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Analyse how the principles and action areas of the Ottawa Charter (detailed below) have been incorporated into your project plan to support a multi-level approach to address the chosen health issue;

Analyse ways in which the six elements of Te Pae Mahutonga have been incorporated within your project plan to support positive health outcomes in a New Zealand context.


Health promotion refers to the process that enables people to grow their control over their health (Eldredge et al., 2016). In the words of McPhail-Bell, Fredericks and Brough (2013) health promotion has been mentioned in the 1986 Ottawa Charter as the process that allows people to attain a level of complete mental, physical and social wellbeing. The issue identified in the previous task dealt with foetal alcohol syndrome that occurs among children whose mothers consumed alcohol during pregnancy (Cook et al., 2016). This report will discuss health promotion strategies on the aforementioned syndrome, in relation to the principles of Ottawa Charter and TePaeMahutonga.

The Ottawa Charter for Health Promotion refers to an international agreement that was enforced at the First International Conference on Health Promotion, in November 1986, at Ottawa, Canada. According to this agreement, the fundamental resources and conditions that are required for optimal health and wellbeing are namely, (1) peace, (2) education, (3) shelter, (4) stable ecosystem, (5) food, (6) income, (7) social justice and equity, and (8) sustainable resources. Enhanced health for all individuals is a chief societal objective of governments and the keystone of sustainable development (Sallis, Owen & Fisher, 2015). Millennium Development Goals (MDGs) have been identified to form the background of the global efforts related to health. Nonetheless, they were not overtlyfocussedon thereasons of poor health in the public health sector. The importance of the Ottawa Charter can be accredited to its role in fostering a collaborative approach and promoting health by bringing about change in the social determinants of health. Hence, it established a fundamental agenda for public health, precisely to convey the standards public health trails, thereby snow balling the prospective for the reflexivity of the arena and occasions to consider balancing values in movements that endorse populace health.The Ottawa Charter recognises three important strategies for promotion of health namely, (i) advocate, (ii) enable, and (iii) mediate (Baum & Fisher, 2014).

  • Advocate- Optimal health has been identified as the primary resource for economic, social and personal development, and imperative for ensuring quality of life of the population. Family advocacy has been found to exert a vital role in assisting individuals and relations affected by FASD. The principle of advocacy has been incorporated in the project plan by seeking assistance from a range of non-profit educational group of parents, who work in collaboration with healthcare and local government professionals for identifying, understanding and caring for persons with FASD, and their family members (Lee, 2015). The primary objective of advocacy is to avert the future generations from living with this disability, in terms of growth, cognitive skills, facial features, and other birth defects (Memo, Gnoato, Caminiti, Pichini&Tarani, 2013). Prenatal exposure to high rates of alcohol is a multifaceted public health concern that creates a major impact on the society. Exposure to alcohol during pregnancy is the sole reason for different functional and neurodevelopmental impairments and learning deficits (Memo, Gnoato, Caminiti, Pichini&Tarani, 2013). Hence, advocating for the affected people encompasses demonstrating a deep commitment towards prevention of the prenatal exposure. This can be achieved by obtaining adequate funds from the government organisations and increasing provisions of education on FASD behavioural phenotype. Women will be asked to intake more juices in place of alcohol and will be educated on FASD related knowledge and skills. This principle is essential since it ensures that all New Zealanders, particularly those who are vulnerable to FASD share their voices on the issues that they perceive important. (Add example related to the poster )
  • Enable- Health promotion often relies on the goal of achieving equity in health in the target population. The basic objective of this principle is to reduce the differences in the present health status of the vulnerable population (Clavier & de Leeuw, 2013). This has been taken into consideration by increasing the access to resources and opportunities for achieving a holistic health potential. Awareness will be increased on the disorder by educating the population (especially females) on the impacts that an alcohol exposure during pregnancy can create on the health and development of their child. Efforts are being taken to provide a supportive environment to the vulnerable people that will provide assistance in realising the complete health potential. Such a supportive environment will protect the New Zealanders from several factors that can threaten their optimal health outcomes. Increasing their access to relevant information on the management and treatment of FASD with the help of control plan will reduce inequities faced by the Maori people. Besides free health services and screening programs, ban on liquor sale to women would help.
  • Mediate- According to Flynn (2015) theprospects and prerequisites for an enhanced health outcome cannot be ensured without adequate help from the government and the economic sectors. Help from non-profit and voluntary organisations facilitate accomplishment of this principle. The industry and media sector is also imperative in interpreting FASD and the associated disabilities, engendering accommodation and change on behalf of the affected people, and providing assistance in meeting attainable goals of reducing alcohol exposure. This is crucial owing to its role in allowing people expand their self-reliance and capabilities. Collaboration between DHB, PHO, and government antenatal clinics will ensure regular checkup of the females. Conferences and seminar for pregnant women and their partners will also increase pregnancy related knowledge.
  • Build healthy public policy-This area principally focuses on making easy healthier choices by applying certain public health policies. These policies will put an emphasis on different health barriers and their removal such as, judgment and stigma associated with reporting and diagnosis of the condition (Fry &Zask, 2016). Furthermore, public health policies will also create new avenues for information provision and will also help in shaping the reaction and attitudes towards women who consume alcohol during their pregnancy. Meeting with GP will also increase the knowledge of the women on FASD.
  • Creating a supportive environment- This will be achieved when the community collaborates with each other, with the aim of constructing a healthy environment that inspires, supports and provides resources towards individuals who have the potential to better their state of health. 
  • Strengthen community action- Community development will draw on prevailing resources to augment social support and self-help for firming public participation (McManus, 2013). Owing to the fact that women belonging to poor socioeconomic sections of the society, free FASD screening programs will be made available to them for early detection of the condition.Strict laws on that prevent liquor stores to sell alcohol to pregnant females will also prove beneficial.
  • Develop personal skills- Educational campaigns and seminars with provide the target population with appropriate skills, essential for improvements in their health. Meeting organisation, social media, and advertisement and antenatal classes for the pregnant females will allow them to explore lived experiences of women who have been affected with FASD, thus increasing their awareness.
  • Reorient health services- Free health services such as, free check-ups for FASD and financial support by the government to people affected with the condition is imperative. Counselling the women on harmful impacts of FASD will also increase their awareness.

