury, e.g. road
accidents, intentional injury, and domestic violence.
Mental Alienation resulting in depression, anxiety.
Work High unemployment.
Family/friends Conflict, violence.
Family Neglect of children by parents.

Again, the factors interrelate which will affect the well-being of both individuals
and groups.

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Ethical Issues (refer to the ethical decision making process in Section 5)

Individual vs Community

Individual: A member of the marae arrives to a meeting at the marae drunk.

View from the perspective of a Maori Chief in 1864 as compared to one in
2003.

Community: Community representatives trying to legislate a ban on the

consumption of alcohol by aboriginals in specific areas.
View from the perspective of an aboriginal leader in 1872 as compared to an
aboriginal leader in 2004.

Truth vs Loyalty

A nine-year-old child has been left at home alone while their parents are at the
pub. Other family members are aware that this happens regularly.
View from a family member’s perspective in 1867 as compared to one in
2004.

Maori were offered money in return for informing on other Maori who
purchased alcohol.
View from a young Maori’s perspective in 1873.

Short term vs Long term

A pakeha businessman offers a Maori shopkeeper a bottle of rum in exchange

for some flour.
View from the perspective of a Maori shopkeeper in 1856 as compared to one
in 2001.

Justice vs Mercy

A solo father of five has been convicted of drink driving for the third time. His
job depends on his ability to drive.
View from the perspective of a judge in 2004 as compared to a non-
indigenous citizen in 2004.

An aboriginal man, who is an alcoholic, vandalises a community hall while on

a drinking binge.
View from the perspective of an Australian policeman in 1852 as compared to
one in 2004.

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What Needs To Happen For Equitable Outcomes?

Maori

• Maori need to have tino rangatiratanga, i.e. self-determination, over the

way support services are delivered and who delivers them.

• Specific needs of Maori need to be identified in order that appropriate

services, practices and procedures are implemented.

• Kaupapa Maori Service needs to be mandated as considered appropriate

by whanau, hapu, or the local Maori community.

• Choices of location, e.g. marae, language (reo), and counsellors

(haimahi), when providing services and treatment.

• Equity and autonomy of funding of services and community initiatives.

• Training for individuals and groups so that they have the skills necessary,
e.g. accounting, counselling, legal.

• Promotion of the Maori concept of wellness.

• Application of the National Alcohol Strategy, i.e. supply-control, demand-

reduction and problem-limitation strategies.

• Acknowledging that tikanga is the preserve of iwi and therefore there can
be no national tikanga guidelines rather each individual iwi must develop
that which best suits them and their community.

• Provision of transport to services.

• Informing the wider community and gaining their support.

• The government and Minister of Health need to make Maori health

inequalities resulting from alcohol a key priority (Whakatataka – the Maori
Health Action Plan 2002 – 2003).

• Structural – tackling root causes of high alcohol consumption and related

harm, i.e. social, economic, cultural and historical factors.

• Early intervention initiatives.

• Using the provisions of the Treaty of Waitangi (e.g. Articles I and II) to build
a framework for the development of policy to minimise alcohol related
harm.

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• Identify ways that Maori traditionally responded to alcohol and draw from
the lessons and experiences of the past. Look for local solutions, e.g.
prohibition in the King Country from the 1880’s to the 1950’s.

• Restore the Maori sense of identity – give control to the Maori community.
Problem drinking is linked to separation from Te Ao Maori (the Maori
World).

Aboriginal

• Continuation of the parallel development of mainstream and community-

based health programmes for indigenous people (began in the 1970’s).

• Programmes need to be initiated by the indigenous people.

~ Supply-reduction strategies, such as prohibition and regulation.
~ Demand-reduction strategies, these should include health promotion,
recreational and cultural initiatives.
~ Harm Minimisation, this could include night patrols, sobering up
shelters, and a range of treatment programmes.

• A unified approach needs to be implemented between both the

government and indigenous communities.

• Intervention strategies need to be developed – with community

participation.

• Self-determination. Aboriginal communities must have control over

initiatives, services and programme development and implementation.

• Restricted areas for the consumption of alcohol and restrictions on sales,

e.g. dry communities, restriction of hours of trading (e.g. Tennant Creek).

• Legislation needs to be developed that will support strategies.

• Diversionary activities need to be developed, e.g. sport and recreation

opportunities, cultural camps, youth drop in centres.

• Health promotion and education campaigns need to be implemented that

use indigenous media outlets and indigenous role models.

• Community controlled services need to be supported by complementary

programmes/activities.

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The effect of globalisation of food on the
incidence of diabetes, and on the health of
indigenous peoples
Introduction
This unit of work is intended to be externally assessed by AS 3.2 – Analyse an
international health issue.
The unit is made up of several components which can be taught separately,
and used in conjunction with other issues at this level, e.g. Health 3.4
Examine contemporary dilemmas or ethical issues. Suggestions for a mixture
of research and field activities are made, with an outline of possible subject
progression. Although the external assessment is on an individual basis, and
in a written format, learning through structured peer groups for field work and
‘expert teacher’ situations will provide a sound basis for the necessary
understanding of the concepts of globalisation.
Although Hauora is not closely examined at this level, students are expected
to have a solid working knowledge and understanding of the concept. The
emphasis at Level 8 has shifted away from the intense focus on the learning
required in order to understand the concept of Hauora. Rather, a societal
view is encouraged – for example, the effects of globalisation on a particular
ethnic group, as seen through a range of qualitative and quantitative data and
an analysis of the impacts of conceptions of identity. The work activities
around diabetes use Hauora as a link to a deeper understanding.
Learning relates to globalisation, McDonaldisation, diabetes, and draws links
between these issues through relating them to the effects on indigenous
peoples. Students are able to explore issues that affect well-being on an
international scale. Comparison between personal beliefs and attitudes and
governmental attitudes and values is possible. Students develop an
awareness of the rights of people as races and nations which includes
environmental and cultural aspects. They have an opportunity to consider
social justice in relation to international policies. They can learn about
corporatisation, legislation and government policy, and active advocacy in
relation to issues such as globalisation.
The advocacy section provides study opportunities around New Zealand and
Australia. Teachers must bear in mind that this achievement standard
involves explaining factors that contribute to an international health issue,
therefore study of overseas situations, possibly using the New Zealand
situation as a comparison is strongly encouraged. The article ‘Sustaining
better diabetes care in remote Australian indigenous communities’ by Robyn
McDermott et al (BMJ) is strongly recommended as a resource, as it contains
an excellent epidemiology, overall case study and many useful statistics.
The resource list included in the outlines of work is extensive and some
suggestions may seem inaccessible. Teachers need to make use of the
Internet, where many informative articles may be found. Some medically
informative websites have free access, for example the British Medical
Journal. Some textbooks are not available in New Zealand, but relevant
sections of these can be found on the net and downloaded for easy access.

