Healthier Lives

Healthier Lives – He Oranga Hauora is one of New Zealand's eleven collaborative research programmes known as National Science Challenges. Running from 2015 to 2024, the focus of Healthier Lives National Science Challenge research is cancer, cardiovascular disease, obesity, and diabetes in the New Zealand population, encompassing prevention, treatment, and reducing health inequity, and including precision medicine techniques, and culturally-centred health programmes for Māori and Pasifika.

Establishment and governance
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). 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 August 2015 MBIE approved funding for the Heathier Lives National Science Challenge (HLNSC), with a budget of $31.26 million over 10 years. 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. HLNSC was to be hosted by the University of 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.

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.

Research
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. At the time of establishment, the goal of Healthier Lives was to reduce the overall burden of these diseases on New Zealand's health system by 25% by the year 2025. 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. This strategy addressed three areas: precision medicine for cancer and cardiovascular disease; culturally-centred health programmes for Māori and Pasifika; and healthy food and physical activity environments. Big or linked data was a focus of research. 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."

Precision medicine
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. 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 under-treatment of vulnerable, high-risk groups. The Ministry of Health adopted the new equations into its 2018 guidelines and issued a new data standard, which was incorporated into MedTech, the medical records system widely used by New Zealand GPs. Healthier Lives has also supported the development of precision medicine techniques, using tumour-derived DNA circulating in the blood (ctDNA). 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.

Culturally-centred Māori and Pasifika health programmes
Research led by Nina Scott, John Oetzel, and Bridgette Masters-Awatere in partnership with Māori health providers Te Kōhao Health and Poutiri Charitable Trust developed a set of guidelines for health interventions with Māori communities—the He Pikinga Waiora Implementation Framework, based on building relationships and co-designing the way health interventions are carried out. The Framework was used to co-design two health programmes, one targeting Māori men at risk of diabetes, cardiovascular disease and obesity, and the other, Kimi Ora, a diabetes intervention.

OL@-OR@, a mobile-phone (app and website) delivering lifestyle support programme for Māori and Pasifika, was co-designed and evaluated in a partnership between a team of university researchers led by Clíona Ní Mhurchú, Lisa Te Morenga, and Rivdan Firestone, and community providers Toi Tangata, The Fono, and SWPICS.

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.

Healthy foods and physical activity
Research by Andrew Reynolds and colleagues established the evidence for the health benefits of increasing dietary fibre and replacing refined grains with whole grains. 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. These findings contributed to updated European guidelines for dietary management of diabetes, including the possibility of reversing type 2 diabetes through weight loss, and World Health Organization guidelines on dietary carbohydrate and fat.

Research led by Cristina Cleghorn found that a New Zealand version of a sustainable healthy diet (based on the EAT-Lancet Commission planetary health diet), when modelled, is no more expensive than current diets, halves associated greenhouse gas emissions, and provides large health gains, cost savings and reductions in ethnic health inequities. 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 contamination and minimising the financial impact on families and farmers. 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.

Big and linked data
Several studies led by Andrea Teng used big data to answer health questions: one looked at the rates of cardiovascular disease following the Canterbury earthquakes of 2010–2011, another at the factors affecting the progression of prediabetes to diabetes in New Zealand (including the novel finding that speaking Te Reo Māori reduced the risk of progression), and a third estimated the prevalence of cancer in New Zealand.

Key outcomes
The Focus on Fibre and Food Monitoring symposium co-hosted in Dunedin by Healthier Lives in February 2019 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. In October 2021, the Ministry of Health commissioned a team at the National Institute for Health Innovation, led by Healthier Lives deputy director Clíona Ní Mhurchú, 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. Healthier Lives called on the Government to develop a national strategy for tackling type 2 diabetes. In 2023, Te Whatu Ora and Te Aka Whai Ora established a working group, co-chaired by Healthier Lives director Jim Mann, to develop a National Diabetes Action Plan.

A 2022 report, Pathways between research, policy and practice, highlighted the frustration of health researchers with the slow uptake of research evidence to improve the health of New Zealanders. The report, which arose from a public webinar held on 17 November 2021, suggested ways of strengthening the pathway between research and its application.

Publications

 * 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. . 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.