Environment Waikato and Waikato District Health Board Technical Report 2008/43

Tokoroa Warm Homes Clean Air Project:

Health and Well-being Impact Assessment

www.ew.govt.nz www.waikatodhb.govt.nz ISSN 1172-4005 (Print) ISSN 1177-9284 (Online)

Prepared by: Polly Atatoa Carr, Waikato District Health Board Population Health Service Wendy Boyce, Environment Waikato Keri Topperwien, Environment Waikato Greg Morton, Waikato District Health Board Population Health Service On behalf of the Tokoroa Warm Homes Clean Air Project Team whose members include representatives of the Raukawa Trust Board, South Waikato Pacific Islands Health Committee and south Waikato District Health Board 26 August 2008 Document #: 1508034

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Peer reviewed by: Wendy Boyce Date June 2009

Approved for release by: Angela Davies Date July 2009

Disclaimer This technical report has been prepared for the use of Waikato Regional Council, Waikato District Health Board, the Tokoroa Warm Homes Clean Air Project and other community initiatives as a reference document and as such does not constitute Council’s policy. Council requests that if excerpts or inferences are drawn from this document for further use by individuals or organisations, due care should be taken to ensure that the appropriate context has been preserved, and is accurately reflected and referenced in any subsequent spoken or written communication. While Waikato Regional Council has exercised all reasonable skill and care in controlling the contents of this report, Council accepts no liability in contract, tort or otherwise, for any loss, damage, injury or expense (whether direct, indirect or consequential) arising out of the provision of this information or its use by you or any other party.

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Acknowledgement This Health Impact Assessment (HIA) has only been possible because of the many people who have contributed their passion, knowledge and experience to the process. The writing team for this report consisted of Polly Atatoa Carr and Greg Morton (Waikato District Health Board Population Health Service); and Wendy Boyce and Keri Topperwien (Environment Waikato). We would like to acknowledge the members of the Tokoroa Warm Homes Clean Air Project Steering Group for the support to conduct this HIA, particularly Marion Brown and Ngawinika Mott from Raukawa Trust Board for their assistance and hard work organising the workshop, and Akarere Henry and the team at the South Waikato Pacific Islands Health Committee who hosted the HIA workshop. We would also like to thank the other staff members from Environment Waikato and the Waikato District Health Board that helped to conduct the workshop, and Lou Belle Barrett and Robbie Atatoa for their excellent facilitation. This report also draws on community profile and cost effectiveness work by economist Sandra Barns. Most importantly, we would like to acknowledge the members of the Tokoroa community who contributed their wisdom, experience, thoughts, songs and time to make this HIA happen.

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Glossary Akama Ashamed or embarrassed (Cook Island Māori).

Air shed An air shed is a volume of air, bounded by geographical and/or meteorological constraints, within which activities discharge contaminants.

Ambient air The air outside buildings and structures. This does not refer to indoor air, air in the workplace, or contaminated air discharged from a source.

Capacity building

Activities that strengthen the ability of organisations and communities to successfully undertake development activities. It also refers to those parts of a project or programme which increase the capacity of the beneficiary community to sustain the development, and control their own destiny.

Community profile

Identifies key aspects (including demographic data, statistics and other information) of the community, which may include but are not limited to: key people; cultural structures and organisations; families, whānau, hapū, iwi; groups; networks; organisations; power structures; resources; concerns, issues, needs and influences that impact on that community.

Cultural well-being

The advancement of intellectual, cultural and spiritual standards; the protection of positive customary values and traditions; the preservation and evolution of the character of communities and lifestyles; promotion of a spirit of personal freedom, resourcefulness, independence and acceptance of diversity; the avoidance of authoritarian and undemocratic political systems and processes; avoiding the negative consequences of unnecessary or intrusive intervention by local government into people’s lives and any other such positive cultural values identified in consultation.

Deprivation The lack of, or limited access to, common necessities that determine quality of life, including food, clothing, shelter and safe drinking water. May also include the lack of, or limited opportunities to, learn, obtain better employment to escape poverty, and/or enjoy the respect of fellow citizens. In New Zealand, deprivation is commonly measured using the NZDep score which includes nine variables (such as income, education, home car and phone ownership, access to health care, access to internet and over crowding) from Census data. This score then provides deprivation information at meshblock level. The higher the number the higher the level of deprivation.

Determinants of health and well-being

A continuum of factors that influence or determine a communities or individuals health and well-being ranging from individual biological factors and behaviours to the social, cultural and economic contexts in which people live, work and play.

Economic well-being

The prosperity of residents as individuals, groups, and neighbourhoods, including the need to balance financial interest with other social responsibilities and the planning of general economic development

Equity The equal distribution of the determinants of health. It is where no one group is privileged over others – by factors such as ethnicity, class, gender, geography or physical ability – so that the generation of social inequalities is avoided.

Environmental well-being

The protection and management of the natural and physical environment according to the views and preferences of people and communities, in a balanced manner which respects personal rights, freedoms and other well-being and accounts for future generations.

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Fono A gathering or meeting (Samoan).

Health and well-being

The term incorporates definitions of both health and broader ‘community well-being’ – expressed in terms of social, economic, environmental and cultural factors that impact on well-being.

Hui A gathering or meeting.

Inequalities Differences in community well-being that are unnecessary, avoidable or unjust (Ministry of Health, 2002).

Kanohi Face. Kanohi ki te kanohi therefore describes interacting face-to-face (Māori).

Kaumatua Elders.

Social well-being

The good of society, including well-integrated and generally accepted organisation of communities and people, good relationships amongst individuals, groups and neighbourhoods, recognition and proportion of accepted customs and the advancement of a spirit of co-operation and goodwill.

Tāngata whenua

Tāngata whenua is literally translated as “people of the land” and can refer to Māori as the indigenous population of New Zealand or to the relationship of a particular iwi (or people in that iwi) with a particular area of land.

Whānau Extended family.

Whānau ora Māori families supported to achieve their maximum health and well-being.

Abbreviations DHB District Health Board

EECA Energy Efficiency Conservation Authority

EW Environment Waikato

HIA Health Impact Assessment

LGA Local Government Act

LPG Liquefied Petroleum Gas

LTCCP Long Term Council Community Plan

MfE Ministry for the Environment

MPIA Ministry of Pacific Island Affairs

MSD Ministry of Social Development

NES National Environment Standard

NZDep New Zealand Deprivation Index

PHO Primary Health Organisation

PM10 Fine particles less than 10 microns in diameter

RMA Resource Management Act

RTB Ruakawa Trust Board

SWDC South Waikato District Council

SWPIHC South Waikato Pacific Islands Health Committee

TPK Te Puni Kokiri

TWHCA Tokoroa Warm Homes Clean Air Project

WHO World Health Organisation

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Table of Contents Glossary iii

Abbreviations iv

Extended executive summary ix

The Health Impact Assessment process used ix Strategic alignment of this Health Impact Assessment xi Potential impact of the NES and the TWHCA Project in Tokoroa xii Findings from the TWHCA Project HIA xiii Lessons from the Project Implementation Stage of the Project xiv

Recommendations xv

Regional policy development xvi Decision-making processes xvii Partnership and participation processes xviii Policy implementation xviii Dissemination xxi Monitoring and evaluation xxi

1 Introduction 1

1.1 Report overview 1 1.2 What is Health Impact Assessment? 2 1.3 The Tokoroa Warm Homes Clean Air Project and HIA 3

2 The HIA process used 9

2.1 Setting the scope and boundaries of the HIA 9 2.2 Policy packages to be assessed 11 2.3 Carrying out the appraisal 12 2.4 Study limitations and reflections on process 13

3 Strategic alignment of this HIA 15

3.1 National strategic alignment 15 3.2 Regional and District strategic alignment 18

4 Tokoroa community profile 20

4.1 Demographics 20 4.2 Socio-economic indicators 21 4.3 Health status 22 4.4 Housing and heating 22

5 Potential impact of the NES and the TWHCA Project in Tokoroa 23

5.1 Change required 23 5.2 Drivers and barriers to change 23

6 Findings of the community workshop/fono 24

6.1 Cultural well-being 24 6.2 Social well-being 27 6.3 Economic Well-being 28 6.4 Environmental Well-being 31 6.5 Equity 31

7 Lessons from the implementation stage of the project 33

7.1 Workshop conclusions 33 7.2 Project resources 34 7.3 Engagement and profile 36 7.4 Policy effectiveness 37

8 Recommendations 39

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8.1 Regional policy development 39 8.2 Decision-making processes 40 8.3 Partnership and participation 41 8.4 Policy implementation 41 8.5 Dissemination 44 8.6 Monitoring and evaluation 44

Bibliography 45

Appendix 1: Whānau ora 49

Appendix 2: Map of an area of Tokoroa 50

Appendix 3: Project partners 51

Appendix 4: Project stages 52

Appendix 5: Policy options – an update 53

Appendix 6: Invitation 55

Appendix 7: Programme 56

Appendix 8: Strategic alignment – further detail 57

National strategic alignment 57 Regional strategic alignment 61

Appendix 9: Tokoroa community profile 63

History 63 Population 63 Age 63 Ethnicity 64 Income and deprivation 64 Employment 65 Housing tenure 66 Home heating 66

Appendix 10: Summary results chart 68

Appendix 11: Questionnaire to assist insulation prioritisation 70

Appendix 12: Community summary 73

Tokoroa Warm Homes Clean Air Health and Well-being Impact Assessment 73

List of Figures Figure 1: Air quality monitoring for PM10 emissions in Tokoroa, 2004 4 Figure 2: Sources of PM10 emissions in Tokoroa 5 Figure 3: Outcomes of TWHCA 7 Figure 4: The Health Impact Assessment Process (Public Health Advisory Committee,

2004) 9 Figure 5: The Determinants of Health and Well-being 10 Figure 6: Ethnic groups for usually resident population (Tokoroa, Waikato and

New Zealand) 21 Figure 7: Proportion of households by income level (Tokoroa, Waikato and New

Zealand) 21 Figure 8: Fuel used to heat dwellings (Tokoroa, Waikato and New Zealand) 22 Figure 9: Fuel used to heat dwellings by ethnicity for usual resident population. 22 Figure 10: The drivers that influence household heating choices. 24

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List of Tables Table 1: Air Quality Standards (MfE, 2005) 4 Table 2: Determinants of health focussed on for the TWHCA Project HIA 11 Table 3: Three policy options presented to the TWHCA HIA workshop 12

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Extended executive summary This report outlines key findings from a Health and Well-being Impact Assessment (referred to throughout this report as a Health Impact Assessment or HIA) conducted in Tokoroa during 2008 as part of the Tokoroa Warm Homes Clean Air (TWHCA) Project. The assessment considers the potential impacts – positive and negative - of proposed air quality policy currently being developed by Environment Waikato on cultural, community, socio-economic and environmental well-being in Tokoroa. A key part of the HIA was a fono held in February 2008.

The report and its recommendations are relevant to the health and local government sectors and others involved in policy, programme and project development linked to air quality, housing quality, the improvement of well-being and reduction of inequalities. It contains specific recommendations relevant to the TWHCA Project and similar projects and processes.

The TWHCA Project is aimed at providing an intersectoral response to air and housing quality issues in Tokoroa. It is intended that this pilot project will develop viable and cost-effective ways of supporting communities across the Waikato region to change their air quality.

The most relevant ambient air quality standard for Tokoroa is PM10 (fine particles less than 10 microns in diameter). Environment Waikato monitoring has shown that PM10

emissions regularly exceed the National Environmental Standards (NES) during winter. The main contributor to PM10 emissions is domestic solid fuel heating, especially older indoor wood burners.

The TWHCA Project’s aims are to:

meet the NES by 2013 eliminate manageable PM10 within 20 years in Tokoroa ensure long term improvement in air quality for the community ensure equitable and effective access to all aspects of the project contribute to the improvement of cardio-respiratory health linked to ambient air

quality, home heating and insulation prioritise the health gain of Māori, Pacific people, lower socio-economic groups and

older persons, and contribute to balancing social, economic, environmental and physical well-being for

the benefit of the Tokoroa community, now and in the future. The TWHCA Project’s key stakeholders include the Raukawa Trust Board, and the Tokoroa community the South Waikato Pacific Islands Health Committee Environment Waikato the Waikato District Health Board South Waikato District Council the Ministry for the Environment the Energy Efficiency and Conservation Authority

The Health Impact Assessment process used Health Impact Assessment (HIA) methodology focuses on the potential direct and indirect health and social impacts of policy before implementation. It also assesses and the distribution of those impacts across the population. HIA is based on the core principles of creating equal opportunities for improving and maintaining health and well-being and supporting community participation in decision-making processes. An important focus of the TWHCA Project HIA is how the policies developed can reduce inequalities for Māori and support advancement of whānau ora. In this sense, while the TWHCA Project HIA has not been written exclusively as a whānau ora health impact assessment, it is consistent with whānau ora HIA principles and processes.

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The four key stages in the HIA process are: Screening: Research associated with the TWHCA Project identified the need for significant changes to improve air quality in Tokoroa. Over 60% of households use wood burners for domestic heating. Almost half of these were manufactured before 1995 and are contributing to the town’s high winter levels of PM10 emissions. Many of these houses are likely to be un-insulated and therefore cold and damp. The top 10 causes of avoidable hospitalisation in Tokoroa include heart, disease, respiratory infections and asthma, all of which can be exacerbated by exposure to un-insulated housing and PM10 emissions. However, the research also showed that Tokoroa would be vulnerable to any air policy change that placed a financial burden on the community or restricted economic activity. Annual income and employment rates are below national and regional figures and 99% of households experience some degree of deprivation, with 76% in the most deprived two deciles of socio-economic status. Scoping: A working group scoped the timeframes and resources available for the HIA and refined its aims and objectives. The working group represented: the Raukawa Trust Board (RTB; the South Waikato Pacific Islands Health Committee (SWPIHC); Waikato District Health Board (DHB); and Environment Waikato. Appraisal and reporting: Given time and resource constraints, the working party decided that the appraisal process would be a one-day workshop, focussed on the population groups most likely to be affected by the air quality policy: Māori and Pacific people, who together make up 56% of Tokoroa’s population and are over-represented in low income and poor health statistics. Invitations to the workshop were provided in English, Māori, Cook Island Māori and Samoan and were hand-delivered by Raukawa Trust Board and SWPIHC members to maximise attendance. A total of 22 community members attended the HIA workshop on 19th February 2008. The majority of these people were members of the Māori and/or Pacific communities of Tokoroa. Three policy options were considered by the day long HIA workshop. All options required wood burners to be upgraded by 2013 unless they had been installed post 2004 and all had the same penalties for non-compliance (smoking chimney check, two warnings and then a $300 fine). However, each contained a different financial incentive and differing amounts of support (information and education). The first offered an interest-free loan to all home owners and landlords plus a lot of information and support including community educators. The second a $500 grant for a new wood burner or a $1000 grant for a heat pump or pellet burner, again targeted at home owners and landlords, with some information and no community educators. The third option offered a large grant of $2000 to $4500 to those in high need (low income home owners), some information and no community educators. In small groups, with the help of facilitators, translators and a set of key questions, participants were encouraged to: bring their own experience and knowledge to bear on key questions about the draft

policies and to share their views with other participants comment on their opinion of intended and unintended consequences of the draft

policy options on the Tokoroa community, and explore evidence linking air quality, household insulation and health and, where

appropriate, to relate this to their own experience and recommendations. Following the workshop, the documented discussions from each small group session and the subsequent feedback sessions were collated and this report and its recommendations were drafted. Evaluation: A reflection on project progress since this HIA is provided in Section 7 of this report. See under “Lessons from the Project Implementation Stage”.

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Strategic alignment of this Health Impact Assessment The key objectives of the Tokoroa Warm Homes Clean Air (TWHCA) Project Health Impact Assessment (HIA) were to develop recommendations that: identify unintended consequences of any new policy, positive and negative test the potential effectiveness of the proposed policies. Secondary objectives were: improve well-being and support equity help policy-makers to consider the well-being of their communities help TWHCA Project policy-makers incorporate evidence into policy-making promote an intersectoral work approach contribute to a sustainable development approach in Tokoroa promote understanding of contributing factors that determine well-being (e.g.

ethnicity and deprivation) on health outcomes; and promote a participatory, consultative approach to TWHCA Project policy-making. There is clear alignment between the details of this objective and strategic priorities at national, regional and local levels.

National strategic alignment Reducing inequalities in health, education, employment and housing is one of six goals identified by the New Zealand government for government agencies to work together to achieve. Below is an outline of national level policy which has relevance to or synergies with the TWHCA Project HIA. achieving Health for All People (Ministry of Health, 2003) provides a strategic action

plan for health in New Zealand to improve the overall health status of all New Zealanders and reduce inequalities in health The most effective means to do this requires application of Treaty of Waitangi-based principles and values; intersectoral approaches; use of prevention strategies that encourage behavioural/lifestyle changes; building on existing initiatives and working alongside communities

the New Zealand Health Strategy (Ministry of Health, 2000) has “to assess public policies for their impact on health and health inequalities” as its first objective

the draft Public Health Bill, recommends HIA as a tool for use across the state sector to help influence policy development with respect to improving public health outcomes

opportunity for All New Zealanders (Ministry of Social Development 2004) identifies the government’s two overarching social policy goals as: achieving and sustaining improvements in social well-being; and reducing disadvantage and promoting equality of opportunity for all New Zealanders

the New Zealand Energy Efficiency and Conservation Strategy (Energy Efficiency and Conservation Authority, 2007) outlines a mix of policy components (incentives, regulation and education like those used in this HIA) to improve energy efficiency and sustainability through the provision of warm, dry, healthy homes, improved air quality and reduced energy costs

the New Zealand Housing Strategy (Housing New Zealand Corporation, 2005) has a vision of access for all New Zealanders to affordable, sustainable and good quality housing appropriate to their needs Like this HIA, it acknowledges the inter-relationships between housing, health, social, cultural and economic well-being

the Local Government Act (LGA) (2002) directs the functions of local authorities It states that local government should provide opportunities for communities to discuss their desired outcomes in terms of the present and future social, economic, environmental and cultural well-being of the community The LGA also emphasises the need for equality within and between communities; the sustainable

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management of natural resources and sustainable economic development for future generations; and

the Building Act (2004) sets insulation and heating standards for new houses and alterations to old houses.

Regional and district strategic alignment Three regional/district government organisations (Environment Waikato, the Waikato District Health Board and the South Waikato District Council) and two iwi/community organisations (Raukawa Trust Board and SWPIHC) are key stakeholders in the TWHCA Project and links between their objectives and those of the TWHCA Project and its HIA are consequently strong. The Raukawa Trust Board’s kaupapa/vision is to promote the “Total achievement and development [of the whanau and hapu] of Raukawa”. It provides leadership, advocacy and support to help its people achieve positive environmental outcomes, improve their standard of housing, enjoy healthy lifestyles and access appropriate social services to help improve their quality of life. Air quality is specifically addressed in the current EW Regional Policy Statement (2000) and Environment Waikato (EW) is charged with monitoring and reducing the harm of PM10 emissions within its region. The TWHCA Project’s work with EW and EECA fits well with the aim of the Regional Energy Strategy in advocating for “…energy conservation and efficiency within the community by fostering partnerships at the national and local level”. The community outcomes process in the Waikato region “Choosing Futures Waikato” contains themes related to the protection of the environment, access to health, equity for Māori, cultural understanding and community involvement in decision-making which are all relevant to the implementation and recommendations of this HIA. Waikato DHB is committed to reducing inequalities in all areas affecting the health and well-being of its population. HIA is recognised by the DHB in the Waikato District Strategic Plan (2005) as a tool to identify impacts on health disparities. Both the Waikato District Strategic Plan and the Waikato Health Needs Assessment and Analysis (2008) identify Māori, Pacific people, low socio-economic groups, and older people as priority groups that are at greater risk of poor quality of life and ill health. Health priorities for strategic consideration in the Health Needs Assessment include reducing the rate of lung disease. The Waikato DHB District Annual Plan (2007-08) also acknowledges that for collaborative initiatives to be successful it is vital for all relevant organisations to be focussed on similar goals and directions. The Long Term Council Community Plan for the South Waikato District Council (2006-16) includes the following community outcome themes for Tokoroa: air quality and health are improved through better insulated homes and clean burning; people are safe at home and in the community; Māori and Pacific Island people are consulted in ways appropriate to them; the quality of the District’s natural environment is monitored, protected and maintained and people are encouraged to respect and understand their environment.

Potential impact of the NES and the TWHCA Project in Tokoroa To meet the NES alone, Tokoroa requires a 33% reduction in peak winter PM10 emissions which may involve the conversion of close to 1000 household wood burners. This would have a significant positive impact on the community’s health and well-being and reduce costs associated with hospitalisation, GP visits, pharmaceuticals and

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restricted activity. Raising awareness alone will not encourage sufficient change to meet the NES and achieve these health gains. This is especially true in Tokoroa where culture, housing quality and socio-economic deprivation have a strong impact on people’s choices. Air quality cannot be improved in an acceptable or sustainable way, without providing opportunity to access improved heating and housing conditions

Findings from the TWHCA Project HIA The findings from the TWHCA Project HIA workshop were themed by the writing group according to the four well-beings.

Cultural well-being Tokoroa has a strong heritage linked to forestry. This is reflected in the community’s high dependence on wood to heat homes and water at every income level. Time spent sitting around the fireplace is important for the community’s families. Many people in the community are current or past employees of the Kinleith Pulp and Paper Mill and may have access to free firewood. This ability to provide free wood (and therefore free warmth) for their families is important. These factors are likely to make the community prefer a cleaner wood burner, or a pellet burner over other clean heat systems such as a heat pump. Tokoroa is a culturally diverse community with high proportions of Māori and Pacific people in comparison to the rest of the region and New Zealand. Many of the older Pacific community members still prefer to speak their own Pacific language. The workshop emphasised that clear, culturally appropriate communication – in language and modes the community understands and values – is essential throughout the policy development process and implementation. Kanohi ki te kanohi (face-to-face) interaction, hui, fono, practical demonstrations and use of community workers are all methods that work well for this community.

