Critical health psychology in New Zealand: Developments,directions and reflections

Beginnings

Defining a critical approach is not straightforward and critical scholars have a variety of perspectives (Teo, 2015). Broadly, the critical approach to health psychology is concerned with issues of power and benefit, asking the fundamental question – who benefits from what we do? Critical scholars are therefore concerned to ensure the application of knowledge for the benefit of society, often with a particular concern for the oppressed and disadvantaged, and with a strong agenda for social justice. The history of the development of Critical Health Psychology in New Zealand involves a number of twists and turns. This discussion traces also how the School of Psychology at Massey University became a centre where a critical version of Health Psychology developed. ¹ This arose within a particular cultural and professional context, and as a consequence of several important, but often serendipitous confluences. These included a series of influential academic staff appointments and a series of academic activities that have helped shape research agendas, including conferences, workshops and collaborations, with critical scholars around the world and international visitors who contributed in a range of ways. All of this led to important research initiatives and activities, production of seminal publications and the development of a Critical Health Psychology postgraduate teaching programme, which is unique in New Zealand.

Health Psychology arose in several countries in the late 1960s and became professionally institutionalised a decade or more later. This history has been described in several chapters (e.g. Chamberlain and Murray, 2009; Lyons and Chamberlain, 2017; Murray and Chamberlain, 2014) and textbooks (e.g. Lyons and Chamberlain, 2006; Marks et al., 2015) identifying the various branches of Health Psychology, including Behavioral, Clinical, Community and Critical Health Psychology. Cross-disciplinary borrowings contributed to the growth of Health Psychology and Behavioral Medicine, as they evolved from Social and Clinical Psychology in the United States, Medical Psychology in the United Kingdom, Sociology of Medicine, Psychosomatics and Psychoanalysis in France, Community Psychology in South Africa and so on. While we focus here on a more recent period and expressly on the local New Zealand development of a Critical Health Psychology, this did not occur in isolation. International professional events and publications were influential and cross-fertilised the local developments.

Locally, at Massey University, one important thread in this development was the appointment of John Spicer to the university. John had conducted his doctoral research on coronary heart disease at Keele University in the United Kingdom and continued related research in postdoctoral positions at the Universities of Michigan, Tasmania and Auckland. He took up a position at Massey University in 1980, teaching research methodology and analysis, but continued his research interests in health. Around this time, Kerry Chamberlain (1985, 1988), in the Department of Psychology at Massey University, was conducting research on social indicators of well-being. This interest led him to spend a period of sabbatical leave at the World Health Organization in Geneva in 1987, where he worked with the Director of the Mental Health Division, Norman Satorius, on the initial development of the World Health Organisation Quality of Life (WHOQOL) measure. This work was a formative experience because it revealed the extensive literature on health research that was focussed around well-being and quality of life. At that time, these two bodies of the literature – on subjective social indicators of well-being and health and well-being, respectively – were only tangentially connected.

This project sparked Chamberlain’s interest in health and health research. On his return to Massey University in 1987, he and Spicer began some collaborations on health research (Chamberlain and Spicer, 1994; Spicer and Chamberlain, 1994, 1996a, 1996b). They had already been co-supervising postgraduate student research on health topics, and these discussions and activities led them subsequently to develop a taught postgraduate course in health psychology (an option for students as part of an Honours or Masters degree in Psychology), offered for the first time in 1990. This was one of the earliest, but not the first, postgraduate courses in health psychology offered in New Zealand (Spicer, 1999; Spicer and Blampied, 1999).^2,3 This course initially functioned as a special interest course for students interested in psychological approaches to health and health research. Over time, the course attracted increasing enrolments and resulted in a number of postgraduate students continuing to complete their master’s research theses on health psychology topics ⁴ and some continuing to doctoral research. ⁵ Two students who completed the course in 1992 are the co-authors of this article (A.C.L. and C.S.).

