Emeritus Professor Elaine Rush, Auckland University of Technology
New Zealand is a world leader in many things, but health promotion and disease prevention, particularly for children, is not one of them.
One exception is the long-running Project Energize programme in the Waikato. Every year for the last sixteen years, Project Energize worked with up to 240 schools attended by 40,000 children.
For the last 10 years, it reached all Waikato primary schools and supported them to “eat healthy, be active and have fun”. No school in the Waikato was left out.
The Waikato District Health Board was a shining light in public health because they recognised the need for a robust and inclusive prevention programme with and for children. And, the ongoing evaluations and research showed that there was a huge, preventative impact. Lower blood pressure, improved movement skills including the ability to run fast, reductions in overweight and obesity, and in sugary drink intake. Sport Waikato was contracted to deliver the programme at a cost of more than $2M a year.
But now, it has stopped.
I have been privileged to lead research and evaluation around this programme from the beginning as a cluster randomised controlled trial. Two PhDs, two masters and 18 peer reviewed publications and regular evaluation have provided ongoing evidence that it was working.
What is Project Energize?
It is based on the work of so-called “energizers,” who effectively act as change agents in the school and school community. The visible philosophy of the programme has not been on “obesity prevention,” rather it promotes a culture of “eat healthy, be active, have fun.”
The programme did not work with individual children but the whole school: through the professional development of teachers, aligning the Energize goals with the school curriculum and creating an environment that supports healthy eating and activity, and clear and consistent messages – such as water being the best drink – and the importance of physical literacy and fundamental movement skills.
By 2011, all primary schools in the Waikato region had signed up to receive the programme. This was reaching more than 42,000 children, 36% who are Māori. The Energize Programme was also picked up by Northland and Capital district health boards for schools with a high proportion of Māori and Pacific children, and the programme was translated into schools in Cork, Ireland where it is known as Project Spraoi. Energize and Spraoi have been recognised internationally.
In 2013, the Ministry of Health contracted Sport Waikato to deliver the ‘Under-5-Energize’ programme to 121 early childhood centres in the Waikato region. In 2021, this programme is also to stop, yet the evidence from the before-school-check of New Zealand four-year-olds showed that children attending an Under-5 Energize centre have less visual dental decay than other children.
The evidence of the impact of Project Energize
We know that eating wholesome food and participating in regular physical activity are sure ways to health – and it is best if this can happen every day of the life course.
A large body of evidence for the efficacy and efficiency of the Energize programme has accumulated. In the 2017 National Health Survey (the last time regional statistics were published), the Waikato District Health Board area showed a reduced rate in obesity and overweight for Māori and non-Māori children aged 2- 14 years compared to measures in 2014. Better than the rest of New Zealand and with the biggest effect for Māori children.
The cost of not having Energize
The programme cost $45 for every primary school child every year – or around 20 cents a day. For early childhood centres, the cost was a hundred dollars per child each year. Cost utility analysis showed that there would be a long-term return on investment in terms of health benefit, particularly for Māori girls.
In 2017, the Labour Party stated in their health manifesto that “if elected we will roll out Project Energize to the whole of New Zealand”. This has not happened.
While we have Covid-19, climate change, unemployment, not enough homes, rising inequity and food poverty as huge problems, Project Energize was a step in the right direction, investing equitably in our children and showing a return on health. Eating an elephant one bite at a time.
Like good cheese, it takes time for outcomes and impact to be measurable and it is intergenerational. Children who were “energized” in the early days of Energize are now having their own children, so the expectation is that for children who were energized, future health will be improved
The good news is that at present Project Energize and a modified Under-5-Energize are still being delivered in the Capital Coast and Northland areas.
Emeritus Professor Elaine Rush, Professor of Nutrition, Auckland University of Technology