Social well-being In Tokoroa community networks and agencies provide the trust and security necessary to help people make decisions and changes. A resourced community educator – a trusted member of the community who could interact with families in a culturally suitable way – was seen as an essential policy component. Careful understanding of tenant and landlord issues in Tokoroa is required. Levels of direct home ownership are higher than elsewhere in the district. However, some homes are rented out to family and rent is not always regular and may not reflect the costs involved in maintaining the property. Policy that targets landlords may place extra financial pressure on already struggling homeowners. The risk of landlords passing on the costs of change to tenants was also raised. Converting large numbers of wood burners was seen as a potential work opportunity for the community. Workshop participants were keen to see this work done by locals as long as people had the qualifications to do it safely. Workshop participants were keen to see community consultation continue as an important part of the ongoing policy process.

Economic well-being Tokoroa is vulnerable to economic hardship and the policy options presented at the workshop were felt to affect economic well-being. All of the cleaner heating systems involve significant installation costs. Only the third policy option presented at the workshop was considered to provide a substantial enough grant to cover installation and then only to high need homeowners. Workshop participants felt that this may result in people complying with the policy by choosing

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cheaper-to-buy heating options (which may be un-economical to run or have negative health consequences); or alternatively result in people not heating their homes at all. Workshop participants said that an interest-free loan was not likely to be seen as an attractive option by a community already dealing with debt. Possibilities of the loan being absorbed into council rates, or remaining unpaid until sale of the home or death of the owner, were preferred to fixed payment schemes. Eligibility criteria needs to be considered carefully and developed in consultation with the community. If grants are targeted at low income, high need families, many ‘in the middle’ would be excluded from benefits but would still struggle to make the financial outlay required. Workshop participants were concerned that policy provisions (financial resources, information, incentives and support) be targeted to the most disadvantaged without increasing disadvantage or difficulty elsewhere. None of the policies provide financial incentives for home insulation, although this would be a pre-requisite for a heating system installation grant. Support for this and for ongoing running/maintenance costs was a concern for workshop participants. The fine for non-compliance was also objected to in favour of having a community educator work with the family to resolve issues.

Environmental well-being and project sustainability Workshop participants were concerned that, as awareness of external air quality issues increased, people may compromise the quality of their internal air by using portable LPG heaters (which generate moisture) or not heating their home at all. The environmental sustainability of heating options relying on electricity was questioned as was sustainability of the TWHCA Project in light of possible political change, current reliance on under-resourced community agencies and Tokoroa’s declining population. Life expectancy of appliances was also raised.

Workshop findings It was clear in the community workshop that a mixture of policy options is the most likely to enhance the ability of Tokoroa to comply with the NES. The policy mix would involve tiered incentives (large grants for high need families, smaller grants and interest free loans for others) and support for local capacity building, education and advice. Effective air policy in Tokoroa will create positive outcomes for the community if there is: clear direction, strong, long-term commitment and adequate funding from central

government a significant time commitment responsiveness to the needs of Māori and to cultural effectiveness strong intersectoral collaboration effective community engagement a variety of complementary measures including grants and incentives, awareness

raising, regulation and market transformation additional assistance for low income households, private rental accommodation

and the elderly, and monitoring and evaluation of programmes.

Lessons from the Project Implementation Stage of the Project This section reviews progress on the Tokoroa WHCA project focussing on resources, community engagement and policy effectiveness.

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Project resources

Security of funding There are 1,000 households in Tokoroa that need to make changes. Funding secured to date will enable insulation to be installed in 350 homes and appliances to be upgraded in 200 homes by June 2009. Insulation is essential to the success of the TWHCA Project but securing reliable funding for it has proved difficult. The TWHCA Project experience has exposed a lack of long-term regional strategy in this area, complex funding arrangements in the health sector, lack of coordination and role definition in the provision of insulation and healthy housing, poor linkages with energy efficiency strategies, regular changes to EECA funding criteria and regional inconsistencies, lack of co-ordination between local government and central government funding cycles. Advocacy on the part of the TWHCA Project Team has resulted in the employment of a community member as an assessor for the contractor to help co-ordinate and manage insulation installations particularly from a cultural perspective.

Prioritisation of resources Funds used to date have been carefully targeted to ensure they went first to those most in need in order to achieve the greatest improvements in community health and well-being and reduce inequality. A questionnaire and assessment structure was developed as part of this process.

Other resources The Raukawa Trust Board and SWPIHC provided informal project management, quality assurance, community support services such as communication of project objectives, a translation service, storage and meeting room facilities, and a raft of other invaluable services for the TWHCA Project. This resource-intensive support has been predominantly funded from their own operational budgets.

Community engagement and profile Engagement with local community members (and between stakeholders and the project team) was an important ingredient in the TWHCA Project’s success to date. The TWHCA Project was developed over an 18 month period. This resulted in clear project goals and principles, strong relationships, clear roles and good use of skills amongst stakeholders, development of an evidence-based strategy document, adoption of a reducing inequalities approach, early adoption of clean heat technology and clear understanding of links between sector policy goals. This contributed to a project approach which was relevant to the community, achieved intersectoral goals and enabled access to a wide range of resources.

Policy effectiveness Lessons from the implementation of the TWHCA Project and the HIA are being used to increase the effectiveness of EW’s air quality policy as it is being developed. Since the HIA workshop, EW has drafted an early set of policy options for community consultation which are consistent with the types of policies preferred by workshop participants. The face-to-face involvement of policy planners and other decision-making staff in the HIA workshop increased understanding, connection and accountability of these staff to the community affected by their decisions. Over 200 households in Tokoroa have been upgraded with insulation and clean heat.

Recommendations This section summarises recommendations emerging from the HIA. They are divided into recommendations relating to regional policy development, decision-making

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processes partnership and participation processes policy implementation, and monitoring and evaluation.

Regional policy development

Rate of change 1. Ensure that decisions regarding the timing of policy implementation are made

explicit. Ideally, provide sufficient time for careful consultation regarding rate of change and targeting before final policy implementation.

Incentives and loans 2. Structure financial assistance to ensure that it reaches the most deprived members

of the community first. 3. Undertake community consultation to ensure eligibility criteria for incentives

schemes is carefully developed. 4. Ensure security and accountability of any loan scheme involved in the policy is

clearly established, with specific attention to addressing community concerns about financial administration, hidden costs and experience of loan sharks in the community.

5. Ensure that the beneficiary-exacerbator analysis takes into account the

consequences of imposing additional costs on low income households and assesses the impact of any targeted rate on that community carefully. Indications from this HIA are that an increase in rates on this community may have the following unintended consequences: exacerbation of financial stress on households; possible rent increases as landlords seek to recover additional costs; potentially colder homes as non-complying appliances are removed, but not replaced; and increased pressure on local social service agencies.

6. Reconsider wording of incentives policy as currently developed (see Appendix 5) by

deleting “subject to central government funding assistance”.

Education 7. Enlarge the definition of education proposed in the policy document to “education

and capacity building” to recognise the role of community groups in supporting and enabling communities to make changes.

8. Ensure that education and awareness raising campaigns are culturally appropriate

and readily available through a number of mechanisms, including hui, fono, face-to-face interaction, and other opportunities for clear communication in appropriate languages and through trusted community members.

9. Increase the opportunity for community members to participate in demonstrations of

the different heating options to further determine the advantages and disadvantages of each option for their situation.

Regulation 10. Explore the opportunity to create local level policy mixes according to a town or

city’s unique demographic characteristics, community aspirations and heating practices.

11. Retain as wide a range of heating appliance choices as possible, enabling the

community to choose high quality wood burners and therefore maintain family, cultural, historical and financial connection to the use of wood for heating.

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12. Explicitly recognise the links between insulation and air quality policy by: working actively with other partners to ensure insulation is funded in the

Waikato region; establishing objectives and targets for insulation within a regional air quality

strategy; monitoring progress of insulation, including tracking indicators of ethnicity and

income; and referring to the Waikato Energy Strategy and EW energy policies in the air

quality policy document.

Monitoring 13. Broaden the definition of monitoring in the EW policy document as currently

described by inserting the following clause into the “monitoring section of the plan”: monitor the social, economic and cultural indicators of policy effectiveness,

including ethnicity, income, location; and evaluate policy effectiveness on community well-being and behaviour change

using social science evaluation techniques. 14. Monitor the social, economic and cultural indicators of policy effectiveness. 15. Monitor the access and effectiveness of policy implementation for Māori.

Decision-making processes

Transparency in decision-making 16. Make policy decisions and criteria for those decisions explicit throughout the

process. This enables communities and other stakeholders to understand and track how and why decisions are made throughout the policy process. This is especially important when trade-offs are made between one aspect of community well-being and another, e.g. for example an incentives scheme is modified because of resource constraints.

17. Maximise the opportunity for decision-makers and community representatives to

meet and discuss decisions in a format that includes culturally-appropriate communication.

Stakeholder and community engagement 18. Communicate and consult with the community throughout the policy development

and implementation processes. 19. Undertake further consultation on the next round of policy options for the purpose of

considering the impact of the pace of change that will be required by communities to achieve and enforce the 2013 deadline, including investigating the availability of appliances and trades people.

20. Undertake workforce capacity research in the region and consider the application

for funding for community capability improvements in the installation of insulation and clean heat systems.

21. Emphasise the need for an intersectoral approach, in particular strengthening the

links between the energy, environment and health sectors and improving these sectors’ understanding of the broader determinants of well-being and the upstream causes of unequal health outcomes.

22. Retain a focus on reducing inequalities, including the use of tools such as HIA,

Whānau Ora HIA and the Health Equity Assessment Tool during TWHCA Project implementation.

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23. Develop a long-term intersectoral resourcing strategy for the installation of

insulation and clean heating appliances. 24. Secure proactive intersectoral participation from those sectors currently absent

from TWHCA Project processes, such as the Waikato Public Health Organisation, Ministry of Social Development, Te Puni Kokiri, Ministry of Pacific Island Affairs, Housing NZ, WEL and Education. An intersectoral approach is not only necessary for consideration of appropriate and sustainable resourcing of insulation and clean heating appliances but also for consideration of the maintenance costs of heating appliances for the most socio-economically disadvantaged sectors of the community.

25. Link proactively with other sector strategies and projects such as Healthy Housing

Waikato and the Regional Energy Strategy.

Partnership and participation processes 26. Give effect to the provisions of the Treaty of Waitangi by:

enabling an effective role of Māori (including Raukawa Trust Board members) in policy decision-making

resourcing Māori community workers involved in implementing policy ensuring that overcoming barriers to policy implementation for Māori are

prioritised to maximise benefits from heating conversion for Māori ensuring any awareness raising campaigns associated with policy are

appropriate and effective for Māori ensuring Māori and other disadvantaged groups continue to be partnered and

engaged effectively throughout policy process; and ensuring adequate records are kept in policy implementation to enable

measurement and analysis of equitable project participation and project outcomes for Māori.

27. Ensure that the Tokoroa air quality policy respects current practices and traditions

for Māori and Pacific community members, while still improving air quality. 28. Enhance the role of South Waikato District Council in the TWHCA Project by:

resourcing a community-oriented project manager, with the appropriate cultural skills to continue work as achieved by the community organisations described in section 7.2.3.; and

enhancing representation of SWDC at consultation events.

Policy implementation 29. Ensure project implementation complies with best practice building standards.

Insulation 30. As insulation is a pre-requisite for eligibility for clean heat conversions, ensure that

insulation retrofitting continues in Tokoroa and is prioritised appropriately. 31. In the short term, regional stakeholders should target limited insulation funding by

considering the following: is the project requiring insulation funding well established, with a good track

record and good local representation are systems and processes in place for prioritising the funding appropriately for

this community (for example considering ethnicity, socio-economic need and other requirements specific to the funding organisations)

to what extent will these funds maximise health and well-being benefits to the local community and reduce ethnic and socio-economic inequalities in health

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to what extent will these funds complement other organisations’ work in the local area (such as clean heat funding) and therefore how does this funding strengthen intersectoral relationships; and

how important is this insulation funding to sustaining the project in this area. 32. Ensure that a sustainable, long-term strategy for the provision of resources for

insulation is developed in the region. This strategy should: include the development of further strategic partnerships with EECA and MoH1

that include regions beyond South Waikato have robust eligibility and prioritisation processes which consider socio-

economic and ethnic inequalities in health outcome allow for the alignment of the funding cycles of the relevant sectors include clear commitment of funding from all relevant sectors such as health, to

minimise the complexity of the organisational processes include effective Māori partnership and participation ensure clarity regarding stakeholder roles and coordination. Coordination could

be facilitated by either EW or Waikato District Health Board (recommendations from a Tokoroa stakeholder forum and the District Health Board suggesting the former); and

strengthen linkages between the Waikato Regional Energy Forum and air quality projects which support insulation (and therefore energy efficiency) initiatives.

Maximise positive policy consequences 33. Maximise the ability of policy to prioritise Māori, improve Māori health outcomes

and reduce health inequalities. 34. Provide effective incentives and community support to prioritise low income

householders to switch to clean heating. 35. Continue to support intersectoral partnership development throughout policy

implementation. 36. Continue to support community engagement in policy development and

implementation, and to appropriately link policy decision-makers with community representatives.

37. Ensure that the final policy options contain a tiered structure which mixes financial

resources, education, and community support. 38. Maximise capacity building and community development opportunities within the

project: support and sustain regional business opportunities and local employment negotiate the best possible prices for appliances ensure availability and quality of trades people installing appliances continue to involve those such as the periodic detention workers to clear debris

from under homes of those who cannot do it themselves enhance awareness about appliance choices (including hidden and up front

costs of different choices, most appropriate options for the Tokoroa community); and

provide an introductions and language translation service for insulation and clean heat installers going into homes.

1 Since 2004 the Ministry of Health has been a financial contributor to the EnergyWise Home Grants Scheme

administered by EECA,. The Ministry of Health’s contribution to the Scheme was $0.889 million (excl GST) in 2004/05, rising to $1.778 million (excl GST) in 2005/06 and out years (2004 Budget Package: Vote Health _ CAB Min (04) 13/3/(33) Refers). In Budget 2007 an additional $1.8 million in 2007/08, 2008/09 and 2009/10 was appropriated into Vote Health and was transferred to EECA through a fiscally neutral adjustment. In Budget 2008 ???? was appropriated additional funding. As a result Vote: Health is contributing $7.5 million per annum towards EECA’s ENERGYWISE™ home grants programme for 2008/09 and 2009/10 financial years.

Minimise negative unintended policy consequences 39. Minimise the need for low income households to service expensive loans to obtain

high quality heating, including loans that require the payment of interest rates on the sale of the house or death of its owner.

40. Minimise the need for financial co-payments for insulation and clean heat provision,

from low income households. 41. Minimise the risk of households changing to un-flued gas by considering regulation

to phase out the sale of un-flued gas heaters. 42. Raise awareness regarding negative effects of un-flued gas, and the inefficiency

and energy costs of portable electric heating. 43. Seek to understand the impacts of the life expectancy of appliances on

communities and the impact of this on the sustainability of communities converting to heat pumps. Advocate to government for clarity on this issue.

44. Ensure that community members understand the need to turn the power off during

clean heat and insulation, which may require temporary heating measures to be put in place.

45. Link with local social service agencies to ensure that low income householders are

assisted with maintenance costs of clean heat appliances. 46. Focus on policy implementation for Māori, Pacific and low socio-economic

householders.

Support communities to make changes 47. Ensure policy implementation includes:

continued employment of at least one local community member as an assessor for the eligibility and provision of insulation and clean heat systems into homes

careful engagement and development regarding eligibility criteria for incentives schemes; and

careful understanding of cultural priorities and historical practices in Tokoroa. 48. Ensure that the current role(s) undertaken by Raukawa Trust Board and SWPIHC

members, including the community educator/assessor roles, are appropriately resourced.

49. Recognise the need for policy implementation to be highly targeted to support

change: promote dissemination of information about the project and the changes and

choices through community networks in a targeted way, rather than relying on printed media such as newspaper reports and leaflets (i.e. adopt a social marketing approach to education);

prioritise kanohi ki te kanohi (face-to-face) interaction and conveying information through trusted community workers

proactively target specific communities such as landlords and tenants; and explore opportunities such as the Housing Energy Rating Scheme to publicise

information regarding housing insulation and energy efficiency for potential renters and home buyers.

Enforcement 50. Apply the fine for non-compliance with discretion, recognising the barriers that low

income households may face when making changes.

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51. Explore the opportunity for local community assessors to assist those who are unable to comply and to ensure these households are receiving all the support available.

Dissemination 52. Disseminate this work to governance and decision-making levels of stakeholder

groups. 53. Return the results of the HIA to the community verbally.

Monitoring and evaluation 54. Develop a register of homes that have been insulated, to be potentially provided to

potential buyers and renters as well as to coordinate with the provision of clean heat systems.

55. Monitor project progress and policy implementation transparently using EW

Geographic Information System (GIS) analysis, to provide pictorial representation of insulation and clean heat systems according to project criteria (such as age of housing stock and socio-economic status).

56. Consider resourcing an independent evaluation of the policy implementation, as

conducted for the TWHCA Project Stage 1. 57. Specifically evaluate policy implementation progression against the

recommendations provided in this report.

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1 Introduction

1.1 Report overview This report provides the key findings from an impact assessment workshop that was conducted in Tokoroa in February 2008 as a component of the Tokoroa Warm Homes Clean Air (TWHCA) project. For this report, the workshop and associated background material related to policy development, is described as a ‘Health Impact Assessment’, or ‘HIA’. It could equally be described as a Social Impact Assessment, or a Well-being Impact Assessment. However, it is important to note that the process of developing this report and the policy recommendations included look beyond ‘health’ as a physical entity and recognise the importance of many other aspects of health, including its cultural, community and socio-economic dimensions. This report also acknowledges the role that the environment plays in health and well-being. The environment is defined in the Resource Management Act as: a) ecosystems and their constituent parts including people and communities b) all natural and physical resources c) amenity values d) the social, economic, aesthetic and cultural conditions which affect all the matters in

A-C (New Zealand Government, 1991). To this end, this report and its recommendations are relevant many sectors (governmental, regional and district council, non-governmental, community) that are involved in policy, programme and project development linked to air quality, housing quality and the improvement of well-being and reduction of inequalities related to the TWHCA Project. This report is structured into the following sections: Section 1 describes the generic Health Impact Assessment Tool and why impact

assessment is a key component of the development of policy relating to the TWHCA Project

Section 2 provides the methodology of this impact assessment, including the focus of the community workshop held in February this year and the policy options considered

Section 3 provides the strategic overview of this impact assessment at national and regional levels

Sections 4 and 5 describe the Tokoroa community profile and how this profile influences the ability of the community to comply with the policies involved in this impact assessment

Section 6 outlines the findings from the HIA Section 7 provides information on the conclusions, considerations and

consequences of project implementation, subsequent to the impact assessment workshop

Section 8 provides recommendations for decision-maker consideration. This impact assessment was conducted with the input and support of a number of stakeholders, most importantly the members of the Tokoroa community that attended the impact assessment workshop (the majority of whom were Māori or Pacific). The recommendations in this report were developed from the workshop in Tokoroa and apply specifically to this community and the Waikato region generally. However, it is likely that some of the negative and positive impacts of air quality policy options (and therefore some of the recommendations) will apply to other regions developing similar policy to comply with National Environmental Standards for Air Quality.

The recommendations presented here provide policy decision-makers with an important opportunity to consider factors that influence the well-being of this community in their approach. These recommendations are not binding.

1.2 What is Health Impact Assessment? “the main purpose of health impact assessment is to enhance the policy-making process. It is a practical aid to help facilitate better policy-making that is based on evidence, focused on outcomes and encourages collaboration between a range of sectors and stakeholders.” (Public Health Advisory Committee, 2004 p.3)

Policy-level impact assessment, particularly that which considers the economic, environmental and social consequences of policy, is not new. Health Impact Assessment (HIA) is a more recent tool. It expands impact assessment methodology to examine any proposed policy, strategy, plan or project for its potential positive and negative impact on the health and well-being of a population and for any effect on health inequalities (Public Health Advisory Committee, 2004). Internationally, the World Health Organisation supports the use of HIA because of its ability to influence policies, programmes and/or projects and to provide a foundation for improved health and well-being of people likely to be affected by such proposals (World Health Organisation, 1999). The New Zealand government also has a commitment to HIA to help develop policy that maximises improvements in well-being and reduces inequalities. In 1998, the National Health Committee recommended that: the Ministry of Health review its current opportunities for input into the policies of

other sectors, collecting evidence and producing high quality advice from a health perspective

health considerations influence central government policy on the funding and provision of basic utilities such as water and electricity, and

local authorities are supported to consider explicitly the health impact of changes to the provision of recreational and environmental services, especially the effect on lower socio-economic groups (National Health Committee, 1998).

In August 2006, the Ministry of Health set up a Health Impact Assessment Support Unit as part of a wider strategy to improve health and reduce inequalities in New Zealand. One of its aims is to embed health impact assessment into public policy and establish it as good practice to support informed decision-making. A report also released at this time, recommended increased investment in ‘sustainable partnerships between local government and the health sector’ to increase collaborative action to improve health and well-being. (Public Health Advisory Committee, 2006). Evidence and practice suggests good communication and collaboration are crucial for effective outcomes. Good health and well-being ‘is significantly an outcome of the setting in which people live their lives’ and as such is a shared responsibility (Public Health Advisory Committee, 2006). In 2007, the Whānau Ora Health Impact Assessment tool was launched by the Ministry of Health. This is a tool to predict the potential health effects of a policy on Māori and their whānau to align with He Korowai Oranga and the promotion of whānau ora (Ministry of Health, 2007). This tool pays particular attention to Māori involvement in the policy development process and articulates the role of the wider health determinants in influencing health and well-being outcomes. Further information regarding whānau ora is provided in Appendix 1. HIA can also be recognised as a valuable tool at the local government level to help recognise community outcomes and deliver social, cultural, environmental and economic well-being as set out in the Local Government Act 2002 (Canterbury District Health Board, 2006).

