What keeps an island community COVID-19 free in a global pandemic?

The COVID pandemic has offered opportunities for islands and other relatively isolated communities to establish pandemic-protection boundaries. A July 2020 survey of Waiheke Island residents sought views on how the island had remained COVID-19 free, despite proximity to a city of 1.6 million (Auckland, NZ). Many attributed that status to 'pure luck' or a 'moat' effect. However, many also attributed freedom from COVID-19 to reinforcing high-level community cohesiveness and shared values. The Waiheke community's response can be seen as a microcosm of New Zealand as an island nation and an exemplar of a response to pandemic threats uniquely possible for small islands.

Enabling participation for disabled young people: study protocol.

BACKGROUND: Participation in community life is vital for health and wellbeing, promoting a sense of belonging, networks of social support and opportunities for physical activity. Disabled young people have lower levels of mobility and participation in recreational activities (physical, social and cultural), education and employment, than their peers without disabilities. This has implications for their health and wellbeing and life course opportunities. Previous research on the participation levels of disabled young people has primarily relied on parent/caregiver reports and been oriented to home and school environments. This study investigates how physical and social environmental factors cohere to support or restrict the everyday mobility and participation of disabled young people. METHODS/DESIGN: The study is located in Auckland, Aotearoa/New Zealand (NZ). Participants comprise 35 young people aged 12-25 years with mobility, vision or hearing impairments. A mixed-methods research design combines objective (global positioning systems, accelerometers, geographical information systems) and self-report measures (travel diaries, and questionnaires) to assess young people's mobility and levels of participation in leisure/educational and employment activities with in-depth interviews exploring their everyday experiences of inclusion/exclusion, and factors enabling or constraining community participation. Parents/caregivers and disability sector key informant viewpoints on the community participation of disabled young people have also been gathered through in-depth interviews. Follow-up workshops with young people and parents/caregivers will identify pathways to increase participation and challenge current disabling practices. DISCUSSION: This study looks beyond barriers in the physical environment to the interplay of personal, social and physical factors that enable or constrain the community participation of disabled young people. In keeping with the study's overarching goal of increasing opportunities for effective community participation and full citizenship of disabled young people, research methods were applied flexibily - negotiated and adapted to maximise each young person's participation in light of their abilities and preferences.

Neighbourhood built environment associations with body size in adults: mediating effects of activity and sedentariness in a cross-sectional study of New Zealand adults.

BACKGROUND: The aim of this study was to determine the associations between body size and built environment walkability variables, as well as the mediating role of physical activity and sedentary behaviours with body size. METHODS: Objective environment, body size (body mass index (BMI), waist circumference (WC)), and sedentary time and physical activity data were collected from a random selection of 2033 adults aged 20-65 years living in 48 neighbourhoods across four New Zealand cities. Multilevel regression models were calculated for each comparison between body size outcome and built environment exposure. RESULTS AND DISCUSSION: Street connectivity and neighborhood destination accessibility were significant predictors of body size (1 SDchange predicted a 1.27 to 1.41 % reduction in BMI and a 1.76 to 2.29 % reduction in WC). Significantrelationships were also observed for streetscape (1 SD change predicted a 1.33 % reduction in BMI) anddwelling density (1 SD change predicted a 1.97 % reduction in BMI). Mediation analyses revealed asignificant mediating effect of physical activity on the relationships between body size and street connectivity and neighbourhood destination accessibility (explaining between 10.4 and 14.6 % of the total effect). No significant mediating effect of sedentary behaviour was found. Findings from this cross-sectional study of a random selection of New Zealand adults are consistent with international research. Findings are limited to individual environment features only; conclusions cannot be drawn about the cumulative and combined effect of individual features on outcomes. CONCLUSIONS: Built environment features were associated with body size in the expected directions. Objectively-assessed physical activity mediated observed built environment-body size relationships.

Environmental and socio-demographic associates of children's active transport to school: a cross-sectional investigation from the URBAN Study.

