George Thomson

This descriptive study examined biographical data on the health conditions of 51 deceased leaders of the nine nuclear weapon states. It found that eight (17%) died from chronic disease while in office, with a mean of 3.9 health conditions per person (range: 1 to 10). A majority of these eight (62%) had cardiovascular disease and other conditions included personality disorders, depression, substance use disorders, and cognitive decline from multi-infarct dementia. Of the leaders leaving office alive, 15 (38%) were considered to have had health reasons playing a potential role in this departure. This group had a mean of 2.9 health conditions per person (range: 1 to 5), and all plausibly had their performance in office impaired by their health conditions (e.g., via a severe stroke, severe depression, likely personality disorders, mood and anxiety disorders, and substance use disorders). In conclusion, these findings indicate that physical and mental health conditions among leaders of these nuclear weapon states have been common (45% [23/51] of the leaders studied). Given the importance of the decision-making around nuclear weapons by political leaders, further research on this group should be prioritized.

In this viewpoint we consider brief case studies of four former Aotearoa New Zealand prime ministers whose poor health impaired their decision making. Two of them died in office-Michael Joseph Savage (leader for 1935-1940) and Norman Kirk (1972-1974)-while a third, Joseph Ward (1928-1930), died shortly after his resignation from his position. The fourth, Robert Muldoon (1975-1984), drank heavily at critical times during his prime ministership. We suggest that further New Zealand research on health-impaired leaders is justified, and discuss possible system improvements that can help to recognise when leaders become incapable or even need, if possible, to be removed from any position of authority.

Aim: There is growing international evidence that outdoor gym equipment in parks can provide health and fitness benefits to the population. As little is known concerning the availability and usage of such equipment in the Aotearoa New Zealand setting, we aimed to study this topic further.

Methods: An internet survey identified outdoor gym equipment in parks in the 10 most populated territorial authorities (TAs). A field survey of 22 selected parks examined the actual equipment. Observational data were obtained on equipment usage in one large urban park over 3 summer months.

Results: The internet survey identified 122 parks with outdoor gym equipment in the 10 TAs. The prevalence ranged from zero (in three TAs) up to 5.6 parks per 100,000 population in Christchurch City (i.e., one such park per 18,000 people). The field survey of 22 parks indicated that all the equipment worked as intended and none was vandalised. Observations from one large urban park indicated that the eight pieces of equipment averaged 16 uses per hour overall. This was extrapolated to estimate around 18,000 episodes of use over the 3 summer months for this park. Usage of the different items of gym equipment varied sixfold (p<0.0001).

Conclusions: There is a need for further research on the relationship between outdoor gym equipment provision and population health and fitness in the New Zealand context. Nevertheless, this study provides preliminary data that such equipment can be extensively used by the public in some settings.

Introduction: There remains uncertainty around the impact of war on the lifespan of First World War (WW1) veterans. In particular, study comparison groups do not typically consider the 'healthy soldier effect'.

Methods: We obtained lifespan data on a random sample of 857 war-exposed New Zealand WW1 veterans and compared this with lifespans of a non-war military cohort (n=1039). This comparison was possible as the non-war-cohort arrived in Europe too late to participate in the war, allowing a 'natural experiment' that avoided the 'healthy solider effect'.

Results: The lifespan comparisons indicated lower mean lifespan in the war-exposed veteran cohort compared with the non-war veteran cohort (69.7 vs 71.1 years; p=0.0405). This gap persisted (range: 0.8-1.1 years) but was no longer statistically significant when only considering the non-Māori ethnic grouping (nearly all European/Pākehā personnel), when excluding additional deaths in the immediate postwar period up to 31 December 1923, and when excluding participation in any other wars. This was the case in both analysis of variance and Cox proportional hazards regression adjusting for year of birth and occupational status. Within the war-exposed cohort, there were suggestive patterns of increasing lifespan with increasing occupational status and military rank (eg, 69.5, 70.0 and 70.7 mean years as group-level occupational status progressively increased). There were also stark differences in lifespan of 8.3 years between Māori (Indigenous) and non-Māori veterans (p=0.0083).