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 Unit Outline: The effect of globalisation of food on
the health of indigenous peoples.
Learning Activity Resources/references
1. Understanding the Issue
The McDonaldization of
Society
Globalisation of food has had a
profound effect on society. For
the purposes of this unit
examine the effect as it
manifests and include
indigenous peoples in our
investigations. Begin by
establishing an understanding
of globalisation in relation to
food through looking at the
history and development of the
fast food industry and how the
structure of the industry relates
to the social determinants of
health e.g. access to
employment, stress, access to
adequate food, social
environment etc. Other
determinants of health are
included - identification and
exploration of these are
encouraged through use of the
suggested resources.
2. Does the Epidemiology
Matter?
Once understanding of the
terms is secure, read the talk
given by Iain MacSaorsa.
Many provocative statements
are made in this talk. Is the
speaker advocating for action
for social justice? Explain,
giving reasons and examples.
* Discuss, firstly as a class,
then individually through
written paragraphs the
following statements:
‘Those with the gold make the
rules…’
‘A green capitalism is
impossible…’
* Draw parallels between the
determinants of health and the
effects of McDonaldization in
Essential reading
• The McDonaldization of Society – George
Ritzer (relevant pages included as text
access may be restricted)
• Why We Hate McDonalds – Iain MacSaorsa
(included)
• Fast Food Nation – Eric Schlosser (available
at general bookstores)
• Items of interest may be found on the
internet by entering McDonaldization into
www.google.com)
*Introduce the topic through use of the resource
found at
• www.tki.org.nz/socialscience/curriculum/SSO
L/ronaldrulz
(included)
This is an excellent unit of work and although it has
been designed for use by Year 11/NCEA Level 1
Social Studies it bears direct relevance to this topic.
Activities may be realigned to meet student needs
at Level 8 of the HPE Curriculum.
Essential reading
• Does the Epidemiology Matter? The key
influences of dietary behaviour – Rosemary
Stanton PhD APD (included)
• Fat Land – Greg. Critser (available from
general bookstores)
• Food is a Political Issue – Robertson,
Brunner and Shielham (excerpt from
Determinants of Health – Marmot &
Wilkinson) (included)
• Newspaper clippings (included – could be
possible student research activity to build
portfolio of relevant clippings)
• Eating Ourselves to Death by Rachel
Cernansky of Satya (included)
• ‘Too Fat For Our Own Good’ The Satya
Interview with Gre.g. Critser (included)
There is a vast amount of information contained
within the recommended reading. It is suggested
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general, and examine this that excerpts pertaining directly to the links between
more closely in relation to the dietary habits and health be chosen, and used as a
USA, Australia and New vehicle for class discussion. This section could be
Zealand. Give examples e.g. viewed as a link between the fast food
employment: fast food outlets industry/social attitudes towards food, and the rising
employ young people and prevalence of type II diabetes, which is explored in
recent immigrants because the following section.
they are generally unskilled
and willing to work longer (Please note: the other main effects of social
hours and shifts. attitudes towards food i.e. obesity and lack of
*Explain and compare physical exercise, are not included in this study.
Fordism, Taylorism, While the direct relationship and relevance of these
McDonaldization. aspects is acknowledged, the direction here
Evaluate the effects of these concerns diabetes type II.)
systems as witnessed in
present-day society.
*Based on your findings, make
predictions on a possible
future.
*Make visits to three different
fast food outlets, including a
McDonalds. Whilst there,
observe the workings of the
four dimensions of
McDonaldization. Do these
dimensions appear to be in
evidence? What confirms your
opinion? Give examples of
each dimension as found, and
explain perceived differences
between the outlets.
3. Diabetes Use the Background Information section at the
This lifestyle disease is now end of this unit
reaching epidemic proportions,
particularly amongst See the following websites for advertising examples
indigenous peoples. Begin www.ndei.org
with a summary of diabetes www.newhealth.govt.nz
type II and follow this with links www.everybody.co.nz
between international food www.diabetesnet.com
habits, leading into a closer www.msnhealth.com
study of the disease as it
relates to indigenous people.

Possible activities (1) Suggested readings – please download from listed

Look at globalisation of food
and how it impacts on the diets
of indigenous people:
- socio-economic aspect:
let’s eat KFC because
then it doesn’t look like
we can’t afford
websites where applicable for first three items. The
British Medical Journal on-line is an excellent
source of information and access to articles is free.
• DHB Toolkit Diabetes (New Zealand Health
Strategy) MOH 2001 www.newhealth.govt.nz
• Diabetes Executive Summary MOH
www.newhealth.govt.nz
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 takeaways
- education aspect:
people’s ability to
choose a healthy diet
- employment aspect:
workers at fast food
outlets are more often
from less well-off
areas/families
.
4. Advocacy
Possible activities (2)
*Research activity: find the
policies issued by various
political parties in New
Zealand and Australia in
relation to healthy eating and
compare them. What results
are found? Look particularly for
mention of health care in
relation to indigenous peoples.
Now recommend for future
action which could see
improved outcomes for all
peoples affected. An
indication of the understanding
of the values of social justice
must be included
• Tips to Prevent Diabetes – Harvard School of
Public Health
www.hsph.harvard.edu/nutritionsource/diabetes/h
tml
• The health of indigenous peoples - Mason Durie,
British Medical Journal 326:510-11 www.bmj.com
(included)
• Prevention and control of diabetes in Pacific
people – Sunia Foliaki, Neil Pearce, BMJ 327:
437-39 (included)
• Sustaining better diabetes care in remote
indigenous Australian communities – Robyn
McDermott et al, BMJ (included)
Suggested readings – please download from
www.bmj.com – all three articles can be found in
volume number 327.
• Providing health services to indigenous peoples –
Mason Durie, British Medical Journal 327: 408-09
• Ethnicity, equity and quality: lessons from New
Zealand – McPherson et al, BMJ 327: 443-44
• UN policy fails to tackle health needs of
indigenous people – Upasana Tayal, BMJ
327:413
• Journal of the Home Economics Institute of
Australia volume 6 no 1, 1999 (included)
• Healthy Action – Healthy Eating: a Draft for
Consultation, MOH 2002 www.moh.govt.nz
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 Background Information
Diabetes – a brief history

Diabetes is not an infectious disease, passed from one person to another.

Some people carry genes which make them more likely to get diabetes.
Diabetes develops in these people only when something triggers the immune
system to start damaging the pancreas. These triggers are believed to be
factors tin the environment but are still not well understood.

