title: Health literacy as a complex practice

authors: Hunter, Judy

abstract: As attention to health literacy grows as an area for policy intervention, policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity. The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date: health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.

text: Health literacy as a complex practice As attention to health literacy grows as an area for policy intervention, policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity. The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date: health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.

year: 2012

title: Anthropogenic phosphorus loads to Lake Rotorua

authors: Tempero, Grant Wayne

abstract: Past wastewater disposal practices and ongoing catchment land-use intensification have resulted in the eutrophication of Lake Rotorua. These changes have been associated with elevated nutrient loads to the lake from point and diffuse sources. Phosphorus and nitrogen are important macronutrients limiting phytoplankton growth. Bioassay studies in Lake Rotorua have shown temporal and spatial variability of phytoplankton growth limitation by either or both of these nutrients, hence the importance of controlling both phosphorus and nitrogen loads to the lake. This report was commissioned by the Bay of Plenty Regional Council to quantify sources of anthropogenic (i.e., associated with human activity) phosphorus in the catchment, so that these sources can be managed with the aim of reducing phytoplankton biomass in Lake Rotorua. This will form part of an integrated framework of catchment management which also aims to reduce the nitrogen load to the lake.
Determination of anthropogenic and natural (baseline) sources of phosphorus is essential for managing lake eutrophication. Natural concentrations (indicative of baseline or reference levels) of dissolved reactive phosphorus (DRP) and total phosphorus (TP) can be modelled from observed concentrations in undisturbed catchments. This model can then be used to estimate anthropogenic phosphorus in other catchments as the difference between natural and observed concentrations.
Mean annual discharge (MAD) was estimated individually for nine major stream sub-catchments of Lake Rotorua, and a combined MAD was estimated for other minor and ungauged stream sub-catchments. Natural stream phosphorus concentrations were derived from published values based on the River Environment Classification (REC) land classes within the lake catchment. Natural groundwater phosphorus concentrations were derived from published relationships between groundwater age and phosphorus concentrations in the Rotorua sub-catchments. Total phosphorus and DRP loads were calculated for each inflow for the period 2007-2014 (‘contemporary loads’) using the daily discharge estimates and time series of estimated daily mean concentrations of each nutrient species (TP, DRP) for each inflow. Daily loads were then summed to calculate annual loads. Natural loads for each inflow were subtracted from contemporary loads to estimate anthropogenic loads. Anthropogenic phosphorus loads to Lake Rotorua were estimated to be 22% (expressed as a catchment areal rate of 0.12 kg DRP ha-1 y-1) of the total DRP load and 48% (0.47 kg P ha-1 y-1) of the TP load. Relative to other New Zealand catchments, anthropogenic phosphorus was a relatively low proportion of the total load, given that the Rotorua catchment is highly developed. This can be attributed to the large volume of groundwater discharge to the lake, which is DRP-enriched due to gradual dissolution of phosphorus in the rhyolitic pumice bedrock. In sub-catchments where groundwater discharge to the lake was volumetrically dominant, e.g., Hamurana (89.3%) and Awahou (79.6%), the natural contribution to DRP loads was high, despite extensive agricultural land-use. By contrast, sub-catchments dominated by surface water discharges, e.g., Ngongotaha (34% groundwater) and Waiteti (14.5% groundwater), had comparatively high anthropogenic TP loads and elevated concentrations of particulate phosphorus. The minor and ungauged catchments, representing drains, small streams, overland flow, groundwater discharge to the bed of the lake, discharge below gauged stream sites and a residual term, were estimated to contribute the largest percentage (33%) of anthropogenic particulate phosphorus loads to Lake Rotorua despite being groundwater dominated.