According to Pitama, Huria and Lacey (2014) TePaeMahutonga refers to the Maori name for constellation of stars, also known as Southern Cross. The four dominant stars are usually used to characterise the four important errands of health promotion and imitate particular objectives: Mauriora, Waiora, Toiora, TeOranga. The two poles are Ng?Manukura and TeManaWhakahaere and embody two pre-requisites for efficacy, namely leadership and autonomy (Warbrick, Dickson, Prince &Heke, 2016). Hence, it helps in bringing together the different components of health promotion in the Maori community.

The four stars and two pointers are the prerequisites of health preservation and promotion and are cited below:

  • Mauriora (cultural identity) – By definition, this star represents a secure cultural identity, it encompasses s inner strength, vitality and a secure identity (Durie, 1999). Hence, this star guide the development and promotion of health prioritizing the secure cultural identity. This will help in reducing the amount of alcohol consumption in women belonging to specific cultures women are allowed to drink. The elders of the community can play a vital role in educating and making the women aware of the ill effects that alcohol consumption will exert on the growth and development of their child. Access to proper knowledge, language and culture is therefore crucial for optimal health
  • Waiora (physical environment)- This is the star representing environmental protection, it is linked to the external world and a spiritual element that links the human wellness with cosmic, terrestrial and water environments (Durie, 1999). Modifying the physical environment will help in promoting the health of pregnant women owing to their increased likelihood of consuming alcohol to combat stress.This will prevent any deformity or disability in the children.
  • Toiora (healthy lifestyle) – Toiora can be considered as the star of personal behaviour, the transition from risky to healthy (Durie, 1999). The women will be encouraged to adhere to lifestyle modification such as, dietary changes, regular exercise, and healthy sleeping habits for enhancing their health and wellbeing (Hopkirk& Wilson, 2014).Deviation from harmful lifestyle will help in positive development and risk management. There should be adequate opportunities for the females to live in a natural environment.
  • TeOranga (participation in society) – This star can be defined as the representative of wellbeing, it is dependent on the terms under which the members of the society can participate with the confidence so that they can avail good health services, or the school of their choice, or sport and recreation (Durie, 1999).A range of community and society programs that encourage participation of pregnant women will prove beneficial. Engagement with the community will make the women aware of the harmful impacts of alcoholism on pregnancy and the child. This in turn will promote active participation of the females in the decision making process.
  • Ng?Manukura (leadership)- This star is defined as the star of leadership, reflecting a combination of skills and a range of influences (Durie, 1999).This will involve clinical leaders, who will be accountable for addressing the critical needs and demands of the pregnant females to improve the quality of the care services that are delivered to them. Advocating for the interests of the target population, and developing their deep knowledge on the syndrome and its ill effects will also prove beneficial (Huria, Palmer, Beckert, Lacey&Pitama, 2017). Community leadership, and alliance between the groups and the leaders are pre-requisites of this element.
  • TeManaWhakahaere (autonomy) – This is the star that represents autonomy reflecting participation in health promotion and the control the people have on it (Durie, 1999). This will address the degree to which the vulnerable groups take ownership of their health and are able to exert a degree of autonomy. The health promotion processes are required to make sense to the community that is primarily affected due to FASD. Alliance and collaboration between different health and government agencies should foster self-governance of the condition.


