Undertaking everyday activities: immigrant Indian women settling in New Zealand

Shoba Nayar BHSc(OT) MHSc(Hons)1*, Clare Hocking PhD2

Doctoral Candidate

Associate Professor School of Occupational Therapy, Division of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand

*Corresponding Author:
Shoba Nayar, 5/28 Evelyn Place, Northcote, Auckland 1310, New Zealand. Tel: 0064 9 419 4677; email: [email protected]

Received: 30 August 2006 Accepted: 20 October 2006

 
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Abstract

To date, very little has been written about Indian people migrating to New Zealand, and yet they constitute the second largest Asian group in New Zealand society. This paper describes the findings of a small-scale qualitative study into the everyday activities of Indian women who have recently immigrated to New Zealand, as they endeavour to settle into a foreign environment. Semi-structured interviews were carried out with eight women of Indian origin who had immigrated within the past five years. Using a grounded theory methodology to guide the study, a model explaining their engagement in everyday activities was generated. The findings show that participation in self-care, productive and leisure activities changes over time, as the women learn about their new environment, the resources available to them, and how things are done in New Zealand. Specifically, three interconnecting processes were identified. The first process, ‘oh God, where did I come?’, describes how being in an unfamiliar environment initially compels the women to do familiar activities that boost their confidence and support wellbeing. The second process, ‘being in the change’, sees women getting to know their environment and engaging in both new and familiar activities. ‘A New Zealander with an Indian soul’ finds women doing more activities that challenge their abilities and knowledge of New Zealand culture. Underpinning these findings is the importance of everyday activities in supporting wellbeing. This paper highlights implications for policy within New Zealand to assistimmigrants to settle, by supporting engagement in activities that promote wellbeing.

Key words

daily activities, immigration, wellbeing

Introduction

Increasingly, New Zealand is becoming home to people from different cultures. Between 1991 and 2001, the Asian sector increased by 100%, mainly due to immigration, and the 2001 New Zealand Census identified over 200 groups of people from culturally and linguistically diverse backgrounds. For the purposes of this paper the word ‘Asian’ is used to refer to the collective set of Asian ethnic groups, which in a New Zealand context includes but is not limited to Chinese, Indian, Korean, Cambodian, Vietnamese, Thai and Filipino. The largest of these groups are the Chinese and Indian communities (Office of Ethnic Affairs, 2002). With rising numbers of immigrants and Asian groups entering the country, the welfare and success of immigrants endeavouring to settle in New Zealand are a growing concern at governmental level.

Part of the human experience, for many people, is going to a new place. However, this transition may be more complex than anticipated. Within the occupational therapy literature, which focuses on everyday activities, it has been acknowledged that a permanent change of living place can be a stressful proposition that requires some form of adaptation and adjustment of valued occupations (Dyck, 1989; Christiansen and Baum, 1997; Blair, 2000; Hamilton, 2004). In this instance, occupation is taken to mean any task or activity that people undertake in their daily life that holds meaning and purpose for them. For some individuals, such change is easily accommodated. However, for those individuals struggling to meet the challenge of performing activities in a new environment, overall wellbeing may decline. That is, activities may come to be characterised as uncomfortable, unfamiliar or energy-intensive experiences that give rise to feelings of incompetence, frustration, foreignness and dis-ease. Add to this the multiplicity of ways an individual’s cultural values and beliefs may be confronted by the commonplace practices and assumptions of the local people, and the potential for disruption to everyday activity performance and wellbeing is immense.

Given the current social and political climate, there is a demand for research that addresses the needs of immigrants as they adjust to living in a new environment. This paper explores the everyday activities that Indian women who have recently immigrated to New Zealand engage in as they endeavour to settle into New Zealand society.

Review of the literature

While there is increasing research addressing the needs of immigrants, it tends to focus on two areas: the wellbeing of refugees and asylum seekers (Begg and Gill, 2005; Broad and Robbins, 2005) and whether healthcare practitioners are culturally competent to work with refugees and other immigrants (see for example d’Ardenne et al, 2005; Krajic et al, 2005; Qureshi and Collazos, 2005). There is a small body of research addressing the experiences of immigrants, such as Matiti and Taylor’s (2005) study of internationally recruited nurses. In addition, a few researchers have explored the cultural and psychological challenges Asian immigrants to New Zealand face, and their crises of identity (Ho et al, 1999; Eyou et al, 2000). However, literature specifically addressing the experience of immigration from the perspective of people who have voluntarily left their country of origin, and the actions they take to settle into a new country, is difficult to locate.

