14 May, 2010

Assignment #2
HLTH 201
National Cervical Screening Programme
New Zealand has a range of varios national health !romotion !rogrammes" #a$h
!rogramme is dire$ted towards a different gro!, however, the overall idea %ehind ea$h
is to hel! !eo!le maintain a state of overall well%eing &'ansnee, 200()" *ne s$h
!rogramme is the National +ervi$al '$reening ,rogramme in New Zealand &N+',)"
This !rogramme was first !t into a$tion in 1((0, and $ontines to develo! overtime to
rea$h the a!!ro!riate target adien$es &Policy, 1((-)" The im!ortan$e of having reglar
$ervi$al smears is !rofond" .y sim!ly having a smear, the mortality ris/ of $ervi$al
$an$er is red$ed %y an astonding ninety !er$ent &National +ervi$al '$reening 0nit,
200()" Today, the $am!aign !ts great em!hasis on Maori and ,a$ifi$ 1slanders %e$ase
they have a m$h higher in$iden$e of $ervi$al $an$er &A Brief Narrative, 1((2)" +ervi$al
$an$er is one of the most !reventa%le ty!es of $an$er and is easily dete$ted %y $ervi$al
smears, ma/ing a health !romotional !rogramme li/e N+', e3$eedingly im!erative
&National +ervi$al '$reening 0nit, 200()"
Cervical Cancer and the NCSP
A%ot two hndred new $ases of $ervi$al $an$er are diagnosed ea$h year in New
Zealand &National +ervi$al '$reening 0nit, 200()" +ervi$al $an$er is $ased %y the
hman !a!illomavirs, referred to as H,4" 1t is im!ortant to note that most women will
%e infe$ted with H,4 at some !oint in their lifetime &National +ervi$al '$reening 0nit,
200()" An H,4 va$$ine was develo!ed, whi$h !rote$ts women from the two main
strains of H,4 that are res!onsi%le for a%ot seventy !er$ent of $ervi$al $an$er &National
+ervi$al '$reening 0nit, 200()" .t, %e$ase the va$$ine does not !rote$t women from
1
every strain of H,4, reglar $ervi$al smears are im!ortant to dete$t any $ell
a%normalities &National +ervi$al '$reening 0nit, 200()" 1t is re$ommended that women
have smears every three years, while they are %etween the ages of twenty and seventy" 1f
an a%normal smear o$$rs, medi$al !rofessionals will re$ommend a shorter in$rement
%etween smears to monitor the growth of these a%normal $ells &National +ervi$al
'$reening 0nit, 200()" 5ring a smear a medi$al !rofessional will $olle$t a small sam!le
of $ells from the $ervi3 that will %e $he$/ed for $ell a%normalities that are !re$rsors for
$an$er" A $ervi$al smear is $ommonly thoght to %e a diagnosti$ test, however, it merely
identifies a%normal $ells that re6ire frther testing to determine the e3a$t a%normality
that has o$$rred &A Guide, 2002)"
The National +ervi$al '$reening ,rogramme7s goal is 8to red$e the in$iden$e of,
and mortality and disa%ility from, s6amos $ell $an$er of the $ervi39 &Policy, 1((-)"
The $reation of the !rogramme $ame after the +artwright 1n6iry re$ommended that a
national $ervi$al s$reening was ne$essary to im!rove the health stats of women in New
Zealand &A Brief Narrative, 1((2: Policy, 1((-)" The N+', %e$ame the first $an$er %ased
s$reening !rogramme in New Zealand &A Brief Narrative, 1((2)" The !r!ose of the
!rogramme was, and still is, to show women the im!ortan$e of $ervi$al smears and offer
them 6ality servi$es that will !revent the high rate of $ervi$al $an$er mortality,
es!e$ially in Maori and ,a$ifi$ 1sland women &A Guide, 2002)" 4arios media
$am!aigns have %een $reated to in$rease the awareness and nderstanding of $ervi$al
$an$er and ltimately to !romote a$tal $ervi$al s$reening"
NCSP Campaign Emphasis
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The $am!aign side of the !rogram has !rogressed overtime, in an attem!t to
in$rease the effe$tiveness of N+'," The first $am!aigns that started in 1((0 fo$sed on
all women in New Zealand, however, %e$ase there was no em!hasis on $ltral
differen$es, many Maori and ,a$ifi$ 1slander women did not rea$t to the $am!aign"
'in$e 1((0, the $am!aign has shifted its fo$s s!e$ifi$ally onto Maori and ,a$ifi$
1slander women who are three times more li/ely to die of $ervi$al $an$er than ,a/eha
women &A Brief Narrative, 1((2)" This radi$al dis!arity in mortality is de to the la$/ of
$ervi$al s$reening %eing done on these women" The !revios $am!aigns failed to
re$ogni;e the different !ers!e$tives these women held on health" Maori women in
!arti$lar, %elieve that the !%i$ area is a ta%oo s%<e$t and, therefore, shold not %e