Diabetes type I does not change to type II as a person gets older and type II is
not caused by eating too much sugar. Type II is by far the most common
form. There is concern about the global increase of type II which is
predominantly related to lifestyle factors, with obesity, inactivity and being
unfit, and an unhealthy diet being the main risk factors.

In the mid 20th century, entertainment in the form of movies and television
became more accessible to the general population. Improvements in
technological processes in food production saw an increase in the use of
additives and preservatives. The first fast-food outlets appeared, mass food
production increased, bringing with them fad diets for fast weight loss and a
whole new industry that focused on body image.

By the end of the 20th century, employment in many sectors had become
screen-based. Fast food production was drenched in cheap saturated fats
and the diet/health industry was profiteering.

Medico-political ignorance
• diabetes has moved from being an historic illness to a high tech
industry: drugs, insulin, glucose equipment
• blaming attitudes not helpful
• environment (social and physical) acts on our survival genes: obesity,
diabesity and metabolic problems, more health issues
• children at risk
• Maori, Pasifika, Asian communities at risk
• lifestyle changes MUST occur

What is diabetes?
A) physical
Diabetes is
• A condition where the body cannot process sugar of glucose
• 3 types: type I, type II, gestational (pregnancy)

Type I
• main problem is insulin dependency
• pancreas is unable to make insulin so insulin therapy is required
• managed through the administering of tablets or injections
• food intake and type, and exercise also need managing in order to
keep blood glucose levels steady
• this is a complex and demanding balancing act

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 • food intake must be closely monitored – balances of food groups and
their effects must be understood
• type I has impacts on cardiovascular system, eyes and feet

Implications
• problem solving skills are needed for managing unpredictable
conditions e.g. coma
• skills for stress management needed
• support for self and others a must

Type II
• main problem is resistance to insulin
• pancreas can make insulin but it will not work as the cells of the body
are resistant to it’s effects
• sometimes the pancreas becomes exhausted and insulin resistance
and insulin deficiency are both present
• sometimes there can be a genetic contribution
• managed through eating in a healthy way, decreasing body weight if
necessary and getting plenty of exercise
• sometimes tablets may be required
• about 90-95% of people with diabetes have type II
• over 120,000 NZers affected, up to ½ don’t realise they have it (around
4% of NZers)
• if undiagnosed, can lead to serious medical complications
• high prevalence amongst Maori and Pasifika – 3x higher than other
NZers
• traditionally diagnosed in adults but increasingly found in younger
people

Implications
• leading cause of avoidable blindness in NZ
• prevalence increasing in NZ and around the world
• linked to an increase in waist circumference – apple shape
• regression with weight loss

Gestational diabetes
• occurs only during pregnancy
• managed through eating in a healthy way and safe exercise
• sometimes insulin may be required
• associated with pre-eclampsia (high blood pressure)

Diabetes presents through the following signs

• excessive thirst
• tiredness
• excessive urination
• weight loss

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 • mood changes
• blurred vision

Links to
• obesity and lack of physical activity (diabesity)
• smoking – particularly high rates in Maori who have a higher
prevalence of diabetes than the general population

B) Mental/emotional
• reconsideration and reconstruction of lifestyle required: motivational
behaviour change
• knowledge of food groups and possible combinative effects
• knowledge of disease and effects if untreated
• skills for problem solving, managing unpredictable conditions
• skills and strategies for stress management
• time management in relation to food intake, exercise
• ability to discern physical changes and treat accordingly
• recognising the effects of social activities e.g. tobacco, alcohol,
recreational drugs etc
• managing social activities in relation to adequate rest

C) Social and spiritual

Students could explore the social and spiritual dimensions relating to change
in lifestyle for
- individual (self image)
- immediate family and friends
- explore implications of societal effects in relation to groups of
adolescents: the elderly: cultural (Maori, Pasifika, Asian)

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 HIV/AIDS – a national or international
health issue

Introduction

This unit of work has been developed for external assessment using AS 3.2
Analyse an international health issue. It could also be used for AS 3.1 if the
focus remains on New Zealand. The MOH resource (2003) HIV/AIDS Action
Plan: Sexual and Reproductive Health Strategy, downloadable from
www.moh.govt.nz would provide excellent material if using HIV/AIDS as a
learning context for AS 3.1.

The HIV-AIDS epidemic is a shared problem threatening people in every

country in the world. The unit can be developed from a number of
perspectives as long as students are able to
• comprehensively explain the contributing factors to the current
epidemic in different regions/countries being studied
• provide an in depth analysis of the implications of this issue for people
who are affected, and
• establish and justify priorities to describe possible strategies to contain
the spread of HIV across the populations, and achieve more equitable
outcomes for people who are affected.

The unit could have a range of foci, for example it could,

• take a global generalised position in which students analyse the world

wide epidemic and then describe how this could impact on countries
such as New Zealand, for example in terms of immigration.
or
• compare two or more underdeveloped regions in relation to their
epidemic
or
• consider one underdeveloped region/country of the world where HIV
and AIDS pose a major health risk to the population (e.g Sub-Saharan
Africa) and contrast this with a developed country such as New
Zealand, where although HIV and AIDS are a significant health risk, the
incidence and spread has comparatively been contained
or
• consider the issues for youth internationally.

The unit outline described here is generalised and teachers should adapt and
extend it to the particular focus chosen.

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Resources

• Contact the New Zealand Aids Foundation librarian with any specific
requests ph (09) 3033124. They are amazingly helpful.
• Ministry of Health, 2003 HIV/AIDS Action Plan: Sexual and
Reproductive Health Strategy. www.moh.govt.nz
• Hughes T., 2003. The HIV/AIDS epidemic in New Zealand:
Environmental Scan. New Zealand AIDS Foundation, Auckland.
• Davis, P. (Ed). (1996). Intimate details and vital statistics: AIDS,
sexuality and the social order in New Zealand. Auckland: Auckland
University Press.
• Worth H. et al, 2001 Silence and Secrecy: Refugee Experiences of HIV
in New Zealand. Institute for Research on Gender, Auckland University,
NZ.
• UNICEF, 2002. Young People and HIV/AIDS: Opportunity in Crisis.
www.unicef.org
• Tasker G. (Ed)., 2000. Social and Ethical Issues in Sexuality
Education. Section 5 HIV/AIDS. Christchurch College of Education
• NZAF report on: World AIDS conference, 2002. AIDS New Zealand;
Issue 50.
• UNAIDS, WHO. Aids Epidemic: Update December 2003(download from UN
website listed).
• AIDS Explained Mark Thomas, 1999. Department of Molecular
medicine, School of Medicine, Auckland, New Zealand
• Leadership and Partnership: The New Zealand Response to the
HIV/AIDS Epidemic. Briefing to members of the New Zealand
Parliament. Prepared by the New Zealand AIDS Foundation, Update
May 2003.
• Mandatory testing and exclusion of HIV positive immigrants and
refugees. NZAF, April, 1999).