Conclusions: The pattern of reduced lifespan in war-exposed versus non-war-exposed veterans was compatible with a smaller previous New Zealand study with comparable methodology. Veterans who were Māori had significantly lower lifespans than non-Māori veterans. There are a number of feasible avenues to further improve this type of work with existing data sources.

The recent repeal of a key law to reduce the enormous health and economic burden from tobacco in Aotearoa NZ is a health, health equity, and economic tragedy. It occurred despite evidence of strong support for the key measures among the public.

To provide political context for NZ smokefree policies, we examined the Parliamentary voting record on 10 relevant laws since 2003. The Labour Party, the Greens and Te Pāti Māori voted consistently in support of progressive smokefree legislation. The National Party voted in favour of progressive smokefree legislation most (70%) of the time, including throughout 2010-2020 when inside and outside of government. However, National failed to support two key laws in 2003 and 2022 (despite appearing to support part of the 2022 Bill) and now is part of the Coalition Government that in 2024 repealed the 2022 smokefree legislation. The NZ First Party and ACT Party generally voted against smokefree policies (ie, NZ First voting for progressive legislation on only 2 of 7 occasions and ACT on only 2 of 9 occasions). A potential implication of these findings is that various parties could form cross-party agreements to ensure greater continuity and resilience of progressive smokefree policies.

Armed conflict remains a tragic feature of the modern world and so it is necessary to continue to study its health impacts. Even the study of historical conflicts is relevant given that certain health impacts are common to most wars e.g., post-traumatic stress disorder (PTSD).
This study built on a previous quantitative analysis of a randomly selected group of 200 New Zealand veterans from the First World War (WWI). From this sample we selected 10 cases that illustrated particular themes around morbidity impacts.
The theme of severity of impacts was illustrated with a case who was severely wounded and died from suicide when back in New Zealand, and another case with severe PTSD. The theme of the high frequency of non-fatal conditions was revealed with cases illustrating new diagnoses (a case with n=8 diagnoses), hospitalisations for new conditions (n=6), non-fatal injury events (n=3) and for sexually transmitted infections (n=3). The theme of chronic debility as a consequence of various conditions was illustrated with cases who had suffered from being gassed or having gastroenteritis, malaria or pandemic influenza.
These 10 selected cases reiterate how severe and extensive the morbidity burden for military personnel in WWI could be. Also illustrated is how the morbidity could contribute to adverse impacts on some of their lives after returning to New Zealand.

Military statues are being attacked and removed in multiple countries, but there is little analytic work on the associated reasons. Therefore, this research aimed to conduct a nationwide survey of outdoor military statues in a case study country (New Zealand) and identify reasons for attacks. Of the 118 statues identified, 11 (9%) of these had been physically attacked. A key risk factor for statue attack was it being linked to the colonial-era New Zealand Wars versus any other specific war (75% vs 8%, p = .003). This finding fitted with other evidence from attacks on statues of named New Zealanders (e.g. politicians) and on attacks of other types of monuments to these particular wars. It is also consistent with past and persisting injustices experienced by the Indigenous Māori population. In conclusion, some of the attacks on the military statues in this country appear to reflect social injustices and harm from colonialism.

This Briefing considers the deaths caused by Cyclone Gabrielle in the context of previous 'sudden mass fatality events' in Aotearoa New Zealand since the year 1900.

But fatalities are just one aspect of the wider harm to health and wellbeing from Gabrielle – which includes impacts on mental health and a major economic burden to the country. Given the scale of the impacts, there is a need for a broader inquiry to the impact and governmental/societal response to Cyclone Gabrielle than the current inquiry focused on forestry slash and land use.

Some of the potential policy implications for preventing such climate-change related extreme weather events includes improved institutional arrangements (for resilient infrastructure and appropriate land use), managed retreat from vulnerable areas, eliminating forestry slash, and making cities ‘spongier’.