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The HIA methodology focuses on the potential direct and indirect health impacts of policy before implementation and the distribution of those impacts across the population. It examines many impacts on the health and well-being of a population which are outside the control of the health sector such as influences (or determinants) in the social and economic environments in which people make decisions about their lives and those of their family (Public Health Advisory Committee, 2007). The HIA methodology is explicitly based on the core principles of equity and fairness (creating equal opportunities for improving and maintaining health and well-being) and supporting community participation in decision-making processes. Once the direct and indirect impacts and the distribution of any intended or unintended consequences of policy are identified, the HIA develops a set of recommendations to inform the policy decision-making process. These recommendations are evidence-based and outcomes-focused and aim to mitigate the negative impacts and protect the positive impacts on health, well-being and health equity of the proposed policy. It is recognised that sometimes policy makers may opt for decisions which are not ideal in terms of health and well-being in favour of other priorities, for example, economic growth. The HIA process helps ensure that, where a trade off is involved, the decisions are transparent and the likely impact on health and well-being is readily understood by all those affected by these decisions. HIA methodology also encourages stakeholders to monitor implementation of recommendations over time (Public Health Advisory Committee, 2007).

1.3 The Tokoroa Warm Homes Clean Air Project and HIA

The primary aim of the Tokoroa Warm Homes Clean Air (TWHCA) Project is to provide an intersectoral response to air quality and housing quality issues in Tokoroa to improve well-being and meet the National Environmental Standards for Air Quality.

1.3.1 National Environmental Standards for ambient air quality In September 2005, five ambient standards for air quality came into effect (Table 1). These are part of 14 national environmental standards introduced through the Resource Management act 1991. They included National Environmental Standards relating to certain air pollutants, dioxins, and other toxics. Regulations 2004 (made under the Resource Management Act 1991). The National Environmental Standards (NES) are administered by the Ministry for the Environment (MfE) and aim to reduce air pollution and protect the health of all New Zealanders (Ministry for the Environment, 2005a,b). These standards for air quality set maximum thresholds for five commonly recognised, or key, air pollutants. These are PM10 particulates, nitrogen dioxide, carbon monoxide, sulphur dioxide, and ground-level. The most relevant ambient air quality standard for Tokoroa is that of PM10, which must be met every day of the year except one (Ministry for the Environment, 2005 a,b). The NES have been developed because of the negative impact that poor air quality is currently having on health. There is accumulating evidence for an association between exposure to PM10 particles (which can penetrate the lower respiratory system) and adverse health effects. Acute effects of PM10 pollution include increased mortality (approximately 1% increase in mortality for each increase of PM10 by 10 μg/m3), increased hospital admission rates for respiratory disease, additional visits to doctors, increased prescription of medicines (particularly for asthma) and more days off work and school (Fisher et al., 2007). There is also increasing evidence of long-term adverse effects associated with chronic exposure to particulate pollution such as cardiovascular and respiratory mortality, bronchitis and reduced lung function. To date, no safe level of PM10 exposure has been identified and the population groups that appear to be more sensitive to PM10 exposure include the elderly, children and infants and those with pre-

Doc # 1508034 Page 3

existing respiratory, chronic disease and/or heart disease. People of maori and pacific island descent and those experiencing high levels of socio-economic deprivation are disproportionately represented in these health statistics. The direct costs of health care alone that result from PM10 emissions in New Zealand are conservatively estimated at approximately $270 million per year (Fisher et al., 2007).

Table 1: Air Quality Standards (MfE, 2005)

Pollutant Standard Time average

Allowable exceedances (per

year)

PM10 (fine particles less than 10 microns in diameter)

50µg/m3 24-hours 1

Carbon monoxide 10mg/m3 8-hours 1

Nitrogen dioxide 200µg/m3 1-hour 9

Ozone 150µg/m3 1-hour 0

Sulphur dioxide 350µg/m3

570µg/m3

1-hour

1-hour

9

0

Management of NES compliance within designated air sheds is directed to regional councils and unitary authorities under the Resource Management Act (New Zealand Government, 1991). Environment Waikato is responsible for the air shed that includes Tokoroa. Failure to comply with the NES by 2013 may result in restrictions on the ability of regional councils to grant resource consents for discharges to air (Wilson, 2007). This may have a significant impact on the economic well-being of communities. Environment Waikato has monitored the air quality in Tokoroa for several years. This monitoring has shown that PM10 emissions regularly exceed the NES during winter. In 2004, the daily standard of 50µg/m-3 was exceeded on 41 days (Figure 1) and the highest measured PM10 concentration for Tokoroa to date is 91µg/m-3 measured during 2007 (Environment Waikato, 2008b).

0

20

40

60

80

100

120

1/01

/200

4

31/0

1/20

04

1/03

/200

4

31/0

3/20

04

30/0

4/20

04

30/0

5/20

04

29/0

6/20

04

29/0

7/20

04

28/0

8/20

04

27/0

9/20

04

27/1

0/20

04

26/1

1/20

04

26/1

2/20

04

PM

10

µg

m-3

Guideline

Figure 1: Air quality monitoring for PM10 emissions in Tokoroa, 2004

The main contributor to PM10 emissions in Tokoroa is domestic solid fuel heating (89%), specifically the use of indoor wood burners as a heating source in homes (Figure 2). Indoor wood burners are also the predominant cause of excess PM10 emissions in the approximately 30 urban areas across New Zealand which currently exceed the NES for PM10 emissions (Fisher et al., 2007). An exception to this is Auckland, where transport contributes more to PM10 emissions than home heating.

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Figure 2: Sources of PM10 emissions in Tokoroa

The annual costs relating to health impacts from PM10 pollution in Tokoroa are significant. The 2006 costs for hospital admissions, productivity losses and GP visits in Tokoroa are estimated to be $552,264 (Barnes, 2008). In addition, the greatest costs associated with emissions from and/or inadequacies of home heating are likely to be in areas where the values are not currently quantified, such as loss of life, loss of ability to fully enjoy life through illness, time away from school for children and lost education and opportunities.

1.3.2 Housing quality Along with air quality, housing is a key influence on well-being. Over two thirds of the housing in New Zealand was built before the 1977 Building Code made it mandatory for new dwellings to be insulated during construction. In 2001, approximately half of New Zealand homes were still not fully insulated and a quarter of homes were not insulated at all (Howden-Chapman et al, 2007). Most people only heat the living room and occasionally a bedroom (Howden-Chapman, 2000). Cold, damp, mouldy, and overcrowded houses result in increased morbidity through infectious disease, respiratory illness (particularly asthma) and heart disease and also result in days off school and work. In addition, the colder the house, the more fuel householders use for heating. Fitting insulation is a cost effective intervention for improving health and well-being and is well accepted by the community, policy makers, and politicians (Howden-Chapman, 2007). In the South Waikato District 90% of houses were built before 1980 and are therefore likely to be poorly or un-insulated. Up until 2007, only 1.5% of South Waikato homes have had insulation packages installed through a formal retrofit programme. The South Waikato District has one of the lowest levels of insulation retrofit activity in the Waikato DHB region relative to need, deprivation, ambient air temperature and air quality (Atatoa-Carr, 2008) (Appendix 2).

1.3.3 The NES and housing In areas such as Tokoroa where houses are poorly insulated (requiring excess fuel use for heating) and householders rely on the use of wood burners (resulting in PM10

emissions) there is clearly a direct relationship between the NES and housing quality. The risks associated with poor air quality and substandard housing conditions are not evenly spread across the Tokoroa community. Older un-insulated housing in a poorer state of repair is more likely to be rented. Those who rent rather than own their houses are more likely to be of lower socio-economic status, so the impact of inadequate housing on well-being is likely to be even more marked for those on lower incomes and with less formal education. Those who rent houses and have restricted economic circumstances are also more likely to be those living with pre-existing respiratory and cardiovascular conditions leading to enhanced vulnerability to poor air quality exposure. Policy that effectively reduces high levels of PM10 emissions may make it more difficult for low income households to budget for their basic needs – particularly those accustomed to collecting ‘free’ firewood because of their proximity or relationship

Outdoor burning 5%

Transport Industry

Domestic heating

89%

to the forestry industry and other sources of low cost wood. Members of the community that have restricted economic circumstances are also more likely to use portable heating systems, particularly if there are restrictions on wood burner use. Portable heating systems tend to have high operating costs for the individual households and provide inadequate heating. Portable LPG heaters also create significant problems with damp air and indoor air pollution (Ministry for the Environment, 2005a). This is because un-flued gas heaters release water vapour during the combustion process. Therefore air quality and housing stock in Tokoroa are important contributors to inequalities in social, economic, environmental and physical well-being in this community.

1.3.4 The Tokoroa Warm Homes Clean Air (TWHCA) project The TWHCA Project is a collaborative intersectoral project with the following objectives (Tokoroa Warm Homes Clean Air Steering Group, 2007):

meet the NES by 2013 eliminate manageable PM10 within 20 years in Tokoroa ensure long term improvement in air quality for the community ensure equitable and effective access to all aspects of the project contribute to the improvement of cardio-respiratory health linked to ambient air

quality, home heating and insulation prioritise the health gain of Māori, Pacific people, lower socio-economic groups and

older persons, and contribute to balancing the four well-beings for the benefit of the Tokoroa

community, now and in the future. The key stakeholders of the TWHCA Project include: the Waikato District Health Board (DHB); Environment Waikato (EW), the South Waikato District Council; the Raukawa Trust Board; the South Waikato Pacific Island Health Committee; the Tokoroa community; and the Ministry for the Environment (MfE); the Energy, Efficiency and Conservation Authority (EECA) (Appendix 3). An effective intersectoral Steering Group for the TWHCA Project meets monthly in Tokoroa to guide the development and implementation of the project. Stakeholders participating in this steering group (Raukawa Trust Board and the South Waikato Pacific Island Health Committee (SWPIHC), EW, South Waikato District Council, the Waikato DHB Population Health Services,) have continued to demonstrate a strong willingness and commitment to work together to meet the NES policy requirements, improve air and housing quality and build community capacity, and strengthen community involvement. Two stages of the TWHCA Project have been completed (Appendix 4). A logic model developed for the outcomes of the TWHCA Project is presented in Figure 3. An important component of these outcomes is to ensure that no sector of the Tokoroa population is disadvantaged from the project process and that the health gain of Māori, Pacific and low socio-economic groups is prioritised, for reasons outlined in sections 3 and 4.

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Warm Homes Clean Air Project Outcomes and Linkages

1.3 To identify the mo steffective me s to an

achieve NES in Toby 2013

koroa

1.1 A clear understanding by the

community of the issues

1.2 Financial, social and economic barriers facing

each of the various sectors in the com unity m

identified

2.1 Clear choices of home heating options

available

2.2 Ability to make changes to way heat

home

2.3 Incentives programme established

1.4 Information produced can be used to

advise project and s funders

LT1 Eliminate manageable PM10 within 20 years in

Tokoroa

I2 Equitable and effective access to all aspects of

the project

I1 Meet National Air Standard (NES) by 2013

2.4 Prioritise the health gain of Maori, Pacific Island people, lower

socio - economic groups and older persons

I3 Contribute to the improvement of cardio -

respiratory health linked to air quality, home heating and

LT2 Long term improvement in air

quality for the community beyond 2013

LT3 Improved social, economic, cultural and

environmental wellbeing

Long TermOutcomes

IntermediateOutcomes

2010-2007 - 2007 2006

insulation, without increased inequalities in health

-LT4 Improve cardiorespiratory health

conditions

Figure 3: Logic model showing outcomes and linkages of TWHCA

This strategy is informed by the project guiding principles outlined in the Project Strategy

Guiding Principles:

1.3.5 Why undertake a Health Impact Assessment on the TWHCA project? As described in Section 1.2, HIA provides an opportunity to examine the social, cultural, environmental and economic influences on well-being of policies, programmes and projects in development. The use of HIA also enhances community involvement in the policy process and helps decision-makers focus on equity. Significant health impacts of pollution can be expected in urban centres throughout the world, since exposure to PM10 is widespread. As a result, many HIA have used PM10 as the marker of pollution. In London for example, an HIA process was used for the draft London Air Quality Strategy. Other HIA’s on air pollution have occurred in Italy, Austria, France and Switzerland (World Health Organisation, 2002). In Tokoroa, a comprehensive effort is required to work towards meeting the NES. A key aspect of this effort is developing regional policies with components such as rules, incentives and resourced community support. In 2008, the regional council, Environment Waikato, is developing these policy options. This provided the TWHCA Project steering group with an opportunity to conduct HIA to: maximise the positive impact of EW’s air quality policy options on the Tokoroa

community’s well-being by focusing on the social, economic and cultural determinants of health

minimise the negative impacts of the air quality policy options build on the existing collaboration between the government, local government, non-

government organisations and community stakeholders within the TWHCA Project, and develop further intersectoral relationships

ensure that preferred policy mix was mindful of the responsibility of TWHCA Project to improve the well-being of Māori community members and their whānau

maximise the potential of the preferred policy options to reduce health inequalities, particularly for Māori, Pacific and low-socio-economic community members

improve the opportunity of the TWHCA Project to partner and engage community members; and

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allow the policy development process to be explicit regarding any trade-offs necessary between the policy objectives and funding allocations.

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2 The HIA process used The four key stages in the HIA process are: screening, scoping, appraisal and reporting and evaluation (Public Health Advisory Committee, 2004; Figure 4).

2.1 Setting the scope and boundaries of the HIA A working group was set up to determine the boundaries for the HIA. The group was comprised of members of the TWHCA Project Steering Group that represented the following organisations: Waikato DHB (Population Health Services) South Waikato Pacific Island Health Committee (SWPIHC) Raukawa Trust Board; and Environment Waikato. The group met regularly from September to December 2007 and held a planning day in early 2008 to detail the scoping process for this HIA and an implementation plan. The scoping process clarified key requirements such as timeframes and resources available. The aims and objectives of this HIA as well as the determinants of health and the population groups of most interest for this HIA were further defined as described in this section.

Figure 4: The Health Impact Assessment Process (Public Health Advisory Committee,

2004)

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2.1.1 Goals The overall goals for the TWHCA Project HIA are to: contribute to Environment Waikato policy development to meet the NES for ambient

air quality in Tokoroa, using the HIA framework and whānau ora tools; and determine the potential impact, both positive and negative, of Environment

Waikato’s policy options on Māori and Pacific well-being, community participation and equity.

2.1.2 Objectives The objectives of the TWHCA Project HIA are to: conduct a HIA workshop on the TWHCA Project policy options with the Tokoroa

community, particularly with Māori and Pacific community members produce a HIA report on the TWHCA Project policy options with recommendations

that will: improve well-being and support equity help TWHCA Project policy-makers to consider the well-being of their

communities help TWHCA Project policy makers incorporate evidence into policy-making promote an intersectoral work approach contribute to a sustainable development approach in Tokoroa promote understanding of contributing factors that determine well-being (e.g.

ethnicity and deprivation) on health outcomes promote a participatory, consultative approach to TWHCA Project policy-making

feed back these recommendations to the TWHCA Project Steering Group, the policy makers and the Tokoroa community; and

highlight the use of HIA in similar project/policy processes.

2.1.3 Population groups most affected The HIA working group favoured an inclusive approach for this HIA process. However, given the time and resource constraints it was decided that the HIA workshop would focus on the population groups determined to be most likely to be affected by potential air quality policy and therefore most important to have a voice: Māori (a priority population for public health action and for partnership and

participation) Pacific – particularly Samoan and Cook Island (the predominant Pacific ethnicities

in the Tokoroa population) low income elderly disabled.

2.1.4 Determinants of health and well-being affected HIA methodology focuses on the influence of policy options on factors that contribute to community health and well-being or determinants as illustrated in Figure 5.

Figure 5: The Determinants of Health and Well-being

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This focus ensures that the strongest influences on a community’s ability to make healthy choices (or indeed to comply with policy) include the social, cultural, economic and environmental context within which people live. Understanding the range of direct and indirect factors that contribute to community well-being and how they interact is important to develop policies that have maximum positive impact on well-being and equity. For example, a family in Tokoroa may live in un-insulated housing that they are unable to improve because of low income. This family may use an ageing wood burner as its only source of heating and access free firewood because of its relationship to the local timber mill. Members of this family may be in the house all day requiring ongoing heating and have pre-existing respiratory conditions worsened by cold, damp housing. The cultural context of this family may result in older family members placing their own individual physical health at a lower priority than expenditure on heat and focusing on caring for their extended family and community networks. The HIA working group used evidence from project screening processes (such as the Tokoroa community profile, barriers to change and economic evaluation) and the participants at the HIA workshop, to identify specific health determinants as priorities for consideration in this HIA (Table 2). These determinants are grouped under the four well-beings as described in the purpose (section 3) of the Local Government Act 2002. To this end Section 3 provides for local authorities to promote the economic, social, environmental and cultural well-being of their communities, taking a sustainable development approach.

Table 2: Determinants of health focussed on for the TWHCA Project HIA

Well-being Component of well-being

Cultural well-being expression of cultural values and practices cultural participation

Economic well-being creation and distribution of economic resources income levels economic security affordability of quality housing

Social well-being education level and opportunities for skill development

social support and social cohesion participation in community and public affairs

Environmental well-being external and internal air quality

energy efficiency

security of electricity supply

longevity of heating appliances and impact of disposal on waste stream

2.2 Policy packages to be assessed The following policy options presented to the HIA workshop were developed by the HIA working group. They represent the relevant policy combinations being developed by Environment Waikato (Table 3).

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Table 3: Three policy options presented to the TWHCA HIA workshop

Policy Option 1

THE RULE (same for all options)

THE MONEY THE HELP THE PENALTY (same for all options)

You have to change your wood burner by 2013 unless it was installed new after 2004

An interest free loan available to all home owners and land lords

A lot of information and support

Regular smoking chimney check.

Two warnings then $300 fine.

Community educators

Neighbours may dob in smoking chimneys.

Policy Option 2

THE RULE THE MONEY THE HELP THE PENALTY

You have to change your wood burner by 2013 unless it was installed new after 2004

All home owners and landlords can access:

a small grant of approx. $500 for a new wood burner or

a large grant of approx. $1000 for a heat pump/pellet burner.

Some information will be available

No community educators.

Regular smoking chimney check.

Two warnings then $300 fine.

Neighbours may dob in smoking chimneys.

Policy Option 3

THE RULE THE MONEY THE HELP THE PENALTY

You have to change your wood burner by 2013 unless it was installed new after 2004

A large grant of $2000 - 4500 is available to those in high need (low income home owners)

Some information will be available

Regular smoking chimney check.

Two warnings then $300 fine.

No community educators.

Neighbours may dob in smoking chimneys.

Since the HIA workshop, Environment Waikato has developed further details regarding the policy options for air quality. This policy update is described in more detail in Section 7.4 and Appendix 5 of this report. The way these policies are implemented is filled out to some extent during Environment Waikato’s ten year plan process (the LTCCP), which is likely to occur between July and November 2008, as described in Section 3.1.4.

2.3 Carrying out the appraisal A day-long appraisal workshop was held on the 19th of February 2008, hosted by the SWPIHC community centre in Tokoroa. The HIA Working Group developed invitations to participate in the TWHCA Project HIA and had them translated into Māori, Samoan, and Cook Island Māori languages (Appendix 6). These invitations were delivered by hand to community members by the Raukawa Trust Board and SWIPHT members of the HIA working group. The HIA workshop (Appendix 7) was opened by tangata whenua present at the workshop. Participants were asked for consent for their comments to be recorded in writing and for their photographs to be taken at the workshop for use in this report and appropriate presentations. Members of the TWHCA Project Steering Group then outlined what was expected from the workshop and provided background information regarding the NES, air quality in Tokoroa, links to health and energy efficiency and the progress of the TWHCA Project. Throughout the background session participants were able to comment and ask questions.

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Following the background session, workshop participants were separated into four small groups, each with facilitators present able to interpret discussion and workshop information into Māori, Cook Island and Samoan languages. Each small group also had an independent observer to record the group’s discussions. Members of the HIA Working Group were available for facilitation and recording discussion. Each small group assessed each of the three policy options in turn and participants had the opportunity to: bring their own experience and knowledge to bear on key questions about the draft

policies and share their views with other participants comment on their opinion of intended and unintended consequences of the draft

policy options on the Tokoroa community; and explore evidence linking air quality, household insulation and health and, where

appropriate, to relate this to their own experience and recommendations. The following set of questions was provided as a guide for each group’s discussion relating to each of the three policy options: What are the good things about this policy (for you, your whānau and your

community)? What are the not so good things about this policy (for you, your whānau and your

community)? Who will be able to comply with this policy and who may not? Who do you think will benefit the most from this policy? What do you think decision-makers need to know about this community and the

possible effects of this policy? Here, workshop participants were encouraged to consider the impact of the aspects of each policy option on the determinants of health listed in 2.1.4.

The small group sessions on each policy option ended with a feedback session to the whole group. This was also recorded in writing. Each workshop participant completed a short evaluation questionnaire towards the end of the day. These were collected by the staff team at the workshop. Following the workshop, the documented discussions from each small group session and from the feedback sessions were collated and a small writing group formed. The four members of the writing group organised the transcribed notes from the workshop into a matrix containing key themes and quotations. This report was drafted by the writing group, who met regularly from February to August, 2008. A short summary report was also drafted by Keri Topperwien specifically for the community groups and individuals who participated in the fono.