Useful websites

• World Health organisation www.who.int/hiv/pub/en/

• United Nations www.unaids/org/en/resources/publications.asp
• New Zealand AIDS Foundation www.nzaf.org.nz/HIV.asp
• Ministry of Health www.moh.govt.nz and www.healthed.govt.nz
• Australian Foundation of AIDS Organisations
www.afao.org.au/index_afa_177.asp

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 ISSUE: The Spread of HIV/AIDS in Sub-Sahara Africa

Teaching Activities Resources/references

1. Clarifying existing ideas about • Social and Ethical Issues in Sexuality
HIV/AIDS Education Section 5, Activities 1/2

Students to write everything they know

about HIV/AIDS, along with questions
they want answered during unit. Do
continuum activity (SEI) to introduce class
discussion.

Keep student questions for future

reference throughout unit; can use as a
starter activity for relevant periods by
putting questions on board and having
students answer them at end of period.
2. What is HIV/AIDS? – The facts • Ministry of Health, 2003 HIV/AIDS
Action Plan: Sexual and Reproductive
Investigate and discuss signs, symptoms, Health Strategy pgs 3-10
modes of transmission, effects of and
differences between HIV/AIDS. Need to • Social and Ethical Issues in Sexuality
emphasise behaviour rather than medical Education Section 5, pgs 126-127
aspects. Spend at most two periods on
the medical aspect, with special mention • UNAIDS, WHO. Aids Epidemic: Update
of window period (3-6mos) – from time of (See Beacon folder information)
infection to antibodies building up in body
and able to show a positive test to HIV –
hence the need to have repeated tests
and the risk of spreading the disease.
3. Epidemiological research – fact • UNAIDS, WHO. 2004 Report on the
finding global AIDS epidemic: Executive
Use appropriate strategies for identifying Summary
rates of infections worldwide and rates of
death due to HIV/AIDS. Do broader • Avert.org AIDS around the world
overview first – jigsaw with world views,
then narrow focus onto Africa.

4. Examine the determinants • Background information in Beacon folder.

Students to do independent research with • Social and Ethical Issues in Sexuality

a focus on economic, political, cultural, Education Section 5, pg 128-130
environmental and social determinants
that contribute to HIV in Africa. Jigsaw
activity: home groups of five, each
student has to do readings for all
determinants (set for homework), then
break up into expert groups, write a 400-
word paragraph to comprehensively
explain the determinant. Put all together
on board.

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5. Describe the implications of • World Vision: A Global Challenge
HIV/AIDS transmission at Powerpoint presentation reinforces
personal, interpersonal and concepts discussed so far, with powerful
societal levels. messages on personal and interpersonal
implications
Using a variety of strategies such as
brainstorming, class discussions, • Avert.org AIDS around the world
watching relevant videos and
independent research, have students • UNAIDS, WHO. 2004 Report on the
describe in detail the implications of global AIDS epidemic: Executive
HIV/AIDS. A good idea to introduce the Summary
exploration of ethical issues at this point
which can be elaborated on later when
• Beacon folder background information.
looking at recommendations.
• Social and Ethical Issues in Sexuality
Education Section 5, Activities 2 & 4
6. Looking at recommendations for • UNAIDS, WHO. 2004 Report on the
prevention and/or treatment of global AIDS epidemic: Executive
HIV/AIDS in Africa. Summary. Excellent comprehensive
source of information on
Analyse what needs to happen to ensure recommendations.
positive outcomes in relation to the
transmission of HIV and support for those
living with HIV/AIDS in Africa. Students
need to identify and justify priorities for
action using the framework of the Ottawa
Charter and a range of health promotion
strategies. All priorities for action need to
be linked to the determinants described
when looking at the factors contributing to
the spread of HIV/AIDS in Africa. Can be
done as a jigsaw activity similar to
determinants jigsaw, but alter groups so
students not looking at same determinant
as before.
7. Putting it all together • 2004/5 Exam Papers

Students work in pairs to practice writing

coherent paragraphs for each factor
(determinant). Students then look at the
implications for these factors. Finally look
at recommendations for each factor.
Utilise the exam papers from 2004 to
practice writing responses.

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 Prior Learning: Resources:
Health Determinants, Health Promotion, Level 3 Beacon Folder, World Vision “A
Interpersonal Skills Global Challenge”, HIV/AIDS – Ministry of
Health booklet, various websites
Unit: Investigate an International Health Issue: HIV/AIDS

Unit Aim: By the end of the unit students will demonstrate an Key Area of Learning: Sexuality Education
understanding of HIV and AIDS, factors that influence and
contribute to global effects of the AIDS epidemic. Students will also Duration: 25 – 28 periods
investigate and analyse the implications of HIV/AIDS for people at a
personal, interpersonal and societal level. Class Level: Year 13/Level 8

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Level Learning Outcomes Processes/Activities/Strategies Underlying Concepts Assessment
Students will: Opportunities
8A4  Investigate and understand the definition of HIV/AIDS Continuum activity (SEI) Learning Journal
What is HIV/AIDS? Hauora
HIV/AIDS.
(identifying the effects of
8C2  Demonstrate an understanding of various terms ­ signs, symptoms HIV/AIDS on a person’s hauora
relating to HIV/AIDS. ­ differences between HIV/AIDS in a holistic view.)
 Demonstrate a clear and accurate understanding of ­ physiological processes
the signs and symptoms, the process of transmission
­ modes of transmissions
and various effects of HIV/AIDS. Learning Journal
 Identify the demographic groups who become Who gets it?
8C2 infected with HIV globally ­ International statistics (www.who.org)
 Investigate the global regions where HIV/AIDS is
prevalent ­ NZ statistics – orientation and gender
8D2 (pg 12 MOH book)
 Research global regions of HIV/AIDS and investigate
­ NZ epidemiology (Beacon folder) Attitudes
the implications on specific societies in those regions Jigsaw Activity
­ Video: All About Eve (Inside NZ) & Values
(developing respect for the
­ World links (OHT – Report on Global rights and opinions of others in
AIDS) respect to HIV/AIDS and
­ HIV Transmission Card Game developing a sense of empathy
with people with HIV/AIDS.
­ World Jigsaw Activity*