People emigrate for a variety of reasons. For some migrants, their decision is guided by a desire to fulfil personal goals, while for others electing to settle in a foreign country may be driven by family needs. No matter what the reason, there is growing recognition by the New Zealand government of the need to provide support to assist immigrants with settling in and becoming part of society. Until recently, advice on employment, health and other government-funded services has been provided to people from culturally and linguistically diverse backgrounds (in this study, Indian women), on the same basis as other residents (Office of Ethnic Affairs, 2002). However, when compared to the New Zealand norms, the trends are for some culturally diverse groups to fare poorly, particularly in relation to health, education, and justice (Office of Ethnic Affairs, 2002). Without policies or services that are specifically designed to meet their needs, these trends may continue, compounding poor outcomes. Thus, ‘new migrants and refugees have been identified as special groups who need more effective policies and programmes to target assistance to achieve better outcomes’ (Office of Ethnic Affairs, 2002, p. 13).

One aspect of policy that has received attention over the past 15 years relates to supporting migrants with high levels of education and skill to enter the country. Many still find it difficult to enter the workforce and obtain employment appropriate to their qualifications and experience (Ethnic Affairs Service, 1996; Office of Ethnic Affairs, 2002). In a recent attempt to co-ordinate development of settlement support services to address the barriers some immigrants experience, the New Zealand government released its New Zealand Settlement Strategy (Department of Labour, 2005a). The strategy outlines six goals for settlement, one of which is to support migrants in ‘obtaining employment’, noting that ‘the speed with which they integrate into the labour market, finding work that fits with their skills and qualifications is a significant indicator of progress with settlement’ (Department of Labour, 2005a, p. 5).

The social engagement and health needs of new immigrants are also being addressed. Asuppo rtive community can play a vital role in helping new migrants feel welcome and settle. Three out of the six New Zealand Settlement Strategy goals address the social aspects of settling in to a new community. These goals relate to forming supportive social networks, participating in community and social activities, and supporting migrants to feel safe in expressing their identity within the wider host community. In addition to these goals, the government’s Ethnic Perspectives in Policy (Office of Ethnic Affairs, 2002, p. 1) calls for an inclusive society, whereby people from culturally and linguistically diverse backgrounds can be ‘seen, heard, included and accepted’.

The third consideration in supporting new immigrants is health care. It has been recognised that an increasing number of immigrants, particularly those from Chinese or Indian backgrounds, are accessing mental health services because of difficulty in establishing life in a new culture. Nonetheless the strategic document Improving Mental Health: the second national mental health and addiction plan 2005–2015 (Ministry of Health, 2004) acknowledges that there is no national strategy or policy to address the mental health issues of the full range of culturally diverse groups living in New Zealand. TheMentalHealth Commission’s report Mental Health Issues for Asians in New Zealand (Ho et al, 2002) proposes thatwith an increasingnumber of people opting to immigrate, there is a need for more research (Ho et al, 2002). In particular, the report found that research addressing the needs of Asian immigrant women in New Zealand is very limited (Ho et al, 2002).

Policies need to be well informed, and current literature indicates an awareness of the need to support new immigrants in the areas of employment, social engagement and health. What appears to be missing from the discourse is recognition of the everyday activities that people need to carry out to live and survive, such as knowing where and how to obtain groceries. This study focused on such daily issues by addressing the question, ‘How do immigrant Indian women use everyday activities when settling in a new environment?’.

Methods

Methodology

To fully examine immigrant Indianwomen’s experiences of engaging in everyday activities when endeavouring to settle in New Zealand, grounded theory, specifically Strauss and Corbin’s (1998) approach, was employed to guide the study. As a methodology, grounded theory guides the exploration of processes that occur within a social group in such a way that ‘explanations of phenomena are grounded in reality’ (Giddings and Wood, 2000, p. 14). That is, the processes that are discovered emerge from the participants’ perspective (Glaser, 1998), which in this study is immigrant Indian women. Grounded theory enables researchers to develop theory that derives from data that are systematically gathered and analysed through the research process, which furthers understanding of social and psychological phenomena (Chenitz and Swanson, 1986; Chamberlain, 1999).