2.4 Study limitations and reflections on process Due to the practical limitations of resources and timing, this HIA was conducted with an emphasis on a one-off appraisal workshop. This may have excluded people who wanted to participate but could not attend on that day due to other commitments. The HIA Working Group wanted to ensure strong participation from Māori and Pacific community members, while avoiding assumptions that the workshop participants reflected the views of the wider Māori and Pacific community sectors. Strong Māori and Pacific representation occurred as a result of invitations being coordinated by the Māori and Pacific representatives on the TWHCA Project Steering Group. The people who did attend seemed enthusiastic to participate, engage in discussion and willing to contribute on behalf of the wider community. Many represented broader community groups and were community elders. This HIA is also a component of the TWHCA Project which has collected relevant information and evidence and developed associated reports such as an economic evaluation of the policy options, the Tokoroa community profile and analysis of the

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barriers to change in the Tokoroa community. The content of the HIA reflects this background work. Another possible limitation was the level of detail provided about each policy. The policies were newly developed and detail like eligibility and conditions of individual schemes was limited. Workshop feedback suggested that the community needed access to more information on these policy details to make an informed decision that suited individual circumstances. However, this limitation could also be considered an advantage because of the nature of the discussion regarding the policies at the workshop. This discussion then provided for further policy recommendations from the community regarding additional policy details. Finally, this HIA report has not been written exclusively as a Whānau Ora HIA with a specific focus on Māori and the principles and responsibilities enacted in the Treaty of Waitangi. However, it was recognised by this HIA Working Group, which included representation from the Raukawa Trust Board, that the Whānau Ora HIA process was relevant for this HIA given the opportunity of air quality policy in Tokoroa to impact (positively and negatively) on the health and well-being of Māori families and on inequalities in health for Māori. This HIA also recognises the need for policy development to align with the principles of the Treaty of Waitangi. To this end, the development and implementation of this HIA workshop involved effective Māori partnership and participation within the various time and capacity constraints involved. Furthermore, the report’s recommendations are intended to ensure that TWHCA Project policy development recognises the particular importance of policy to advance the well-being of tangata whenua and the need to focus specifically on improving outcomes for Maori, as well as reducing or eliminating inequalities.

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3 Strategic alignment of this HIA There is a clear alignment between the identified strategic priorities at national, regional and local levels and the goals and objectives of the Tokoroa Warm Homes Clean Air Project and this HIA.

The alignment of this HIA to the strategic direction of the national, regional, and local governments and to the District Health Board is presented in brief here. Further details regarding the strategic alignment of this HIA can be found in Appendix 8.

3.1 National strategic alignment There are a number of agencies that have statutory responsibilities for promoting and/or protecting public health and well-being. In New Zealand two recently introduced pieces of legislation which have increased sector responsibility for protecting the health and well-being of the population are of particular interest to the TWHCA Project – the Local Government Act 2002 and the Building Act 2004. In addition the proposed Public Health Bill is likely to include a statutory acknowledgement of the importance of HIA (Public Health Advisory Committee, 2007). Strategic priority alignment at a national level is significant as it reflects government’s intention to work collaboratively to improve well-being and reduce inequalities and strengthens associated programme implementation and outcomes.

3.1.1 Health and reducing inequalities Reducing inequalities in health, education, employment and housing is one of six goals identified by the New Zealand Government to guide the public sector in achieving sustainable development (New Zealand Government Department of Prime Minister and Cabinet, 2005). The intent is that government agencies work together, focus and report on reducing inequalities as part of their core business in their statements of intent and annual reports (Ministry of Social Development, 2004). The New Zealand Health Strategy (Ministry of Health, 2000) is underpinned by seven key principles which include: good health and well-being for all New Zealanders an improvement in health status for those currently disadvantaged; and active involvement of consumers at all levels. Achieving Health for All People (Ministry of Health, 2003) provides a framework for a strategic action plan for public health in New Zealand. The goals identified in the strategy include improving the overall health status of New Zealanders and reducing inequalities in health. The data clearly indicates that health inequalities exist across dimensions such as socio-economic position, ethnic identity, geographic place of residence and gender (Ministry of Health, 2002). Intervention to help reduce inequalities can occur at a structural, intermediary pathway, health and disability services and impact level. The most effective intervention occurs at a structural level to address the root cause of inequalities. This structural intervention includes policy development in the social and economic sectors (Ministry of Health, 2002). Inequalities are defined as “differences, which are unnecessary and avoidable but in addition are considered unfair and unjust” (Whitehead, 1990. p5). Currently in New Zealand, there are significant inequalities in health outcomes for Māori. Māori have poorer health status than non-Māori at all educational, occupational and income levels, predominantly as a result of social and economic policy and practice. The acceptance of these inequalities breaches the principles of the Treaty of Waitangi and contravenes the New Zealand Health Strategy and other policy (Durie, 1994; Ministry of Health

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2000; Woodward and Kawachi, 2000). Similarly, health inequalities also affect Pacific people in New Zealand and those living in socio-economic deprivation. A focus on reducing inequalities ensures that all population groups enjoy equitable outcomes, which may not result from equal sharing of resources. While there is little agreement as to what changes equate to success, or what degree of intervention is regarded as desirable, comprehensive action is required to address inequalities in a targeted and sustainable way and reducing inequalities is critical for social and economic growth (Ministry of Health, 2002; Economic and Social Research Council, 2006)2. The most effective way to improve health and reduce inequalities in health strategy is likely to require (National Health Committee, 1998; Ministry of Health, 2002; Ministry of Health, 2008; Public Health Agency of Canada, 20083): application of Treaty of Waitangi-based principles and values intersectoral action use of prevention strategies with a focus on social investment (particularly

investment in vulnerable families with children) through appropriate policies and programmes

building on existing initiatives; and working alongside communities to build community capacity. With these in mind, intended outcomes of this HIA include supporting equity, promoting cross-sectoral work and promoting a participatory, consultative approach to the TWHCA Project policy-making, including effective community participation and partnership in the HIA process. The first objective included in the New Zealand Health Strategy (2000) is “to assess public policies for their impact on health and health inequalities” (Ministry of Health, 2000). Since then, actions have been taken to raise the profile of health, well-being and equity considerations on the policy development agenda (Ministry of Health, 2002; Signal et al, 2006). In line with this, use of HIA as a tool has also been included in the Draft Public Health Bill which is awaiting its second reading in Parliament at the time of writing. In this Bill, HIA is included as a recommended tool for use across the state sector to help influence policy development with respect to improving public health outcomes (New Zealand Government, 2007). This is a move to build on the current Health Act (1956) and the Health and Disability Act (2001), neither of which encourage or enable statutory recognition of the health impacts that result from policy development. For more details on the draft Public Health Bill see Appendix 8. There is an increasing awareness of the need to reframe health issues to focus on the importance of prevention and development of a collaborative, cross sector approach to improving the health and reducing inequalities (Public Health Advisory Committee, 2006). HIA methodology encourages and supports this goal. Individuals and policy agencies surveyed after their involvement in HIA’s are very positive about their experience (Public Health Advisory Committee, 2007).

3.1.2 Social and economic well-being Social development aims to improve well-being across a range of areas (such as social assistance, health, education, employment and safety) and support individuals, families and communities to develop and deliver their own solutions (Ministry of Social Development, 2001).

2 Economic and Social Research Council. (2006). Policy briefing publication for ‘Developing the evidence base on

health inequalities and differential effects seminar’ 27 September 2006, London. Retrieved 17 October 2008 from: http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre/Images/Developing%20the%20evidence%20base%20for%20tackling%20health%20inequalities%20and%20differential%20effects_tcm6-17859.pdf

3 Public Health Agency of Canada. (2008). Chief public health officer’s report on the state of public health in Canada 2008. Ontario: Public Health Agency of Canada.

Over recent years in New Zealand there has been an emphasis on strengthening a ‘whole of government’ approach to improving social and economic well-being. The release of Opportunity for All New Zealanders (Ministry of Social Development, 2004) marked a significant step in social development at a national level and brought together the social strategies of over 30 government agencies. Opportunity for All New Zealanders is the social counterpart to the Growth and Innovation Framework, New Zealand’s strategy for economic development. It recognises that social and economic developments are closely connected and that an approach involving both local and central authorities is essential to improving social well-being and reducing disadvantage. The government’s two overarching social policy goals identified in Opportunity for All New Zealanders (2004) are: achieving and sustaining improvements in social well-being; and reducing disadvantage and promoting equality of opportunity for all New

Zealanders. These goals also align with those of this HIA and with the HIA recommendations in Section 8.

3.1.3 Energy efficiency and housing The New Zealand Energy Efficiency and Conservation Strategy, published by the Energy Efficiency and Conservation Authority (EECA) in 2007, is a detailed action plan for increasing the uptake of energy efficiency, conservation and renewable energy programmes in New Zealand through the provision of warm, dry and healthy homes, improved air quality and reduced energy costs. There is a clear commitment to sustainability outlined in this strategy which supports and guides housing, heating, and air quality related project work occurring across the country. The strategy defines the need for a comprehensive mix of policy components, such as those used in this HIA workshop: incentives (including interest free loans and clean heat grants for homes), regulation and education to achieve behaviour change and improve energy efficiency and sustainability (Ministry for the Environment, 2007). The New Zealand Housing Strategy sets out priorities for housing and a programme of action to lead the sector over the next 10 years (Housing New Zealand Corporation, 2005). Its vision is for all New Zealanders to be able to access affordable, sustainable, and good quality housing appropriate to their needs. The strategy acknowledges the complex interrelationships that exist between housing, health, well-being and social and economic development. The Strategy also recognises that housing policy can support wider goals (such as social, cultural and economic well-being) and contribute to sustainable development. The Housing Strategy takes an intersectoral approach, involving central government agencies such as the Housing New Zealand Corporation and the Department of Building and Housing as well as local government, industry and communities to: reduce unmet housing need; reduce inequalities in housing; improve the quality of New Zealand’s housing stock; and develop a housing sector that encourages appropriate provision of, and investment in, housing (Housing New Zealand Corporation, 2005). This HIA also acknowledges the inter-relationships between health, social, cultural and economic circumstances, housing and environmental well-being. The recommendations from this HIA are intended to ensure that an appropriate mix of policy tools is available for the Tokoroa community to maximise improvements in health, well-being and sustainability.

3.1.4 Local Government Act and community outcomes The Local Government Act (LGA) (2002) is the primary legislation that directs the functions of local authorities. The LGA’s purpose includes recognises the diversity of New Zealand communities and states that local government should “…provide opportunities for communities to discuss their desired outcomes in terms of the present

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and future social, economic, environmental and cultural well-being of the community” (New Zealand Government, 2002). To help identify these well-beings, the LGA encourages local authorities to work with their communities to help identify community outcomes in terms of social, economic, environmental and cultural vision and value statements now and for the future. These provide the foundation upon which a local authority can develop its Long Term Council Community Plan (LTCCP). Under the LGA, the LTCCP is expected to plan for at least 10 years (with three-yearly reviews) and describe the intended contribution of each council towards promoting or achieving the community outcomes over the life of the plan. The LGA also requires description of the council’s monitoring of progress towards the achievement of community outcomes and emphasise: the need for equality within and between communities the sustainable management of natural resources; and sustainable economic development for future generations. These are also important themes that arose in the HIA workshop described in this report in Section 6 and are reflected in the recommendations in Section 8.

3.2 Regional and District strategic alignment

3.2.1 Regional Energy Strategy The Regional Energy Strategy sets out the aims and objectives in relation to energy within the Waikato region. The purpose of the strategy is to “advocate for energy conservation and efficiency within the community by fostering partnerships at the national and local level”. The TWHCA Project contributes to this purpose by working collaboratively with key agencies such as EW and EECA to improve overall energy efficiency (Waikato Regional Energy Forum, 2008).

3.2.2 Environment Waikato

3.2.2.1 Regional Policy Statement As described in Section 1.3.1 of this report, EW is charged with monitoring and reducing the harm of PM10 emissions within its region, which includes Tokoroa. Under the Resource Management Act 1991 (RMA), EW is also responsible for developing its Regional Plan and Regional Policy Statement. Air quality is specifically addressed in section 3.6 of the current EW Regional Policy Statement (Environment Waikato, 2000).

3.2.2.2 Community Outcomes: Choosing Futures Waikato The community outcomes process in the Waikato region is called ‘Choosing Futures Waikato’. Community outcomes relevant to the management of air quality and home heating efficiency within the Waikato region are: Our natural environment is protected and respected. Its ecological balance is

restored, its air, soil and water quality is improved and its native biodiversity is enhanced

We are healthy, with active lifestyles and enjoy a total sense of well-being. Everyone has access to affordable quality health services throughout the Waikato region

Māori enjoy the same quality of health, education, housing, employment and economic outcomes as non-Māori

All communities participate in decision-making. They are educated, informed and have the resources they need to take responsibility for their own futures

We are accepting and knowledgeable about the many and diverse cultures and ways of life of the people who live here.

These community outcomes are also themes that are relevant to the implementation process and the recommendations of this HIA.

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3.2.3 Waikato District Health Board

3.2.3.1 District Strategic Plan and District Annual Plan The Waikato DHB aims to improve the health and well-being of its population, including ensuring that the population of the Waikato has access to the prerequisites of health through a whole of government approach (Waikato District Health Board, 2005). The Waikato DHB is committed to reducing inequalities in all areas affecting the health and well-being of its population utilising principles that support overcoming health inequalities (Ministry of Health, 2002). HIA is recognised by the DHB in the district strategic plan as a tool to identify impacts on health disparities (Waikato District Health Board, 2005). The Waikato DHB District Strategic Plan (2005-15) identifies four priority groups in its district that are at greater risk of poor quality of life and ill health: those living in areas of low-socio economic status; the elderly and Māori and Pacific people. In consultation with Waikato communities, the Strategic Plan of the Waikato DHB has adopted the following guiding principles to plan, fund and deliver services (Waikato District Health Board, 2005): improving access to health services for all populations (priority population groups in

particular) within available resources health promotion and strengthening ill health strengthening intersectoral collaboration building workforce capacity to meet the needs of the diverse populations supporting Māori, whānau, hapū and iwi to achieve maximum health gain; and implementing continuous quality improvement in the delivery of health and disability

services that are based on best practice models. The Waikato DHB District Annual Plan (2007-08) indicates a commitment to work collaboratively alongside local and regional authorities in the Waikato DHB region to contribute towards outcomes identified in Long Term Council Community Plans (Waikato District Health Board, 2008a). The Plan acknowledges that for collaborative initiatives to be successful it is vital for all relevant organisations to be focused on similar goals and directions. This is evident in the high levels of stakeholder commitment to date in the TWHCA Project. The Waikato DHB Health Need Assessment and Analysis (2008) makes reference to a broad definition of health. Health or hauora encompasses and is about the treatment of mental well-being (hinengaro), spiritual well-being (wairua) family and community well-being (whānau) and physical well-being (tinana). It states that it is essential to understand the culture and values systems of an ethnic group to accurately explore the relationship between health and society (Waikato District Health Board, 2008b). The population priorities identified in the health needs assessment remain unchanged from those identified in the Waikato DHB Strategic Plan (2006-15) and include: Māori Pacific people those living in low-socio-economic status; and older people (Waikato District Health Board, 2008). Health priorities for strategic consideration in the health needs assessment includes reducing the rate of lung disease. These population and health priorities have clear links to the rationale for the TWHCA Project and this HIA.

3.2.4 South Waikato District Council The TWHCA Project and this HIA directly contributes to the following community outcomes themes for Tokoroa, which have been developed as part of the Long Term Council Community Plan for South Waikato District Council (2006-16).

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Vibrant, growing communities: CO3.2: Air quality and health are improved through better insulated homes and

clean burning CO3.8: People are safe at home and in the community. Standing tall together: CO2.5: Maori and Pacific Island people are consulted in ways appropriate to them. A better environment for our children: CO5.1: The quality of the District’s natural environment is monitored, protected and

maintained and people are encouraged to respect and understand their environment (South Waikato District Council, 2008).

4 Tokoroa community profile As part of the HIA process, a profile of the community that is likely to be most affected by the implementation of air quality policy was developed. Detailed description of the Tokoroa community profile, including history, demographics, socio-economic status and housing can be found in Appendix 9. For the purposes of this document it is important to note the following demographic, socio-economic, health and housing profiles for this community. This information is extracted from a report by Sandra Barns, (2008).

4.1 Demographics Tokoroa was developed around the pulp and paper mill industry and in 2006 and had a population of over 13, 000 in that year. In the 2006 Census, people who identified as either Māori (37%) or Pacific (19%) ethnicity made up the majority (56%) of the Tokoroa population (Figure 6). This compares with Maori (20%), Pacific (3%) and European (70%) in the Waikato region and Maori (14%), Pacific (6%), and European (63%) for New Zealand as a whole. There has been a fall in the population of Tokoroa over the last 15 years, predominantly as a result of downscaling at the pulp and paper mill at Kinleith and in other industries.

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Figure 6: Ethnic groups for usually resident population (Tokoroa, Waikato and

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4.2 Socio-economic indicators In 2006, approximately one-third of households (31%, 1482 households) earned under $30,000 per annum, compared to 25% regionally and nationally. The full-time employment rate in Tokoroa (40%) was below that for the Waikato region and New Zealand (both 48%). More than one-fifth (22%) of the workforce in Tokoroa is employed by the manufacturing sector (Figure 7). The Tokoroa population experiences significant socio-economic deprivation with 99% of Tokoroa households within census area units reflecting some degree of deprivation. The majority of Tokoroa households (76%) are in the most deprived two deciles of socio-economic status (NZDep 9 and 10) and a further 23% in NZDep 6, 7 and 8. This compares with 24% of households in NZDep 9-10 across the Waikato DHB region and 20% for New Zealand as a whole.

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4.3 Health status In Tokoroa, the top 10 causes of avoidable hospitalisation include heart disease, respiratory infections and asthma, all of which can be exacerbated by exposure to un-insulated housing.

4.4 Housing and heating The Tokoroa community has a high dependence on wood for domestic heating, with wood burners the main source of heating in over 60% of households. Almost half of Tokoroa wood burners were manufactured before 1995 (Wilton, 2002). Wood is most likely to be used in homes of people of Pacific Island ethnicity (74%), followed by homes of people of Māori ethnicity (71%). In 2006, 45 households in Tokoroa reported having no heating (Figures 8 and 9).

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5 Potential impact of the NES and the TWHCA Project in Tokoroa

5.1 Change required To improve well-being in relation to air quality and to work towards achieving the NES in Tokoroa by the target date of 2013, considerable intervention will be necessary particularly in this community built around the forestry industry, with wood fuel readily available.

To meet the NES alone Tokoroa requires a 33% reduction in peak winter PM10 emissions, which may involve the conversion of close to 1000 household wood burners, or the conversion of over 50% of household wood burners in Tokoroa. A 28% reduction in PM10 emissions in Tokoroa is estimated to result in: reduced PM10-related annual mortality by 20% reduced PM10-related hospital admissions by 22% reduced restricted activity days by 18% savings of $9,000 per year in Tokoroa hospitalisation costs alone; and significantly more costs saved in GP visits, pharmaceuticals and improvements in

restricted activity. However, as described in the introduction of this report, there is no known threshold below which PM10 emissions are safe for health and the EW Regional Plan sets a higher standard for emissions reduction. Therefore the policy response to poor air quality in Tokoroa needs to focus beyond the NES and 2013 to achieve the maximum improvements in community well-being.

5.2 Drivers and barriers to change Initially, raising awareness and information sharing are important steps in encouraging people to change. However, it is clear that raising awareness alone will not encourage sufficient change to meet the NES and improve community well-being. This is particularly true in Tokoroa where layers of community influence that include cultural norms, housing quality and socio-economic deprivation have an important influence on the choices available to community members. In Tokoroa, a strategy to raise awareness of the negative effects of poor air quality without providing an opportunity to improve access to improved heating and housing conditions is not appropriate or sustainable. Since 2005, the TWHCA Project has attempted to develop a more effective and comprehensive approach that reflects evidence and best practice (Ministry for the Environment, 2005a, b). In New Zealand, the Ministry for the Environment (MfE) has documented the drivers and barriers for New Zealanders to make home heating and energy efficiency improvements. It found that (Figure 10): there is a strong retention of solid-fuel burning among New Zealanders. Reasons

for this include retaining access to local fuel sources (‘free’ or self-collected wood), concerns about the cost and reliability of electricity and gas and the attraction of the flame effect

however, counter balancing this trend, there has also been a steady movement towards heating systems that provide instant heat, therefore there is strong growth in the use of heat pumps in certain sectors and a very large increase in portable gas heater availability and use due to lifestyle and convenience factors; and

portable heating also reflects avoiding the risk of relying on a single heating source and preference for heating that is cheap to purchase, has single room capability, is

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capable of quick heating, easy to control and has low running costs (Ministry for the Environment 2005a).

Figure 10: The drivers that influence household heating choices.

6 Findings of the community workshop/fono A total of 22 community members attended the HIA workshop on 19th February 2008, and over 70% of the participants were members of the Māori and/or Pacific communities of Tokoroa. The findings from the HIA workshop/fono were themed by the writing group and are structured here under the four well-beings: cultural, social, economic and environmental. Within each of these well-beings, key themes emerged from the HIA workshop and these themes relate to the determinants of well-being described in section 2.1.4 and are presented here. A summary results chart combining information from the fono and the community profile is provided in Appendix 10.

6.1 Cultural well-being The policy options presented to the HIA workshop were determined to influence Tokoroa cultural well-being under the following key themes as described in this section: historical practices responsibility; and expression of cultural values and language. Each theme is accompanied by relevant quotes and a summary description of the important features of this theme related by the HIA workshop participants.

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6.1.1 Historical practices

Wood burning is an important part of the history and heritage of the Tokoroa community.

