It was one heck of an eye-opener for recently arrived diabetes expert Prof Jim Mann when he first travelled to Te Tai Rāwhiti some 35 years ago.
The National Science Challenges were just a twinkle in a far-off government’s eye, as was truly collaborative co-designed health research between Māori and Pākehā, mātauranga and Western medicine.
"Ngāti Porou Hauora had invited me to visit them to discuss how best to deal with diabetes, already recognised as one of the major health issues they, and the country, were facing," the now Sir Jim recalls.
"I flew up to Gisborne, and was met at the airport by a colleague who shocked me with a comment which turned out to be words of wisdom. As he shook my hand and said ‘welcome’, he made it very clear to me that if I believed I was one of those know-it-all professors I might as well get back on the plane.
"I was quite taken aback. For a newly appointed professor that’s quite a baptism of fire. However, the colleague became a close friend. But it really shocked me at the time. I nearly thought, ‘well, I wonder if I can still get a seat on the plane going back?’."
Several decades later, the now-defunct challenges — including Healthier Lives-He Oranga Haora, of which Mann was director and also on its leadership board — are being held up as examples of real collaboration.
"I tell you that story as it made it easier for me because of what I had learned and respected, and tried to practise, from the message I had received from the friend and colleague all those years ago. A lot of other people had to be got there."
In the past, collaboration on health matters was sometimes as insulting and inappropriate as having "a cup of tea and a biscuit" with Māori and asking what they thought.
"And then the same process with Pasifika, and then you’d ‘consulted’.
"But genuine co-design involves serious relationship-building from ground-level up, including co-governance."
Life-changing for thousands of Kiwis and for New Zealand science itself, the National Science Challenges may be gone but they won’t be forgotten.
More than $650 million of funding for the 11 challenges set up 10 years ago by the John Key National government spluttered and finally dried up during the past two months.
The Labour government’s plan had been to replace the challenges with "national research priorities", as outlined in the Te Ara Paerangi white paper. However, National’s Science, Innovation and Technology Minister, Judith Collins, threw the white paper and its science reforms in the bin in February.
The sector is now in a holding pattern while former prime minister’s chief science adviser Sir Peter Gluckman runs two major science reviews. The demise of the challenges has added to the wide-ranging concerns about science funding in New Zealand and fears about the effects on the career paths of young, and even mid-career, scientists.
Gluckman told the NZ Listener in July it had been long known by programme directors and boards of the national challenges they would not continue indefinitely.
"Because science changes," he said then.
Two of the challenges were hosted by the University of Otago — Healthier Lives, and Ageing Well-Kia eke kairangi ki te taikaumātuatanga.
A retrospective evening was held recently to celebrate their work and mourn the end of an era for their collaborative, mission-led, co-designed research.
Otago vice-chancellor Grant Robertson told the gathering it was "one of those strange days — it’s a day of celebration ... but it is also a day that will be tinged with sadness".
There were lessons for everyone from the work, he said.
"What I think we ask of universities is to be here, where the big issues of our times are. In our society, how we look after an ageing population, how we address inequality, what we do about the big killers of our time, of cancer, of diabetes, of obesity, they are the issues we want our universities to be at the forefront on, and that’s what these challenges have done."
Some in the science sector say there has been disappointing rhetoric from government officials that the challenges weren’t actually all that collaborative or successful.
However, Minister Collins told The Weekend Mix each challenge has made "a lasting impact on the sectors they’ve worked alongside".
"When implemented, these will save lives, save money, increase productivity, and protect the planet."
Ageing Well’s work will enable all New Zealanders to "maintain their full potential into the later years of life".
"The work of these challenges will continue to inform policy, management, and future direction of research," Collins says.
New Zealand Association of Scientists co-president Troy Baisden says the problem is the financial support for the challenges was only enough to achieve "a fraction" of their stated goals.
"The collapse of the challenges has been the largest symptom of New Zealand’s inability to properly invest in a foundation of research, science and technology to support innovation and our future well-being."
He says their demise also reflects a loss of the vision that funding can support clusters of research to tackle the thorny problems of the 21st century, that more integrated communication and engagement can encourage that approach, and that Māori perspectives can therefore be more properly embraced.
Too often, the challenges "doggedly pursued the right areas of research the wrong way; in other cases, they did the wrong research the right way".
"The resulting frustrations have caused the government to throw the baby out with the bathwater, with nothing learned nor preserved to support our future in areas a previous government saw as the 11 most important priorities for research to serve our nation."
An hour with Mann, the University of Otago’s venerable professor in human nutrition and medicine and co-director of its Edgar Diabetes and Obesity Research (EDOR) centre, passes quickly.
It’s not an easy question to answer: What has Healthier Lives actually achieved?
Mann runs his hand through his hair and takes a deep breath.
In a nutshell, Healthier Lives had the smallest budget of the challenges, with $31 million over 10 years, which required careful allocation.
It emphasised community consultation, co-governance and co-design, and its programmes led to significant advancements in public health, Māori and Pacific health, and precision medicine. Cornerstone projects included modelling the health, economic and environmental benefits of dietary changes, developing culturally sensitive diabetes care models, and improving cardiovascular-risk assessment.
The work on diabetes is especially close to his heart.
"We got together with Diabetes New Zealand and our Edgar research group and PwC, and said we need to know what is going to happen with diabetes, for example, if we don’t do something to stop the epidemic.
