With the aim of reducing ethnic health disparities, the Rheumatic Fever Prevention Programme has targeted Māori and Pacific communities with messages to get sore throats checked. Although the Health Promotion Agency consulted with Māori and Pacific health leaders to develop a culturally-appropriate intervention, the structural roots of rheumatic fever and the potentially harmful effects of the message presentation were not considered. By targeting health promotion to Māori and Pacific communities with the highest rates of rheumatic fever, the intervention inequitably distributed responsibility and created collateral damage in the form of stigma, internalised blame, emotional suffering and hypervigilance. Conceptually this can be regarded as structural violence. The authors suggested that consideration of how families experience public health messaging in the context of their daily lives may extend health promotion beyond awareness and behaviour towards equity.