“We sit around the fire.”

“[With a heat pump] there’s no visual link.” “Pacific people will go for a burner.”

Tokoroa has a strong heritage linked to the forestry. It is still very much a ‘mill town’ and much of its economic life has come from forestry. Access to firewood and the use of wood to heat homes and hot water (via a wetback system) are common. There is a high and sustained dependence on wood at every income level which reflects the association of the community with the forestry industry over and above financial constraints on heating. Many workshop participants felt that their wood fires had more than just an aesthetic value. It was considered a tradition to gather around the fireplace and sitting around the wood burner was described as providing a time where the family could all meet together. The ability to collect firewood from the forest and the mill site was another important consideration for these workshop participants and linked to their cultural roots. Therefore, for many community members, the pellet burner and a cleaner wood burner were seen as preferred alternatives to their current system, compared to an electric heat pump.

6.1.2 Responsibility

Providing for other members of the immediate and extended family is one of this community’s highest priorities and at times these responsibilities to family are more important than individual needs.

Providing warmth for the family was an important concept that arose in the HIA workshop. Many of the workshop participants had a family member with current or previous employment at the Kinleith Pulp and Paper Mill and many of these employees say they currently get free firewood to take home. At certain times of the week firewood can also be gathered from the forest associated with the mill, although access has reduced in recent times with new mill ownership. This accessibility of wood and the link between wood and employment was important to members of the workshop. One participant described how three generations of their family worked in the mill and provided wood for free. Now that the mill is “laying people off”, free wood is seen by some as the only remaining benefit of their service to the local industry. Any policy option that moves away from burning wood for fuel will mean that this benefit will become redundant. The community raised their concern about the added strain (in both a monetary and psychological sense) of this change in routine and sense of contribution as family providers.

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6.1.3 Expression of cultural values including language and communication

Throughout the workshop, emphasis was placed on the need for face-to-face interaction and clear communication with the community throughout the policy development process and during any implementation of policy.

“Kanohi ki te Kanohi.” “Language is a barrier to our people.”

“We are a visual and verbal community.” “Make it easy for our people to understand…we have ideas but we

can’t explain.” “Who’s going to change? The people that understand the message.”

“I’m thinking about my children when thinking about the need to change.”

Tokoroa is a culturally diverse community with lower proportions of European people and higher proportions of Māori and Pacific people by comparison to Waikato region and New Zealand averages. Many older Pacific community members speak predominantly their own Pacific language. Throughout the workshop, emphasis was placed on the need for kanohi ki te kanohi (face-to-face) interaction and clear communication with the community throughout the policy development process and during any implementation of policy. Participants agreed that information should be conveyed in a suitable manner that was clear to understand and that community workers would be a good way to ensure that communication was clear and encouraging (this component links to the social support theme in 6.2). It was recognised that the TWHCA Project had already put significant effort into improving community awareness of the issues regarding air quality. Participants mentioned the importance of community hui and fono where this information had been provided verbally to community members. For some, the information was still not clearly understood and workshop participants stressed the need to continue this awareness-raising activity throughout the policy process. The workshop participants noted that it was important for this information-sharing process to focus on health issues and the health impact on children. Communication issues were also described as important for community members that had already been involved in having their wood burners converted to a cleaner heating system. These workshop participants described how they had difficulties communicating with the installers of their heating system and did not know who to talk to regarding appliance and maintenance issues. Participants felt that if there was readily available and accessible information in the form of community demonstrations on the different heating options, then people could learn about and interact with the various models available.

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6.2 Social well-being The policy options presented to the HIA workshop were determined to influence Tokoroa social well-being under the following key themes as described in this section: social support and social cohesion through community networks tenure education level and opportunities for skills development; and partnership and participation. Each theme is accompanied by relevant quotes and a summary description of the important features of this theme related by the HIA workshop participants.

6.2.1 Social support and social cohesion through community networks

Community networks are strong in Tokoroa and information is most effectively transmitted through existing social and cultural activities.

“No community support is not good for our people…We won’t let that happen.”

“When we lose the association between the hard working community members [on the project team] and the community once we get this done

then who will the community have to go to [if there are problems]?” In Tokoroa there is a strong reliance on community networks and agencies to assist community members to make decisions and changes. The workshop participants felt that retaining this community support was a critical component of any air quality policy. Currently, members of the SWPIHC and Raukawa Trust Board are acting as community translators, advocates and supporters: “They are taking the responsibility”. These existing roles are largely un-resourced or under-resourced but are seen by the workshop participants to be providing the wider community with the security and trust required to make changes. Resourced community educators was only included as a possibility within the first policy option discussed at the workshop, yet this component was seen as essential to understanding the eligibility criteria of the loans/grants, making the most appropriate choice between heating systems (according to family circumstances and financial ability) and helping families cope with change required. It was also agreed that the community educator role should be undertaken by a trusted member of the community who could represent and interact with families in a culturally suitable way and that the current commitment of the SWPIHC and Raukawa members was likely to be difficult to sustain.

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6.2.2 Tenure

Careful understanding of tenant and landlord issues in Tokoroa is required. Targeting programmes that place more pressure on landlords may further disadvantage those who have “whanau homes”, or may result in additional financial pressure on tenants.

The proportion of direct home ownership of housing is higher in Tokoroa than in other parts of the Waikato. However, a number of workshop participants expressed concerns regarding the impact of the policy options on landlords and the definition of “landlord”. Conventional definitions (e.g ‘property investors’) may not represent the situation in Tokoroa. As pointed out at the workshop, the need to provide affordable housing for other family members can mean that these landlords may be already struggling to meet the expenses of multiple properties. An example of this was shared at the workshop when a young woman told how she and her partner had brought a house for an aunt and her children to live in, “…so rent is intermittent”. The low rate of rent received by these home owners does not reflect the mortgage and other expenses of the property. A related issue discussed by the workshop participants was that of landlords passing on the costs of changes to their tenants, creating a greater burden on this sector of the community.

6.2.3 Education level and opportunities for skill development

Employing locals and using local businesses is far preferable to using external trades people. It is most likely to result in change because of trust within the community and in sustainable change because of workforce development.

Workshop participants saw the need to convert so many wood burners as an opportunity to build capacity and develop skills in Tokoroa which would be “…better than using people from the outside”. It was questioned whether Tokoroa currently has enough trades people to make these changes. Workshop participants wanted assurance that appropriately qualified trades people would be involved in the process to avoid any possible negative consequences. Workshop participants were concerned that the appropriate number of qualified trades people would be available to implement such changes in the near future in Tokoroa.

6.2.4 Partnership and participation

It is essential that the community voice is involved in policy development and that meaningful consultation is an important part of the ongoing policy process.

“Pacific people will only be able to make the change with one-to-one consultation and the opportunity to sit down and ask questions.”

This community workshop was seen by the participants as an excellent opportunity to make a start in ensuring that the community voice was involved in policy development. However, it was seen as only a start. Many participants said that a lot more work was required to ensure that meaningful consultation was an important part of the ongoing policy process.

6.3 Economic Well-being This community is particularly vulnerable to economic hardship and the policy options presented at the community workshop were felt to affect economic well-being in Tokoroa according to the following themes as described in this section: income and financial burden economic control and security

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distribution of economic resources affordability of quality housing and hidden costs; and financial penalty. Each theme is accompanied by relevant quotes and a summary description of the important features of this theme related by the HIA workshop participants.

6.3.1 Income and financial burden

There is an over-representation of low income families and socio-economic deprivation in Tokoroa which means that any capital costs of insulation or heating changes will have a significant impact on many members of this community and may have further negative consequences on health.

“If the power gets cut off, I can still provide my family with water and warmth if I have a wood burner.”

“If I had a heat pump, I could switch the switch and not know about the size of the bill until the bill comes in.”

“I’m also thinking about my children, their needs…Clean air but also about food, school etc.”

“With your heat pump it’s an ongoing bill. If you’ve got a fire it’s seasonal and you can plan for it.”

The concern of workshop participants about the draft air quality policies reflected the over-representation of low income families and socio-economic deprivation in Tokoroa. All of the cleaner heating systems involve a significant installation cost and a large grant that would cover this installation is only available for high need homeowners in the third policy option. The other policy options would not provide financial cover for the installation cost of the heating systems, let alone consider any maintenance costs (see 6.3.4). Workshop participants described how many of their community members are currently barely able to meet the costs of food, petrol and other basic needs. Concern was expressed that, given the cost of these systems, families may just use cheaper to purchase heating alternatives such as portable electric and LPG heaters because they would not need to come up with a large amount of money up front. Workshop participants described how some community members had had heat pumps installed but did not use them because of their inability to pay existing power bills. One community member was reportedly not going to turn on her heat pump “…until it was paid off”.

6.3.2 Economic control and security

High socio-economic disadvantage in Tokoroa could be compounded by policy that requires financial contribution by community members, or the

servicing of expensive loans.

“We can’t afford it.” “[We don’t want to end up] carrying the debt on our back.”

“When it comes to lending, don’t make it hard.” Many of the participants described the negative effect of existing financial debt in their community and that the possibility of further debt (with or without a fixed repayment scheme) may prevent community members taking up an incentive scheme that involves an interest free loan. If a loan scheme was provided, workshop participants expressed the preference for the loan to be administered locally, with the money circulated within the community. Furthermore, possibilities of the loan being absorbed into council rates, or not requiring payment until the sale of the home or the death of the owner were seen as more attractive than fixed payment schemes.

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Workshop participants also described that in their community the ability to provide any cash outlay was minimal. Therefore it was important that the policy ensured that the project partners obtained the best possible price for heating systems and installation for the community. Support for maintenance costs also needed to be considered. With either loan or grant schemes, the workshop participants stressed that the specific needs of the Tokoroa community needed careful consideration when considering loan eligibility and payments schemes.

6.3.3 Distribution of economic resources

Further work is required to ensure that the eligibility criteria for any of the financial and resource support attached to any preferred policy option is clear and appropriate for the Tokoroa community.

“Who would really be eligible…and would they know?”

“[We will have to] identify [those] that are eligible etc…This will put people off and many will be too Akama – not confident in asking questions and

don’t want to be ‘high need’.” One of the most predominant concerns at the workshop was the need for careful consideration of the details of the eligibility criteria for aspects of the policy options. Community members approved of the policy option that provided a significant grant for low income ‘high need’ families, although this term was not favourable. Many participants expressed that there would be a large percentage of families “in the middle” that would be excluded from these benefits but would be unlikely to be able to make any financial commitment: “What will happen to the next layer up?” While there was some agreement that these community members may access an interest free loan, there was a consensus that this would simply add to currently crippling financial burden and that many of these ‘middle income’ families would be unwilling or unable to take up a loan scheme because of existing financial commitments: “The gap between middle class and low is closing”. Compliance with any policy was also unlikely for those not determined as ‘high need’ if additional support was not available for other costs associated with changing heating systems, such as insulation (Section 6.3.4).

6.3.4 Affordability of quality housing and hidden costs

“Does the loan cover…what….insulation? Maintenance costs?” “Don’t want extra ‘fees’ to be added on…as long as we understand where

our money is going.” In their current state, the policies presented at the HIA workshop have no financial incentive for houses to be insulated. However, a house will not be eligible for an incentive or grant to change the heating system if it is not effectively insulated. There was significant concern from the workshop participants regarding the support and eligibility for insulation provision. Further concern about hidden and/or additional costs associated with the various heating options including: ongoing maintenance costs (such as electricity bills or the cost of pellets for the pellet burner), costs of administering the loan/policy and other housing maintenance issues that are identified in the scoping process for the installation of insulation/heating systems.

6.3.5 Financial penalty

“Fining poor families for keeping warm….a double whammy!” At the workshop, there was also discussion around the inclusion of a fine as a penalty for non-compliance in each of the policy options. This was seen by many participants as further penalising low income families and compounding the problems of debt.

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Getting the community educator/advocate to work with families struggling to reduce their emissions to air was suggested as a more appropriate and effective action.

6.4 Environmental Well-being

6.4.1 External and internal air quality

There are clear links between people being encouraged to change their heating system and those who attempt to get through each winter with

inadequate, potentially toxic, or non-existent heating. Concern was expressed that with increasing community awareness regarding the adverse consequences of poor air quality, people will trade-off their emissions to external air with poor internal air in the form of cold (no heating or poor heating) or the use of portable LPG heaters.

6.4.2 Sustainability

“A lot of power cuts in Tokoroa – electricity is an issue.” “Encouraging electricity with [our] environmental problems is solving one

issue but making another issue.” “There is a reality that Tokoroa is a beautiful town. We never know what

will happen in the next five to ten years.” The community workshop participants mentioned the need to ensure that policy implementation did not have an adverse effect on the environment or environmental resources. This was particularly related to recent concerns regarding electricity supply and the drive for energy efficiency. Additional concerns relating to sustainability in one form or another that were mentioned in the workshop included: concern that 2008 is a national election year – “What will happen if the government

changes or maybe changes their mind” concern regarding the life expectancy of the recommended appliances concern regarding the ability of the current community agencies to maintain their

advocacy and supporting roles for the community as the programme is rolled out; and

that Tokoroa is currently experiencing job losses and a decline in population and it is difficult to determine how these issues may affect the community’s future and ability to comply with air quality policy.

6.5 Equity “Are we reaching the target group?”

“It's very important to understand the makeup of this community.” “Who’s going to pick up the people that fall through the gaps?”

An important theme of equity emerged at the community workshop in discussions under all four well-beings. The participants described clearly the need for policy provisions (such as financial resources, information, incentives and support) to be carefully targeted to the most disadvantaged. Participants also expressed that some degree of disadvantage was very common in Tokoroa and that careful targeting needed to be managed in policy development and implementation to prevent further disadvantage and difficulty. Many of the policy requirements to carefully address equity issues discussed by the workshop participants have been described in the sections above. They relate to: appropriate engagement of Māori and Pacific community members in policy

development and implementation

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close attention to the eligibility criteria for loans and grants; policy provisions determined for landlords and home owners, ensuring that tenants

do not miss out provisions for the ‘middle income’ community members consideration of ongoing costs after cleaning system conversion; and provision for first prioritising opportunities to resource and install insulation.

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7 Lessons from the implementation stage of the project As the writing of this HIA report has progressed (from February – September 2008), implementation of the TWHCA Project has continued in Tokoroa. This has provided further information and evidence for this HIA which has been incorporated into this report. It also provides a more complete record of the TWHCA Project progression and encompasses information that relates to process evaluation. This section incorporates components of the HIA process defined as ‘recommend and justify options for action’, and ‘evaluate the impact of HIA’, as described in Section 2 of this document. The information in this section has been derived from the conclusions drawn from the HIA workshop and the recalled experiences and project notes of several project team members.

7.1 Workshop conclusions An aim of the NES is to improve population health through reducing exposure to poor air quality. This HIA workshop was delivered to identify the components of three draft policy options for air quality improvement that may impact on community well-being in Tokoroa. Such policy development needs to be mindful of upstream social, cultural, economic and environmental considerations and of avoiding the exacerbation of hardship and inequalities. Māori and Pacific people in Tokoroa are particularly disadvantaged in relation to many of the determinants of well-being. These include timely, appropriate and effective access to health and other services, higher quality employment, adequate income and education and high quality housing. As a result, occurrences of ill health which are exacerbated by poor air quality are also higher in these populations. This sector of the community is also particularly vulnerable to any policy intervention that may increase inequity. Work within the Tokoroa community over the past two years has echoed that of the HIA workshop participants regarding the need for an approach that is culturally appropriate for the unique make up of the Tokoroa community and mindful of the principles of the Treaty of Waitangi. Significant and meaningful input from the Māori and Pacific communities into the policy development and implementation stage will be required to identify and overcome the barriers to change and maximise compliance with heating conversion. In Tokoroa, affordability presents a significant challenge to encouraging better, cleaner forms of heating and insulation, especially as wood for fuel is available at little or no cost. The level of deprivation in Tokoroa limits the choices people can make. The ability of this community to fund changes at the household level to improve health at the population level will be limited. This community wants to comply with air quality policy to improve the health status of their families but complying may mean: relying on un-flued gas heaters and suffering from poor indoor air quality relying on inefficient heating such as portable electric heaters; and more families in Tokoroa going without any heating at all. Alternatively, many families will not be able to comply with policy requiring the conversion of their wood burner to a cleaner heating system because of the financial commitment required for insulation provision, appliance installation and possible ongoing energy or appliance maintenance costs. Not complying with these policies may result in families: continuing to use their wood burners (with or without reconditioning); and

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not using their wood burners and using inefficient or no heating instead because of their increased awareness of the impact of poor air quality on community health.

These negative and unintended consequences of air quality policies in Tokoroa are more likely to effect the most disadvantaged and vulnerable sectors of the community, which in turn could increase community inequality. It was clear in the community workshop that a mixture of the policy options is the most likely to enhance the ability of Tokoroa to comply. Such a mix will require a tiered process where there are substantial financial incentives, such as a large grant available for low income and high need families and smaller grants and interest free loans available for others. This would mean that more families would be able to benefit from economic relief. Effective policies will also require resources to support local capacity building, education and advice. More flexibility in the incentive options would allow for variation in individual circumstances. In summary, effective air quality policy in Tokoroa will create positive consequences to the community if there is: clear direction and strong commitment from central government with a long term

commitment and adequate finding a significant time commitment clear responsiveness to the needs of Māori and to cultural effectiveness involvement from all sectors, including central, regional and local government, the

private energy sector and non-profit organisations effective community engagement a variety of complementary measures and initiatives including financial grants and

incentives, awareness raising, regulation and market transformation additional targeted assistance (often financial) to make changes, particularly for

low income households, private rental accommodation and the elderly; and monitoring and evaluation of programmes (Ministry for the Environment, 2005b).

These policy principles are also transferable to other parts of the Waikato region with non-complying airsheds and are reflected in this report’s recommendations (Section 8).

7.2 Project resources This section describes experiences relating to project resources - the leveraging of funding, prioritising of its allocation and provision of community support.

7.2.1 Funding – leverage and coordination The TWHCA Project successfully sourced government funds from a number of organisations for the retrofitting of insulation into Tokoroa homes. These organisations have included EECA, EW, the South Waikato District Council Development Fund, Waikato District Health Board, Waikato Primary Health Organisation4 and the Ministry of Health (see Table 4 below). In addition, the MfE provided $100,000 in the project start up phase to scope barriers to change and field test heating technology. The TWHCA Project’s insulation resources have been significant and can be considered an important indicator of success. Retrofitting insulation into housing is also critical for successful conversion of wood burners to cleaner heating systems, as the have to be fully insulated to receive heating system conversions. However, the processes used to secure, manage and sustain the resourcing for insulation has

4 Primary Health Organisations are the local structures for delivering and co-ordinating primary health care services. PHOs bring together doctors, nurses and other health professionals (such as Maori health workers, health promotion workers, dieticians, pharmacists, physiotherapists, psychologists and midwives) in the community to serve the needs of their enrolled populations. PHOs get a set amount of funding from the government to subsidise a range of health services. The funding is based on the numbers and characteristics (e.g., age, sex, ethnicity) of people enrolled with them (from www.waikatoprimaryhealth.org.nz/wpho/).

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generated many challenges, particularly as much of the funding has resulted from one-off funds, or end of year surpluses. Some of the successes and challenges are described here.

7.2.1.1 Positive results and lessons emerging from the project resourcing Advocacy by the TWHCA Project Team has resulted in the employment of a local community member as an assessor for the contractor, Energy Options. This assessor has appropriately managed and coordinated the process of retrofitting insulation, particularly from a cultural perspective. This has ensured that the project has prioritised Māori and Pacific homes, maximising the improvement of health outcomes and reducing health inequalities. Energy Options has also taken the initiative to combine Tokoroa, Te Kuiti and Taupo communities into one strategic alliance for their 2008/2009 funding application to the EECA. This will enable the latter two communities to access central government funding more effectively than as individual applicants and maximises the outcomes possible within the resource constraints. The project has been successful in securing funding from central and local government; the Waikato District Health Board; and Waikato PHO for both insulation initiatives and clean heat upgrades. Small grants have also been available to install wetbacks. Grants ranged in size from $36,000 up to $300,000 in the years 2007 – 2009. Some funding to support the community liaison teams has been accessed from Trust Waikato ($17,778 in 2007/2008).

7.2.1.2 Challenges relating to resourcing and sustaining funding When there is no ongoing plan for insulation funding significant time and effort is spent negotiating and accessing resources annually. Difficulties then arise as a result of: a lack of a long-term regional strategy for the provisions of insulation complex funding arrangements within and across the government and local

government sectors a lack of agreed stakeholder and coordinator roles for insulation provision and

healthy housing variable linkage between regional energy efficiency strategies, projects and

insulation provisions; and changes to EECA criteria, uncertainty regarding the availability of long-term EECA

funding, the annual funding cycles of government agencies contrast with the 10 year funding cycles of local government.

Recommendations to address these issues are provided in Section 8.

7.2.2 Prioritisation of resources Funds for Tokoroa allocated to date have been carefully targeted, in line with the TWHCA Project strategy document to ensure they went first to those in the community with the highest need. Highly targeting funding also made sure that the TWHCA Project achieved the greatest improvements in community well-being and maximised opportunities to reduce inequalities. Priorities were: householder must hold a community services card (EECA criteria) house must be built pre-1978 house must be located in an area of high deprivation according to the NZ

Deprivation index5 householder identified (predominantly by Raukawa Trust Board and SWPIHC) as

Māori or Pacific; and

5 The New Zealand Deprivation Index is a small area measure of socio-economic position, including deficiencies in

income, home ownership, household composition (single parent, number of people in house), employment, education and access to telephone and cars (Statistics New Zealand).

house has a solid fuel burner needing an upgrade, which is used frequently and is the primary heat source.

The questionnaire and assessment structure developed as a part of this prioritisation process can be found in Appendix 11 of this report.