dis$ssed" Also, the Maori, as a !eo!le, view health on a holisti$ level, m$h li/e how
health shold %e viewed a$$ording to the *ttawa +harter &A Brief Narrative, 1((2)" .t,
%e$ase the N+', $am!aign is so s!e$ifi$, $ervi$al health was %eing !ortrayed as the
a%sen$e of disease, or more s!e$ifi$ally the a%sen$e of a%normal $ervi$al $ells" This
la$/ of $ltral nderstanding set forth in the first media $am!aigns, limited the
effe$tiveness of the N+', for this !arti$lar gro! of women" As a reslt, the N+',
$reated a National Maori Health +oordinator who leads the Maori Health =ro! &A Brief
Narrative, 1((2)" Their <o% is to modify the $ervi$al smear $am!aign in a way that will
en$orage Maori women to !arti$i!ate"
Negative Aspects of the NCSP Promotion Campaign
The N+', has $hosen to ta/e a !rimarily medi$al a!!roa$h within their
!rogramme" They aim to identify those with a%normal $ervi$al $ells throgh $ervi$al
smears, in order to de$rease the mor%idity from $ervi$al $an$er" Althogh the aim of the
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$am!aign in meant to %e s!e$ifi$, its !rimary goal, of health %eing the a%sen$e of disease,
somewhat oversim!lifies the idea of health" The !rogramme !ts almost all of its
em!hasis on having $ervi$al smears, whi$h is e3tremely im!ortant" However, this is so
the medi$al field $an identify a%normal $ells $ased from H,4, a virs $ommonly
transmitted se3ally" 1t may %e relevant to add a $ondom distri%tion $am!aign to the
!rogramme as another !reventative measre against $ervi$al $an$er" The !rogramme
mentions that all women %etween the ages of twenty and seventy %e s$reened if they are
se3ally a$tive" Therefore, adding a safe se3 se$tion to their $am!aign $old !otentially
!revent some women from $ontra$ting H,4 in the first !la$e" Also, dring one of the
more re$ent $am!aigns, %eginning in 2002, the slogan ?having reglar $ervi$al smears
$old save yor life7 is sed &National +ervi$al '$reening 0nit, 200()" 1t is easy to agree
with this slogan, %e$ase@ yes, $ervi$al smears $old save yor life, %t so $old wearing
yor seat %elt, eating $orre$tly and e3er$ising" The N+', has on$e again minimi;ed the
view of health to essentially %eing the a%sen$e of $ervi$al $an$er, when in reality there
are many more dimensions of health that have nothing to do with disease"
Ahen the N+', was !t into a$tion in 1((0, women were addressed as one whole
gro! with no res!e$t to $ltral differen$es &A Brief Narrative, 1((2)" This !roved to %e
ina!!ro!riate for Maori women %e$ase the to!i$ of $ervi$al $an$er and $ervi$al smears
was not $ltrally a$$e!ta%le in the way it was !resented" The N+', failed to ta/e
$ltral !ers!e$tive into a$$ont on the initial $reation of the $am!aign" This failre did
not lead to a red$tion in the in$iden$e of $ervi$al $an$er in Maori women, instead it
!rovo/ed some feeling of dis$ontent within the Maori $ltre"
4
L$/ily, this la$/ of $ltral nderstanding was soon $orre$ted with the develo!ment of
the Moari Health =ro! who is a%le to $ommni$ate the im!ortan$e of $ervi$al smears to
Maori women in a $ltrally a!!ro!riate manner"
Positive Aspects of the NCSP Promotion Campaigns
The N+', has ta/en into a$$ont $ertain as!e$ts of the *ttawa +harter dring the
$reation of the !rogramme, most im!ortantly, selfBem!owerment" The $am!aign
em!hasi;es that women are in $ontrol of their health" .y sim!ly getting s$reened, the
li/elihood of death de to $ervi$al $an$er is de$reased dramati$ally, ma/ing it the %estB
/nown !rote$tion against $ervi$al $an$er &Improving the National, 2001)" The !rogram
also does its %est to ena%le women, %y giving 6ality information, a variety of $lini$s
where women $an %e s$reened, and offering s$reeners of the same se3 or $ltral
%a$/grond, to ma/e women $omforta%le &Policy, 1((-)" The !rogramme !res$ri%es a
sim!le %ehavior that is not time $onsming, that is afforda%le, and one in whi$h the
!ositive ot$omes of ta/ing !art in the !rogram greatly otweigh the negatives"
The !rogramme registers women into a data%ase, allowing statisti$s a%ot
$ervi$al $an$er to %e $olle$ted" The information that is $olle$ted allows the N+', to alter
the way they a!!roa$h their $am!aigns, if the statisti$s are not desira%le &Cervical
Screening, 2002)" Cor e3am!le, if women are not having smears done every three years