Data collection

Data collection took place in Auckland in 2004–2005, after the Auckland University of Technology Ethics Committee granted approval for the study.Apo tential ethical issue involved the possibility of participants being identified by other members of the Indian community within Auckland, as it is still relatively small. This issue was addressed by ensuring all identifying details were removed when quoting extracts from the data, and using pseudonyms. In addition, participants were asked to sign a consent form for participation prior to the interview.

Indian women who had immigrated to New Zealand within the previous five years, were over the age of 18 years and able to speak English fluently were sought as participants. An initial sample of women was solicited through the researcher’s contacts within the Indian community. As the findings began to emerge, participants whose experiences could refine and expand the limits of emerging conceptualisation were recruited. For instance, the overall experience of being in New Zealand was described in initial interviews as a positive experience, although the women did acknowledge that there had been difficult times. To further explore the notion of ‘difficult times’, a participant who acknowledged that she was not happy living in New Zealand was invited to participate. In this way, theoretical sampling allowed for full saturation of categories. The final sample contained eight women, aged between 19 and 45 years, who had arrived in New Zealand between 2001 and 2004. Five of the women had immigrated with their families, and seven were university educated, including three with postgraduate qualifications.

One semi-structured interview was undertaken with each participant. Each interview lasted approximately 90 minutes, was audiotaped and transcribed. In total, 105 typewritten pages of data were generated. Each participant received a transcribed copy of her interview to check for accuracy. Three women responded to this opportunity, requesting minor grammatical amendments. Data saturation was reached when, after the eighth interview, no new information about the emerging theory was forthcoming.

Analysis of data followed Strauss and Corbin’s (1998) three-level system of coding and categorising: open coding, axial coding and selective coding. Open coding requires a detailed line-by-line examination of data from the transcribed interviews, to identify concepts that represent phenomena. During this line-byline examination, labels are given to sentences or phrases that capture the meaning of the phenomenon. These labels are formed into codes that describe the concepts that arise directly from words or phrases in the data, also known as ‘in-vivo codes’ (Strauss and Corbin, 1998, p. 115). In the next phase of open coding, concepts found to be similar in nature are grouped together under the term categories.

During axial coding, data are reassembled according to connections between categories, as patterns amongst the categories emerge. At this point, the links between established categories are further defined by the make-up of subcategories. Subcategories ‘specify a category further by denoting information such as when, where, why, and how a phenomenon is likely to occur’ (Strauss and Corbin, 1998, p. 119). During axial coding, the conditional paradigmconstructed by Strauss and Corbin (1998) was used to assist with organising the data.

Ideally, data collection continues until a point of ‘theoretical saturation’, when no new relationships between categories emerge from new data. It is then that the third stage, selective coding, occurs. Selective coding seeks to integrate and refine theory with the aim of discovering a central core category (Strauss and Corbin, 1998). During this stage, three key processes emerged as discussed below. At each step of analysis, memos were written to record suggested questions, thoughts, hypotheses and relationships. These memos formed the basis of the final written report. In addition, three participants agreed to read drafts of the findings and provided their comments.

Findings

The three processes to emerge from the data concerning the experience of engaging in everyday activities in a new environment were named, using the women’s words, as ‘oh God, where did I come?’, ‘being in the change’ and ‘a New Zealander with an Indian soul’. Each process captures the common experiences of Indian women who have recently immigrated to New Zealand, while allowing for individual variations to be incorporated in the process. From the outset it was clear that these processes do not stand in isolation from one another but at times overlap as the women move from one process into the next. It is also important to observe that the women’s progression through the three processes is not always linear, and that at times they moved back and forth between processes.

‘Oh God, where did I come?’

This process was named using the words of one participant who asked the question ‘oh God, where did I come?’ soon after arriving in New Zealand. It encapsulated the experiences of those early days: arriving in a foreign country where everything appeared new and unfamiliar. This process identifies the ‘not knowing’ that occurred when the women entered a new environment. Feeling as though they did not know had the potential to undermine their confidence in doing daily activities, as the women faced the challenge of rebuilding their lives in a strange and unfamiliar place. When placed in a threatening situation, the women found themselves performing familiar activities which engendered a sense of competence, thus facilitating the beginning of their settling in to New Zealand society.