A second thread, important for the future critical orientation at Massey University, was the appointment of Andy Lock as Professor of Psychology and Head of Department in 1991. Lock was a critical scholar who had studied with John Shotter; he had eclectic interests and through various academic staffing appointments facilitated the development of critical and qualitative research ⁶ within the Department. One key appointment was Mandy Morgan in 1992, who nurtured and encouraged a feminist critical approach to psychology. Several current academic staff members and students were also starting to develop qualitative research projects and were keen to develop their skills and expertise in this area. Keith Tuffin developed a critical discourse postgraduate course around this time, which facilitated student engagement with critical approaches. Morgan set up a discourse group, which met regularly to discuss discursive research and completed several research projects (e.g. Morgan et al., 1994, 1997). Many more theses and projects began to utilise qualitative research approaches (see notes 3 and 4). This increasing interest in critical approaches and qualitative research reflected a shift that was occurring more widely across the discipline of psychology (see Kidd, 2002; Rennie et al., 2002), albeit as a minority approach in health psychology (see Smith and Suls, 2004 ⁷ ).

However, health psychology was not inured against the debates that were occurring within the discipline around this time, such as challenges about the value of critical theory and post-structuralism (e.g. Sampson, 1978, 1983), arguments for a social constructionist approach to research (e.g. Gergen, 1985), as well as strong challenges about the directions of social psychology (e.g. Parker, 1989), alongside an increasing engagement with language and discourse (e.g. Antaki, 1988; Billig, 1982; Potter and Wetherell, 1987) in the discipline (for a more detailed account, see Chamberlain and Murray, 2017). These pressures inevitably led to changes in health psychology internationally, but the particular events at Massey University shaped the health psychology that was forming there in advance of many other places around the world.

Connections

A third thread that encouraged and sustained the development of health psychology in New Zealand was a range of involvements in local and international activities. Across this early period, Spicer and Chamberlain drew on Massey University grants – the University Distinguished Visitor Fund and the Psychology Visiting Scholar Programme – to support visits from internationally renowned researchers in health research and thus facilitate the development of health psychology. These visitors made contributions to health psychology teaching, met with and provided advice to graduate research students, discussed collaborative activities with academic staff and, in the case of Visiting Scholars, conducted some research or publication activity of their own. Some other international visitors were supported by University of Auckland funding. Many of these visitors were also asked to appear as keynote speakers at the New Zealand Health Psychology conferences after 1996 (see below). Visitors included Aaron Antonovsky (Israel), Ralph Schwarzer, Uwe Flick (Germany), Christina Lee, Neville Owen, Jane Ussher (Australia), Michael Murray (Canada), Peter Molnar (Hungary), Jamie Pennebaker, Stephen Weiss, Stanislav Kasl, Neil Schneiderman (United States), John Weinman, Sheila Payne, Doug Carroll, Alan Radley, Charles Abraham, and Wendy Stainton Rogers (United Kingdom).

Keith Petrie also became actively involved during this period. He had completed a PhD in suicidal ideation in 1983, supervised by Kerry Chamberlain, alongside a qualification in clinical psychology. He subsequently worked in a hospital setting and collaborated with Chamberlain on several health-related research projects (Chamberlain et al., 1992; Petrie et al., 1989). In 1994, Petrie organised a New Zealand Health Psychology Conference at Okoroire, a very small rural location. Here, a motel and meeting room accommodating 40 people allowed local health researchers to meet together and discuss their work. The associated thermal pools, golf course, volleyball and pétanque courts also provided for some congenial diversions. This conference continued in 1995, with Chamberlain and Spicer taking over its organisation in 1996.