8C2  Investigate and analyse the prevalence of HIV/AIDS Why is Africa so hard hit and how does
throughout the Sub-Sahara region in Africa. Africa compare with the west?
 Compare and contrast the prevalence of HIV/AIDS in ­ Individual African countries’ endemic
8D1 Africa with the rate of infection in Western World infections (www.avert.org website)
­ Video: HIV/AIDS in South Africa Practice Exam
(2004 Level 3
(Assignment 2001) Socio-Ecological
8D2 Exam)
­ World Vision: A Global Challenge Perspective
8D1  Identify and explain how the Determinants of Health ­ Western world health determinants that
contribute to the widespread infection of HIV/AIDS affect HIV/AIDS rates (identifying factors that
globally, with specific focus on Africa influence HIV transmission and
8D3 ­ Determinants of Health in Africa that actively contribute to the health
contribute to widespread infection of other societies by
(Report on Global AIDS) investigating equity
­ discrepancies between African
nations and Western society’s
8A3  Describe the implications of HIV/AIDS transmission How does HIV/AIDS affect society? treatment of HIV/AIDS.)
at personal/interpersonal and societal levels. ­ Personal, interpersonal and societal
8C2  Explore the ethical issues relating to HIV/AIDS in implications
Africa and NZ. ­ World Vision: A Global Challenge
How do Africa and Western world differ in
8D1 Health Promotion
their treatment of HIV/AIDS?
(investigating and exploring
­ Costs and availability of drugs options available for countries
­ Mandatory testing with people with a high rate of
­ Mandatory reporting HIV/AIDS infections.)
- 27 -
­ Mandatory disclosure
8D1  Critically examine the HIV/AIDS policies and What are countries doing about HIV/AIDS
practices adopted in various countries, particularly now?
Essential Skills Communication Skills 1 2 3 4 5 6 7 8 9 Social & Cooperative Skills 1 2 3 4 5 6 7 8 9 10 11

Self Management Skills 1 2 3 4 5 6 7 8 Problem Solving Skills 1 2 3 4 5 6 7 8

- 28 -
 Background Information
Adapted from: Sample Assessment for Health Scholarship developed in February 2003.

1. The most relevant categories of determinants for countries of high HIV/AIDS

prevalence are:

 Economic determinants national economic forces play a crucial role in the spread
of HIV. e.g. in Africa, exploitation of resources including human resources by foreign
countries shifts population groups from rural to urban environments. The prevalence
of HIV is higher in urban centres, along trade routes, amongst commercial sex
workers and amongst male migrant workers. Lack of national financial resources
means governments cannot provide adequate health and education services and
results in widespread poverty.

 Cultural determinants e.g. religious beliefs such as HIV is a punishment from God,
moral beliefs about monogamy for women, denial or ignorance about modes of HIV
transmission due to attitudes to sexuality, concepts of masculinity that cause
resistance to condom use.

 Political determinants e.g. war making many people refugees; government health
policies that do not provide support services and medication for HIV sufferers;
interference in national economies by foreign investors.

 Environmental determinants e.g lack of access to adequate housing, clean water

 Social determinants including lack of personal economic resource, lack of

adequate care for children, social exclusion caused by the stigma of HIV, lack of
adequate nutrition, lack of employment, lack of access to health services

2. Interrelationships between these factors

Increased foreign competition reduces demand for local rural production. Rural workers
are forced to migrate to urban centres to where work is available. This may influence
patterns of sexual relations since male migrant workers move from a single partner to
having multiple casual partners in urban centres. When the migrant partner returns they
facilitate the spread of HIV into the rural communities and to casual partners along the
highways. Women infected with HIV in rural areas become stigmatised and are social
outcasts. In addition downturn in economies caused by war or political interference or
foreign competition may cause women to become casual sex workers and ability to
negotiate safer sex decreases as competition in this area increases. Women and men
may turn to the drug industry to complement declining wages. Decreased government
spending on health and education will also impact negatively on people’s ability to stay
safe.

3. Immigration Issues for New Zealand

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 ‘Under the United Nations High Commission for Refugees(UNHCR)New Zealand
has a commitment to accepting 750 refugees annually, selected under various
criteria including women at risk, medical/disabled and family reunification. This
number does not always include family members who arrive later under the family
sponsored categories, nor asylum seekers who are granted refugee status in New
Zealand each year. Our overall commitment, when these refugees are included, is
actually around 1,250 refugees a year which is around 2.5% of the annual NZ
Immigration Programme’. (From: World Refugee Day Speech by Hon. L. Dalziel,
2001)

‘The World health organisation discourages the use of restrictive measures as a

response to HIV infection. The WHO Assembly (1987) and the United Nations
(1991) has urged member states to protect the human rights of people with HIV
and AIDS, and in particular to avoid discriminatory action against them in travel
and immigration. The UN (1919:55) states that the following measures would in
present circumstances, constitute interference with the right to privacy of the
individuals concerned, and would not be justifiable under international human
rights law on public health(or any other) grounds:

 Mandatory testing of any individuals (other than voluntary donors of blood,

semen, or tissues or organs) for HIV infection, no matter how they are
selected

 Compulsory registration of suspected HIV carriers’

(From: Mandatory testing and exclusion of HIV positive immigrants and
refugees. NZAF, April 1999)

a)Health Requirements for Refugees, Asylum Seekers and Migrants

(1999 NZ regulations)
Temporary entry as a tourist, or to work or study:
a) Under two years: no full medical or X-ray required, but Immigration Services can
request it
b) Over Two years: Must supply medical and X-ray certificates. Certificates can be
referred to a doctor, who may recommend and application be declined because of
risk of disease infecting New Zealanders or burden to the health system.
Immigration Service can waive the requirement in some circumstances, but not for
visitor or student visas or permits.

Permanent Residence: Not compulsory to have HIV or AIDS test for migrants. But
migrants are asked if they have ever suffered from AIDS or AIDS related condition. If
migrant answers yes or if tests positive for HIV or AIDS in other tests, they can be
declined. However Immigration. Service can still allow entry for humanitarian reasons.

Refugees: Given full medical tests including those for HIV, AIDS and TB once they
arrive in New Zealand – the test is voluntary but to date there have been no refusals to
have the tests. They are entitled to the same public health support as New Zealand
citizens.

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Asylum Seekers: Tested only if they sign a consent form. While they are making a
case to stay in NZ they can get public health support.

- 31 -
b) The major health determinants and their impact on well-being for refugees
diagnosed HIV positive when living in New Zealand

Many of the refugees arriving in New Zealand are from countries of high HIV/ AIDS
prevalence. It is important to be aware of the health determinants that most significantly
contribute to their vulnerability to HIV/AIDS infection in their countries of origin, and also
the major health determinants and the impact of these on all aspects of well-being, for
those refugees diagnosed as living with HIV/AIDS when they take up residency in New
Zealand These determinants may inter-relate and compound the issues in relation to
HIV/AIDS.