BACKGROUND: Active transport (e.g., walking, cycling) to school (ATS) can contribute to children's physical activity and health. The built environment is acknowledged as an important factor in understanding children's ATS, alongside parental factors and seasonality. Inconsistencies in methodological approaches exist, and a clear understanding of factors related to ATS remains equivocal. The purpose of this study was to gain a better understanding of associates of children's ATS, by considering the effects of daily weather patterns and neighbourhood walk ability and neighbourhood preferences (i.e., for living in a high or low walkable neighbourhood) on this behaviour. METHODS: Data were drawn from the Understanding Relationships between Activity and Neighbourhoods study, a cross-sectional study of physical activity and the built environment in adults and children in four New Zealand cities. Parents of participating children completed an interview and daily trip diary that assessed their child's mode of travel to school, household and individual demographic information, and parental neighbourhood preference. Daily weather data were downloaded from New Zealand's national climate database. Geographic information systems-derived variables were calculated for distance to school and neighbourhood walkability. Bivariate analyses were conducted with ATS and potential associates; factors related to ATS at p < 0.20 were considered simultaneously in generalized estimation equation models, and backwards elimination of non-significant factors was conducted; city was treated as a fixed effect in all models. RESULTS: A total of 217 children aged 6.5-15 years participated in this study. Female sex, age, city, household income, limited/no car access, residing in zone of school, shorter distance to school, neighbourhood self selection, rainfall, and sunlight hours were simultaneously considered in multivariate generalised estimation equation modelling (all p < 0.20 in bivariate analyses). After elimination of non-significant factors, age (p = 0.005), shorter distance to school (p < 0.001), city (p = 0.03), and neighbourhood self selection (p = 0.04) remained significantly associated with ATS in the multivariate analysis. CONCLUSION: Distance to school is the prevailing environmental influencing factor on children's ATS. This study, in conjunction with previous research, suggests that school siting is likely an important associate of children's ATS.

Contemplative practices: The body as therapeutic site linking health and place.

During times of upheaval, supporting stability, health and wellbeing on all levels is essential. While literature regarding 'therapeutic landscapes' has burgeoned over the last 30 years, to date no studies have considered the therapeutic potential of embodied contemplative practices (CP), such as yoga and meditation, within the most accessible, ordinary environment - the body at home. Equally, the field of mobilities appears to have overlooked the spiritual and political nature of these deliberately immobilising acts of resistance. Our paper draws on narrative data collected over the course of three months of daily CP. We interpret the resulting autoethnography through thematic analysis. We conclude that within a fast-paced, hyper-connected world, CPs can be a therapeutic counterpoint, connecting health and place by nurturing an appreciation for the immaterial, interdependent aspects of life.

Kids in the city study: research design and methodology.

BACKGROUND: Physical activity is essential for optimal physical and psychological health but substantial declines in children's activity levels have occurred in New Zealand and internationally. Children's independent mobility (i.e., outdoor play and traveling to destinations unsupervised), an integral component of physical activity in childhood, has also declined radically in recent decades. Safety-conscious parenting practices, car reliance and auto-centric urban design have converged to produce children living increasingly sedentary lives. This research investigates how urban neighborhood environments can support or enable or restrict children's independent mobility, thereby influencing physical activity accumulation and participation in daily life. METHODS/DESIGN: The study is located in six Auckland, New Zealand neighborhoods, diverse in terms of urban design attributes, particularly residential density. Participants comprise 160 children aged 9-11 years and their parents/caregivers. Objective measures (global positioning systems, accelerometers, geographical information systems, observational audits) assessed children's independent mobility and physical activity, neighborhood infrastructure, and streetscape attributes. Parent and child neighborhood perceptions and experiences were assessed using qualitative research methods. DISCUSSION: This study is one of the first internationally to examine the association of specific urban design attributes with child independent mobility. Using robust, appropriate, and best practice objective measures, this study provides robust epidemiological information regarding the relationships between the built environment and health outcomes for this population.

Coastal Communities, Leisure and Wellbeing: Advancing a Trans-Disciplinary Agenda for Understanding Ocean-Human Relationships in Aotearoa New Zealand.