7.2.3 Other resources There were many other resources made available to the TWHCA Project to assist successful implementation. In particular, Raukawa Trust Board and the SWPIHC contributed informal project management, quality assurance and community support services. These organisations also: hosted project consultation events at community venues participated in the recruitment of the local assessor housed and advised the local assessor and provided resources such as a

temporary laptop provided yard space for a scrap metal waste container diverted the periodic detention team to clear debris from under houses prior to

implementation tracked installations, checked quality, maintained the insulation database and

followed up contractors vetted applications to ensure that Community Service Card status was authentic; answered phone calls from locals checking the legitimacy of the TWHCA Project

(“Is this funding for real? Will I have to pay anything back? Are they loan sharks?”); translated communications material into Māori, Samoan and Cook Islands

languages informed the TWHCA Project team of important community matters impacting on

participation in the project kept in contact with EW to discuss any grey areas in the policy, such as the impact

of chip heaters (for hot water) on emissions and draft rules answered media enquiries and attended photo opportunities; and connected a visit by the Prime Minister and the Minister for the Environment into

the TWHCA Project, enabling staff to negotiate an extension to the grant period. The resource-intensive support provided by these community-based organisations was largely informal and predominately funded from their own operational budgets.

7.3 Engagement and profile Engagement with local community members, as well as between stakeholders and the project team was an important ingredient in the projects success. The TWHCA Project was developed over an 18 month period, while much of the work relevant to this HIA workshop was implemented. This 18 month period was valuable as it enabled: clear discussion about project outcomes and principles stakeholders to strengthen relationships, understand mandates, identify skills and

assess resources available to the TWHCA Project development of an evidenced-based strategy document which integrated social

marketing, capacity building and evaluation knowledge in the TWHCA Project team health sector staff to advocate for a reducing inequalities approach early consultation and piloting of clean heat technology the ability of the TWHCA Project team to establish linkages between policy goals,

such as air quality, health, social development, economic development and energy efficiency. This has resulted in a project approach which was more appealing and relevant to the community, achieved more cross sector goals and enabled access to a wider range of resources

an early decision to combine project objectives (Warm Homes, Clean Air), rather than focus on Clean Air; and

stakeholders to work towards higher quality processes, such as culturally appropriate facilitation, face-to-face fono or hui, meaningful engagement of

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community representatives (particularly kaumatua and members of key agencies such as Raukawa Trust Board and the SWPIHC) and ensuring that cultural traditions, methodologies and world views are a central focus.

Other indications of success to date have included: invitations to make presentations about the TWHCA Project to various fora an approach by a university research term to evaluate links between the TWHCA

Project and community outcomes; and an application by SWDC to enter the TWHCA Project in the local government

awards.

7.4 Policy effectiveness Lessons from project implementation to date can also be used to increase the effectiveness of policy as it is being developed. For example, the TWHCA Project team has been able to feed back suggestions on early policy drafts to EW. Since the HIA workshop, EW has drafted an early set of policy options for air quality (May 2008) for the Waikato region which will require consultation with the community (Environment Waikato, 2008c). In general these options are consistent with the types of policies described at the Tokoroa HIA workshop. For example EW will include a wide choice of heating appliances in its provisions, including high quality wood burners and heat pumps (compared to other regions which have eliminated wood burners). EW has also begun investigating different mechanisms for funding heating upgrades across the region. Councils have a number of ways that they can fund projects such as TWHCA Project. These include: a general rate for all households across the region a targeted rate applied specifically to those communities with non-compliant

airsheds; and rate postponement and reverse equity options. The most common method is a blend of general rates across the whole Waikato region and some community specific rates. The criteria for determining these rates are defined in the Local Government Act 2002 and relate to: who benefits from improvements to air quality (everyone in the region; or just

people in the non-complying air sheds); and who contributes to the emissions. This is often called a beneficiary-exacerbator analysis. Most commonly a mix of charges to both regional rates and local rates is applied, topped up with national funding. An initial assessment of different rating scenarios should be completed by October 2008. Further details regarding this policy development subsequent to this HIA workshop is presented in Appendix 5. Policy implementation to date has also engaged a wide range of relevant stakeholders which increases the opportunity for relevant and credible submissions to the policy process. The face-to-face involvement of policy planners and other decision-making staff in the HIA workshop also had the effect of increasing understanding, motivation, connection and accountability of these staff members to the communities most impacted by their decisions.

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8 Recommendations

8.1 Regional policy development

8.1.1 Rate of change 1. Ensure that decisions regarding the timing of policy implementation are made

explicit. Ideally, provide sufficient time for careful consultation regarding rate of change and targeting before final policy implementation.

8.1.2 Incentives and loans 2. Structure financial assistance to ensure that it reaches the most deprived members

of the community first. 3. Undertake community consultation to ensure eligibility criteria for incentives

schemes is carefully developed. 4. Ensure security and accountability of any loan scheme involved in the policy is

clearly established, with specific attention to addressing community concerns about financial administration, hidden costs and experience of loan sharks in the community.

5. That the beneficiary-exacerbator analysis takes into account the consequences of

imposing additional costs on low income households and assesses the impact of any targeted rate on that community carefully. Indications from this HIA are that an increase in rates on this community may have the following unintended consequences: exacerbation of financial stress on households; possible rent increases as landlords seek to recover additional costs; potentially colder homes as non-complying appliances are removed, but not replaced; and increased pressure on local social service agencies.

6. Reconsider wording of incentives policy as currently developed (see Appendix 5) by

deleting “subject to central government funding assistance”.

8.1.3 Education 7. Enlarge the definition of education proposed in the policy document to “education

and capacity building” to recognise the role of community groups in supporting and enabling communities to make changes.

8. Ensure that education and awareness raising campaigns are culturally appropriate

and readily available through a number of mechanisms, including hui, fono, face-to-face interaction, and other opportunities for clear communication in appropriate languages and through trusted community members.

9. Increase the opportunity for community members to participate in demonstrations of

the different heating options to further determine the advantages and disadvantages of each option for their situation.

8.1.4 Regulation 10. Explore the opportunity to create local level policy mixes according to a town or

city’s unique demographic characteristics, community aspirations and heating practices.

11. Retain as wide a range of heating appliance choices as possible, enabling the

community to choose high quality wood burners and therefore maintain family, cultural, historical and financial connection to the use of wood for heating.

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12. Explicitly recognise the links between insulation and air quality policy by:

working actively with other partners to ensure insulation is funded in the Waikato region;

establishing objectives and targets for insulation within a regional air quality strategy;

monitoring progress of insulation, including tracking indicators of ethnicity and income; and

referring to the Waikato Energy Strategy and EW energy policies in the air quality policy document.

8.1.5 Monitoring 13. Broaden the definition of monitoring in the EW policy document as currently

described by inserting the following clause into the “monitoring section of the plan”: monitor the social, economic and cultural indicators of policy effectiveness,

including ethnicity, income, location; and evaluate policy effectiveness on community well-being and behaviour change

using social science evaluation techniques. 14. Monitor the social, economic and cultural indicators of policy effectiveness. 15. Monitor the access and effectiveness of policy implementation for Māori.

8.2 Decision-making processes

8.2.1 Transparency in decision-making 16. Make policy decisions and criteria for those decisions explicit throughout the

process. This enables communities and other stakeholders to understand and track how and why decisions are made throughout the policy process. This is especially important when trade-offs are made between one aspect of community well-being and another, e.g. for example an incentives scheme is modified because of resource constraints.

17. Maximise the opportunity for decision-makers and community representatives to

meet and discuss decisions in a format that includes culturally-appropriate communication.

8.2.2 Stakeholder and community engagement 18. Communicate and consult with the community throughout the policy development

and implementation processes. 19. Undertake further consultation on the next round of policy options for the purpose of

considering the impact of the pace of change that will be required by communities to achieve and enforce the 2013 deadline, including investigating the availability of appliances and trades people.

20. Undertake workforce capacity research in the region and consider the application

for funding for community capability improvements in the installation of insulation and clean heat systems.

21. Emphasise the need for an intersectoral approach, in particular strengthening the

links between the energy, environment and health sectors and improving these sectors’ understanding of the broader determinants of well-being and the upstream causes of unequal health outcomes.

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22. Retain a focus on reducing inequalities, including the use of tools such as HIA, Whānau Ora HIA and the Health Equity Assessment Tool during TWHCA Project implementation.

23. Develop a long-term intersectoral resourcing strategy for the installation of

insulation and clean heating appliances. 24. Secure proactive intersectoral participation from those sectors currently absent

from TWHCA Project processes, such as the Waikato Public Health Organisation, Ministry of Social Development, Te Puni Kokiri, Ministry of Pacific Island Affairs, Housing NZ, WEL and Education. An intersectoral approach is not only necessary for consideration of appropriate and sustainable resourcing of insulation and clean heating appliances but also for consideration of the maintenance costs of heating appliances for the most socio-economically disadvantaged sectors of the community.

25. Link proactively with other sector strategies and projects such as Healthy Housing

Waikato and the Regional Energy Strategy.

8.3 Partnership and participation 26. Give effect to the provisions of the Treaty of Waitangi by:

enabling an effective role of Māori (including Raukawa Trust Board members) in policy decision-making;

resourcing Māori community workers involved in implementing policy; ensuring that overcoming barriers to policy implementation for Māori are

prioritised to maximise benefits from heating conversion for Māori; ensuring any awareness raising campaigns associated with policy are

appropriate and effective for Māori; ensuring Māori and other disadvantaged groups continue to be partnered and

engaged effectively throughout policy process; and ensuring adequate records are kept in policy implementation to enable

measurement and analysis of equitable project participation and project outcomes for Māori.

27. Ensure that the Tokoroa air quality policy respect current practices and traditions

for Māori and Pacific community members, while still improving air quality. 28. Enhance the role of South Waikato District Council in the TWHCA Project by:

resourcing a community-oriented project manager, with the appropriate cultural skills to continue work as achieved by the community organisations described in section 7.2.3.; and

enhancing representation of SWDC at consultation events.

8.4 Policy implementation 29. Ensure project implementation complies with best practice building standards.

8.4.1 Insulation 30. As insulation is a pre-requisite for eligibility for clean heat conversions, ensure that

insulation retrofitting continues in Tokoroa and is prioritised appropriately. 31. In the short term, regional stakeholders should target limited insulation funding by

considering the following: is the project requiring insulation funding well established, with a good track

record and good local representation; are systems and processes in place for prioritising the funding appropriately for

this community (for example considering ethnicity, socio-economic need and other requirements specific to the funding organisations);

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to what extent will these funds maximise health and well-being benefits to the local community and reduce ethnic and socio-economic inequalities in health;

to what extent will these funds complement other organisations’ work in the local area (such as clean heat funding) and therefore how does this funding strengthen intersectoral relationships; and

how important is this insulation funding to sustaining the project in this area. 32. Ensure that a sustainable, long-term strategy for the provision of resources for

insulation is developed in the region. This strategy should: include the development of further strategic partnerships with EECA and MoH6

that include regions beyond South Waikato; have robust eligibility and prioritisation processes which consider socio-

economic and ethnic inequalities in health outcome; allow for the alignment of the funding cycles of the relevant sectors; include clear commitment of funding from all relevant sectors such as health, to

minimise the complexity of the organisational processes; include effective Māori partnership and participation; ensure clarity regarding stakeholder roles and coordination. Coordination could

be facilitated by either EW or Waikato District Health Board (recommendations from a Tokoroa stakeholder forum and the District Health Board suggesting the former); and

strengthen linkages between the Waikato Regional Energy Forum and air quality projects which support insulation (and therefore energy efficiency) initiatives.

8.4.2 Maximise positive policy consequences 33. Maximise the ability of policy to prioritise Māori, improve Māori health outcomes

and reduce health inequalities. 34. Provide effective incentives and community support to prioritise low income

householders to switch to clean heating. 35. Continue to support intersectoral partnership development throughout policy

implementation. 36. Continue to support community engagement in policy development and

implementation, and to appropriately link policy decision-makers with community representatives.

37. Ensure that the final policy options contain a tiered structure which mixes financial

resources, education, and community support. 38. Maximise capacity building and community development opportunities within the

project: support and sustain regional business opportunities and local employment; negotiate the best possible prices for appliances; ensure availability and quality of trades people installing appliances; continue to involve those such as the periodic detention workers to clear debris

from under homes of those who cannot do it themselves; enhance awareness about appliance choices (including hidden and up front

costs of different choices, most appropriate options for the Tokoroa community); and

6 Since 2004 the Ministry of Health has been a financial contributor to the EnergyWise Home Grants Scheme

administered by EECA,. The Ministry of Health’s contribution to the Scheme was $0.889 million (excl GST) in 2004/05, rising to $1.778 million (excl GST) in 2005/06 and outyears (2004 Budget Package: Vote Health _ CAB Min (04) 13/3/(33) Refers). In Budget 2007 an additional $1.8 million in 2007/08, 2008/09 and 2009/10 was appropriated into Vote Health and was transferred to EECA through a fiscally neutral adjustment. In Budget 2008 ???? was appropriated additional funding. As a result Vote: Health is contributing $7.5 million per annum towards EECA’s ENERGYWISE™ home grants programme for 2008/09 and 2009/10 financial years.

provide an introductions and language translation service for insulation and clean heat installers going into homes.

8.4.3 Minimise negative unintended policy consequences 39. Minimise the need for low income households to service expensive loans to obtain

high quality heating, including loans that require the payment of interest rates on the sale of the house or death of its owner.

40. Minimise the need for financial co-payments for insulation and clean heat provision,

particularly for low income households. 41. Minimise the risk of households of changing to un-flued gas by considering

regulation to phase out the sale of un-flued gas heaters. 42. Raise awareness regarding negative effects of un-flued gas, and the inefficiency

and energy costs of portable electric heating. 43. Seek to understand the impacts of the life expectancy of appliances on

communities and the impact of this on the sustainability of communities converting to heat pumps. Advocate to government for clarity on this issue.

44. Ensure that community members understand the need to turn the power off during

clean heat and insulation, which may require temporary heating measures to be put in place.

45. Link with local social service agencies to ensure that low income householders are

assisted with maintenance costs of clean heat appliances. 46. Focus on policy implementation for Māori, Pacific and low socio-economic

householders.

8.4.4 Support communities to make changes 47. Ensure policy implementation includes:

continued employment of at least one local community member as an assessor for the eligibility and provision of insulation and clean heat systems into homes;

careful engagement and development regarding eligibility criteria for incentives schemes; and

careful understanding of cultural priorities and historical practices in Tokoroa. 48. Ensure that the current role(s) undertaken by Raukawa Trust Board and SWPIHC

members, including the community educator/assessor roles, are appropriately resourced.

49. Recognise the need for policy implementation to be highly targeted to support

change: promote dissemination of information about the project and the changes and

choices through community networks in a targeted way, rather than relying on printed media such as newspaper reports and leaflets (i.e. adopt a social marketing approach to education);

prioritise kanohi ki te kanohi (face-to-face) interaction and conveying information through trusted community workers;

proactively target specific communities such as landlords and tenants explore opportunities such as the Housing Energy Rating Scheme to publicise

information regarding housing insulation and energy efficiency for potential renters and home buyers.

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8.4.5 Enforcement 50. Apply the fine for non-compliance with discretion, recognising the barriers that low

income households may face when making changes. 51. Explore the opportunity for local community assessors to assist those who are

unable to comply and to ensure these households are receiving all the support available.

8.5 Dissemination 52. Disseminate this work to governance and decision-making levels of stakeholder

groups. 53. Return the results of the HIA to the community verbally.

8.6 Monitoring and evaluation 54. Develop a register of homes that have been insulated, to be potentially provided to

potential buyers and renters as well as to coordinate with the provision of clean heat systems.

55. Monitor project progress and policy implementation transparently using EW

Geographic Information System (GIS) analysis, to provide pictorial representation of insulation and clean heat systems according to project criteria (such as age of housing stock and socio-economic status).

56. Consider resourcing an independent evaluation of the policy implementation, as

conducted for the TWHCA Project Stage 1. 57. Specifically evaluate policy implementation progression against the

recommendations provided in this report.

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Appendix 1: Whānau ora An important focus of this impact assessment is how the policies developed can reduce inequalities for Māori and support the advancement of whānau ora. Whānau ora involves supporting Māori families to achieve their maximum health and well-being. Whānau ora also acknowledges the diversity of the Māori population and perspective, and considers Māori reality as encompassing the complexity of living in contemporary New Zealand (Minister of Health and Associate Minister of Health (2002) He Korowai Oranga, Ministry of Health, Wellington). The attainment of whānau ora is underpinned by the strategic framework described in He Korowai Oranga, the Māori Health Strategy (2002) (Figure 6): Figure A: The overarching framework for achieving Whānau Ora (Ministry of Health, 2002).

The key themes of this strategic framework include: the need to ensure Māori involvement in decision-making; the need to work directly with whānau, hapū, iwi and Māori communities; the need for all services (not just Māori-specific services) to be effective for Māori;

and the importance of all sectors (not just the health sector) working to address Māori

health outcomes. All of these are tied together with a focus on reducing inequalities. The themes of this strategic framework are relevant for this impact assessment report, and also form the basis of the whānau ora health impact assessment tool, which is designed to evaluate policies for their impact on whānau ora and inequalities for Māori. This tool follows closely that of the New Zealand Public Health Advisory Committee Guide to Health Impact Assessment (2004) and uses the same stages of screening, scoping, appraisal and reporting and evaluation.

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Appendix 2: Map of an area of Tokoroa Extract of map of Tokoroa showing deprivation, un-insulated housing and retrofits completed to 1 Jan 2007

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Appendix 3: Project partners The TWHCA Project Steering Group has operated under the umbrella of the South Waikato District Council. The following organisations have been active members of the Steering Group: South Waikato District Council – needs to ensure the sustainable management of its communities. The South Waikato District Council is a local authority with responsibility for four main towns within its district, namely, Tokoroa, Putaruru, Tirau and Arapuni. Tokoroa is the largest town in the district. Raukawa Trust Board – vitally interested in the welfare of its people. The Raukawa Trust Board was established in 1987 as a Charitable Trust incorporated under the Charitable Trust Act 1957. Environment Waikato – responsible for monitoring and managing air quality for the Waikato region under the RMA 1991. The Ministry for the Environment has developed national environmental standards for air quality and a regional plan such as the Waikato Regional Plan (section 6-air module) must be consistent with these standards. Environment Waikato has monitored air quality in Tokoroa since 1999 and provides technical advice and expertise to the TWHCA Project to bring about a full understanding in the community of the issues and strategies to address them. Waikato District Health Board – recognises the importance of clean air to the health and well-being of the community. The Waikato District Health Board (WDHB) is one of the largest of New Zealand's 21 district health boards. It is responsible for planning, funding, providing and monitoring health and disability services for the Waikato population of approximately 353,000. The WDHB provides or buys the health and disability support services that best meet the needs of the community. Health Waikato forms part of the organisation that provides public hospital and other related health services, such as the Population Health Service. South Waikato Pacific Island Health Committee – also keenly interested in the welfare of people in the community and actively involved in the provision of community services and in the implementation of the TWHCA Project. Figure C. Members of Tokoroa Warm Homes Clean Air Steering Group, June 2007

Front row (left to right): Wendy Boyce (EW), Roger Fisher (SWDC), Keri Prendergast (SWDC), Lou Belle-Barrett (EW Contractor). Back row (left to right): Brent Sinclair (EW), Sarah Pitches (Waikato DHB), Sue Arthur (Contractor SMF, MFE), Polly Atatoa-Carr (Waikato DHB), Marion Brown (Raukawa Trust Board), Sandra Barns (EW), Megan Collins (EW). Absent: Ngawinika Mott and Stephanie O’Sullivan (Raukawa Trust Board), Akarere Henry (SWPIHC), Greg Morton (Waikato DHB).

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Appendix 4: Project stages

TWCA Project Stage 1 (July 2006-June 2007) Stage One of the project was funded by the MfE, SWDC and EW and focused on improving the awareness and understanding by the Tokoroa community of the issues around the TWHCA Project. This stage also collected information about the financial, social and economic barriers facing each of the various sectors in the community. Project outcomes in Stage 1 include further development of the Steering Group relationship, implementation of communications that included information leaflets (translated into Māori, Cook Island Māori and Samoan); a Warm Homes Clean Air expo (held in February 2007 and attended by approximately 1500 people); and community fono. An independent evaluation of Stage 1 determined that key stakeholders in the Steering Group were involved from the beginning of the project, successful working partnerships were developed between the Steering Group members and the TWHCA Project was delivered to the most relevant groups in the Tokoroa community. During community focus groups, the evaluator found that the majority of those interviewed had some knowledge of the TWHCA Project and some Tokoroa high-need community members had already made changes within their ability to their heating and insulation options, or had made small changes such as adjusting the way they burn their fires. An economic analysis conducted as a component of Stage 1 determined that in Tokoroa there are approximately: 5.6 deaths per year due to PM10 emissions 2-7 PM10-related cardiac and respiratory admissions 16,000 days of restricted activity due to PM10-related illness (Barnes, 2008).

TWCA Project Stage 2 (July 2007-June 2008) The focus for Stage 2 is the development of policy options for the Tokoroa community to enable installation of cleaner heating systems and improved household energy efficiency and therefore movement towards achieving NES compliance and improved community well-being. Components of Stage 2 include increased community engagement, expanding project partners, building community capacity and exploring funding options. Policy development by Environment Waikato and/or South Waikato District Council is a key component of Stage 2. The most likely policy approach to reduce PM10 pollution in Tokoroa is a mix of regulation with associated compliance considerations, incentives (financial and non-financial) and community engagement. Regulation on its own would require a high level of monitoring and enforcement for success and it would be unlikely that many Tokoroa community members would be able to comply with a strict regulatory policy. Incentives alone could be expensive and would be unlikely to result in change at a level sufficient to achieve the TWHCA Project air quality objective. Either regulation or incentives alone would therefore be unlikely to meet the programme objectives and would be likely to have important negative consequences on well-being and inequalities in Tokoroa. Stage 2 of the TWHCA Project presented an opportunity to contribute a Health Impact Assessment (HIA) to a significant local policy-planning process which will meet a national policy requirement and influence the health and well-being of people living in Tokoroa.