An HIV positive diagnosis can have devastating effects on refugees in New Zealand
who are already coping with having fled from their own homes, communities and
countries. As forced migrants, refugees not only suffer displacement but are also
compelled to live in new settings and conditions not of their own choosing. HIV is
generally regarded as a source of shame and fear among most refugee groups in New
Zealand. There is a common perception that HIV is a punishment from God. Thus their
spiritual wellbeing in terms of their sense of self is deeply affected. Similarly, they often
lose their hopes and aspirations for a new and better life as their experience of people
living with HIV/AIDS in their country of origin has been very negative in terms of general
health and life expectancy.

If their emotional well-being is adversely affected by feelings of fear, shame and guilt
this may mean they choose not to tell anyone in their community that they are HIV
positive. They may suffer from depression.

Fear and shame can have a serious impact on their relationships and may result in
partnership break-ups. This is an issue particularly for women, anxious about rejection if
they tell their partner and the difficulty of negotiating condom use to keep their partner
safe if they don’t tell. Their social support networks are thus non-existent or very limited
within their own community and language barriers make it difficult for them to access
social support within the wider community. They have left most of their family behind in
Africa and many are in New Zealand on their own. Isolation (social exclusion)
compounds their fear and depression.

Coupled with lack of employment (most frequently due to language barriers,

qualifications from their previous country not being accepted here, and sometimes
racism) and consequent limited financial resources, secrecy may also be a barrier to
accessing medical assistance. Their physical well-being is harmed and may be further
compounded through economic hardship, through lack of adequate housing and poor
nutrition and limited access to health services.

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c) An example of an ethical dilemma and conflicting perspectives in relation to
containing the spread of HIV/AIDS in New Zealand.

‘Mandatory testing for HIV of refugees, asylum seekers, immigrants and even
tourists has been suggested as the best way to control the spread of
HIV/AIDS by some sections of New Zealand society’.

Arguments for mandatory testing could include:

 The rights of New Zealanders should come before the rights of immigrants and
refugees.

 HIV is a killer disease and the government has an obligation to prevent any
unnecessary entry of infectious diseases into New Zealand.

 Refugees already are a high cost on the public systems of health, education and
social welfare. People living with HIV/AIDS will increase the burden to the taxpayer
even further.

 HIV is set to become an enormous drain on the country’s economic resources as

drug resistant strains are developing and new HIV treatments are so costly. Access
to treatment cannot be denied once a person is living in New Zealand so from a
purely economic view it would be advantageous to identify HIV positive people
coming into the country

 Statistics clearly show that the increase in the rate of HIV infection in recent years is
a result of arrival of people from countries of high HIV prevalence (may use graph
data here)

 New Zealand is a country that compared to other countries, has effectively contained
the spread of HIV (data provided). Our track record is at risk if we allow people with
HIV into our country.

 We have had cases such as that of Mwai, where one HIV positive individual infected
several New Zealand women with devastating effects.

Arguments against mandatory testing should include arguments involving economic,

social, human rights and public health and safety issues such as:

 Mandatory testing is against international human rights legislation (Cite evidence

from material provided)

 There would be many negative outcomes for refugees as to send them back to their
country of origin could result in their death. They would be unlikely to receive the
level of care from their country of origin compared to New Zealand

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 People living with HIV can still be useful productive members of society, actively
contributing to the economy.

 It would be inconsistent to single out HIV infected individuals as opposed to people

with other conditions who may place a similar cost on the health system e.g. people
with cancer.

 The indirect (opportunity costs) associated with mandatory testing programmes

would divert resources away from educational programmes, which have proven
effectiveness, and from protection of the blood supply

 Considering the number of immigrants, refugees and asylum seekers (not to

mention tourists) who enter NZ each year, the direct costs of large-scale mandatory
testing would be enormous. The cost of a test is between $10 -$15, without costs of
pre and post counselling taken into consideration.

 Restrictive policies would fail to reduce the overall reservoir of infection in a

population where HIV is already present. Would people returning from overseas
visits to areas of high HIV prevalence also be included in the testing regime?

 There are logistic issues such as where testing would take place; whether the elderly
and young would also be tested; how specimens and data would be managed.

 There would be a question over the validity of screening results since an individual
may give a ‘false negative’ if the test was administered within the up to six month
‘window period’.

 Screening and excluding infected individuals from New Zealand may create a false
sense of security amongst residents. This would run contrary to public health aims
as residents may be less consistent in their practices of ‘safer sex’.

The belief that prospective immigrants infected with HIV are a danger to public health
and safety would set a precedent that all people living with HIV should be similarly
viewed. HIV/AIDS is a very specific disease .It is not casually transmitted and is
different from other diseases such as TB which can be transmitted through the air. It is
certain behaviours that put people at high risk of infection ie just because a person is
living with HIV/AIDS does not make them a risk to public health. In addition, the rate of
infection is lower for HIV than for many other infectious diseases (for example, the
hepatitis B virus) that also can cause death. The exclusion of HIV infected immigrants
reinforces the message to the public that HIV is casually contagious, or that avoiding
certain people will give protection, thus increasing discrimination and isolation for
people living with HIV/AIDS. Prevention measures designed to prevent the epidemic
from spreading must counteract incorrect information about ‘risk groups’ and ‘risky
behaviours’ that are present in particular communities. All people must adopt safer sex
practices to prevent transmission of HIV, not just those currently infected.

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Education requires financial resources and policies that divert funding to large scale
testing programmes may limit this and other health promotion strategies.

- 35 -
d) Making a difference

A range of priorities to contain the spread of HIV/AIDS in New Zealand could include:

 education about the specific nature of HIV and it’s transmission and the need to
dispel myths about this for all sectors of the community
 the New Zealand data on groups most at risk, (men who have sex with men,
refugees and immigrants from areas of high HIV prevalence)
 the impact of positive HIV/AIDS diagnoses for refugees
 human rights issues
 economic considerations including the provision of appropriate health services

Justifications for priorities according to how benefits could accrue could include:

(i) benefits for refugees:

Comprehensive programmes to assist with language and NZ customs, education about
HIV/AIDS and it’s transmission, housing assistance, development of support networks
and provision of employment opportunities will all contribute to improved personal
health; improved relationships; improved employment/education opportunities and
experiences; better integration into the NZ community; improved ability to help self and
others manage the transition to a new environment and culture; more acceptance,
empathy and assistance for those in their community living with HIV/AIDS.