The initial meeting set the pattern for the following years, with the conference structured around two- or three-day sessions of presentations running morning to mid-afternoon, late afternoons devoted to recreation and evenings given over to entertainment. The conferences always included two or three keynote speakers, funded by visiting awards, alongside a range of presentations from local researchers, with evening entertainment in the form of debates, quizzes, games and team challenges, followed by a dip in the hot pools, where health psychology issues continued to be discussed and debated. For example, the 1998 programme reveals that the keynote speakers were Alan Radley from the United Kingdom (Psychology and health: From science to metaphor) and Neville Owen from Australia (Health psychology and behavioural epidemiology: Understanding and influencing risk of cardiovascular disease and cancer in populations). These conferences were held in February, in summer, and before the start of the academic year. Presentations from local speakers at these conferences ranged widely over health psychology content, from clinical approaches to pain relief, to psycho-neuroimmunology, lay understandings of health and discourses of illness. The critical health psychology content was always present and increased over the years.

These conferences also revealed the widespread interest in health issues by a diverse group of psychologists and health researchers across the country, few of whom considered themself to be health psychologists at that time. These stimulating Okoroire meetings ran annually from 1994 to 2000, with the eighth and ninth conferences moving to an Auckland venue in 2001 and 2002. ⁸ After the fourth conference in 1998, Keith Petrie began to organise separate, competing meetings. ⁹ This led New Zealand health psychologists to fall into two separate factions driven by differing interests and agendas, with those located at Auckland Medical School breaking away from those located at Auckland University School of Psychology and Massey University. The New Zealand Health Psychology conferences continued successfully in spite of this. They ceased after the 2002 conference when it was decided to merge the New Zealand Health Psychology Society with the Australian Society for Behavioural Medicine to form the Australasian Society for Behavioural Health and Medicine (ASBHM) (see below).

In 1996, Chamberlain and Spicer founded the New Zealand Health Psychology Society to provide a national and international identity for health psychology in New Zealand (Health Psychology at Massey, 1996). Membership was open to anyone interested in health psychology research and who paid the minimal joining fee of NZ$10; there was no annual subscription and membership was accepted from students and researchers, medical sociologists and public health researchers, as well as psychologists. Membership grew quite rapidly to around 70 members, reflecting the diversity of people interested in health research across the country. This society provided the figurehead for the annual conference and a national identity for health psychology that provided a means to engage with international organisations, such as the International Association of Applied Psychology. This also assisted the Massey University health psychology programme to be listed in the International Directory of Health Psychology Training Programmes from 1996. The Society issued a sporadic newsletter (New Zealand Health Psychology Society, 1996–2001), which provided announcements of positions and conferences, reviews of the local conference and news of members (this newsletter has been used as an archival aide-mémoire for some of the events reported in this article).

After several years, interest in attending international conferences increased and energy for sustaining this small annual health psychology conference began to decline, leading to discussions between the New Zealand Health Psychology Society and the Australian Society for Behavioural Medicine about mutual interests and the possibility and practicality of holding joint conferences. A semi-formal meeting was held in Brisbane in 2000 to discuss this, with Kerry Chamberlain and Glynn Owens representing the New Zealand Health Psychology Society and Christina Lee and Brian Oldenberg representing the Australian Society for Behavioural Medicine. After discussion and negotiation with the respective societies, it was agreed to merge the two organisations into one, called the Australasian Society for Behavioral Health and Medicine (ASBHM). This society then proceeded to meet annually from 2001, initially alternating conferences between Australia and New Zealand and currently holding every third conference in New Zealand. These changes, although providing increased international recognition and professional legitimacy, led to the demise of the New Zealand Health Psychology Society, and this in turn led to fewer opportunities for a sympathetic venue for presenting critical research. ASBHM became a more mainstream organisation, ¹⁰ and critical health psychologists did not feel completely at home there. By contrast, the Society for Australasian Social Psychology (SASP) always made room for symposia by critical social and health psychologists at their annual meetings.