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Appendix 5: Policy options – an update Early policy options from EW (2008) are summarised here.

Airsheds have been prioritised Airsheds have been divided into two categories, according to their pollution levels. Category 1 airsheds are those with high levels of pollution and include five urban centres in the Waikato are Hamilton City; Taupo; Tokoroa; Putaruru; and Te Kuiti. All other urban centres in the Waikato region are Category 2 airsheds. This is because they currently have low levels of air pollution.

Restrictions in high priority airsheds People living in airsheds which exceed the national standards (Category 1) have a more limited range of options for how they can heat their homes. They are likely to be able to use heat pumps; pellet burners; or high quality wood burners that are compliant with the NES for wood burners when they replace an existing lower quality burner. High quality wood burners are those authorised by the Ministry for the Environment for use because of their low levels of pollution. Wood burners are not likely to be allowed in houses that do not have an existing wood burner or open fire.

Lower priority airsheds have fewer restrictions People living in airsheds which do not exceed the national standards (Category 2) have more options for heating their homes. They are likely to be able to use: heat pumps pellet burners high quality wood burners (whether or not the property has an existing wood burner

or open fire).

Changes to the policy over time The policy allows for some changes to be made further down the track if pollution targets are not met. The types of changes might include: moving towns in Category 2 into Category 1; applying tighter standards to appliances. The draft policies do not say what consultation and decision-making processes would be undertaken before these changes are made. However, it is likely to be a process which is smaller in scale than the current process. It is also not yet clear from the draft policy document whether towns in Category 1 would be down-graded if air quality targets were met or exceeded.

Pace of change and regulatory interventions Much of the change required in Category 1 airsheds must occur by 2013. This has potentially large impacts on these communities. For example, all those houses with old wood burners or open fires will need to update their burners within the next five years. It is not yet clear whether change will be structured by a targeted number of households each year up to 2013, or whether the majority of household changes could occur in 2013.

Policies to assist households to change There are a number of policies which will support people to make changes, including education and monitoring, incentives, partnerships and advocacy. To date these are described as follows with the draft policies listed by their policy section numbers. Policy Number: 6.1.5.1 Environmental Education EW will use environmental education to help the community understand:

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1. the types of adverse effects on air quality that can be caused by domestic sources such as open fires, incinerators and heating appliances

2. the energy efficient and environmentally beneficial alternatives that can be adopted, including alternative home heating methods and alternatives to burning combustible materials outside

3. the regional rules applicable to domestic home heating and the incentives or funding options available to assist with upgrading to low or zero PM10 emission appliances.

Policy Number: 6.1.5.2 Monitoring the Effectiveness of Regulatory Controls EW will implement rules 6.1.12.1(b) to (f) of the Air Module of the Waikato Regional Plan relating to domestic solid fuel burning and Rules 6.1.13.1(a) and (b) relating to open burning. EW will monitor their effectiveness in improving ambient air quality and consider options for further regulatory controls should the measures prove inadequate to ensure compliance with the NES for PM10 in airsheds where domestic sources are the principal contributor to the non-compliances. These may include: 1. tighter standards for heating appliances 2. restrictions on types or quality of fuel that can be burnt 3. applying domestic solid fuel burning restrictions in airsheds or areas not already

restricted under this Plan. Policy Number: 6.1.5.3 Incentives EW will make provision in the LTCCP to create an incentives fund for replacement of old wood burners (pre-2005) in Category 1 airsheds, subject to the availability of central government funding assistance. Policy Number: 6.1.5.4 Partnerships EW will work with energy efficiency and health authorities to promote warmer and more energy efficient homes, in particular via encouraging improved insulation. Policy Number: 6.1.5.5 Advocacy EW will advocate to territorial local authorities to ensure integrated management of domestic sources and consistency of messages to the regional community. One other ‘incentive’ to help support change is the possibility of inserting into legislation a requirement to upgrade a wood burner/open fire when a house is sold (‘point of sale’). This is referred to in the background policy document. Further work commissioned will investigate the issues and options associated with creating an incentives package. It will investigate a range of incentives, including grants at different levels and interest free loans. Options for funding these incentives and average rate impacts on Waikato communities will also be covered. Monitoring and enforcement at the household level is not discussed in the policy document.

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Appendix 6: Invitation This invitation was also translated into Maori, Cook Island Maori and Samoan languages and was hand-delivered.

Invitation to Community Fono Kia ora, Kia orana & Talofa lava,

Nau mai, haere mai.

You are warmly invited to attend a hui/fono about the Tokoroa

Warm Homes, Clean Air project. As a representative of your

community, your thoughts and concerns are really valuable to us.

This project is at the stage of making policies and decisions about

how to change the way that people in Tokoroa heat their homes.

The project team need to understand the community effects that

any of these new policies may have before the decisions are made.

When: Tuesday 19t h February, 2008

9am-3pm

Where: South Waikato Pacif ic Is land Health Trust

1 Maraetai Rd, Tokoroa.

Who: Invi ted Māori and Pacif ic community representatives

Why: To update you on the project ’s progress, and to include

your feedback into project decisions for the future.

Lunch, morning and afternoon tea will be provided

I f you have any questions please contact: Marion Brown (07) 885 0260, Akarere Henry (07) 8868600 or Pol ly Atatoa Carr 021501274

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Appendix 7: Programme Tokoroa Warm Homes Clean Air Hui/Fono Programme. Tues 19th February 8.30am-3pm South Waikato Pacific Island Health Trust, 1 Maraetai Rd, Tokoroa. Time Description Responsibility 8.30am Facilitators, scribes, TWHCA Steering

Group Briefing Session Facilitators

9am Opening mihi - Tangata whenua Introductions: people and programme, housekeeping and timekeeping

Kaumatua (MB to invite) Facilitators

9.15 Background information TWHCA Background information (PM10, health, NES, changes required, progress to date, why we are here today)

PA-C, MB, AH* *Steering group members to support presenters

9-30-10 Introduce small groups, check progress Facilitators 10-10.20 Blessing for kai - Samoan

Morning tea

10.20-10.40

Introduction to policy process Background to policy Non-negotiable decisions Info re heating options Examples from other areas.

WB* *Steering group members to support presenters

10.40-11 Introduce policy option 1 PA-C/WB 11-11.30 Small group session on policy option 1 Facilitators

Scribe Small group supporters

11.30-12 Feedback on policy option 1 Whole group 12-12.15 Introduce policy option 2 PA-C/WB 12.15-12.45

Small group session on policy option 2 As above

12.45-1 Feedback on Policy option 2 Whole group 1-1.40 Blessing for kai - Samoan

Lunch

1.40-1.50 Introduce policy option 3 PA-C/WB 1.50-2.20 Small group session on policy option 3

Evaluation questions As above

2.20-2.40 Whole group Feedback on policy option 3 2.40 PA-C What happens next 2.50 Close – Cook Island

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Appendix 8: Strategic alignment – further detail

National strategic alignment

Improving well-being and reducing inequalities Government’s intersectoral Reducing Inequalities Strategy requires government agencies to report on reducing inequalities as part of their core business in their statements of intent and annual reports. This reporting has been used to monitor progress in reducing inequalities and make recommendations on the focus of future policy development. Priorities that have been identified in the past have included developing ways to address problem debt for low income New Zealanders (particularly people with debt to more than one government agency) and policies and services to improve transitions for young people between school, work or training. Inequalities are defined as “differences, which are unnecessary and avoidable, but in addition are considered unfair and unjust” (Whitehead, 1990). It does not necessarily mean that resources are equally shared. Rather, it acknowledges that sometimes different resourcing is needed to enable different groups to enjoy equitable outcomes. Comprehensive action is required to address inequalities in a targeted and sustainable way. Reducing inequities is critical for economic growth. The prosperity of New Zealand depends on improving the productivity of all citizens. Educational under-achievement, chronic poor health, unemployment and crime are all barriers to economic participation and prosperity. The Living Standards Report (Ministry of Social Development, 2006) identified the multiple problems encountered by families in the bottom income decile. Many of these persistent disadvantages relate to the unequal distribution of the resources, including income, housing, and health, necessary for an adequate quality of life. To improve social and economic well-being, it is recognised that these social and economic policy goals need to be sustainable and be reflected in relevant policy development and planning processes within and across a wide range of sectors. With this in mind, the overarching theme of this HIA is to identify the links between national, regional and local responses to Air Quality and the associated environmental and health impacts. Dealing with such issues involves agencies working together to develop a collaborative approach based on shared objectives. Part of this strategy involves establishing a partnership with the community. The HIA is a useful tool to use because it spans the many sectors of government (whole of government) interest in social, cultural, economic and environmental well-being and enables agencies to connect directly with affected communities. The purpose of this section is to outline the interconnecting themes between specific legislation and policies which underpin and direct the management of air quality and health related aspects.

Health The New Zealand Health Strategy is underpinned by seven key principles (Ministry of Health, 2000). Any new strategies or developments that are carried out in the health sector should relate to these principles. These principles include but are not limited to: good health and well-being for all New Zealanders; an improvement in health status for those currently disadvantaged; and active involvement of consumers and consumers at all levels

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The goals and objectives of the strategy that sit underneath these principles were chosen according to a variety of criteria including the degree to which they can improve the health status of the population and their potential for reducing health inequalities. Addressing health inequalities is a major priority requiring ongoing commitment both within and outside the health sector as the actions of many different sectors have an impact on health and social well-being. In New Zealand, health inequalities affect Māori. At all educational, occupational and income levels Māori have poorer health status than non-Māori as a result of social and economic policy and practices. The acceptance of these inequalities breaches the principles of the Treaty of Waitangi and contravenes the New Zealand Health Strategy and other policy (Cram, 1993, Durie, 1994, Ministry of Health 2000, Woodward and Kawachi, 2000. Similar statistics are reflected in those of Pacific Island descent, whose health status is generally intermediate between Māori and Pakeha. Health inequalities also affect people living in areas of deprivation whereby poverty causes poor health and poor health causes poverty. The most effective means to reduce disparities will focus on a number of factors including: application of Treaty of Waitangi-based principles and values intersectoral approaches use of prevention strategies, with a population health focus building on existing initiatives; and modifying behaviour and lifestyle risk factors through appropriately tailored policies

and programmes Most public health services are preventative services aimed at concerned with the health and well-being of population groups and communities in New Zealand rather than addressing individual health issues per se. There are some preventative or treatment services that are part of public health services. Achieving Health for All People provides a framework for a strategic action plan for public health in New Zealand. The overall aim of the strategy is to achieve health for all people (Ministry of Health 2003). The goals identified in the strategy include improving the overall health status of the New Zealand Population and reducing inequalities in health. It reinforces the importance of taking an integrated approach to public health that is strongly based on intersectoral collaboration, working alongside communities and comprehensive programmes across all groups within society. Co-ordination and alignment are critical to effective public health action and achieving improved health and well-being outcomes.

Draft Public Health Bill Public health issues and approaches have altered radically since the middle of last century, when the previous Public Health Act was created. The sphere of interest of public health has expanded beyond environmental health and infectious diseases and now encompasses other challenges to the health of New Zealanders: health inequalities, non-communicable diseases and incorporation of a wider view of what makes a person healthy. The Draft Public Health Bill is a response to these changes. Accordingly, the tools, frameworks and techniques employed to improve public health have broadened. Health Impact Assessment (HIA) is one example of this. HIA has been included in the Draft Public Health Bill as a recommended tool for use across the state sector to help influence policy development with respect to improving public health outcomes. There is provision made in the Draft Public Health Bill for the Director General of Health to encourage health and other sectors to use HIA to strengthen health outcomes and help reduce inequalities (New Zealand Government, 2007).

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New ways of working utilising HIA, including influencing decisions and activities of local and central authorities (e.g. urban development issues) have increased in importance as understanding has emerged that many factors affecting health and well-being lie outside the core health sector. Health improvement is a shared responsibility (Public Health Advisory Committee, 2006). There is also a growing cross-sector commitment at a national level to sustainable policy, planning and action to improve health and well-being particularly in settings where people live work and play.

The Local Government Act

The local Government Act describes a planning cycle which must be followed by all local authorities. This includes the development and production of a Long-Term Council Community Plan. The LTCCP covers at least 10 years and identifies desired community outcomes - the things the community considers are important for its well-being. The LTCCP describes the council's intended contribution to those outcomes - the activities the local authority will engage in over the life of the plan (and why) - and how those activities will be funded. The LTCCP is reviewed every three years (New Zealand Government, 2002).

Community outcomes are statements of what communities want to achieve now and in the future. Another way of viewing community outcomes is ‘the things that the community thinks are important for its well-being’. The local authority’s role in the outcomes process is to: facilitate the process promote or achieve the outcomes (as one of the parties that is capable of doing so

and to the extent that the elected council deems appropriate in the LTCCP) monitor progress towards the achievement of community outcomes.

The Resource Management Act: air quality The actual management of air quality is directed under the Resource Management Act 1991 (RMA). The purpose of the act is to “promote the sustainable management of natural and physical resources” (New Zealand Government 1991, section 5). The sections of the RMA that relate specifically to air quality are:

Section 5 (b) safeguarding the life-supporting capacity of air, water, soil

and ecosystems (d) avoiding, remedying, or mitigating any adverse effects of

activities of the environment Section 6 (e) the relationship of Māori and their culture and traditions,

with their ancestral lands, water sites, waahi tapu and other taonga

Section 7 (f) the maintenance and enhancement of the quality of the environment

Section 17 Duty to avoid, remedy or mitigate adverse effects Section 30 Functions of Regional Councils under this Act.

Sections 43 and 44 of the RMA prescribe the functions of local authorities in accordance with the National Environmental Standards (NES) set by the Ministry for the Environment. The Ministry for the Environment has set out clear directives concerning the standard of acceptable air quality which may not exceed 50 μg m-3 (24 hour average). It is the role of each local council to ensure that this standard is met by 2013 or it could effect the ability for Councils to grant resource consents for discharges to air in non-complying airsheds (Wilton, 2006). These types of national environmental standards are important to identify the possible flow on and varying effects of declining air quality on cultural, economic and social well-being within communities as well. Managing the air quality of Tokoroa comes under the duties and responsibilities of Environment Waikato. Directed by the RMA, these responsibilities include the monitoring of PM10 levels within the Tokoroa region to ensure compliance with the NES.

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Energy Efficiency and Conservation Authority The New Zealand Energy Efficiency and Conservation Strategy, published by the Energy Efficiency and Conservation Authority in 2007, is a detailed action plan for increasing the uptake of energy efficiency, conservation and renewable energy programmes in New Zealand. There is a clear commitment to sustainability outlined in this strategy (Ministry for the Environment, 2007). The strategy defines the need for a comprehensive mix of incentives (e.g. Energy wise interest free loans and clean heat grants for homes), regulation (e.g. National Environmental Standards) and education (e.g. Energy Star programme) to achieve behaviour change and improve energy efficiency and sustainability. Achieving Energy wise Homes in New Zealand is one of five key targets identified within the Strategy. The objective of Energy wise Homes is to provide warm, dry and healthy homes, improved air quality and reduced energy costs. This strategy supports and guides at a national levels housing, heating and air quality related project work occurring at a local level across the country.

Social development and well-being Government strategy development over the past five years has been to strengthen a ‘whole of government’ approach to improving social and economic well-being for all New Zealanders. Social development is a central factor in this. It is a process of co-ordinated social change that promotes the well-being of the population as a whole and of disadvantaged groups within it. It aims to improve well-being across a range of areas such as social assistance, health, education, employment and safety (Ministry of Social Development, 2001). Successful social development ensures that social and economic interventions support each other and are sustainable in supporting individuals, families and communities to develop and deliver their own solutions. This requires the government sector to work in partnership with local authorities, with the community and voluntary sector and with the private sector to develop ‘joined-up’ local services and ensure there is flexibility to respond to regional and local needs. The release of Opportunity for All New Zealanders (Ministry of Social Development, 2004) in December 2004 marked a significant step in strengthening a whole-of-government approach to social development at a national level. This document sets out the ‘big picture’ of the Government’s work across the social sector, drawing together the social strategies being implemented by over 30 government agencies. Opportunity for All New Zealanders (2004) is the social counterpart to the Growth and Innovation Framework, New Zealand’s strategy for economic development. It recognises that social and economic developments are inextricably linked and that a whole of government approach (involving both local and central authorities) is essential to improving social well-being and reducing disadvantage. The government’s two overarching social policy goals identified in Opportunity for All New Zealanders (2004) are: achieving and sustaining improvements in social well-being; and reducing disadvantage and promoting equality of opportunity for all New

Zealanders

Housing The New Zealand Housing Strategy sets out priorities for housing and a programme of action to lead the sector over the next 10 years (Housing New Zealand Corporation, 2005). The strategy acknowledges the complex interrelationships that exist between housing, health and well-being and social development. Housing policy alone cannot guarantee desirable housing. Monetary, labour market, transport, social assistance and

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planning policies all have the potential to exercise as much, and sometimes more, influence on housing outcomes. There was clear support during the consultation process for the strategy to adopt an integrated or holistic view of housing, rather than one isolated from other policy areas. The strategy recognises that housing policy can support wider goals - social, cultural and economic – and contribute to sustainable development. It takes a sector-wide approach, involving local government, communities and business, together with Housing New Zealand Corporation, the Department of Building and Housing and other central government agencies. New approaches reflect the expansion of the range of responses to housing needed at both local and central government levels. Government’s vision for housing is that all New Zealanders have access to affordable, sustainable, good quality housing appropriate to their needs. To achieve that vision, the government is working with the community, industry and local government to among other things: reduce unmet housing need; reduce inequalities in housing; improve the quality of New Zealand’s housing stock and develop a housing sector that encourages appropriate provision of, and investment in, housing. Improving housing standards and increasing integration of housing with the community and other services are two of the action areas identified within the strategy that link to the national strategic goals of improving social and economic well-being for New Zealanders. The strategy’s commitment to improving access to affordable and sustainable housing also reinforces governments broad commitment to reduce disparities and encourage sustainability within communities at all levels and across all sectors.

Regional strategic alignment

The Regional Policy Statement Under the RMA every council must prepare a Regional Policy Statement. The objective of a regional policy statement is to identify important environmental issues from a regional perspective and to “establish policies to achieve integrated management of the regions natural and physical resources” (Environment Waikato, 2000). Section 3.6 of the Operative Waikato Regional Policy Statement relate to air quality within the Waikato region and specifies the characteristics that are used to determine the level of air quality including issues such as the effect of stationary effect of diffuse sources like urban heat and the cumulative effects of household fires. These issues are reflected in the objectives of the air module in the Regional Plan. The current objectives that are relevant to improving the air quality and energy efficiency are:

1. Significant characteristics of air quality should be: a) Protected when they are high b) enhanced when they are degraded c) otherwise maintained

2. No significant adverse effects from individual site sources on the characteristics of air quality beyond the property boundary

3. Cumulative effects of discharges on ambient air quality do not: a) present more than a minor threat to the health of human, flora or fauna c) result in levels of suspended or deposited particulate matter that are

objectionable to the extent that they cause adverse effects. f) cause significant adverse effects on the relationship as kaitiaki have

with identified taonga such as air, water and wahi tapu.

Waikato District Health Board Strategic Plan The Waikato District Health Board Strategic (DHB) Strategic Plan (2005-15) identifies four population priorities. Within the Waikato DHB region, those living in areas of low socio-economic status, the elderly, Māori and Pacific people are at greater risk of poor quality of life and ill health. Waikato DHB is committed to reducing inequalities in all

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areas affecting the health and well-being of its population utilising principles that support overcoming health inequalities (Ministry of Health, 2002). Waikato DHB, in consultation with Waikato communities, has adopted the following guiding principles that underpin the strategy and are used to plan, fund and deliver services: Improving access to health services for all populations (priority population groups in particular) within available resources; health promotion and strengthening ill health; strengthening intersectoral collaboration; building workforce capacity to meet the needs of the diverse populations; supporting Māori, whānau, hapū and iwi to achieve maximum health gain and implementing continuous quality improvement in the delivery of health and disability services that are based on best practice models. The Waikato DHB goals to improve the health and well-being of its population include ensuring the population of the Waikato has access to the prerequisites of health through a whole of government approach (Waikato District Health Board, 2005). The strategic population priority (‘To improve the health of low socio-economic people living in the Waikato region’) is linked to strengthening intersectoral collaboration and using Health Impact Assessment as a tool to identify impacts on health disparities (Waikato District Health Board, 2005). There is a clear alignment between these identified strategic priorities at both national and regional levels and the goals and objectives of the TWHCA Project and the characteristics of the Tokoroa community.

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Appendix 9: Tokoroa community profile This community was extracted from Sandra Barns, 2008)/

History Tokoroa is one of the newest towns in New Zealand history and has been built around the pulp and paper mill industry. The first sawmill in the South Waikato district was installed by the Taupo Totara Timber Co. of Putaruru in 1903 at Kopokorahi, 9.5km south of Tokoroa. Settlement of Tokoroa began in 1910 and by the 1920s large areas of pine forest were established around the Tokoroa village. The end of the Second World War saw the return of many soldiers to nurture the pine forests, work at the Kinleith pulp and paper mill (established in 1948), or clear scrub for farming. In 1948 the town population was 1100, and by the 1980s the population had grown to over 18,000 with 9 primary schools, 2 intermediate schools and 2 secondary schools.