During this process, a sense of familiarity was achieved through performing activities that related to keeping one’s culture and involved sticking to the known. ‘Keeping one’s culture’ involved performing activities that utilised traditional resources, such as clothes or cooking ingredients, or implementing traditional practices, as one participant described:

‘I do my Indian cooking, so there is nothing different as such. I brought allmy vessels from India, so it’s, the vessels are the same. I’ve got my masalas, the ingredients, everything. The rice, whatever I cook in India, I still cook here.’ (Kate 5:12)

Being able to continue cultural practices in a new context provided a sense of comfort in strange surroundings. Thus the women tended to keep their culture even when there was no external demand to do so. This was particularly evident in the home where, within the Indian culture, there was a clear demarcation around the roles and activities women had within the household. Immigrating to New Zealand provided an opportunity to re-evaluate role expectations and choice of occupations. Doing familiar activities, though, was integral to maintaining a sense of security; thus the women found themselves drawn towards performing activities that were culturally bound.

‘But it’s not like you know, my husband has very high expectations that I should have three dishes cooked for him. No, nothing like that. So he’s quite okay even if I don’t cook. But it’s just that within, I mean, I don’t know, probably I’m too Indian at heart. You know, I’m supposed to be the one cooking for him. He’ll be okay even if there’s no food to eat, he’ll get something from out. But I think, why do that when I can? If I can’t, I can’t. But if I can why not?’ (Megha 1:43)

The second type of activity women engaged in was described as ‘sticking to the known’. This was a technique that women employed as a way of creating familiarity when performing daily occupations in their new environment. For some of the women this meant having a local place they had come to know, within which they could perform activities with minimal stress:

‘And I would just go to one superstore, ah supermarket. So that was easier for me you know, not going to a different one. I mean, if you go to a completely different one you kind of get lost. You don’t know where’s what. But if you’re used to your own, you know where things are and what you like.’ (Megha 1:14)

Similarly, other participants reported deliberate and repeated use of bus routes, petrol stations and shopping centres. Engaging in activities that involved ‘keeping one’s culture’ and ‘sticking to the known’ focused the women on doing things that provided a sense of safety and support in an unfamiliar setting. ‘Oh God, where did I come?’ was the starting point for Indian women arriving in New Zealand. The need to change their ways of doing things to start integrating into their new community drove them towards the second process.

‘Being in the change’

As time passed, the women’s sense of ‘oh God, where did I come?’ diminished and was replaced by an awareness of ‘being in the change’. However, the length of time taken to progress between the two processes differed for each woman, depending on personal circumstances.While there was a progression, aspects of the two processes overlapped. For instance, ‘keeping one’s culture’ was still important for many Indian women when ‘being in the change’, although not as crucial for feeling settled as when they first arrived. Therefore, they still did activities that were culturally based and familiar. In addition, they actively explored their community, trying new activities or altering previous ways of performing activities. Not all women found ‘being in the change’ a comfortable process; however, this did not prevent them from attempting to integrate with New Zealand society.

In this process, the things that the Indian women did on an everyday basis can be described as ‘gaining skills and expertise’, ‘doing things differently’ and ‘being discriminating’. ‘Gaining skills and expertise’ captured the process of initiating an unfamiliar activity and becoming increasingly competent at accomplishing the task.

‘So after coming here I learnt. Yeah, I learnt a lot. Like how to cook properly, how to yeah, be organised and clean your room yourself. Not getting someone to clean it.’ (Millie 3:30)

For the participants, ‘gaining skills and expertise’ was acquired in a variety of activities including household tasks, driving, gaining employment and leisure pursuits.

As the women were able to ‘gain skills and expertise’, they also started ‘doing things differently’. Living in New Zealand provided an opportunity to reshape cultural expectations pertaining to the traditional roles of women in Indian society, the activities associated with these roles, and thirdly, the routines they constructed to support their daily activities. One such role that was challenged was their role of maintaining the household, including cooking and cleaning. Jyothi began ‘doing things differently’ and shared the role with her husband:

‘I mean here you have to do, day in and day out, everything has to be done by you. Which is really hard to, initially it was very hard to accept. I mean my husband must have never done any house work before coming here, but here has to. He has no choice.’ (Jyothi 6:33)

Feeling comfortable within their environment facilitated the increased doing that became evident in the women’s process. With a vast array of choices, the women could afford to ‘be discriminating’ about which activities or aspects of their Indian culture they wished to retain, not only for themselves but for their family.