However, critical health psychologists in New Zealand were soon given another international alternative for their research presentations. Following his participation in the New Zealand Health Psychology Conference in 1996 (see below), Michael Murray determined that there was a need for an international critical health psychology meeting ¹¹ and in 1999 convened the first International Conference on Critical and Qualitative Approaches to Health Psychology at Memorial University in St John’s, Newfoundland, Canada. This meeting was well attended, reflecting the growing interest in critical and qualitative approaches that was developing within Health Psychology internationally. It was decided to hold a follow-up meeting 2 years later, at Aston University in Birmingham, United Kingdom, at which the International Society of Critical Health Psychology (ISCHP) was formally founded (see https://ischp.info/). This society has continued to hold a biennial conference since that time. Academic staff within the Massey University Health Psychology programme have had a strong on-going involvement in this society, with Chamberlain serving as Chair from 2005 to 2009 and Communications Coordinator since then, Lyons serving with Sue Dalton as Co-Treasurer from 2001 to 2009, and Stephens serving as Treasurer from 2009 to 2017 and Chair from 2013 to 2017. Massey University Health Psychology academic staff members organised and hosted the third ISCHP conference in Auckland in 2003. Together with their graduate students, they have been regular attendees and presenters at all ISCHP conferences across the period, and Chamberlain, Stephens and Lyons have all been keynote speakers at ISCHP conferences. This international network has been very valuable for making connections and collaborations for both students and academic staff.

Massey University as ‘cradle of the critical’

From the 1990s onwards, Massey University School of Psychology became a ‘cradle of the critical approach’, with action research projects, critical psychology theorising, critical approaches to feminism and the evolving Critical Health Psychology programme. Another major thread in solidifying the critical health psychology agenda was through the research activities and the range of critical publications on health psychology produced by Massey University academic staff members. Discussions between Spicer and Chamberlain in the mid-1990s led to the publication of a highly critical article on theorising in health psychology (Spicer and Chamberlain, 1996b), which critiqued the ‘pathology of flowcharting’ extant in social cognition models and challenged health psychology to theorise more adequately across the biopsychosocial divides. Chamberlain also saw the need to promote qualitative research to the international health psychology community and invited Stephens and Lyons, postgraduate students at the time, to participate. This resulted in the production of one of the first articles published in health psychology presenting selected qualitative methodologies and arguing for their value for health psychology research (Chamberlain et al., 1997 ¹² ). In 1993, Chamberlain attended the European Health Psychology Society Conference in Brussels seeking out other researchers using qualitative methods. There were very few (only two in fact), but there he met Michael Murray, who delivered an engaging presentation on the narrative analysis of cancer stories in books written by women ‘cancer survivors’. Chamberlain subsequently invited Murray as a Massey Visiting Scholar, and Murray visited Massey University in 1996 and gave a keynote address at the third New Zealand Health Psychology Conference. Their discussions led to two important collaborative activities. The first of these was the production of a special issue in the Journal of Health Psychology on qualitative research (Murray and Chamberlain, 1998), where nine qualitative articles using a range of methodologies showcased good practice in the field ¹³ and provided the first health psychology special issue focussed on qualitative research.

The second was the development of a qualitative research textbook (Murray and Chamberlain, 1999), designed to illustrate a range of qualitative approaches and methods for researching in health psychology. This edited book was the first text to appear with a specific focus on qualitative methodologies for health psychology research, although there were a number of other books around this time with related agendas (e.g. Crossley, 2000; Nightingale and Cromby, 1999; Radley, 1994; Smith et al., 1995; Stainton Rogers, 1991; Yardley, 1997). During his Massey visit, Murray (1997b) also produced a monograph on narrative research, which foregrounded a series of other publication he has authored on narrative methodology (e.g. Murray, 1997a; Murray and Sools, 2014). The collaboration between Chamberlain and Murray has continued productively since that time (e.g. Chamberlain and Murray, 2009, 2017; Murray and Chamberlain, 2015) and reflects the range of important collaborations between critical health researchers at Massey University and other researchers, both locally and internationally (discussed below). In summary, there was an array of connections, activities and engagements that were shaping health psychology in New Zealand and critical health psychology at Massey University in particular. We now turn to the critical health psychology research and teaching that arose from these.