Population The Tokoroa urban community comprised 10 Statistics New Zealand Census Area Units, with a total population of 13,350, covering 4,740 households in 2006 (Table i). Tokoroa’s usually resident population has continued to decline over the past 15 years (Table ii), falling a total of 18 per cent over the period predominantly due to downscaling at the Kinleith pulp and paper mill and in other industries. This decrease is substantial, equaling nearly a fifth of the 1991 population. As expected, the number of total occupied dwellings over time is steadier, given that housing structures are usually less mobile than people. Table i: Percentage changes in usually resident population and total occupied

dwellings Tokoroa Waikato New Zealand

2001-06 -4.6 6.8 7.8 1996-01 -6.6 1.7 3.3

Usually Resident Population Count

1991-96 -8.1 5.4 7.2

2001-06 -1.8 8.0 8.3 1996-01 -3.8 6.1 6.6

Total Occupied Dwellings

1991-96 -1.6 7.8 7.6

Age In 2006, 28% (3774) of Tokoroa’s population were aged 14 years and younger, compared with 23% regionally. The proportion of the population of working age in Tokoroa (52%) was lower than regional (57%) and nationally (59%).7

7 Assuming working age begins at 20 years when some form of tertiary or job training has been completed

Figure D: Age groupings for usually resident population

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Ethnicity One of the special features of Tokoroa is that people from over 25 different national origins have made their homes in the town, predominantly due to migration in the 1950s and 1960s to work in the pulp and paper industry. The Tokoroa community has lower proportions of European peoples and higher proportions of Māori and Pacific Island peoples when compared to either the Waikato region or New Zealand (Figure 8). In 2006, people of European ethnicity were 55% (6915) of the Tokoroa community, compared to 70% regionally. People of Māori ethnicity made up 37% (4707) of the Tokoroa community, significantly more than the regional average of 21%. Pacific people made up 19% (2373) of the Tokoroa community – over 6 times the regional average of 3%. People of Asian ethnicity are few in number and proportion in Tokoroa (3%, 336).

Income and deprivation Households with low income are over-represented in Tokoroa, while high household incomes are under-represented. In 2006, approximately one-third of households (31%, 1482) earned under $30,000 per annum, compared to 25% regionally and nationally. At the other end of the income scale, 18% of Tokoroa household earned in excess of $70,000 per annum, compared with 27% earning in this range regionally. Household income is also one of the nine variables combined in the 2006 deprivation index, NZDep2006. This measure provides a deprivation score for each meshblock in NZ as defined by Statistics New Zealand. These meshblocks are geographical units containing a median of approximately 87 people and other variables contained in the NZDep 2006 for each meshblock include: home ownership, unemployment, access to a telephone and access to a car. The NZDep2006 scale of deprivation is valued from 1 (least deprived) to 10 (most deprived). A value of 10 indicates a meshblock in the most deprived 10 percent of areas in New Zealand, while 1 represents an area within the least deprived 10 percent in New Zealand (NZDep Index of Deprivation, 2007). According to the NZDep 2006, Tokoroa is a community of significant deprivation as 99% of households are within area units reflecting some degree of deprivation. Seventy-six percent of Tokoroa households are in census areas scored NZDep 9 and 10 and a further 23% in areas NZDep 6, 7 and 8. Table ii: Tokoroa Area Units, population, households and NZ Deprivation Index

CAU Name (Number) Population Households NZ Dep Index

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Mangakaretu (535211) 210 78 7 Kinleith (535212) 228 84 6 Paraonui (535310) 1,785 678 6 Parkdale (535320) 714 258 8 Matarawa (535330) 2,028 729 9 Stanley Park (535340) 2,055 747 10 Tokoroa Central (535350) 807 297 10 Aotea (535360) 3,141 1,044 9 Strathmore (535370) 2,403 765 10 Amisfield (535380) 159 60 2 TOTAL 13,350 4,470

Employment Also reflected in the NZDep score for this region, in 2006 the full-time employment rate in Tokoroa (40%) was below that for the Waikato region and New Zealand (both 48%) (Figure 57). The rate of unemployment in Tokoroa (6%) was nearly double that of the Waikato region and nationally (approximately 3.5%). This difference in employment may not draw much attention with a buoyant economy but will reduce the resilience of this community should the economy, employment prospects or other pressures on community sustainability worsen. In addition to the relatively high levels of unemployment, Tokoroa has a higher proportion of people outside the labour force than the regional average. Likely reasons for this include: personal or family responsibilities (such as care of children and elderly); temporary or permanent loss of ability to work due to illness; or those not actively seeking work. Figure E: Work and labour force status

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In 2006, manufacturing was the chief employment industry in Tokoroa, as it was nationally. The key difference was that in Tokoroa more than one-fifth (22%) of the workforce was employed by this single sector, while across New Zealand just 11% of the workforce was dependent on the sector. This local high dependence makes this community vulnerable to economic changes that impact directly or indirectly on their major site of employment. The next highest sector was retail, at less than half the numbers of manufacturing, employing just 11% of the local Tokoroa labour force. The education and training sector employed 10% and agriculture, forestry and fishing employed 8% of the labour force.

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Housing tenure The proportion of direct home ownership is relatively high in Tokoroa, with 55% (2610) of the homes owned by the usual residents in 2006, compared with 50% regionally (Figure 58). Family trust ownership was lower than regional and national averages, at 5% (255). Homes ‘not owned by usual resident’ made up 30% (1440) of the Tokoroa housing stock. It is likely that this level of home ownership reflects programmes to assist workers from the pulp and paper mill to buy their own homes. Figure F: Tenure of housing

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Home heating In 2006, 59% (2826) of Tokoroa households reported that wood was the fuel they used for home heating compared to a regional average of 42% (Figure 4). Fifty per cent (2391) of Tokoroa households reported using electricity for home heating, which was considerably less than regional and national averages. The relative position of electricity to wood supports suggestions that the Tokoroa community has a high dependence on wood for domestic heating. This high and sustained dependence on wood is present at every income level within this community. In addition, wood is the dominant form of heating for both owner-occupied (64%) and rental housing (61%) in Tokoroa. A distinct and sustained decline in the number of households using wood was evident over the 15 years to 2006 (Figure 54). From 2001 to 2006 wood use fell by 7% (216 homes). At the same time there was a slow and steady decline in coal use, in common with most other communities. Electricity as a source for home heating in Tokoroa increased over the five years to 2006 by 5% (150 homes). Bottled gas usage remained steady. Mains gas usage reduced in the five years to 2006, falling back to 1996 levels. Of all ethnicities wood was most likely to be used in homes of people of Pacific Island ethnicity (74%), followed by homes of people of Māori ethnicity (71%). It was least likely to be used in homes of people of Asian ethnicity (50%). Conversely, electricity as a method of home heating was most likely to be used by people of Asian ethnicity (73%) but much less likely to be used by people of Pacific Island (50%) or Māori ethnicity (46%). Bottled gas was used by about a third of all ethnic groups, although whether as a primary or secondary source of heating is unknown. Mains gas was most likely to be used in homes of people of Asian (21%), Other (21%) or European (20%) ethnicity. It is least likely to be used in homes of people of Māori (14%) or Pacific Island (10%) ethnicity. Instances of no home heating in Tokoroa have fluctuated around 50 households for the last 15 years, peaking in 2001 at 57 households. In 2006 45 households reported

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having ho heating. Not surprisingly, the likelihood that houses have no heating increases as incomes decrease. It is more likely that rental homes have no home heating compared to owner-occupied houses. In the Tokoroa community the likelihood of having no heating was higher for Māori (2%), Pacific Island (1%) or European (1%) ethnicities, than for Asian or Other ethnicities. Figure G: Trends in domestic heating methods 1991 – 2006

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Appendix 10: Summary results chart TOKOROA What the statistics tell us

What the community

tells us What this means for

policy makers Social Well Being Lower levels of access to health, transport, employment. A young population

Tokoroa is overrepresented in the lower household incomes, and underrepresented in the higher household incomes. Māori and Pacific people in particular are have lower access to many of the determinants of well being. These include access health and transport services, higher quality employment and housing. As a result, occurrences of ill health are also higher in these populations. Population groups that appear to be more sensitive to air pollution are the elderly, smokers, children, infants and those with pre existing respiratory and/or cardiovascular disease. There are disproportionately more people 14 years and younger compared to the Waikato and NZ. This suggests a relatively high level of dependence within the community.

“I’m thinking about my children when thinking about the need to change” “I’m also thinking about my children, their needs, clean air but also about food, school etc. “No community support is not good for our people…we won’t let that happen”

A community wanting to comply, but complying may mean: o un-flued gas o portable electric o no home heating

(2001 = 1.2% households)

Or not complying: o recondition aging

wood burner o continue to use in

spite of regulation. Significant input from communities with high levels of need will be required to overcome barriers to change. Policies will need to include incentives, but also resources to support local capacity building, education and advice.

Cultural Well Being Culturally diverse Strong community Forestry heritage

Tokoroa is a culturally diverse community with lower proportions of European peoples and higher proportions of Māori and Pacific Island peoples by comparison to the Waikato region and New Zealand averages. Community networks are strong in Tokoroa, with information transmitted through the many social and cultural activities occurring n the community. Tokoroa has been a mill town and much of its economic life has come from forestry. Access to firewood and the use of wood to heat homes and hot water are common.

“Kanohi ki te Kanohi” “Language is a barrier to our people” “We are a visual and verbal community” “Young people express for all of us how we feel, what we think and what we need” “Make it easy for our people to understand…we have ideas but we can’t explain”

Culturally appropriate approaches are important in designing and implementing any policy: o kanohi ki te kanohi

(face-to-face) o in people’s first

language o going through he

right channels in the right way (recognising authority and role of Raukawa Trust Board)

o use the existing networks to disseminate information and gather feedback

We may need to find ways to assist people to respect current practices and traditions, while still improving air quality

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TOKOROA What the statistics tell us

What the community tells us

What this means for policy makers

Economic Well Being Declining population High level of wood burners Low levels of insulation Manufacturing dependent

Tokoroa’s population declined by 18% over the past 15 years. Wood is used for heating by 59% (2826) of households compared to 42% regionally. Wood use fell by 7% (216 houses) from 2001 to 2006. There is a high and sustained dependence on wood at every income level. There are an estimated 4000 (89%) pre 1977 properties in Tokoroa. The proportion of direct home ownership of housing is higher in Tokoroa, than in other parts of the Waikato. The Tokoroa community’s full-time employment rate (40%) was well below the rates for the Waikato region and New Zealand (both 48%). In 2006, manufacturing was the chief employment industry in Tokoroa, as it was nationally. The key difference was that in Tokoroa more than one-fifth (22%) of the workforce was employed by this single sector, while across New Zealand just 11% of the workforce was dependent on the sector.

“If the power gets cut off, I can still provide my family with water and warmth if I have a wood burner” “If I had a heat pump, I could switch the switch and not know about the size of the bill until the bill comes in” “With your heat pump its an ongoing bill, if you’ve got a fire its seasonal and you can plan for it” “Don’t want extra ‘fees’ to be added on, as long as we understand where our money is going” “When it comes to lending, don’t make it hard” “Important to put things in place now for the future”

This small community is vulnerable to economic changes that impact directly or indirectly on their major employment. The ability of this community to fund changes at both the household and population level will be limited.

Environmental Well Being Sustainability of project and environmental resources

The well-being of the environmental resources in Tokoroa, including the land, water and air is an important component of community well-being

“There is a reality that Tokoroa is a beautiful town. We never know what will happen in the next 5-10 years”

Policy implementation will need to ensure that unintended adverse consequences on environmental resources, and the indoor environment, are minimised.

The indoor environment of Tokoroa homes is cold and damp in winter. Portable heating systems, such as electric heaters and LPG heaters have adverse negative consequences on the quality of the indoor environment in Tokoroa.

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Appendix 11: Questionnaire to assist insulation prioritisation

TOKOROA WARM HOMES CLEAN AIR INSULATION RETROFIT

APPLICATION FORM

All information received will be kept confidential

Please note that completion of this form does not automatically qualify you for a free energy efficient upgrade

1. Name 2. Address 3. Phone 4. What ethnic group do you belong to? Mark the space or spaces that apply to you New Zealand European Maori Samoan Cook Island Maori Tongan Niuean Chinese Indian Other, please state: 5. What is your household income < $20,000 per year $20,000-30,000 per year $30,000-50,000 per year $50,000-70,000 per year $70,000+ per year 6. Do you have a community Services Card (CSC)? Y / N If Yes, number……………………… 7. How many people live in your home and how old are they?

Person Age Person Age 1 7 2 8 3 9 4 10 5 11 6 12

8. How many bedrooms do you have in your home? _________ 9. Do you own the property? Y / N 10. What year was the house built (approx., if known)? __________ Unknown 11. Is there any insulation already in the house Y / N If yes, where? _________________________ 12. The retrofit requires putting insulation underneath the floor boards and on the ground under the house. Is there access to underneath the house? _____________________ 13. What Health problems do you or your whanau in your house have? Please list these problems (eg. Child has asthma, ear infections, tonsillitis, pneumonia; adult has arthritis, rheumatism, circulatory problems, diabetes) _____________________________________________________________________ _____________________________________________________________________ 14. Have you any smoke alarms fitted in your home: Y / N If yes do they work Y / N 16. Do you have a home escape plan: Y / N If no would you like a Fire Department referral? Y / N

17. Would you participate in a health survey associated with this project? Y / N I agree to my name being put forward for the Tokoroa Warm Homes Clean Air Project: Y / N Signature of householder Date: ___ Signature of Tokoroa Warm Homes Clean Air Representative (assessor) ___________________ Tracking the Application: Eligibility Committee Approved……. Date……. Job completed and reported on ……………………. Notes (eg specific health needs, referrer information): ______________________________________________________________________________________ ______________________________________________________________________________________ To be filled in by Assessor NOTE THE QUANTITY OF POINTS ALLOCATED TO EACH INDICATOR ARE TO BE DETERMINED BY THE STEERING GROUP Name of Assessor Phone Reason/s house was nominated ______________________________________________________________________________________ Ethnicity Maori or Pacific (x points) ___ Health Status For every child with a disability, respiratory or other health problems (x points) ___ For every adult with a disability, respiratory or other health problems (x points) ___ House overcrowded* (x points) ___ Over 55 years of age (x points) ___ Disabled householder (x points) ___ Income/deprivation NZDep 8,9,10 (map) (x points) ___ High power bills/ poor house heating (x points) ___ Total points ____ Other Notes: *The most commonly reported measure of crowding in New Zealand is the Equivalised Crowding Index (ECI). This is based on census results and is calculated as the number of occupants relative to the number of bedrooms. The ECI formula is adjusted to “adult equivalents”, with married and de facto couples counted as a single adult and children less than 10 years counted as half an adult. An alternative measure of overcrowding is to define “high occupancy” as:

Any one-bedroom dwelling with three or more occupants; and Any two-bedroom dwelling with five or more occupants; and Any three-bedroom dwelling with seven or more occupants; and Any other dwelling with eight or more occupants

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Appendix 12: Community summary The summary in this appendix was prepared to deliver the findings and recommendations of this report to the community in a readily-accessible form.

Tokoroa Warm Homes Clean Air Health and Well-being Impact Assessment

Background In September 2005 new national environmental standards for air quality came into effect. These standards set maximum limits for some common air pollutants that are bad for the environment and for your health. Studies show that levels of these pollutants are high in Tokoroa over winter – regularly higher than the new standard allows. The main reason for this is that many people in Tokoroa (around 60%) use wood burners to keep their homes warm. The smoke from these wood burners – particularly older ones that don’t burn cleanly - carries the pollutants into the air. Almost half of Tokoroa’s wood burners were installed before 1995 and are unlikely to burn cleanly. Using wet wood makes things even worse. The Tokoroa Warm Homes Clean Air (TWHCA) Project was set up in 2007 to reduce the town’s air pollution problem and significantly improve the health of the community by 2013. The project team includes people from The Ministry for the Environment, the Energy Efficiency and Conservation Authority, the Waikato District Health Board, Environment Waikato, the South Waikato District Council, the Raukawa Trust Board, The South Waikato Pacific Island Health Committee and the Tokoroa community. Environment Waikato (EW) is currently developing an air quality policy to help meet the national environmental standards in the Waikato region. This air quality policy will eventually say what changes people may need to make to their home heating to help reduce pollution, such as upgrading their wood burner if it is over a certain age or installing another clean heating system (e.g. a heat pump). The air quality policy will outline the assistance that will be available to help people switch to clean heat systems (such as grants and loans) and actions that could be taken if people don’t switch. EW and the rest of the TWHCA Project Team want to try and make sure that the air quality policy (and the way it is put into action) considers the community’s resources, likes and dislikes. We also want to try and avoid changes or approaches which place people under financial pressure, or cause stress in other ways. In February 2008, 22 members of your community attended a hui/fono to discuss the effect that EW’s draft air quality policy options might have on the community’s health and well-being from a cultural, economic, social and environmental perspective. Information from the hui/fono helped develop a Health and Well-being Impact Assessment for the TWHCA Project.

Findings from the hui/fono This is a summary of what the hui/fono attendees told the TWHCA Project Team. A wood fire means more than heat. Tokoroa is a mill town and wood and wood burning is at the heart of the community. Families like sitting by the fire and those who can get free wood from the mill like being able to provide firewood for their family. Wood is secure: you know how much you’ll need for the winter, you know what you’re using, there’s no surprise bill and it’s always there even if the power goes off. “If I had a heat pump, I could switch the switch and not know about the size of the bill until it comes in.” “Pacific people will go for a burner.” The community wants to be involved – in developing the air quality policy and in putting the policy into action by helping people understand the need to make changes, doing the actual work and

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making sure people access all the support they can get. Tokoroa’s community networks are strong and a lot of information is spread through these networks. There are already well-respected people and organisations working in education and support roles. The best way to achieve change is to work with the community using its languages, its people and its preferred ways of doing things. “Who is going to change? The people that understand the message.” “We are a visual and verbal community.” Many of Tokoroa’s families are under financial pressure. It is important that complying with the air quality policy doesn’t increase this pressure. It is important to make it affordable to purchase clean heating systems, help pay for ongoing maintenance costs where necessary and ensure that grants or loans to help people change their heating systems are available to the right people. People may be embarrassed to ask for help and may find other ways of complying with the policy that could be bad for their health (such as using un-flued gas heaters, choosing not to heat their home at all) or risk penalties by continuing to use their old wood burner. These situations need to be handled carefully by providing support in a way that is culturally acceptable. “When it comes to lending, don’t make it hard.” “I’m also thinking about my children, their needs, clean air but also about food, school, etc.” “Many will be too Akama – not confident in asking questions and don’t want to be in ‘high need’.” The solutions outlined in the air quality policy must be long lasting. People need to be sure that the heating system they choose will be worth the investment; that they won’t be left stranded by political changes; that things are in place to support the project into the future; that changes will have an ongoing, positive effect on the environment and the community. “Encouraging electricity with [our] environmental problems is solving one issue but making another issue.”

Resulting recommendations The findings from the hui/fono shaped a series of recommendations which will help develop the Waikato regional air quality policy and possibly similar policy in other regions. The recommendations are contained in the TWHCA Health and Well-being Impact Assessment report, which can be found [?] or obtained by contacting [?]. Below is a summary of the recommendations grouped into key topics or themes.

Communication Make sure that the community knows when the air quality policy will come into effect. Allow

plenty of time to discuss the changes involved and who they will affect Make sure the air quality policy allows and supports community groups to help people make

changes. When explaining why or what changes are needed use language the community understands, people it trusts and ways that work best for it

Make sure the community can see how and why decisions are being made. Keep talking with the community as the air quality policy is put into action.

Options for creating warm homes and clean air Allow as wide a range of heating appliance choices as possible so that, for example, Tokoroa

can choose to use high-quality wood burners and continue to enjoy the traditional benefits of a fire

Use practical demonstrations to help people decide which clean heat system will be best for them. Make sure all costs – upfront and ongoing - are clear. Let people know how long each clean heat system is likely to last

Consider regulation to phase out the sale of un-flued gas heaters as these create damp, unhealthy homes. Warn the community about the downsides of un-flued gas heaters and the inefficiency and energy costs of portable electric heating

Good home insulation will help to achieve the air quality policy’s targets and should be incorporated into its goals, monitoring programme and any financial help schemes.

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Managing the costs Make it easy for low income households to switch to clean heat systems. Negotiate the best

possible prices for appliances. Minimise the need for expensive loans. Get local social service agencies to help low income householders with maintenance costs. Use fines for non-compliance as a last resort. Get a community assessor to find out why householders have not switched systems and check they are receiving all the support they are entitled to first.

Financial help and other incentives to help people comply with the air quality policy must reach those who are most in need first. Consult with the community to get the eligibility criteria right. Financial help must be safe to use and all the costs involved in using it must be clear.

Develop a long-term strategy to support/fund the installation of insulation and clean heat systems and get more organisations involved.

Building local skills and work opportunities Assess how many local trades people will be available to install insulation and clean heat

systems and consider looking for funding to help train others in the community to do this work safely. Provide introductions and language translation services for insulation and clean heat installers going into homes.

Building partnerships Take action to build links between different organisations, strategies and programmes in the

energy, environment and health sectors. Help increase their understanding of what contributes to community well-being and what happens down the track when people do not have equal access to the things they need to stay well.

Respect the Treaty of Waitangi by effectively involving Māori in clean air policy decision-making, implementation and strategy development and seeing Māori get the maximum benefit from clean heat system installations.

Measuring success When measuring the effectiveness of the air quality policy it is important to assess its uptake in

relation to social, economic and cultural factors (including ethnicity, income, location) and its impact on community well-being.

What next? Environment Waikato has already refined some points of its draft air quality policy in response to the hui/fono findings and recommendations. Work is continuing to refine the type of financial assistance that will be made available and how this will be funded. The TWHCA project team will continue to work with the community as the policy evolves. For further information, contact Environment Waikato or Waikato District Health Board.