On a concluding note, foetal alcohol syndrome (FASD) refers to a state in a child that from alcohol exposure during the pregnancy period of the mother. Working on the major principles, action areas will reflect on the health priorities of the New Zealand population and will also reduce all forms of health inequities between different groups. Use of TePaeMahutonga as the essential model will act in the form of a symbolic map for getting together the noteworthy constituents of health promotion, as they relate to Maori health and other New Zealanders, who demonstrate a susceptibility of suffering from FASD.


Baum, F., & Fisher, M. (2014). Why behavioural health promotion endures despite its failure to reduce health inequities. Sociology of health & illness, 36(2), 213-225.

Clavier, C., & de Leeuw, E. (Eds.). (2013). Health promotion and the policy process. OUP Oxford. Retrieved from

Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E., ...& Mallon, B. F. (2016). Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan. Canadian Medical Association Journal, 188(3), 191-197.

Durie, M. (1999, October). Te Pae M?hutonga: A model for M?ori health promotion. In Health Promotion Forum of New Zealand Newsletter (Vol. 49, No. 2, p. 5). Retrieved from 

Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Kok, G., Fernandez, M. E., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons. Retrieved from

Flynn, M. A. (2015). Empowering people to be healthier: public health nutrition through the Ottawa Charter. Proceedings of the Nutrition Society, 74(3), 303-312.

Fry, D., &Zask, A. (2016). Applying the Ottawa Charter to inform health promotion programme design. Health promotion international, 32(5), 901-912.

Hopkirk, J., & Wilson, L. H. (2014). A call to wellness–Whitiwhitiaiteora: Exploring M?ori and occupational therapy perspectives on health. Occupational therapy international, 21(4), 156-165.

Huria, T., Palmer, S., Beckert, L., Lacey, C., &Pitama, S. (2017). Indigenous health: designing a clinical orientation program valued by learners. BMC medical education, 17(1), 180.

Lee, M. S. (2015). The principles and values of health promotion: building upon the Ottawa charter and related WHO documents. Korean Journal of Health Education and Promotion, 32(4), 1-11. DOI : 10.14367/kjhep.2015.32.4.1

McManus, A. (2013). Health promotion innovation in primary health care. The Australasian medical journal, 6(1), 15. doi:  10.4066/AMJ.2013.1578

McPhail-Bell, K., Fredericks, B., &Brough, M. (2013). Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter. Global health promotion, 20(2), 22-29.

Memo, L., Gnoato, E., Caminiti, S., Pichini, S., &Tarani, L. (2013). Fetal alcohol spectrum disorders and fetal alcohol syndrome: the state of the art and new diagnostic tools. Early human development, 89, S40-S43.

Pitama, S., Huria, T., &Lacey, C. (2014). Improving Maori health through clinical assessment: Waikare o teWaka o Meihana. The New Zealand Medical Journal (Online), 127(1393). Retrieved from

Popova, S., Lange, S., Shield, K., Mihic, A., Chudley, A. E., Mukherjee, R. A., ...&Rehm, J. (2016). Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. The Lancet, 387(10022), 978-987.

Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health behavior: Theory, research, and practice, 5, 43-64. Retrieved from

Warbrick, I., Dickson, A., Prince, R., &Heke, I. (2016). The biopolitics of M?ori biomass: towards a new epistemology for M?ori health in Aotearoa/New Zealand. Critical Public Health, 26(4), 394-404.

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