Commentators are advocating for research to better understand relationships between healthy coastal ecosystems and human wellbeing. Doing so requires inter- and transdisciplinary approaches across humanities, arts, social sciences, and science and technology disciplines. These approaches include culturally diverse knowledge systems, such as indigenous ones, that locate sustainable use of and relationships to marine ecosystems. This paper contributes to this agenda through a case-study of relationships between coastal ecosystems and human wellbeing in Aotearoa New Zealand. This article highlights interconnected cultural and wellbeing benefits of, and socio-ecological relationships between, these coastal ecosystems drawing on a case study of one ocean-based, 'immersive' leisure activity, surfing. Further, it examines how these relationships impact human physical, emotional and spiritual wellbeing, and the wellbeing of communities and ecosystems. The research illustrates that surfing creates strong bonds between practitioners and coastal places, linking the health of marine environments and people. We demonstrate the value of a transdisciplinary place-based approach that integrates research across the humanities and social sciences and engages with Indigenous knowledge (Matauranga Maori). This argument for multicultural co-learning shows the value of Western and Maori vantage points for how we understand coastal blue spaces. Indigenous perspectives, we conclude, deepen appreciation, as well as equity considerations, of how we understand place, wellbeing, and long-term sustainable relationships with marine ecosystems.

Can virtual streetscape audits reliably replace physical streetscape audits?

There is increasing recognition that the neighborhood-built environment influences health outcomes, such as physical activity behaviors, and technological advancements now provide opportunities to examine the neighborhood streetscape remotely. Accordingly, the aims of this methodological study are to: (1) compare the efficiencies of physically and virtually conducting a streetscape audit within the neighborhood context, and (2) assess the level of agreement between the physical (criterion) and virtual (test) audits. Built environment attributes associated with walking and cycling were audited using the New Zealand Systematic Pedestrian and Cycling Environment Scan (NZ-SPACES) in 48 street segments drawn from four neighborhoods in Auckland, New Zealand. Audits were conducted physically (on-site) and remotely (using Google Street View) in January and February 2010. Time taken to complete the audits, travel mileage, and Internet bandwidth used were also measured. It was quicker to conduct the virtual audits when compared with the physical audits (χ = 115.3 min (virtual), χ = 148.5 min (physical)). In the majority of cases, the physical and virtual audits were within the acceptable levels of agreement (ICC ≥ 0.70) for the variables being assessed. The methodological implication of this study is that Google Street View is a potentially valuable data source for measuring the contextual features of neighborhood streets that likely impact on health outcomes. Overall, Google Street View provided a resource-efficient and reliable alternative to physically auditing the attributes of neighborhood streetscapes associated with walking and cycling. Supplementary data derived from other sources (e.g., Geographical Information Systems) could be used to assess the less reliable streetscape variables.

Placing therapeutic landscape as theoretical development in Health & Place.

This commentary reviews the development and application of therapeutic landscape ideas as they have appeared and developed within issues of Health and Place to date. This framework builds on landscape ideas drawn from humanist and structuralist influences in the 'new' cultural geography and seeks to deepen interpretation of the therapeutic reputation of certain places. These ideas have gained particular traction within health geography. We identified 119 papers published within Health and Place that have invoked the term in their titles and/or key words. Close scrutiny of these papers identified three main themes: spaces of care, mobile experiences of therapeutic places; and applications reaching beyond the Anglo-American world. Drawing on extracts from a 2017 exchange with Wilbert Gesler, who developed the construct, we note that some work in this field has drifted significantly from the tripartite foundations of therapeutic landscape he initially identified. We highlight the importance of maintaining the integrity of this foundation while recognising the value of new thinking that has usefully extended the concept around relationality and enabling (human and non-human) resources. We conclude that some applications of therapeutic landscape thinking have reached well beyond its intended scope, resulting in a dilution of the construct's interpretive power. Nevertheless its influence within health geography has been potent. Specifically, it has been a theoretical pivot facilitating methodological experimentation and diversification; allowed a return of the idiographic tradition; and offered a platform from which deeper theorising has occurred.