Developments

In terms of teaching, the health psychology programme at Massey University offered quite conventional health psychology in its very early stages but quickly became more critical and strongly aligned with qualitative research. Following the initial course in health psychology offered by Chamberlain and Spicer, the programme moved ahead quite rapidly. John Spicer moved into teaching research methods, and Kerry Chamberlain continued and developed the course to include critical perspectives. Christine Stephens was appointed to an academic position in the Department in 1996 and developed a course in health promotion within the programme, which was offered from 2001. The (now) School of Psychology moved to teaching all graduate courses in smaller formats (semester-length; 15 credits) and offering all courses in block mode. ¹⁴ The original Health Psychology course was consequently split in two, with one course retaining the original name (Understanding Health and Illness) and the other named The Social Context of Health and Illness. Antonia Lyons took up a position at the University of Birmingham in 1996 after completing her doctorate but returned to an appointment at Massey University in 2002, and in 2003 became coordinator of the Understanding Health and Illness course. This established the core three course structure that we have today (see MSc (Psychology with endorsement in Health Psychology), 2017).

Currently, all Health Psychology students complete an MSc degree, involving 1 year of course work and 1 year of thesis research when completed full time. The programme has continued to place emphasis on presenting health psychology from a perspective which incorporates ‘community, public health, and critical’ (Health Psychology at Massey, 2017) and which also recognises the bicultural status of New Zealand. Within the programme, we have been proactive in teaching bicultural perspectives and to locate health issues within the context of the Treaty of Waitangi and a critical appreciation of the history of colonisation. The programme attracts a considerable number of Māori students, and we have supervised several Māori students on Māori health-related topics. At undergraduate level, a third-year course in health psychology was developed by Linda Jones in 2005, drawing on her interests in occupational health psychology. It was transformed into a critical health psychology course when coordination moved to Antonia Lyons in 2013.

We were keen to include a workplace practicum component as part of the programme, which we established in 2003. This has had various iterations, depending on the requirements of the University and the national Tertiary Education Commission but is currently a 15-credit course required within the programme (see Health Psychology Practicum, 2017). The practicum placement involves students working in a health-related organisation, completing a project of value for that organisation and bringing their academic learning to bear on real-world issues. These placements are supervised by academic staff and local practitioners and have been located in very diverse settings, ¹⁵ with the only proviso being that the project undertaken must have a health focus. Alongside these Masters students we have a strong cohort of PhD students researching health psychology topics with a critical perspective. To facilitate networking between our students, who are scattered across the country, we host an annual Health Psychology Research Day, where students can present their thesis proposals or research, or their practicum experiences, and hear an invited keynote speaker.

Academic and professional degrees

In some countries, such as the United Kingdom (British Psychological Society, 2016), a prescribed curriculum has been developed for a Masters degree in Health Psychology and for a Professional Qualification in Health Psychology, allowing employment with a professional status. In New Zealand, there is a similar professional degree qualification for health psychologists, which allows them to become registered with the New Zealand Psychologists Board under a general scope of practice. ¹⁶ The University of Auckland is the only New Zealand University offering such a qualification, through its mainstream Masters in Health Psychology, followed by a clinically focussed postgraduate diploma in Health Psychology. ¹⁷

Although professional accreditation has value for critical health psychology students, at Massey University, we have resisted providing a specific professional pathway in Health Psychology to registration as a psychologist, for several reasons. One is that many of our students find employment in various places without such registration, and many progress into academic and research positions where they do not need it. ¹⁸ For those who do seek registration as a psychologist (a legally protected term in New Zealand), Massey University does offer a postgraduate qualification, the Postgraduate Diploma in Psychological Practice, which can be completed after the MSc. Resistance to professionalisation is also part of an overall critical stance, promoted strongly within our programme. As Ingrid Lunt (1999) has argued, professionalisation can produce external pressure on what is taught and how it is taught, and also involve regulation of the programme to meet accreditation requirements. This could produce restrictions on our multidisciplinary approach to fostering a critical stance on health. Most professionalisation agendas are about protection of the profession, the title involved and the field of practice. Professionalisation thus can, and does, involve boundary work and political activity in responding to other sub-disciplines within the field. In our critical approach to health psychology, we constantly reinforce the political nature of knowledge and remind our students that as Derek Hook (2004) has stated,

one of critical psychology’s basic preoccupations lies with those ‘taken-for-granted’ assumptions concerning reality, human nature, and knowledge that are reflected and perpetuated by psychology … a kind of knowledge that is produced by a certain group, in certain ways, and for certain interests. (p. 16)