(ii) benefits for the whole of society:

Education for all sectors of society could contribute to adoption of ‘safer-sex’ behaviours
by all those sexually active and hence a containment of the spread of HIV; a reduction
in discrimination and stigmatisation of groups perceived to be more likely to be HIV
infected; acceptance (even valuing) of diversity of cultures, sexuality and lifestyles;
empathy and assistance for people living with HI/AIDS; inclusive behaviours and
practices towards refugees. This could contribute to reduction in health costs through
improved personal health across all dimensions of hauora ( i.e, not just the containment
of the spread of HIV ) resulting in lower demands on public health services.

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 OHP 1: HIV/AIDS Determinants
In Sub-Sahara Africa

ECONOMIC
• Lack of national financial resources means govts
cannot provide adequate health and education
services and increases widespread poverty

• Foreign countries exploit resources (ie oil, land,

gold, diamonds, humans) which shifts populations
from rural to urban environments, where HIV
rates are higher (male migrant workers,
commercial sex workers, trade routes etc.)

• Anti-retroviral drugs (ARV) are expensive, costs

determined by foreign pharmaceutical companies
who do not produce cheaper/generic products for
widespread use amongst African nations (patent
protection)

ENVIRONMENTAL
• Lack of access to adequate housing, clean water
• High density population living in poverty, which
facilitates spread of diseases such as HIV

• Lack of high quality infrastructure with adequate

medical facilities or schools
- 37 -
CULTURAL
• Moral beliefs about monogamy for women but
polygamy for males

• Religious beliefs such as HIV is a punishment from

God or caused by bad supernatural spirits

• Denial or ignorance about modes of HIV

transmission due to attitudes to sexuality

• Cultural beliefs about condom use (seen as threat

to masculinity or example of disrespect or
mistrust)

• Early marriages for females to prevent HIV (often

reverse effect happens) and female circumcision
makes women more susceptible to HIV infection

POLITICAL
• Prevalence of war making many people refugees

• Government health policies that do not provide

support services and medication for HIV sufferers

• Denial or ignorance about HIV/AIDS situation by

government leaders

• Interference in national economies by foreign

investors

- 38 -
SOCIAL
• Lack of personal economic resources

• Social exclusion for HIV sufferers because of

stigma

• Lack of adequate care for children

• Lack of adequate nutrition (malnourishment makes

people more susceptible to HIV infection)

• Unemployment leads to increases in sex industry,

drug trade

• Lack of access to health services

INTERRELATIONSHIPS BETWEEN FACTORS

Construct a paragraph to show the interrelationship
between the factors given, ie how the economic,
political, environmental, cultural, and social
determinants can work together to increase the rate
of HIV transmission in Sub-Sahara Africa.

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 OHP 2: The Effects of HIV/AIDs
In Sub-Sahara Africa

PERSONAL
• Sickness and physical effects of HIV infection

• Inability to work, go to school or look after

children

• Loss of income and increased strain on limited

resources to purchase medicines, hence poverty
increases due to financial stress

• Increased risk of catching other opportunistic

infections or diseases

• Social isolation due to stigma of being infected,

can often lose companionship if “found out” to be
HIV-positive

• Female children take on adult roles with helping

with other children or looking after sick relatives;
often shortens childhood and interferes with
schooling

• Death

- 40 -
INTERPERSONAL
• Family members have to care for sick relatives

• Loss of income for families which have to spend

money on medicine or funeral costs; widows and
orphans can lose land, homes and possessions
because property and inheritance rights are denied

• Productive family members may have to drop out

of school or leave work to care for others at home

• Grandparents forced to look after grandchildren

when parents die

• Extended families may be forced to take in

orphans from dead family members; again adding
financial stress to limited resources which
increases poverty

• Malnourishment increases in families as resources

are spent on medical care and funeral costs instead
of food; overwhelmed guardians may choose to
feed own children first, leaving orphans hungry and
malnourished

• Normal immunizations of children may be

abandoned because of having to look after sick
relatives; increased risk of diseases such as
malaria or TB in families

- 41 -
SOCIETAL
• Reduced labour supply and productivity due to
illness and deaths because of HIV/AIDS

• Reduced exports and increased imports reduces

economic growth and increases risk of governments
relying on international economic aid to get out of
debt

• Reduced skills in labour market due to deaths, ie

school teachers and nurses, forcing closure of
schools and lack of medical care

• Increased numbers of orphans needing care

• Females become more at risk and bear the brunt

of the epidemic which increases gender
inequalities; they are most likely to lose jobs,
income and schooling, face stigma and
discrimination and usually care for the sick

• Lower life expectancies for populations

• Poverty and hunger increases by reducing

agricultural productivity and families’ incomes for
food
• Strain on health services as medical sectors are
forced to deal with burden of AIDS patients and
loss of staff due to AIDS deaths

- 42 -
 OHP 3: Recommendations for
HIV/AIDS
In Sub-Sahara Africa
ECONOMIC
• Increase in global AIDS funding to Sub-Sahara
Africa and ensure funds are actually delivered;
according to World Vision, out of the $10 billion
promised annually for the African AIDS crisis in
2001, to date only $3billion has actually been paid
up. In contrast, after Sept 11, $40billion was
allocated to the war on terrorism.

• Reduction in price for ARV drugs; costs are down

from US$10,000 per patient to US$300, needs to
come down to US$50. This can be done by foreign
drug companies releasing their patents and
enabling technology transfer to African companies
to make ARV drugs locally and cheaply

• Governments direct funding into education

prevention programs and treatment programs;
increase access to condoms, ARV drugs, HIV
counselling and testing, school-based AIDS
education and peer counselling services for those
not in school

- 43 -
 • Trade agreements need to be established to
enable Sub-Sahara countries to trade their way
out of reliance on international economic
assistance

• Increase funding to health services by increasing

incentives and working conditions for health
workers to reduce impact of labour shortages due
to AIDS-related deaths and/or skills migration to
higher income countries

• Cancelling the debts of Sub-Sahara African

countries to the World Bank in order to enable
governments to put resources into education,
health care and AIDS treatments instead of
paying off loan interests and debt-service
payments

• Strengthening the coping capacity of AIDS-

affected households by providing direct financial
assistance, home visits from health services, food
and nutritional support and waiving of school fees

ENVIRONMENTAL
• Developing infrastructures at local and regional
levels with adequate housing, water facilities,
schools and hospitals

- 44 -
 • Develop rural communities with stronger
infrastructures in townships, agricultural
assistance to develop farmlands (IFAD), try to
develop social and economic change for rural people
with microcredit and income generation schemes

SOCIAL
• Social support structures put in place to assist
families with HIV-positive members

• Assistance programs for families/individuals to

access adequate nutrition, health care and
sanitation

• Anti-discrimination legislation put in place to assist

individuals with HIV obtaining employment,
education and health care

• Financial assistance available to help families with

childcare, especially for those who have to adopt
orphans because of AIDS deaths in families