‘Ladies’, ah women’s life is different over here but um, I like that. Like um, she [daughter] can live in house and she can look after the children, become a normal woman but she got a freedom. But like here, women got um, you know like here divorce and separation is very common. So all these things, like I want that freedom, I want that but in certain ways. Like she know her duties. She got the freedom but she know how to manage the house and husband, which ah, is hard to do.’ (Rajni 7:65)

Having started with ‘oh God, where did I come?’ and progressing through to ‘being in the change’, women began integrating familiar and new activities while still retaining a degree of caution about what they needed to do to facilitate their settling in to the new environment. Thus they progressed towards the third process.

‘A New Zealander with an Indian soul’

This process addresses the everyday activities in which the Indian women engaged as they settled in New Zealand. It was a time for reflecting on the past, celebrating achievements and looking towards the future. It was a process that integrated the women’s experiences, situating them within the new culture, as opposed to being on the periphery, where they began their journey. During this process the women strove to attain equilibrium in their lives as immigrants in a new country, holding on to traditional ways of doing things while, on some occasions, adopting New Zealand practices. Sometimes the two cultures merged, as in the women taking Indian food to a pot luck dinner, a New Zealand custom.

Along their journey, women acquired knowledge and understanding about the New Zealand environment, so that when they reached this process, they were familiar with their surroundings. This familiarity meant that the women now sought to do more, which involved pursuing opportunities, that is to say creating and taking opportunities in all facets of life, to assist with the settlement process.

‘I was thinking of teaching yoga and meditation classes, yes, you can do here. And socialising with people, it’s up to you. If you want, there is a lot of changes, lot of places where you can go out. And the best thing what I can do here is go to pub! Can’t do that in India. I love to do that here, go to pub and have a drink, like I can’t think of doing it in India.’ (Girija 2:15–16)

However, the women could not always predict the challenges they might face in the future, and so had to persevere with the things they wanted or needed to do. Persevering propelled the women to further themselves and do more than they had believed possible.

This encouraged them to recognise their full potential, thus promoting feelings of competence and optimism for the future.

‘Finding my job and ah, working towards, I’m still working towards my career. I’m going to start working towards my registration as a psychologist, so that’s quite a challenge for me still. I mean, I know I have to work hard, I mean I haven’t started, um, I’ve been accepted for registration but I haven’t gone with the plans yet.’ (Megha 1:62)

During this process, women performed those activities with which they felt comfortable but which also posed a challenge to extend their skills and abilities. These activities might either be driven by the New Zealand environment or arise out of their Indian heritage. Choosing which activities to engage in, and knowing they could do them with ease, helped the women to realise that they had settled as immigrants in a new society.

Discussion

The act of immigrating significantly impacts upon immigrants’ wellbeing (Barger, 1977; Kuo and Tsai, 1986; Aroian, 1990; Pernice and Brooks, 1996). If new immigrants are not carefully supported, this impact can lead to detrimental health outcomes, as identified in the Mental Health Issues for Asians in New Zealand report (Ho et al, 2002). The findings of this study highlight the health benefits of retaining activities that are culturally familiar and involve traditional practices, both when new immigrants initially arrive in the country and as they go about establishing their daily lives in New Zealand. Ensuring that migrants incorporate cultural activities in their daily routines engenders a sense of comfort, safety and familiarity in an otherwise turbulent time, which this study suggests has positive repercussions for health and wellbeing.

In addition to supporting immigrants to continue culturally relevant activities, the findings show that building routines, such as the repeated use of key community resources like the supermarket, helps build a sense of familiarity and ease in their new surroundings. From this stable base, immigrants can begin to explore their community and try new activities. In so doing, they gain skills and expertise, and learn how New Zealanders do things. Achieving this, cautiously and over time, provides a sense of competence and lays the foundation for a sense of belonging, which supports health and wellbeing. Moving towards finding their place in New Zealand society requires perseverance, particularly in relation to seeking and creating opportunities to get involved in different activities. This is a necessary part of choosing which activities or aspects of activities to pursue, and allows immigrants to make decisions for themselves aboutwhat they need to do in their daily lives to feel at home in their adopted country.