Furthermore, professionalisation can reduce ethical codes to a regulatory and disciplining pursuit, rather than an emancipatory and active engagement with ethical standards in everyday practice settings. Hence, we have continued to promote freedom from professionalisation to our students, while providing a broad range of course content and engaged research, and ensuring that students take up a strongly critical, reflexive and ethical practice.

The critical agenda (and extension of the ‘cradle of the critical’) was also bolstered by the appointment of more critical scholars to the School across the period. Leigh Coombes was appointed in 2003, bringing interests in critical psychology, gender and disadvantage. Clifford van Ommen was appointed in 2011, bringing interests in critical psychology, biosociety, health and mental health, and providing supervision for health psychology research students. Denise Blake was appointed in 2011 and has been heavily involved in teaching health psychology at both undergraduate and postgraduate levels. Veronica Hopner was appointed in 2012 but had contributed to teaching and supervision in health psychology as a contract lecturer for some time before that. Darrin Hodgetts was appointed in 2015, bringing critical agendas in social, community and health psychology, and contributing into teaching and supervision within the health psychology programme. Tracy Morison (from Rhodes University in South Africa) was appointed in 2016, with interests in critical psychology, gender and health, and has taken over the Health Promotion course, as well as providing research and practicum supervision for health psychology students. These appointments, along with the earlier appointments of critically aligned academic staff, mean that the School of Psychology at Massey University has the largest concentration of critical psychology scholars in Australasia. Having the support and acceptance of our departmental colleagues for a critical approach to Health Psychology has certainly facilitated our progress, helped students orient to this different perspective and gained widespread acceptance for the programme.

As the health psychology programme at Massey University developed a stronger critical, community and public health perspective, it became difficult to source relevant textbooks for student use. Our faculty responded by providing key articles, chapters and books. Lyons had been approached to write a critical health psychology textbook while at Birmingham University, and this was completed and published after her return to New Zealand (Lyons and Chamberlain, 2006). Stephens (2008) published a critical text on health promotion. These became texts for the three core Health Psychology courses, making the programme relatively unique among health psychology programmes for having texts written by the course teachers for all core courses within the programme.

Alongside these critical teaching developments was a stream of research activity and publications, often involving collaboration with local and international health researchers, with the resulting cross-fertilisation of ideas. The collaboration between Chamberlain and Murray was noted earlier. Alan Radley’s visit in 1998 led to several further collaborations with Chamberlain and Hodgetts, including on major research grants, funded by the Royal Society’s Marsden Fund and the Health Research Council of New Zealand, for homelessness research (e.g. Radley et al., 2010) and medication research (e.g. Dew et al., 2014), with the latter project also involving several local and international health sociologists. Chamberlain has been invited as a keynote speaker to conferences, to run workshops on qualitative research in a number of local and international locations and to visit a number of overseas institutions, which have led to further collaborative research and publications (e.g. Santiago-Delefosse and Chamberlain, 2008). Lyons has been a keynote at several conferences and has links and collaborations with international researchers, which have produced research collaborations and outputs (e.g. Gough and Lyons, 2016; Lyons and Cromby, 2010; Lyons et al., 2014; Rohleder and Lyons, 2014). Her links with Christine Griffin at the University of Bath have facilitated collaboration on a drinking cultures project funded by a major grant from the Royal Society’s Marsden Fund (e.g. Goodwin et al., 2016). Chamberlain and Lyons have been commissioned by Routledge to edit the new series Critical Approaches to Health. Stephens has been awarded a number of major research grants on ageing and health from the Health Research Council and the Ministry of Business, Innovation and Employment, and has developed collaborations with a wide range of local and international researchers in the gerontology field (e.g. Stephens, 2017; Stephens et al., 2015; Szabo et al., 2017). Morison brings with her a wealth of international connections and publications (e.g. Morison and Lynch, 2016). Hodgetts has a wide range of international connections, invitations as a keynote speaker and extensive critical publications on health matters (e.g. Hodgetts et al., 2015; Stolte and Hodgetts, 2015) and has held major grants from the Royal Society’s Marsden Fund, the Health Research Council, and Nga Pae o Te Maramatanga, the Māori Centre of Research Excellence.

