I’d like to thank Mauri Ora Associates for organising this hui and providing us all with a vital opportunity to extend our thinking and our actions around cultural competency in delivering health services.
And I have to say I am really excited by the wide range of specialist areas represented in those attending today’s hui. It is so important that we make the connections and learn from each other in applying our understandings around cultural competence.
I congratulate Riripeti Haretuku, the chief executive officer of Mauri Ora associates – and the team – for your vision in bringing together attendees from registered health authorities including the Medical Council, National Nurses Council, ACC, dieticians, the Podiatrists Board, Physiotherapy New Zealand, and psychologists.
There is a delicious symmetry about the fact that we are gathered here at Pipitea Marae to talk about health sector relationships and in particular cultural competency.
For it was at Pipitea Marae, some eight years ago, that the health sector paid tribute to, acknowledged and farewelled the creator of Kawa Whakaruruhau – Dr Irihapeti Ramsden.
Irihapeti was never one to do things by halves.
Her tangihanga encompassed the unique celebration of her life at this marae in a thoroughly modern way; and the traditional hikoi to her ancestral home at Koukourarata / Port Levy; to Rapaki and then to her final resting place at Tutehuarewa Marae.
But throughout it all, Irihapeti’s final instructions had made it clear that the tangihanga was also to be a learning experience. One of her close friends, Dr Papaarangi Reid, then Director at the Eru Pomare Centre at Wellington School of Medicine, told those gathered at Pipitea that there was another purpose for the hui and I quote:
“To teach us something. She is challenging us to do something about the Treaty and the distribution of power and privilege in New Zealand society”.
So here we are, eight years on, picking up on her final challenge by revisiting, reinvigorating and evaluating progress in achieving a comprehensive and all-enduring approach to cultural competency.
Cultural safety in nursing education was written into the nursing curriculum in 1992. The basic thesis was that cultural safety was about nurses understanding how their own cultural identity affected their patients who did not share the same upbringing or trust. The impacts of understanding and appreciating the power dynamics between nurse and patient were key to developing trust.
Ten years later, Section 118 of the Health Practitioners Competence Assurance Act 2003 made setting standards of clinical competence, cultural competence and ethical conduct one of the functions of health professional registration authorities.
In addition, the Code of Health and Disability Services Consumers Rights guarantees to patients the right to services by a health professional that “take into account the needs, values and beliefs of different cultural, religious, social and ethnic groups’.
Alongside of the legislation, we were insisting that policy standards be established, and in He Korowai Oranga, in 2002, we included the expectation that the health and disability sector must deliver culturally appropriate services to Maori to improve outcomes and reduce inequalities.
Over and above all of these sources, other initiatives have occurred by each of the specialists areas represented here. The Medical Council for instance, worked with Mauri Ora Associates to develop a statement on cultural competence and the statement of best practices when providing care to Maori patients and their whanau.
I am so very proud of this legacy; indeed this prescription for transformation that began with the vision of cultural safety and now nearly twenty years later has become written into our standards and our expectations of the relationship between cultural understandings and clinical care.
That one word – relationship – is the crucial basis for the transformation of practice we need.
Just yesterday I was visiting a health provider and they told me the story of a Samoan elder, a kuia, who was suffering from a chronic urinary tract infection. The doctor felt that it was not an issue that could be discussed with the woman in the company of her son, with whom she lived. There were issues around the appropriateness of a son and a mother talking about urinary infections; an issue which was described as ‘the culture got in the way’.
And as a consequence, the mother restricted her movements; too anxious that she might face the humiliation of being unable to be in control. She became confined to her home; separated from the community she loved.
And it made me wonder how it might have been different if the conversations had been had with other members of the family who might well have understood the dynamics between mother and son; the relationship between culture and behaviour; and how to support her in times of discomfort.
It seemed so tragically sad that this woman who had so much wisdom and experience to offer her community had limited her activities; in effect she had become prevented from participating in the wider world.
Cultural competency is all about helping families to be supported to recognize their maximum health and wellness. It shifts the thinking from the disease or the condition – such as urinary tract infections – to instead focus on wellness.
What can we do to nurture the potential in all our families?
How do we restore our proud history and traditions of being hunters, gatherers, growers?
How do we make ourselves well?
Your presence here today gives me confidence that health practitioners are committed to developing the knowledge and the abilities to reduce the barriers that exist for some of our most vulnerable populations.
One thing we know for certain is that the ethnic diversity of our population will continue to increase. The Asian, Pasifika and Maori populations are growing; and their share of the total population will grow with it.
These projections highlight how critical it is to upskill and expand our understanding and our attitudes in order to establish relationships with people from diverse cultural backgrounds.
This can be a challenge – and it can also be a fabulous opportunity.
We need to convince ourselves and our colleagues of the enduring value of being able to reduce every barrier that gets in the way of our most vulnerable populations being able to receive the highest quality of healthcare.
It will mean assisting more open communication; respecting the belief systems of others; building trust.
All of you will know the statistics that describe a different experience of health care access, treatment and health outcomes being sustained by Maori and Pasifika populations; those in low socio-economic groups and other ethnicities.
We might know this background – so what are we doing about it?
I want to acknowledge the presence of Health Literacy New Zealand and in doing so to highlight the vital role that health literacy plays in all of our families having the power of knowledge to recognize the first signs of medical issues, the confidence to access health care services and the capacity to communicate well with health professionals.
But of course health literacy is more than just following the instructions on the prescription. Korero Marama – Literacy and Maori – describes health literacy as also being about understanding the health messages, being able to process and make sense of basic health information in a way which puts learning into practice.
And as we all know – for these messages to really be effective, they must be conveyed, discussed and interpreted within the whanau. It is about the whole family taking on the belief that excellent health is a whanau entitlement – that together they become the best authorities on health and wellness.
I truly believe that we must invest in the expertise and the enthusiasm of all our whanau if we are truly to lift outcomes for the nation.
And so I am delighted that the Ministry of Health and Mauri Ora Associates have developed a Cultural Competency Online Training tool – which includes a health literacy component - to put into practice our commitment to transformation of attitudes, of skills and ultimately of outcomes.
The tool has been designed to help health practitioners, providers and professional bodies to demonstrate the links between building cultural competency and building awareness of health literacy and the impact it has on outcomes for whanau.
Now there is nothing standing in our way – and most importantly of all – standing in the way of all of our whanau; the vast range of families that call Aotearoa home.
I want to thank Irihapeti, Dr David Jansen and all of the team at Mauri Ora associates for helping us to focus not on what’s wrong – but instead to be driven by the aspirations our families seek to be well; to be healthy; to be strong.
Finally I return to the legacy left of my dear friend Irihapeti. Have we responded to her challenge to do something about the Treaty and the distribution of power and privilege in New Zealand society?
Perhaps that is a question that we will continue to ask ourselves – throughout this hui; across our practice; in our own lives?
I thank you all for your courage and your determination to do something different; to make all of our lives better.