Speech: Nga Ara Tohungatanga o te Hauora: Defining professional pathways in health promotion - Hon Tariana Turia

Runanga Whakapiki Ake i te Hauora o Aotearoa; Health Promotion Forum of NZ Symposium
Brentwood Hotel, Wellington; 7 July 2011; 1pm 

The other day I received a letter which reduced me to tears.

As a Minister that’s not unusual in itself.

Every day I read the letters of worried wives, of anxious providers, of frustrated neighbours, of families under stress. They send me copies of their bills; their medical records; photos of their children; incident reports; poetry.

And each and every one of them, shares with me a glimpse in time; the issues that impact on their health and wellbeing.

But this one letter was a bit different. This is what it said:

“Mama, I’m growing up. Soon I’m going to be ten. I know you’re not going to be with me forever, and that one day you will pass, but I want you to know how much I love you, and that for the rest of my life you will always be with me”.

This letter – left on my pillow from my mokopuna – told me everything about a young lady, preparing her own life pathway, being aware; being prepared and being herself.

In many ways, it resonated with me about the message I would hope we might all share in this 2011 Health Promotion Forum Symposium.

And that is about the preparation and the attitude that we take in embarking upon a professional pathway in health promotion.

What are the steps we have taken to develop a professional infrastructure for health promotion?

How are we equipped to best serve our communities? Are we aware of the silent voices, the marginalized members of our society who might otherwise miss out?

So I come to you today, thinking of that note on my pillow, and wondering what sort of letter might cause you to review and reflect on your practice – much as my mokopuna’s words have done for me.

I need to get it right – for the future of my mokopuna – and I don’t have time to waste in settling for second best. I want to ensure we have all bases covered, and that we do the very best that we can to make the difference we need.

In many ways it is the same vision that drives the Health Promotion Forum.

It is now some 23 years since the forum was established to bring together a workforce dedicated to the pursuit of health education and health promotion.

Your origins were admirable – being inspired by the five strands of the Ottawa Charter as well as the driving force of Te Tiriti o Waitangi.

And the focus was unashamedly positive – strengths based – choosing to promote and improve health rather than give undue emphasis to illness and disease.

And of course your leadership has always stood out – whether it was Dr Erihapeti Rehu-Murchie in the early days, or Donna Leatherby today - this Forum has always been determined to support your members to be confident and competent practitioners – working within the context of a sustainable, proficient and capable workforce.

And that really is the greatest challenge of a symposium like this - to see exactly what it is we can together to make a way forward. In this pathway forward, I liked the definition John Quiggan gives of professionalism;

“the idea that membership of a profession gives with it a set of internalized values that will be reflected in the way in which work is carried out and the ethical standards that are adhered to”.

The questions we might ask of ourselves are – what is professionalism in a Maori context?

How does increased professionalism build the foundation for Maori health?

Mihi Ratima in her paper (Maori health promotion – a comprehensive definition and strategic considerations) issues the challenge that although there is an important role for professionals, without community leadership, interventions are unlikely to succeed.

She suggests instead, that professionalism will be built from cooperative relationships, open communication and recognition of leadership roles and responsibilities.

And of course professionalism is not an end in itself – what we must be most interested in are outcomes that respond to the priorities of our communities, and acknowledge their own autonomy.

Two of the key Maori health promotion models - Te Pae Mahutonga and Kia Uruuru Mai a Hauora – place emphasis therefore on Maori increasing their own control over health determinants by both recognizing community leadership alongside of the health professional.

If I could extend this idea further I would refer also to the Whanau Ora approach as being driven by whanau, allowing whanau to determine the outcomes that best suit their aspirations.

The greatest opportunity ahead of us all – whether it is in Whanau Ora or in health promotion, is to place our value on a comprehensive collective approach to addressing the determinants of health.

It is about taking up the incentive to collaborate and work together; to be proactive rather than reactive.

Whanau Ora does not wait for people to arrive, sick, at the doctors before support is enabled.

Whanau Ora is a means of actively forging relationships and partnerships to promote and protect health whether by organizing regular exercise, encouraging auahi kore households, or promoting open communication and honesty.

The strengths of health promotion approaches are that they are absolutely in alignment with a Whanau Ora approach, in that it reframes the health message to focus on shared values.

This is not about finger-wagging and tut-tutting – such as smoking/eating that/drinking is bad for your health.

Instead it’s about visualizing and expressing a new norm: it’s about whanau being alive, being healthy, being there for our mokopuna.

The smokefree parks initiative in Rotorua is a classic example – it’s designed to reduce exposure to second-hand smoke and to de-normalise smoking in society.

If our children see fewer people smoking they are less likely to take up the habit themselves.

Yesterday I was asked whether I would support a smokefree parliament – no smoking in the grounds; in the carpark, behind the buildings and so on – and I have to say I thought it was a brilliant way of preparing a new paradigm – all of us living by shared values about being smokefree.

Creating healthy environments is also about coming together – integrating programmes, taking a comprehensive approach to action.

The Iwi Maori Recovery Network, established by Te Runanga o Ngai Tahu, is a wonderful example of intersectoral partnerships.

In the first six weeks following the February earthquake the Network made ten thousand community contacts, distributing and facilitating assistance with food, water, blankets, medical health, psycho-social support and labouring efforts.

The crisis of rheumatic fever is another timely example where integrated approaches are required – with the recognition that healthy housing, safe environments, access to appropriate treatments and effective health promotion messages can have a marked impact on the determinants of health.

I have recently returned from the World Health Organisation Global Forum in Moscow, Russia – Addressing the Challenge of non-communicable diseases.

The message that came through over and over again, is that addressing determinants such as sub-standard housing, unhealthy living conditions and environments, and combining this with the practice of health promotion is fundamental to making change to the inequitable health outcomes that are experienced particularly by Maori and Pasifika communities.

Finally, I want to sound a note of caution to us all.

The onslaught of rheumatic fever; the ongoing epidemic we call diabetes; and the shattering human tragedy of unimaginable proportions that has occurred in the context of the youth suicides throughout Kawerau over these last eighteen months; provide a very disturbing impression of the broader progress in the health sector that no health promoter can ignore.

Health promoters in Aotearoa have established a reputation of being both courageous and innovative in developing a framework to guide health promotion.

The Ministry of Health’s public health workforce development strategy, Te Uru Kahikatea, takes heart from your motivation, and tries to bring to the fore best practice in building and strengthening capability and professional pathways for the health promotion workforce.

The key now is to apply all of these lessons, to implement the frameworks, with vigour – and with rigour – to promote the goals of health across every community.

I wish you ongoing determination, a boldness of spirit; to carve out a pathway which is health promoting and health enhancing every step of the way.

Tena tatou katoa