Healthier Lives

Walking onto Ōtākou marae at the launch of Healthier Lives on 4 December 2015, Hon Steven Joyce on the far left

The New Zealand Government agreed in August 2012 to fund National Science Challenges: large multi-year collaborative research programmes that would address important issues in New Zealand's future. The funding criteria were set out in January 2014, with proposals assessed by a Science Board within the Ministry of Business, Innovation, and Employment (MBIE).[1]

The Healthier Lives Governance Group and Science Leadership Team at its launch in December 2015

In April 2015 Jennifer McMahon was appointed the first Chair of the 7-member Governance Group for Healthier Lives, which held its first full meeting on 27 October 2015. In November 2015 the University of Otago was chosen to lead the Heathier Lives National Science Challenge (HLNSC), with a budget of $31.26 million over 10 years.[2] University of Otago Professor Jim Mann was appointed as director, and the programme was launched at a ceremony at Ōtākou Marae on Otago Peninsula on 4 December 2015.[3] HLNSC was to be hosted at Otago, with other research partners around New Zealand including AgResearch, Auckland University of Technology, ESR, the Malaghan Institute of Medical Research, Massey University, the University of Auckland, the University of Canterbury, the University of Waikato and Victoria University of Wellington.[4]

A 4-member Kāhui Māori was established in 2016, and on 19 October this group proposed a co-governance arrangement with the Governance Group, to be trialled for a year; HLNSC became the first National Science Challenge to adopt co-governance. A review in May 2018 endorsed co-governance arrangement and in February 2019 it was formalised in the Collaboration Agreement with other institutions. A single 8-member entity, the Governance Group and Kāhui Māori was established. In 2020 at the end of the first 5-year funding period Jennifer McMahon stepped down, and Sir Jerry Mateparae was appointed Chair.[5]

The focus of Heathier Lives is four chronic, non-communicable diseases cancer, cardiovascular disease, obesity, and diabetes, which together account for one third of total death and disability in New Zealand.[6] At the time of establishment, the goal of Healthier Lives was to reduce the overall burden on these diseases on New Zealand's health system by 25% by the year 2025.[3] At the halfway point HLNSC underwent a public consultation process and a research review by six international scientists to develop its 2019–2014 research strategy.[7] This strategy addressed three areas: healthy food and physical activity; culturally-centred health programmes for Māori and Pasifika; and precision medicine for cancer and cardiovascular disease.[6] At the end of the review, MBIE commented that HLNSC had "developed exemplary methods of community engagement, and has co-created 40% of its research with stakeholders, which means implementation of research is more likely."[8]

A study led by Rod Jackson created new and more accurate equations for predicting the risk of cardiovascular disease. The clinical study of 400,000 New Zealanders aged 30–74 revealed differences in risk from socioeconomic factors and ethnicity: Māori, Pacific, and Indian patients had a 13–48% greater risk of cardiovascular disease than Pākehā, but Chinese and other Asian New Zealanders had a 25–33% lower risk.[9][10] The research replaced risk prediction equations developed from a much earlier US study of just 5,000 people which significantly overestimated risk for the healthy majority, while underestimating risk factors in others, potentially leading to undertreatment of vulnerable, high-risk groups.[10] The Ministry of Health adopted new equations into its 2018 guidelines[11] and issued a new data standard,[12] which was incorporated into MedTech, the medical records system widely used by New Zealand GPs.

Tanis Godwin, Parry Guilford, and Donghui Zou in Guilford's lab

Healthier Lives has also supported the development of precision medicine techniques, such as using tumour-derived DNA circulating in the blood (ctDNA) to detect cancers and monitor treatment. Parry Guilford and Cris Print have developed sensitive ctDNA assays for colorectal cancer and melanoma, both prevalent in New Zealand, and the technology is being applied to breast, stomach, lung, prostate and neuroendocrine cancers to detect early relapse and allow timely treatment.[13][14]

A research project by Andrew Reynolds and colleagues established the evidence for the health benefits of increasing dietary fibre and replacing refined grains with whole grains.[15] Their work also supported the importance of replacing trans fats and saturated fats with polyunsaturated fats, plant monounsaturated fats, and slowly-digested carbohydrates in one's diet to reduce the risk of coronary heart diease.[16] These findings contributed to updated European guidelines for dietary management of diabetes, including the possibility of reversing type 2 diabetes through weight loss,[17] and World Health Organisation guidelines on dietary carbohydrate and fat.