text: Anthropogenic phosphorus loads to Lake Rotorua Past wastewater disposal practices and ongoing catchment land-use intensification have resulted in the eutrophication of Lake Rotorua. These changes have been associated with elevated nutrient loads to the lake from point and diffuse sources. Phosphorus and nitrogen are important macronutrients limiting phytoplankton growth. Bioassay studies in Lake Rotorua have shown temporal and spatial variability of phytoplankton growth limitation by either or both of these nutrients, hence the importance of controlling both phosphorus and nitrogen loads to the lake. This report was commissioned by the Bay of Plenty Regional Council to quantify sources of anthropogenic (i.e., associated with human activity) phosphorus in the catchment, so that these sources can be managed with the aim of reducing phytoplankton biomass in Lake Rotorua. This will form part of an integrated framework of catchment management which also aims to reduce the nitrogen load to the lake.
Determination of anthropogenic and natural (baseline) sources of phosphorus is essential for managing lake eutrophication. Natural concentrations (indicative of baseline or reference levels) of dissolved reactive phosphorus (DRP) and total phosphorus (TP) can be modelled from observed concentrations in undisturbed catchments. This model can then be used to estimate anthropogenic phosphorus in other catchments as the difference between natural and observed concentrations.
Mean annual discharge (MAD) was estimated individually for nine major stream sub-catchments of Lake Rotorua, and a combined MAD was estimated for other minor and ungauged stream sub-catchments. Natural stream phosphorus concentrations were derived from published values based on the River Environment Classification (REC) land classes within the lake catchment. Natural groundwater phosphorus concentrations were derived from published relationships between groundwater age and phosphorus concentrations in the Rotorua sub-catchments. Total phosphorus and DRP loads were calculated for each inflow for the period 2007-2014 (‘contemporary loads’) using the daily discharge estimates and time series of estimated daily mean concentrations of each nutrient species (TP, DRP) for each inflow. Daily loads were then summed to calculate annual loads. Natural loads for each inflow were subtracted from contemporary loads to estimate anthropogenic loads. Anthropogenic phosphorus loads to Lake Rotorua were estimated to be 22% (expressed as a catchment areal rate of 0.12 kg DRP ha-1 y-1) of the total DRP load and 48% (0.47 kg P ha-1 y-1) of the TP load. Relative to other New Zealand catchments, anthropogenic phosphorus was a relatively low proportion of the total load, given that the Rotorua catchment is highly developed. This can be attributed to the large volume of groundwater discharge to the lake, which is DRP-enriched due to gradual dissolution of phosphorus in the rhyolitic pumice bedrock. In sub-catchments where groundwater discharge to the lake was volumetrically dominant, e.g., Hamurana (89.3%) and Awahou (79.6%), the natural contribution to DRP loads was high, despite extensive agricultural land-use. By contrast, sub-catchments dominated by surface water discharges, e.g., Ngongotaha (34% groundwater) and Waiteti (14.5% groundwater), had comparatively high anthropogenic TP loads and elevated concentrations of particulate phosphorus. The minor and ungauged catchments, representing drains, small streams, overland flow, groundwater discharge to the bed of the lake, discharge below gauged stream sites and a residual term, were estimated to contribute the largest percentage (33%) of anthropogenic particulate phosphorus loads to Lake Rotorua despite being groundwater dominated.

year: 2015

title: Are they really at risk? Students' stories of success.

authors: Gray, Sheridan

subjects: Student engagement

abstract: In 2011, as the year level dean for year 13, I was surprised and pleased to see a group of students complete their fifth year of secondary schooling, contrary to teacher expectations, and in spite of earlier signs of disengagement and struggle.  Such students are frequently labelled “at risk” in our secondary schools. Truancy, lack of achievement, conduct issues, learning difficulties and health problems are seen as indicators of an at risk student by teachers. 

Statistically in Aotearoa, Māori and Pasifika students and students from low socio-economic families tend to be overrepresented among disengaged or early leavers from secondary schools, and so being from these cultures, and being from a low socio-economic group becomes a “risk” factor.   This can lead to assumptions among teachers about the students’ families, how parents value education, and even about the capacity of these groups to be able to succeed in education.  A range of strategies and programmes have been implemented in an attempt to address these issues, including Te Kotahitanga, Ka Hikitia and the Pasifika Education Plan, Resource Teachers Learning and Behaviour, Restorative Practice, and more recently Positive Behaviour for Learning

While there has been a shift in such approaches from deficit of students to emphasising more positive attitudes in teachers, the perspectives of the students themselves are missing from the discussion about these issues.  This study asks students what factors helped them to stay, and to achieve at least a level one NCEA qualification

The findings show that retention and engagement of “at risk” students requires careful attention to the quality of relationships across the school community: students, teachers and parents. They discredit some commonly held assumptions that “at risk” students and their parents do not value education and that teachers cannot support these students sufficiently. These quality relationships are respectful, responsive and tenacious showing a high level of respect for and interest in the students that goes beyond a teaching and learning relationship.  It also suggests that the discourse of “risk” invites a disrespectful response to retention and engagement of students.

text: Are they really at risk? Students' stories of success. In 2011, as the year level dean for year 13, I was surprised and pleased to see a group of students complete their fifth year of secondary schooling, contrary to teacher expectations, and in spite of earlier signs of disengagement and struggle.  Such students are frequently labelled “at risk” in our secondary schools. Truancy, lack of achievement, conduct issues, learning difficulties and health problems are seen as indicators of an at risk student by teachers. 

Statistically in Aotearoa, Māori and Pasifika students and students from low socio-economic families tend to be overrepresented among disengaged or early leavers from secondary schools, and so being from these cultures, and being from a low socio-economic group becomes a “risk” factor.   This can lead to assumptions among teachers about the students’ families, how parents value education, and even about the capacity of these groups to be able to succeed in education.  A range of strategies and programmes have been implemented in an attempt to address these issues, including Te Kotahitanga, Ka Hikitia and the Pasifika Education Plan, Resource Teachers Learning and Behaviour, Restorative Practice, and more recently Positive Behaviour for Learning

While there has been a shift in such approaches from deficit of students to emphasising more positive attitudes in teachers, the perspectives of the students themselves are missing from the discussion about these issues.  This study asks students what factors helped them to stay, and to achieve at least a level one NCEA qualification

The findings show that retention and engagement of “at risk” students requires careful attention to the quality of relationships across the school community: students, teachers and parents. They discredit some commonly held assumptions that “at risk” students and their parents do not value education and that teachers cannot support these students sufficiently. These quality relationships are respectful, responsive and tenacious showing a high level of respect for and interest in the students that goes beyond a teaching and learning relationship.  It also suggests that the discourse of “risk” invites a disrespectful response to retention and engagement of students.

year: 2012