In our grant funded research, we have actively worked with Māori researchers and colleagues, and involved Māori and Māori communities in the research (e.g. Dulin et al., 2012; Mark et al., 2017; Moewaka Barnes et al., 2016). Critical health psychology academic staff have also been active in publishing articles promoting the use of qualitative and critical methods for health research (e.g. Chamberlain and Murray, 2017; Gough and Lyons, 2016; Hodgetts et al., 2011; Morison et al., 2015; Stephens and Breheny, 2013) and are on editorial boards, and involved in a range of editorial roles, for international health psychology and qualitative research journals. These collaborative activities, with connections spanning local and international networks, have been synergistic for both parties – the critical health group at Massey University and those external to it – and have produced enduring relationships and impacts.

Reflections

From small beginnings, activities focussed around Critical Health Psychology in New Zealand have grown significantly. Research activity and productivity from this academic group is high and student numbers in the associated Critical Health Psychology programme have grown and are currently strong. ¹⁹ This brief historical account of the development of Critical Health Psychology in New Zealand leads us to reflect on the critical approach we have taken to health psychology.

On reflection, we consider that we have made significant contributions to the body of critical knowledge in health psychology (many of these works have been referenced above) and have had a major involvement in advancing the critical agenda. We have consistently authored articles and chapters, and continue to receive invitations to author more, often in collaboration with other critical scholars internationally, on critical aspects of health, and on critical methods for health research. We have consistently developed and participated in critical symposia at mainstream health psychology conferences, again frequently in collaboration with international colleagues. We have conducted a significant number of workshops on critical approaches in many locations internationally. We have had a very substantial involvement in advancing the critical agenda within the International Society for Critical Health Psychology. A significant number of our graduates have gone on to academic and research positions and taken the critical approach forward. Although the critical voice has been requested and accepted in these wide-ranging ways, we are still aware that this is a minority endeavour within the broader health psychology arena. However, we see a number of encouraging signs that critical and qualitative approaches are coming to be more widely accepted and utilised within health psychology.

Another reflection concerns the development of new generations of scholars. Are we rendering positive value to our students in promoting and inducting them into a critical perspective on health psychology? We are aware that this does make them (currently) a minority group within the sub-discipline, but we argue that it also leads them to be critical in a broad sense, able to challenge practices and understanding beyond health psychology, extending to psychology at large, to medicine, to other disciplines like public health they may engage with and to frameworks of research and practice. Students initially can find this tough going, but they emerge with enhanced perspectives that deliver them skills and opportunities. As the programme goes from strength to strength, we continue to find that our graduates are productive, engaged, critical and positive about the experience and ultimately contribute their knowledge and skills in a range of positions both within and beyond New Zealand.

A further reflection concerns the very approach we have taken. In many ways, critical health psychology has developed in New Zealand in rather unique ways. We have been fortunate that a number of synergistic events have brought together a similarly minded group of critical scholars with interests in health and that there was academic support for their research and teaching. We wonder if this has been assisted by our location, as a small country in the Southern hemisphere, far away from the potential influences and demands of the mainstream in the global North. We wonder also if it has been facilitated by the local experience of neoliberal reform, undergone before the Northern experience, and the inevitable and consequent rise in disparities and health inequalities that have accompanied it. Whatever the reasons, we have been free to take up a distinctive perspective and approach to health psychology and to advance the critical agenda in undertaking our work.