Mātauranga Māori and Systems Thinking for improved children’s nutrition

Abstract

Background: Current nutrition-related health outcomes for children in Aotearoa New Zealand (ANZ) are poor. Food systems and environments are not designed to promote health and wellbeing. This thesis aims to understand what is needed to catalyse systemic change in children’s nutrition in regional ANZ. Methods: The state of food environments, nutritional behaviours, health and wellbeing for students in Hawke’s Bay was evaluated using a survey and measured Body Mass Index. Additionally, I surveyed schools and Early Learning Services on their food environments. The second phase compared and combined System Dynamics methods with Indigenous approaches, identifying synergies to enhance community engagement in interventions. This approach used cognitive mapping interviews (CMI) and group model building (GMB) workshops. The final phase responded to the largest intervention in children’s nutrition in ANZ in several decades; I held focus groups and interviews with students, families and school principals to gather their perspectives on the impact of the introduction of universal government-funded healthy school lunches. Findings: Over 2000 students (aged 9 or 13) from 41 schools participated in the baseline evaluation. Overall, 16.8% experienced food insufficiency at home and few met daily intake guidelines for vegetables (12.9%) and fruit (39.6%). Only 54.6% had a healthy weight and this rate dropped in low advantage schools. Fifty-two schools and 62 ELS provided information on barriers and enablers to promoting healthy food environments. Across eleven CMI, stakeholders set the vision and principles (Pou) for how to effect change in these nutritional patterns. Nineteen youth and 26 adult community members participated in GMB, identifying structural drivers of poor nutrition like inequity and colonisation and recommending actions such as connection with culture in schools and support for school lunch best practices. Students, families and principals attested to the positive impact of the introduction of school lunches through reduced financial hardship, broader taste preferences and reduced stigma when well implemented. Conclusions: These results provide comprehensive and robust data on the poor status of health and wellbeing for students in regional New Zealand. Through combining mātauranga Māori and systems approaches, potential community-led solutions enhancing cultural connectedness and provision of school lunches may improve this.