Permeable boundaries? Patient perspectives on space and time in general practice waiting rooms.

This paper considers an under-examined space in primary health care - the reception area/waiting room. This space can be challenging to negotiate, particularly for those who experience social marginalisation. We begin by situating the significance of the 'entry into the health care setting' in the patient journey in terms of time as well as space. Through an analysis of interview and focus group data gathered in a New Zealand study, we highlight ways that patients view these spaces as firmly bounded and confronting. In reflecting on the data, we then identify the potential for these spaces to be more permeable. We conclude that this spatio-temporal context need not be one of constraint. Rather, there are ways in which the boundaries of this space can be potentially enabling to those required to pause in the process of enacting patienthood.

Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study: research design and methodology.

BACKGROUND: Built environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study. METHODS AND DESIGN: The URBAN Study is a multi-centered, stratified, cross-sectional research design, collecting data across four New Zealand cities. Within each city, 12 neighborhoods were identified and selected for investigation based on higher or lower walkability and Maori demographic attributes. Neighborhoods were selected to ensure equal representation of these characteristics. Within each selected neighborhood, 42 households are being randomly selected and an adult and child (where possible) recruited into the study. Data collection includes: objective and self-reported PA engagement, neighborhood perceptions, demographics, and body size measures. The study was designed to recruit approximately 2,000 adults and 250 children into the project. Other aspects of the study include photovoice, which is a qualitative assessment of built environment features associated with PA engagement, an audit of the neighborhood streetscape environment, and an individualized neighborhood walkability profile centered on each participant's residential address. Multilevel modeling will be used to examine the individual-level and neighborhood-level relationships with PA engagement and body size. DISCUSSION: The URBAN Study is applying a novel scientifically robust research design to provide urgently needed epidemiological information regarding the associations between the built environment and health outcomes. The findings will contribute to a larger, international initiative in which similar neighborhood selection and PA measurement procedures are utilized across eight countries. Accordingly, this study directly addresses the international priority issues of increasing PA engagement and decreasing obesity levels.

Recycling former psychiatric hospitals in New Zealand: echoes of deinstitutionalisation and restructuring.

This paper addresses a gap in the understanding of the geography of deinstitutionalisation: the fate of closed asylums. We contend that the closure process was an exercise in both deinstitutionalisation and welfare state restructuring, and examine discourses surrounding the re-use of two former psychiatric hospitals in New Zealand-Seaview in Hokitika and Kingseat near Auckland. Drawing on an analysis of media coverage and field observation, we consider former asylums as sites of celebrity. We find the shadow of stigma to be prominent, manifested directly in suggestions that the former hospitals be used as prisons and in the partial redevelopment of one as a 'horror theme park'. Indirectly, we see stigma reflected in the physical deterioration of the asylums prior to closure. While this stigmatising is attributable in the first instance to deinstitutionalisation, the evidence suggests strongly that it was co-opted and exploited by the forces of restructuring.

Precariously placed: Home, housing and wellbeing for older renters.

Older renters may encounter a wide range of challenges and constraints in their experiences of ageing, housing and community life that influence their wellbeing. We employ a two-part conceptualisation of precarity and resilience to investigate how housing-related precarities may impact upon experiences of ageing and home during later life. We draw on narratives collected through in-depth interviews with 13 older renters living in a particularly high-pressure housing market within the greater Auckland area. We ground our analysis in ideas of precarity and resilience evident in participants' experiences of being 'at home' at the scale of both the dwelling and wider community. Results show that experiences of renting and ageing can be complicated and compromised in diverse ways by interrelated aspects of precarity and resilience related to housing, community, health, financial and personal circumstances. Distance or isolation from services and healthcare, tourism-related infrastructural pressures, and community changes can intensify precarious experiences of home, and can have implications for older people's wellbeing, as well as their ongoing opportunities to age well in place. In addition to these potential precarities, older renters appear to draw strength from their familiarity with, attachment to, and enjoyment of, place and community. These responses demonstrate older renters' capacity for resilience to challenge and adversity when ageing in rented places.