or if they are not re$eiving additional tests after an a%normal smear is dete$ted, the
registry will $onta$t them &Cervical Screening, 2002)" All this information is
do$mented and allows for great im!rovement within the $am!aign and mandates
followB!s on women to hel! maintain their $ervi$al health" The registry allows for a
$riti$al analysis of how well the $am!aign is doing, and to date there are over one million
D
women enrolled in the N+', registry, whi$h is over ninety !er$ent of the eligi%le
!o!lation &National +ervi$al '$reening 0nit, 200()" The registry was the %est way for
the N+', to a$hieve their targets %y monitoring the $ervi$al health of all women that
registered &A Brief Narrative, 1((2)" The registry also allows for an ?o!tBoff7 o!tion that
allows women to remove or !revent themselves from having their information in the
registry &A Brief Narrative, 1((2)" This allows for some !riva$y that some women worry
a%ot within the health se$tor and maintains their sense of em!owerment"
The N+', has develo!ed over time, as has its !artnershi!s" The most !ositive
!artnershi!s that are $rrently !resent in the !rogramme are !ro%a%ly with the Maori
Health =ro! and its National Maori +oBordinator" At the start of the !rogramme, the
%iggest !ro%lem with the $am!aign was with the la$/ of $ltrally, res!e$tfl
$ommni$ation towards Maori women &A Brief Narrative, 1((2)" This la$/ of a
$ltrally a!!ro!riate $am!aign did not en$orage Maori women to !arti$i!ate in the
$ervi$al smear !rogram" .t now, %e$ase !artnershi!s have %een $reated within the
N+', and the Maori Health =ro!, a!!ro!riate $am!aigns have %een formed that
en$orage Maori women to !arti$i!ate, ltimately de$reasing their li/elihood of
develo!ing $ervi$al $an$er" More re$ently, the N+', has $reated !artnershi!s with The
+an$er 'o$iety, Camily ,lanning and even Eohnson and Eohnson for $ervi$al s$reening
awareness month &National +ervi$al '$reening 0nit, 200()" These organi;ations
em!hasi;ed the im!ortan$e of having reglar $ervi$al smears and Eohnson and Eohnson
even !t an advert on their tam!on %o3es with information from the N+', &National
+ervi$al '$reening 0nit, 200()"
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Conclusion
The National +ervi$al '$reening ,rogramme has %e$ome a very well develo!ed
$an$er !revention !rogramme sin$e its initiation in 1((0" 1t has %e$ome more and more
effe$tive as time has !assed" A stdy done on the first ten years of the !rogramme showed
a si3ty !er$ent red$tion in death de to $ervi$al $an$er in New Zealand &National
+ervi$al '$reening 0nit, 200()" 'tatisti$s li/e this !rove that the !rogramme is having a
!ositive effe$t on the female !o!lation %etween the ages of twenty and seventy" The
N+', is a !rime e3am!le of how the ministry of health has intervened with a health
!romotion $am!aign in order to limit one of the most !reventa%le forms of $an$er" The
!ro%lems that have %een identified %y the N+',, li/e the la$/ of $ltral nderstanding at
the initiation of the !rogramme, were diligently wor/ed ot and in 1((F ninety seven
!er$ent of eligi%le Maori women were enrolled in the registry &Statistical Report, 2002)"
1 thin/ this shows an im!ortant !rogression and assessment of a !rogramme that is
willing to $hange in order to %e$ome as effe$tive as !ossi%le"
2
Bibliography
Ministry of Health" &1((2)" A Brief Narrative on Maori Women and the National
Cervical Screening Program" Aellington@ 5ire$torB=eneral of Health"
Ministry of Health" &2001)" Improving the National Cervical Screening Programme
!a" changes to support the audit of the programme" Aellington@ Minister of
Health"
Ministry of Health" &1((-)" National Cervical Screening Programme Policy#
Aellington@ 5ire$torB=eneral of Health"
Ministry of Health" &2002)" National +ervi$al '$reening ,rogramme@ 'tatisti$al Ge!ort
1((-B1((F" Aellington@ Minister of Health"
National +ervi$al '$reening ,rogramme" &2002$ Cervical Screening A guide for "omen
in Ne" %ealand [.ro$hre]" Aomen7s Health A$tion Trst"
New Zealand@ National +ervi$al '$reening ,rogramme" &200() National +ervi$al
'$reening 0nit" Getrieved ( May 200( from the National '$reening 0nit Ae%
'ite@ htt!@HHwww"ns"govt"n;H$rrentBnsB!rogrammeHD-4"as!
'ansnee, Eiro<wong" &200()" Population &ealth' Communities and &ealth Promotion"
F
'oth Mel%orne, Astralia@ *3ford 0niversity ,ress"
(