Rachel Williamson
A research centre in Aotearoa-New Zealand is eyeing a global role for the Pacific, as a source of health practices and policy tailored to non-Western cultures.
That is not, of course, the stated aim of the Te Poutoko Ora a Kiwa (Centre for Pacific and Global Health) research centre at The University of Auckland, but it is inferred by the ‘global’ nature of its ambitions.
And it’s one co-director Professor Judith McCool and incoming chair Sir Ashley Bloomfield can get behind.
“We see that typically, historically and traditionally the influences of decision making have been looking upward to the north, to where the global health institutions of power are…Iit’s flipping that around and saying there is innovation, there are approaches that come from this part of the world,” McCool tells Cosmos.
“I’m interested in how health and the priorities around the region strengthen [the Pacific], so it’s not just a broker between major powers but establishes its own power as a region.”
The new research centre’s overarching aim is to build health research capacity in Polynesia, partly by hiring researchers from the island nations and working with, rather than studying, communities.
But the bread and butter will be to dive deeply into non-communicable diseases, young people’s health, pandemic responses and climate change.
The ‘global’ aspect of the centre is to then export that knowledge and shape global health policy in regions where systems and ideas tailored to a Western audience don’t quite fit.
As McCool says, “you don’t have influence by just publishing articles”.
Influence and power as the Great Game shifts east
The Pacific is a forum in the latest ‘great game’ between China and the US, as they and their allies scramble to block out spheres of influence with promises and investment in telecommunications, security or climate initiatives.
This new position comes with challenges, as one Te Poutoko paper pointed out: island nations must choose between traditional donors or China; self-sufficiency or interdependence, especially when it comes to demands for climate action; and empowerment versus the need to present as vulnerable to keep donor money flowing.
Last year, long-time Pacific health researcher Dr Eileen Natuzzi called for a “medical detente” in the region to stop competitive medical oneupmanship by China and the US – such as deploying hospital ships that offer brief stop-over clinics while in port but no long-term development help.
She wants all countries operating in Pacific development to coordinate their medical capacity-building programs to improve care, as opposed to playing out a foreign policy theatre.
Furthermore, it would allow regions such as Polynesia to negotiate development programs as a bloc rather than the bilateral deals preferred by China.
“A coordinated medical détente program will have co-benefits. It will require Chinese, Australian, American and Japanese health teams to communicate and find common ground while implementing a program that benefits the very countries they are sparring over,” Natuzzi wrote for the Lowy Institute’s publication last year.
“Working together towards better health in the Pacific Islands might just be an opening to see America and China getting along.”
Dr Eileen Natuzzi
Te Poutoko chair Bloomfield, who has worked with the World Health Organisation (WHO) for 19 years, hopes the centre could help broker a ‘medical détente’ in the Pacific.
“I think on the face of it it’s a really good idea to be floating and I would hope that the work of a centre would be able to help support it…coming together to identify common needs and then working together with those countries and local communities to address those needs.”
Political change in New Zealand
Whether New Zealand wants to broker that kind of detente comes down to its new conservative National Party and its right-wing coalition partner, ACT, elected in November 2023.
The new government is keen on reviving military allegiances with Australian and the US, but in health two of its first actions have been to kill off the Māori Health Authority and the country’s pioneering smokefree legislation, which banned smoking for anyone born after 2009.
Both of these moves have been widely criticised for disproportionately hurting Maori and Pacific Islander health, who are both more likely to smoke and face more health inequality than Pakeha, or white New Zealanders.
And yet McCool and Bloomfield are optimistic about the new government’s priorities towards health research and aid in the Pacific, thanks to the return of maverick MP Winston Peters as foreign minister.
During his second stint as foreign minister, Peters initiated the 2018 Pacific Reset which leant into viewing the Pacific as a zone of strategic competition but which also birthed the Ministry of Health-led Polynesian Health Corridors scheme – which is currently funding Te Poutoko’s regional multi-year cancer control program and mental health survey.
“I’d say there’s a really strong synergy there so I don’t see the focus on Pacific health being diminished or diluted,” Bloomfield says.
“We’re confident the work will be just as valuable and of interest to government agencies. Now just as it was previously.”
While new Prime Minister Christopher Luxon chose not to attend the Pacific Islands Forum leaders meeting in the Cook Islands in November after he won power, Peters appears keen to rejuvenate his 2018 policy.
Cancer and mental health research as global exports
New Zealand has a long track record of global health diplomacy and feeding the results of Te Poutoko’s research out into the world is a fundamental part of a commitment to this, McCool says.
Her two pet programs, the cancer control consultation and the mental health survey, are an example of this: incidences of both are rising around the world, but large scale research around what can be done to support health infrastructure and sufferers in non-Western cultures is needed.
The results will inform policy and aid decisions, but also turn Polynesian countries into creators of knowledge and influence in the world, rather than just be a “thoroughfare” for great powers.
Judith McCool
The WHO estimates that in the Western Pacific nearly 6.8 million new cases of cancer occurred in 2022. The 2010 Global Burden of Disease study suggested that mental disorders were the leading cause of disability across the Pacific even then.
In early February McCool had just wrapped up work in Samoa and Tonga for the mental disorder project, before flying out again to do the same in Tokelau and Niue.
“This would be one of the first times for the Polynesian regions [that a] consistent series of work has been done using the same methodology and tools to generate this understanding of the burden of mental disorders,” she says.
The challenge is making those clinically-tested methods and concepts, largely designed for a Western audience, understood by people in culturally-diverse Polynesian countries.
The cancer control study has so far gathered in-depth information on what systems are in place to detect and treat the disease, or provide palliative care, in Niue, Samoa and the Cook Islands.
“That is important. Most countries low on the development index do comparatively poorly with cancer outcomes. People are likely to present late. Their treatment, if it is delivered in-country, is perhaps not to the same level of availability. But really importantly we’re finding [problems with] palliative care [such as obtaining medication for managing pain],” McCool says.
The results will inform policy and aid decisions, but also turn Polynesian countries into creators of knowledge and influence in the world, rather than just be a “thoroughfare” for great powers.