"That report, called The Economic and Social Cost of Type-2 Diabetes (2020), persuaded the government they had to appoint a committee to actually develop an action plan for diabetes. It showed that by 2040 the annual cost of type-2 diabetes was projected to increase by 63% to $3.5 billion."
That action plan is "in incubation" and getting closer, Mann says.
Healthier Lives has focused on three main themes: public health, Māori and Pacific-specific initiatives, and precision medicine.
"If you’re going to reduce disease, if you’re going to prevent disease, then you’ve got to have a population approach, and most of what you can do to prevent disease is really lifestyle. You can prevent disease with drugs, but lifestyle is really the best hope you’ve got.
"What we know from the global burden of disease is that diet, and particularly what we eat but also physical activity, can have a profound effect on cardiovascular disease and now increasingly we know with cancer. The role of diet has overtaken cigarette smoking in terms of public health, mainly through obesity’s effect on cancer. Of course, we want people to give up smoking too.
"Being overweight and obesity, along with less-than-ideal food choices, are now the most important preventable causes of premature death and ill health globally, mainly because they appreciably increase the risk of heart disease, diabetes and several cancers. Dietary changes along with increased physical activity could profoundly improve health and wellbeing and reduce the escalating demand on healthcare."
The Healthier Lives project Sustainable New Zealand Kai modelled five policies which could help adopt a healthy and sustainable diet across the population and bring large health gains, save the health system money, reduce greenhouse gas emissions, and improve health equity.
The research team, led by Dr Cristina Cleghorn, of the University of Otago, Wellington, found removing GST from core sustainable foods, education campaigns, and healthy food and drink policies in schools, would save the country money. The Garden to Table programme in schools was cost-effective, and māra kai and community gardens were borderline cost-effective.
Mann says some of the programmes in theme two are yet to reach a conclusion.
"The big thing about theme two was the development of a number of models of care that would make a difference in terms of providing services and preventing. For example, in diabetes, pretty much until recently the diabetes care we offered Māori and Pacific people was the standard Western medicine approach.
"Basically, it wasn’t working. It was totally insensitive to te ao Māori, it just didn’t fit."
One project carried out was Mana Tū, in which 400 participants with poorly controlled type-2 diabetes worked with kai manaaki (case managers, health navigators) who were nurses, social workers, psychologists and community health workers, to gain a more integrated approach to deal with their conditions and make changes.
"This, to a large extent, relied on kaiāwhina in the community with a certain level of knowledge that can be imparted in conjunction with standard medical care. It’s getting to the people — it is so blimming obvious, that you can’t see how people didn’t come up with this before."
Other projects included the Pasifika Prediabetes Youth Empowerment Programme, in which young people with leadership potential work to influence older family members in an attempt to avert type-2 diabetes.
"That has been very popular, very successful, and they’ve been developing their own recipe books, based on Pacific recipes.
"We also had a project with the Heart Foundation finding out why Māori and Pacific people have got these terrible statistics for heart disease, and trying to devise ways of improving things."
Theme three focused on precision medicine, which aims to target treatments more effectively by taking into account differences in an individual’s genes, environment and lifestyle, rather than apply a blanket approach for an "average" patient.
That includes Prof Parry Guilford’s work on circulating-tumour DNA (ctDNA) technology, which offers an early diagnosis and monitoring of cancer-treatment response through a simple blood test.
"CtDNA has been tremendously exciting," Mann says. "This is work which has been largely, but not exclusively, funded by the challenge. So, if you are having cancer treatment, and this is particularly important for rural people, usually if you want to know if the treatment’s working, you’ve got to go and travel miles to have CT scans.
"But you can use ctDNA to look at response to treatment. So, this is precision medicine, and you can go to a clinic or you can get blood taken on the marae or wherever, and see whether you are responding, and then you can change the treatment."
Another project, led by Prof Greg Jones, has refined the assessment of cardiovascular risk, making it more accurate especially for Māori and Pacific populations.
The work on epigenetics by Prof Jones helped quantify the impact of smoking on cardiovascular risk, providing a more precise understanding of health effects
"He is looking at epigenetics to take that one step further. Looking at cigarette smoking in terms of epigenetic terms, you can potentially look at what you might get from being exposed to smoke if your spouse is a smoker, or if you’re an ex-smoker."
As the host of two challenges, the University of Otago is well aware of what they brought and what it has now lost.
At the retrospective, vice-chancellor Robertson acknowledged the mana the challenges’ researchers and staff had bestowed on the university.
Deputy vice-chancellor, research and enterprise, Prof Richard Blaikie told The Weekend Mix the challenges had contributed much more than just the funding to support mission-led research.
"Importantly, they brought us opportunities to learn how to better govern collaborative research in areas where health inequities were a key focus. Bringing outstanding leaders and community members in to serve in governance roles, and through this showing national leadership in research co-governance and co-design, are some of the enduring legacies that will remain.
"But we also need to recognise that the work that was set out to achieve is not complete for these challenges, namely achieving better and more equitable health outcomes ... for all New Zealanders.
"Major issues with the health and wellbeing of our people and communities remain, and future investment in new research consortia that can pick up on the excellent foundational work of these challenges is essential."
Mann says he will miss the Healthier Lives challenge and its collegiality.
"I came in last week and the people weren’t here. I’ve had emails from people saying, how are we going to continue? And funding for research is going to be very hard because of the financial situation, and it’s not going to get any easier.
"My aim is to try to get EDOR to help, if we are talking locally, to fill some of that gap. But I think it is going to be a very hard few years."
