I am delighted to be in the company of the three wise women of the South – our kuia from Oraka Aparima, Jane Davis; Elizabeth Cunningham, the interim Chair of this inaugural wanaka, and representative of Manawhenua ki Waitaha; and Lisa Tumahai – the funding portfolio holder for Maori – deputy chair of Te Runanga o Ngai Tahu and Canterbury DHB.
When we are talking about Maori leadership within Te Waipounamu, these three wahine represent between them, the range of responsibilities and relationships that are so critical to the health and wellbeing of our whanau.
And as I look wider around the wharenui, it would appear indeed that we have exactly the right group of people to share together, our visions and our concerns around the impact of cancer on our whanau.
I am really pleased to see here today representatives of:
Te Waipounamu Maori health governance – the mana whenua;
The Te Tau Ihu Board
Te Runanga o Ngai Tahu Board
DHB staff and board
And whanau, hapu and iwi from across Ngai Tahu and Te Tau Ihu.
This is a vital opportunity for key people in health, in tribal development, and across our whanau, hapu and iwi to come together and focus on the impact and implications of cancer on Maori in Te Wai Pounamu.
And I want to commend the initiative of the Southern Cancer Network in establishing Te Kahui Kaihautu - a leadership forum to set the direction for decisions around strategy and operational delivery of services. For what you are doing in creating a cancer control plan that works for you is to give priority to improving Maori health outcomes.
This is not just a work plan; a set of indicators to base your professional duties around.
This is about the very essence of life – it is about the opportunity for Maori to live long, healthy and independent lives. And importantly it is about doing all that we can to be well.
And I want to just touch on the terminology that is often associated with cancer, in particular the language of consumerism.
I have to say I have always had a problem with transferring the language of the market place into health settings.
The terminology of user; client or consumer seems to me a crude way of expressing what I presume is about being able to describe the rights that whanau have to navigate the health system in a way which will ensure best outcomes.
I fully support the rationale that the term, patient, can be too often interpreted as being about suffering; thereby disempowering the individual from positioning themselves as the leaders of their treatment, recovery and healing.
But I would ask whether replacing one concept – patient - with another – consumer; service user or survivor – is necessarily the way to create the change we need.
In my view, the change we need – to be self-determining; to drive our own treatment; to create our own wellness plan - has to be about more than terminology.
Actually, I believe it has a lot to do with whakapapa; with whanaungatanga; with manaakitanga.
It is about taking a collective view – at this level it is about working out what we can do, to reduce the incidence, impacts and inequalities that come with cancer.
At the whanau level, a collective approach is also required to ensure that everyone takes ownership of the health journey.
My greatest hope is that we can come together, right across the health community, to combat and confront the issues associated with cancer.
Take for instance, some of the key facts that lead us towards the eradication of lung cancer.
We know that smoking is the single leading preventable cause of early death in New Zealand; with an estimated 4,500 to 5,000 New Zealanders dying each year due to smoking or exposure to second-hand smoke.
We know too that Maori are disproportionately over-represented in these mortality statistics. About 45% of the Maori population aged between 15 and 65 - 155,000 Maori are current smokers. Just to put some sort of context around that – that’s over three times the size of the population of Invercargill.
Quite frankly, that’s staggering.
So it’s not as if we can hope the impact of cancer won’t touch our lives – the reality is that every single person in this whare will have had personal experience within their own whanau, their mahi, their hapu and iwi.
The point is, what can we do to ensure we improve access to services and make rapid progress in terms of outcomes and health gain for people with cancer?.
So going back to tobacco – at a health systems level we have set some key targets in place such as:
95% of hospitalized smokers are to be provided with help and advice to quit smoking by July 2012;
90% of enrolled patients who are smokers and who are seen in general practice are also to be provided with help and advice;
And a pilot project in the Midlands and Northland regions, has focused on early detection and raising awareness of lung cancer symptoms across Maori and local communities.
But I have also been keen to send some strong signals through Government levers, to prevent the takeup of tobacco. We have a goal of Aotearoa becoming smokefree by 2025 and so we’ve been working away at a number of levels to achieve the change we need. We increased tobacco excise in April last year – the last increment of another 10% increase comes into effect on 1 January next year.
And we’ve removed the display of tobacco products in shops so that our rangatahi aren’t confronted with a wall of cigarettes each time they go up to the counter.
And I’ve got a few other ideas on the go as well including plain packaging of cigarettes, and looking into the viability of banning smoking in cars when children are present.
But we can’t make the difference on our own. And that’s where all of you here are so important.
Your role is essentially about supporting our whanau to achieve optimal health and wellbeing; to care for whanau; to engage with whanau; to improve the information flow; to achieve a more robust collection of data.
I think that’s one of the most important messages I could share when I think about the concept of Maori leadership in health – and that is about the vital work that needs to occur to bring about whanau ora.
And I want to share one more example of things we can do to improve cancer outcomes.
There are some non-negotiables that we must take up if we want to experience change in our lifetime. I’m thinking of things like improving wait times, access, quality of services and of course reducing risk factors.
I am confident we are making progress –even if it is not as rapid as I am sure we would all want. One area for instance that we can be pleased about is the target to achieve shorter waits for cancer treatment. The breaking news around this is that the quarter one result for 2011/12 shows that 100% of patients started radiation treatment within four weeks – and that has to be important in helping to improve access.
But perhaps the most important thing of all that we can do, is to think what we can do to achieve the quality of life difference within the context of whanau.
The Oranga Wairua Project is an innovative example of caring for whanau needing palliative care. This project is essentially driven by the aspirations of whanau who were terminally ill and wanted to live and die in their own homes, surrounded by their whanau.
Te Korowai Hauora o Hauraki has been taking a coordinated approach; ensuring that whanau and the palliative care nurses work together to provide care. All the services are brought together – health, education, social services, housing, justice, employment support.
Already the results are tangible and they are significant – stress is dramatically reduced on the whanau; whanau are gaining an increasing awareness of how to achieve wellness; and there has been a discernible reduction in hospital admissions.
It’s about caring for needs; catering for choice; supporting whanau with information; and doing it their way.
I’m really proud of the initiative you have taken in holding this wanaka.
You are taking bold steps into your future; driven by the promises you make to your whanau; that a healthy life is not just the luck of the draw.
You are inspiring hope and encouraging courage for your colleagues; your workplaces and most of all your whanau.
I wish you a wonderful wanaka – and I want to thank you for the honour and the opportunity of learning from your leadership.