In March 1991, the New Zealand government established a working party to investigate the effects of immigration within New Zealand. From this working party it was recommended that a points system be adopted to regulate immigration into New Zealand. The idea was to help select immigrants for business investment in New Zealand who had skills and money (Bedford et al, 2000). However, the findings of this study into the lives of immigrant Indian women raise questions about how new immigrants can utilise their skills effectively in the workforce when they initially struggle with routine activities. The women participating in this study were all educated yet still experienced difficulty with seemingly basic tasks, including knowing how to use an ATM machine, locate a mechanic or negotiate their way around a supermarket. Such tasks, which are taken for granted by those brought up within the environment, are generally performed within the home or localcommunity and provide a platform for new immigrants to develop confidence and skills to function within the wider society.

Implications for policy makers and immigrant support services

Over the last decade, New Zealand has seen increasing numbers of immigrants from various parts of the world. While the government has policies in place to aid migrant settlement (New Zealand Immigration Service, 2004; Department of Labour, 2005a,b), there is growing recognition of the need for local government to provide hands-on support services. The findings of this study inform the development of such services in two ways. First, the current focus of immigrant support services is on occupation, in the sense of finding paid employment. This study took a broader view of occupation, revealing the need for services to consider the full range of activities new immigrants perform, and the impact these have in determining how positive they feel about finding their place in New Zealand.

Second, the women in this study identified that gaining support through informal community networks was very difficult, even when they made the first approach. For instance, one woman talked of going to visit her New Zealand neighbour and having to conduct her conversation on the front door step. Many migrant women arrive as part of a family unit, and some have friends and family already living in the country, which makes it easier for them to get support with performing everyday activities. However, others make the journey to New Zealand on their own or with a partner and do not have the support of a community network. For these immigrants in particular, it is important that there are services available.

In considering the need for support around everyday activities, service providers need to determine how such support might best be implemented. This study iden-tified that for many of the women, having initial support from others helped with learning where to perform activities, and how to perform them. This support came either as practical assistance from someone doing the activity alongside them, or in the form of instructions and being provided with the information needed to successfully complete the task. Therefore, service providers may need to consider how to link new immigrants with people with sufficient local knowledge to be able to help them perform everyday activities. Additionally, educational services may prove beneficial in imparting information on accessing health services and formal education, as well as community services such as for getting appliances repaired. Establishing support groups within the local community that new immigrants can attend and share their experiences of trying to do things in a new environment may also be beneficial in assisting immigrants to create an extended support network. Such support groups might also provide a rich insight into the information immigrants need to successfully navigate their local community and New Zealand society.

Assisting immigrants to engage in everyday activities in an unfamiliar context is likely to increase their ability to master new ways of doing things and thus support the development or nurturing of a positive sense of self and wellbeing. This in turn will ease the stress implicit in the process of integrating into a new culture.

Implications for future research

This study has contributed an initial understanding of the everyday activities in which Indian women engage in entering a new culture, in order to settle successfully. This understanding is, however, limited in its scopewith regard to the number and representation of the women who participated, and in terms of the time elapsed since their arrival in the country. Further research in this field involving both men and women and a variety of culturally diverse groups may generate different understandings of the everyday activities involved in settling into a new country. In addition, because the study reported here focused on experiences in the first five years, the three processes identified may not capture everyday strategies employed in the longer term or as immigrants enter new life stages. In addition, the efficacy of immigrant support services informed by this study would need to be evaluated.

Conclusion

This study sought to answer the question: ‘how do immigrant Indian women use everyday activities when settling in a new environment?’. It has generated insights founded on the understandings of Indian women who immigrated to New Zealand within the last five years and who had to make changes to their activities to successfully live a healthy life in a new culture. Making these changes required three interactive and interdependent processes: ‘oh God, where did I come?’, ‘being in the change’ and ‘a New Zealander with an Indian soul’. This study highlights the importance of daily activities in facilitating the settlement process for new immigrants in a foreign environment. The study identifies the beginnings of important insights with regard to developing social policy that best supports immigrants in their endeavour to be seen and heard, as they learn howthings are done in New Zealand. Such policy would assist immigrants to be included and accepted, facilitating not only the settlement process, but also the health and wellbeing of this group of New Zealanders.

CONFLICTS OF INTEREST

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