New Zealand children's health stamps: Ideological artefacts linking health and place.

This paper addresses a hitherto unexamined phenomenon in the geography of health promotion: the use of postage stamps. We 'read' health stamps as featuring imagery and exhortations that reflect temporally-specific understandings of children's health and wellbeing. As a case study, we examine examples of the stamps sold annually since 1929 as a fund-raiser for New Zealand Children's Health Camps Foundation. This government-supported voluntary sector agency sought to offer respite for children from unhealthy environments and enhance their wellbeing through offering opportunities in semi-rural locations focusing on nutrition and exercise. Recently, emphasis changed to concern with behavioural issues such as self-esteem. The annual stamp appeal continued until 2016 with nuanced themes (e.g., birds and butterflies, invoking associated ideas of children as vulnerable yet precious and needing protection). Our goal is two-fold: first, we seek to theorise the role of the postage stamp in mobilising health-promoting messages; and, second, we examine changing imaginaries associated with child health included in this annual series of stamps. Drawing on assemblage theory, we read the act of purchasing children's health stamps as offering a tacit seal of approval for child health. Through assembling resources, personnel and ideas about health, they reflected and reproduced the nation state and its goals for children's health while also crossing national boundaries.

'A level playing field': Young people's experiences of wheelchair basketball as an enabling place.

Using a novel case-study of a youth wheelchair basketball team in Auckland, New Zealand, we investigate the experiences of young people with physical disabilities in recreational sports places. We consider the 'enabling places' created by this sport, which can enhance disabled young people's wellbeing and social inclusion. Semi-structured interviews with the team's players and coordinators revealed logistical and societal challenges associated with facilitating youth-oriented sports, as well as those encountered by team members personally. They also identified physical health and social benefits experienced through involvement in wheelchair basketball. The material, social and affective dimensions of participants' experiences of wheelchair basketball elucidate the capacity for the sport, and its team members and settings, to affirm young people's identity and place-in-the-world. We conclude that youth-specific, inclusive sports generate enabling places that enhance young people's social inclusion, wellbeing and life enjoyment.

Children's Transport Built Environments: A Mixed Methods Study of Associations between Perceived and Objective Measures and Relationships with Parent Licence for Independent Mobility in Auckland, New Zealand.

Children's independent mobility is declining internationally. Parents are the gatekeepers of children's independent mobility. This mixed methods study investigates whether parent perceptions of the neighbourhood environment align with objective measures of the neighbourhood built environment, and how perceived and objective measures relate to parental licence for children's independent mobility. Parents participating in the Neighbourhood for Active Kids study (n = 940) answered an open-ended question about what would make their neighbourhoods better for their child's independent mobility, and reported household and child demographics. Objective measures of the neighbourhood built environment were generated using geographic information systems. Content analysis was used to classify and group parent-reported changes required to improve their neigbourhood. Parent-reported needs were then compared with objective neighbourhood built environment measures. Linear mixed modelling examined associations between parental licence for independent mobility and (1) parent neighbourhood perceptions; and (2) objectively assessed neighbourhood built environment features. Parents identified the need for safer traffic environments. No significant differences in parent reported needs were found by objectively assessed characteristics. Differences in odds of reporting needs were observed for a range of socio-demographic characteristics. Parental licence for independent mobility was only associated with a need for safer places to cycle (positive) and objectively assessed cycling infrastructure (negative) in adjusted models. Overall, the study findings indicate the importance of safer traffic environments for children's independent mobility.

Bringing health home: householder and provider perspectives on the healthy housing programme in Auckland, New Zealand.

