Transnational health in the Pacific through the lens of TB

Project outline

Pacific peoples in New Zealand and the Pacific are interconnected and travel frequently between their multiple homes. This study analyses the health implications of these interconnections and movements of people. It uses a study of TB, and other diseases with which TB is connected, as a lens to examine the effects of socio-economic and life-course processes on health over time and space. It asks, how and how well do New Zealand and island nations' health services cope with this mobility? What helps to produce effective TB control and treatment? How can stigma be overcome?

Using historical, ethnographic, demographic and health promotion methodologies, and engaging local communities and Pacific research students, the project works in two island nations as well as New Zealand. It aims to produce new knowledge and work in partnership with specific communities to plan interventions which will help reduce TB, improve health and reduce health inequalities.

The research objectives therefore are:

1. To analyse the implications of transnationalism for the persistence and transmission of TB in NZ and the home islands and why that varies;
2. To determine the macro-socioeconomic and life course determinants of TB among the same populations;
3. To identify whether and how the high rates of TB among some Pacific people cluster with other health related conditions by person, place or time (syndemics) and the implications of that for effective interventions and policy aimed at social disparities in health;
4. To identify historical barriers to effective intervention through documenting the history of public health and specifically TB services in the two island nations and the history of Pacific TB in NZ since 1950;
5. To identify the contemporary factors that create barriers or facilitate successful TB prevention, diagnosis, contact tracing and treatment among Pacific peoples;
6. To work alongside the communities participating in this research from inception to completion and design of pilot interventions that are effective and culturally appropriate and to seek funding in support of these interventions;
7. To support emerging Pacific health researchers in undertaking social science of health research and advancing Pacific research models in a collegial environment.

In 2008 we were granted funding from the Health Research Council, and we received funding from the University of Auckland Faculty of Arts Research Development Fund to undertake consultation before our HRC application. The project has been running for three years thus far.

For a full description of the project, download the information pack.



Project team members include academic researchers from the University of Auckland, international collaborators, and researchers.



  • Rochelle Newport enrolled in a Master's programme supervised by Jennifer Hand, following her summer studentship. She was awarded an HRC Master's Scholarship.
  • Ph.D. students Evelyn Marsters and Tufoua Panapa completed their fieldwork reports, and moved towards their completion deadlines, guided by reading and writing group and supervisory meetings.
  • Based on the work of the two graduate students (Sagaa Malua and Rochelle Newport), two applications were made for health promotion to the Health Research Council.
  • We gave presentations in both the HRC Pacific Health Fono and the Cook Islands Health conference.
  • One element of outreach was the publication of a small book in Cook Islands Maori and English on the Healthy Lunch programme in Enuamanu School, Atiu, Cook Islands. This book, put together by Julie Park and the school students, was produced in Auckland and then returned to the school and to the Ministries of Health and the Prime Minister's Department, Cook Islands.
  • Collaboration with Dr Nelesone, Cook Islands Ministry of Health, continued with the publication of two manuscripts concerning the syndemic relationships between tuberculosis and helminth infestation.
  • Sagaa Malua – now working as a part-time research assistant – has been continuing with her work researching the Tuvaluan community in Auckland.


  • “Better Lives: The Struggle for Health of Transnational Pacific Peoples in New Zealand,1950-2000” published as an e-book as part of the RAL series at the University of Auckland in December 2011.
  • Julie Park and Judith Littleton carried out three weeks of fieldwork in the Cook Islands, primarily on the sister island of Atiu exploring issues of transnationalism and heatlh, particularly continuity of healthcare.
  • The ethnographic project undertaken with Cook Islanders by Evelyn Marsters has continued this year, with Evelyn undertaking fieldwork and interviews in New Zealand.
  • Tufoua Panapa has spent the year in Tuvalu doing fieldwork and researching the intersection between health and education.
  • Sagaa Malua has been undertaking her graduate research on the analysis of New Zealand immigration policy and its relationship to the health of Tuvaluans resident in Auckland.
  • Rochelle Newport has also been undertaking graduate research on the analysis of health promotion in the Cook Islands, including undertaking fieldwork in Rarotonga in August.


  • Debi Futter-Putai (Cook Islands) and Setapu Resture (Tuvalu) completed Masters theses on the history (1950-2008) of health and health services with a focus on TB and its interacting conditions in their respective island groups, and with Cook Islands and Tuvalu people in New Zealand.
  • Tufoua Panapa was appointed as a Ph.D. candidate who will investigate the intersection of health and education and health development in Tuvalu, with a focus on the TB/Diabetes syndemic. In November/December 2010, Anne and Keith Chambers accompanied Tufoua to Tuvalu on his preliminary fieldtrip, meeting key people in Fiji and Tuvalu and presenting copies of the group’s historical report to the relevant bodies.
  • Evelyn Marsters, a Ph.D. candidate, undertook preliminary fieldwork in the Cook Islands accompanied by Yvonne Underhill-Sem and Julie Park.
  • Work progressed on the group’s report on Pacific Islander Health and Tuberculosis in New Zealand from 1950-2000. The report, which includes contributions from most team members, was submitted to Research in Anthropology and Linguistics e-series in November.
  • Collaborative projects were undertaken with a research team working on tuberculosis among First Nations people in central Canada. A student associated with that team, based in Saskatoon, visited Auckland for three months and explored the commonalities between TB epidemiology in both places.
  • Sagaa Malua was appointed as a graduate student in the mid-year. Sagaa’s research will involve working with the Tuvaluan community in Auckland.


  • Debi Futter (Cook Islands) and Setapu Resture (Tuvalu) commenced Masters of Arts in History, focussing on the history (1950-2008) of health and health services with a focus on TB and its interacting conditions in their respective island groups, and with Cook Islands and Tuvalu people in New Zealand.
  • Evelyn Marsters was appointed as a Ph.D. candidate to carry out an ethnographic project with Cook Islanders.
  • An ethnographic study with the Tuvalu communities began through participation and an evaluation of a TB awareness program conducted in Auckland by Auckland Regional Public Health Service. Three members of the team were involved in this, and we produced a technical report for ARPHS which has been circulated in the community.
  • Fieldwork trips were undertaken by Setapu Resture, Anne and Keith Chambers to Tuvalu where they worked on archival material and conducted oral history interviews. Debi Futter has spent time in Rarotonga doing similar research. Both students have made research trips to Wellington as well as conducting work in Auckland.
  • A paper on TB and syndemics is in press with the journal Social Science and Medicine.