Research led by Cristina Cleghorn found that sustainable healthy diets (based on the EAT-Lancet Commission diet),[18] when modelled, are no more expensive than current diets, halve associated greenhouse gas emissions, and provide large health gains, cost savings and reductions in ethnic health inequities.[19] Collaborative research with the Our Land and Water National Science Challenge modelled the changes in New Zealand land use that would produce food for this optimised healthy diet, and found that it would be possible to feed all New Zealanders while both reducing greenhouse gas emissions and freshwater contaminatio and minimising the financial impact on families and farmers.[20] Related research led by Andrew Reynolds modelled five scenarios for replacing red meat in the New Zealand diet and found significant benefits associated with all of them.[21]

Healthier Lives researchers in partnership with Māori health providers developed a set of guidelines for health interventions with Māori communities, the He Pikinga Waiora Implementation Framework, which is based on building relationships and co-designing the way health interventions are carried out.[22] A network of primary health providers and researchers, the Healthier Lives Implementation Network, was set up to translate research into practice and better meet the health needs of Māori and Pacific communities.[23] Researchers also developed a mobile-phone (app and website) delivered lifestyle support programme for Māori and Pasifika, OL@-OR@, which was co-designed and evaluated in partnership with those communities.[24][25]

Several Healthier Lives studies used big data to answer health questions:[26] one looked at the rates of cardiovascular disease following the Canterbury earthquakes of 2010–2011,[27][28] another at the factors affecting the progession of prediabetes to diabetes in New Zealand (including the novel finding that speaking Te Reo Māori reduced the risk of progression),[29] and a third estimated the prevalence of cancer in New Zealand.[30]

Presentation of The Economic and Social Cost of Type 2 Diabetes report to the New Zealand Paliament in 2021

A February 2019 symposium in Dunedin hosted by Healthier Lives presented the latest research on the role of dietary fibre in preventing and treating non-communicable diseases; it also identified the need for a national nutrition survey to inform New Zealand health research and policy.[31] In October 2021, the Ministry of Health commissioned a team at the National Institute for Health Innovation, led by Healthier Lives Deputy Director Cliona Ni Mhurchu, to develop the methods and tools for the next survey.

A 2021 report, The Economic and Social Cost of Type 2 Diabetes, commissioned by Healthier Lives amongst others, estimated that the number of New Zealanders with type 2 diabetes would increase by 70–90% by 2040, and examined the projected economic and social costs.[32][33] Healthier Lives called on the Government to develop a national strategy for tackling type 2 diabetes.[34][35]

• Healthier Lives – He Oranga Hauora. (June 2019). Heathier Lives National Science Challenge Research Strategy 2019–2024. Dunedin: Department of Medicine, University of Otago.
• Leakey, C.J., Curtin, J., and Greaves, L.M. (24 March 2022). Healthier Lives National Science Challenge: Policy Inventory. Auckland: Public Policy Institute, University of Auckland. doi:10.17608/k6.auckland.19372769. A list of the 15 New Zealand Government policies relevant to the Healthier Lives research programme.
• Mann, J., Cockram, J., Glen, J., and Stayner, C. (November 2022). Pathways between research policy and practice for equitable evidence-informed health and wellbeing in Aotearoa’s new health system. Healthier Lives–He Oranga Hauora National Science Challenge. ISBN 978-0-473-64187-0. This publication grew from a public webinar on 17 November 2021 on developing more effective pathways between research, policy and practice.[36]

• Healthier Lives website
• Healthier Lives Implementation Network
• He Pikinga Waiora Implementation Framework
• OL@-OR@
• Manawataki Fatu Fatu
• Virtual Health Information Network