This paper describes the Healthy Housing Programme, an ongoing intervention initiated for New Zealand public housing tenants in 2000 and presents findings from an evaluation conducted over three consecutive years. The Programme aims to improve well-being by addressing the housing circumstances of families at high risk of infectious diseases, experiencing high levels of deprivation, and living in areas with high concentrations of low-income, and largely public, housing. This is achieved through improving the housing stock and better integrating housing, health and social services. The evaluation was based on Brinkerhoff's Success Case Methodology and sought to address the question: 'how have providers and householders responded to an intervention that addresses the dynamism of the physical and social aspects of housing?' Members of 30 households were interviewed, along with all available Programme providers (n=19). Thematic analysis reveals that in the households evaluated the Programme promotes participation in housing decisions and, indirectly, neighbourhood life more generally. Benefits include a larger stock of social housing units appropriate to residents' needs, increased co-ordination between sectors and organisations, strengthened community networks through referrals to helping agencies, and heightened insight by government officials into the housing conditions of tenants. We argue that a programme originally seeking only to address specific health problems and risk factors has been strengthened as it has evolved to adopt a more holistic approach to promoting household well-being.

Discourses of disease: representations of tuberculosis within New Zealand newspapers 2002-2004.

This paper critically examines the ways that tuberculosis (TB) has been represented in the print media in New Zealand over recent years (2002-2004). Our broad contention is that, notwithstanding its biomedical reality, TB is socially constructed by, and through, human experience. Further, public health practitioners depend, to a large extent, on the media to alert the public to threats of disease and opportunities for protection. However, the messages conveyed are sometimes neither helpful nor accurate. In our analysis of TB coverage in three major daily newspapers in New Zealand, we enumerate and classify references to the disease, as well as undertake a discursive analysis of the revealed themes. Of the 366 texts we retrieved in the database search, we selected 120 for in-depth analysis. Our examination indicated the importance of bovine TB within the national consciousness, the stigmatised character of TB and the association between TB and immigrants. We observe that newspaper 'stories' in general, and commentaries by public health officials in particular, are invariably offered on a 'case by case' basis. We conclude that this specificity in time and place avoids more challenging discourses linking TB with deeply embedded determinants of health such as the strong link between TB and poverty.

Creating a place for population health: interpreting the spaces of a new School in Auckland, New Zealand.

Although the reconfiguring of health care within the hospital sector has gained considerable attention by social scientists, the tertiary education sector's response to new health philosophies and practices has proceeded largely unexamined. This paper considers the new School of Population Health at the University of Auckland, accounts for its origins and considers the synergies between its design and workplace organisation. The results of a thematic analysis of narratives offered by 24 employees collected in 2004 are then presented. Findings suggest that the amassing of academics from a range of health-related backgrounds is advancing interdisciplinary dialogue even if the nature and purpose of population health remains unclear to some. A key concern of respondents was the openness of the workplace which encourages a collaborative atmosphere but also generates distraction. The degree to which conduct within the new building is perceived as regulated was also of concern. Place clearly matters in the story of the new School: the form of the building (featuring an architecture of openness) complements its function (generating new collaborations and creative thinking about health). However, the question of how 'salutogenic' a setting it is remains contested.

Sociocultural barriers to cervical screening in South Auckland, New Zealand.

Cervical screening has been subject to intense media scrutiny in New Zealand in recent years prompted by a series of health system failings through which a number of women developed cervical cancer despite undergoing regular smears. This paper considers why underscreening persists in a country where cervical screening has a high profile. It explores how the promotion of cervical screening has impacted on the decisions of women to undergo a smear test. Ideas of risk and the new public health are deployed to develop a context for thinking about screening as a form of governing the body. Qualitative interviews with 17 women who were overdue for a cervical smear were undertaken in 2001-2002, yielding understandings of their knowledge of screening and their reasons for postponement. Nine providers of screening services were also interviewed. Concurrent with socioeconomic limitations, concerns over exposing one's body loomed large in women's reasons for delaying being screened. In particular, feelings of shyness and embarrassment were encountered among Maori and Pacific women for whom exposing bodies in the process of smear taking compromises cultural beliefs about sacredness. We conclude that medicalization of the body has, paradoxically, assisted many women in dealing with the intrusion of screening. For others, compliance with the exhortations to be screened brings a high emotional and cultural cost which should at least be considered in health policy debates.