Sara Knowles is the Senior Public Health Advisor at Taranaki District Health Board.
“I started out in clinical dietetics – I went to university and became a dietitian, then I worked initially in Palmerston North Hospital. My first non-hospital job was working on the Food Composition Database, in the early days of nutrition information labelling. It was so interesting, but it made me wish I’d been better at food science and chemistry.
Once I started having my children, I picked up community nutrition work with Plunket, which involved a variety of things like being the dietitian to talk to at Plunket health days or delivering community nutrition sessions. It was a fabulous job at that stage of my life. My third child was a very settled baby, so I’d be talking to people about infant nutrition while I was sitting there breastfeeding.
When we moved to Taranaki in 1999, one of the public health dietitians got me involved in working for a budget cooking trust. I worked there for about five years, teaching budget cooking, nutrition and food safety. It was about teaching people key concepts like eating seasonally and adjusting recipes so things would be cheaper, such as reducing the meat content and bulking up a family meal with beans and lentils or other vegetables. I loved working with such a diverse group – people who were recovering from mental illness, people who were on training courses, teenagers on transitional programmes – because it was fascinating learning people’s stories. It really helped me to understand a broad range of experiences that were new to me. One of the rewarding things was working with women who had been through mental illness; they had been cooks for their families but lost a lot of confidence. The course ran for 6-8 weeks and it was great seeing their confidence grow when they realised that they could do these things. That role made me aware of a lot of assumptions I had, so it was good preparation for working in public health.
In 2003, I started working in the nutrition and physical activity team at Taranaki DHB and I’ve been in working in public health in Taranaki ever since. When I started, we had a real health education focus, making well-intentioned assumptions about what communities needed. We work so differently now. We were talking just recently about how we used to evaluate the programmes with the participants. Of course, they told us what a good job we’d done but we never heard the voices of people who weren’t participating! Now there’s a shift to prioritising those voices and challenging our own practices.
Because we don’t have a lot of resources (I work in a really tiny team) we have to be very strategic. Back in 2017 we had a strategic review and prioritised our work quite differently into two main workstreams. One is health equity, with a particular focus on health equity for Māori, and the other is wellbeing in all policies, working to influence decision makers in areas outside health. It hasn’t been an easy three years, but we are making an impact. Our equity focus has been largely within the DHB; we really felt that if we are working out in the community we have a responsibility to ensure that what’s happening in our own organisation matches the shift we want to see outside. For myself as Pakeha it’s about acknowledging the privilege I have and making it clear that everyone in the system has a role to play in changing the system.
That shift towards equity for Māori is so important; there’s still a lot of power sharing that needs to happen. There’s a lot of talk about co-design, but sometimes when people talk about it it’s not really letting go of that power. It’s about being willing to listen and to establish relationships. Indigenous peoples around the world have the answers but we’ve imposed these Western ways of doing things. We need to stop, listen and learn.
I really love the people I work with. I feel like there is a type of person who works in public health; we tend to be positive, passionate and real believers in social justice and equity. We feel very strongly about enabling the voice of those who may not be otherwise heard. Many of the people who work in the field have a similar desire to make a real difference.
Working in this area can be hard at times. I think Covid-19 has been good at reminding people of the importance of public health. In our health system, the day-to-day treatment of people requires the biggest chunk of funding. You don’t need a lot of money to make a difference in public health, but it would be good to have a bit more!
Working in public health is about the person you are, not just the knowledge you may bring. Community relationships are key. It’s great to see that the younger people coming through have a greater awareness and experience of tikanga and mātauranga Māori, which my generation (especially Pākehā) didn’t have. You need to be open-minded, positive, and be able to bounce back when you don’t have the wins you’d like to have. Having a real passion for people and for equity is really important.”