- 45 -
CULTURAL
• Implementation of factual education programs to
dispel myths of HIV transmission and causes that
target specific cultural beliefs and values; combat
stigma of ‘bad spirits’ or a ‘vengeful God’

• Addressing the gender and cultural inequalities for

women by promoting women’s rights and decision-
making strategies, empowerment of women,
development of negotiation skills and to teach men
respect and support of women

• HIV/AIDS education that emphasises the

importance of condoms as an effective barrier for
HIV transmission

• HIV/AIDS education that emphasize social norms

and skills for healthy human relationships,
effective communication and responsible decision
making

- 46 -
POLITICAL
• Create policies to help reduce the vulnerability of
people by including access to education, prevention
services and enabling the empowerment of women

• Eliminate AIDS-related stigma and discrimination

through effective legal frameworks and protecting
individual rights (50% of sub-Sahara Africa yet to
adopt legislation to prevent HIV discrimination)

• Developing national AIDS plans that incorporate

ARV treatments for HIV-positive individuals

• Expand voluntary counselling and testing to

promote widespread knowledge of HIV status,
treatment and prevention

• Political commitment from governments by showing

strong national leadership and ownership of HIV
prevalence (ie in Lesotho, PM and 80 senior civil
servants publicly tested for HIV to break stigma)

• Create mechanisms for civil society and business to

contribute to AIDS response through public-
private partnerships

• Establish accountability mechanisms to track

resources and ensure effective use of them

- 47 -
LEARNING JOURNAL
NCEA Level 3
Achievement Standard 3.2
International Health Issue

NAME:_________________________________

- 48 -
 Why use a learning journal?
This learning journal will help you understand the unit of work being
studied, and will help you retain important facts for the assessment (it
will help determine what kinds of questions you need to clarify to fully
comprehend the unit).

Although your teacher will ask to view the journal as it will be

assessed, it is for your benefit. You should fill it out after each class
(as soon as possible as this is the best time to remember!)

(Recommend the insertion of a world map showing HIV/AIDS rates – source from
UNAIDS website or WHO website)

- 49 -
Things I have learnt from this lesson …

What is the difference between HIV and AIDS

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How is it transmitted? List all of the ways that you can think of…
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Can you tell if someone is HIV positive? Why? Why not?

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Why can’t HIV be treated with antibiotics?

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- 50 -
Name some of the symptoms that someone may experience if they are
HIV…

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The total number of people in the world with HIV/AIDS is_____times

greater than the population of New Zealand.

A person with HIV may look and feel healthy for years after they
contract the virus – why is this scary?
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For those of you

wondering what the Insert diagram of HIV – can
Human Immunodeficiency obtain off website
Virus looks like: www.howstuffworks.com

- 51 -
Reflection: All About Eve
After watching the ‘All About Eve video’ – Please write a full paragraph about
your feelings while watching it and afterwards.

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Insert
picture of
African child

In what ways can children contract HIV?

1.________________________________________________

2 ._______________________________________________

3 ._______________________________________________

- 52 -
List the countries where there is a high prevalence of HIV, a moderate level,
and a low level of prevalence.

High
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Moderate
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Low
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What are some of the lifestyle factors that can affect the life
expectancy of someone who’s contracted HIV?
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Some people who contract HIV are risk takers? What sort of
things could they be doing that would increase their chances of
contracting the virus?
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- 53 -
Read the statements/definitions below and link them to the
correct meaning by drawing a line.

PANDEMIC 15,000 PEOPLE INFECTED

WITH HIV/AIDS (APPROX)

HIV PREVENTATIVE TREATMENT

AGAINST THE DEVELOPMENT
OF DISEASE

NZ A SYNDROME OF DISEASE
THAT A PERSON ACQUIRES
ONCE THEIR IMMUNE SYSTEM
HAS BEEN DAMAGED BY THE
HIV VIRUS

PROPHYLAXIS AN OUTBREAK OF DISEASE

IN A PARTICULAR AREA

EPIDEMIC A VIRUS THAT PEOPLE

CAN BECOME INFECTED WITH

OPPORTUNISTIC A WIDESPREAD CONTAGIOUS

INFECTIONS DISEASE CROSSING
GEOGRAPHICAL BOUNDRIES

AIDS OVER 29 MILLION PEOPLE

INFECTED WITH HIV OR AIDS

SUB-SAHARAN SEVERE INFECTIONS WHICH

AFRICA RESULT FROM A DEPRESSED
IMMUNE SYSTEM
Why are Sub-Saharan African countries affected so much more
than other countries? Think about the socio-ecological
perspective.
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Identify and explain the following factors (determinants) that
influence the spread of HIV in Africa. Be sure to write
complete paragraphs.

Lack of medical resources

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Cultural Attitudes (about gender & sexuality)

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Religious Beliefs
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Economic Issues (including exploitation by Western countries with

Free Trade Agreements, shrinkage of rural incomes, migration and
urbanization, mobility and the economic recession)
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___________________________________________________
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When considering the economic determinants of HIV/AIDS,

because many poor countries are indebted to wealthy nations,
what sort of impact does this have on social services and the
medical treatment of HIV/AIDS?

Availability of medicine…
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Access to contraception…
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Access to good food and water…

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HIV/AIDS compounds problems that many poor countries face.
It attacks the most productive age group of people. In the
spaces below write down all the implications for the following
areas affected:

Agriculture…
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Food production…
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Family income, support/functioning…
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Social services…
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 This graph is for your
information, so that you can
understand what an impact this
Insert graph diagram virus/disease is having on young
of HIV/AIDS orphans people. Many children look after
themselves and will also
in Africa – obtain contract HIV, or may have been
from WHO or born with it. The problem is so
UNAIDS huge and it is going to
completely devastate some
countries unless they introduce
more education programmes and
treatments for their people.

Considering the determinants that

affect the spread of HIV/AIDS, what
recommendations could be made to
counteract the implications (effects) of
AIDS in Africa? Be sure to indicate who
you would make the recommendations
to and specify the strategies you think
they should adopt. GIVE EVIDENCE
AND REFERENCES FOR YOUR
RECOMMENDATIONS!
Report to _____________________________________________ (person or
group)

Recommendation 1:
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Supporting evidence:
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__________________________________________________
______________

Recommendation 2:
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Supporting evidence:
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__________________________________________________
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Report to _____________________________________________ (person or
group)

Recommendation 1:
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Supporting evidence:
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Recommendation 2:
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Supporting evidence:
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____________
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__________________________________________________
___
Now that we are at the end of the unit…what really
sticks in your mind? Please summarise what you have
personally got out of this learning journal? What things
did you not find interesting or useful?
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Congratulations! You have just completed

your learning journal.