Speech: Maori Partnership Board -CCDHB

Capital and Coast DHB Maori Partnership Board

Annual Hui with Stakeholders : Tau Puehu

Hon Tariana Turia, Associate Minister of Health

Pipitea Marae, Thorndon, Wellington

Wednesday 10 June 2009; 9.30am

 

I am greatly honoured to be present at this Maori Partnership Board Hui – to learn from the aspirations and perspectives of the mandated iwi representatives from across the iwi and communities of Whanganui a Tara.

 

I acknowledge the mana whenua who care for the people living within the rohe of Te Atiawa, Te Atiawa ki Whakarongotai, and Ngati Toa.

 

I recognise also the community appointees to the Maori Partnership Board; and the broad representation from Maori providers, local government, and non-government organisations.

 

It is a wonderful opportunity to be here today and to be a part of the discussions around the hot issues in Maori health today and in the future.

 

I was fascinated with the reference to Tau Puehu – the settling of dust – as the theme for this hui.

 

The connection between the ‘settling of dust’ and Maori health has been well-established.

 

At the most obvious and literal level, there is the direct connection between exposure to house dust mites and the range of asthma and respiratory conditions that Maori suffer from.

 

In research released just last week from Dr Lis Ellison-Loschmann from Massey University's Centre for Public Health Research we learnt that asthma prevalence and severity in Maori may in fact not be due to a higher incidence, but rather to a longer duration of the condition resulting from reduced access to care.

 

So straight away I’m wondering if the theme of Tau Puehu, is really just a cover for an all-out attack on institutional racism.

 

And then I went back in time to 1951, when the Maori Women’s Welfare League passed a remit asking the Minister of Health for more health education for the Maori people.

 

Before long, the Minister obliged and an article duly appeared in Te Ao Hou; entitled Ko te Mate Kohi (You and your tuberculosis).

 

The article described the death of approximately 130 Maori from TB in 1951; with a total of 3000 Maori presenting with TB chests.

 

The advice from the Minister was that if your home had a wooden floor, it was a good idea to sprinkle it with damp tea leaves before sweeping it, so that the dust will not fly around while you are sweeping.

 

The moral being that if you keep your house clean (and free of visitors) you are less likely to end up with the dust and dirt that TB germs thrive on.

 

So then I wondered, if the theme of Tau Puehu was to start anew, to eliminate all the dust and dirt in the system that is affecting Maori health outcomes, and to prepare the way for a good sprinkling of damp tea leaves to achieve the outcomes we all desire.

 

And then finally, the pièce de résistance, was found in a proverb unique to Te Whaiti-nui-a-Toi: ‘He whenua pua, he whenua puehu’: the forest which is frequented by birds, the forest which will turn to dust.

 

In essence this speaks to me of kaitiakitanga, of preserving our natural taonga, including the health and wellbeing of our people.

 

If we are careful and invest wisely in whanau ora, we should expect to achieve whanau wellbeing – the challenge is up to us.

 

Before dusting off these metaphors, I do want to emphasize three key issues for me, in relation to the pathway forward for Maori health.

 

That is that we must address the systematic barriers such as institutional racism or inadequate access to care in our pursuit of health outcomes.

 

Secondly we must have specific tangible outcomes in mind so that we can identify, measure and evaluate progress made in achieving physical, spiritual, mental and emotional health for our whanau.

 

Thirdly, it is all about whanau ora - the capabilities whanau have to care for themselves, to seek the best possible outcomes for their people, and to enhance their strengths and potential.

 

These three major challenges to my aspirations for Maori health have, in turn, inspired me to bring to this forum, three important announcements that I hope will allow the lay of the land to be seen more clearly in the months ahead.

 

I have talked, publicly, about wanting to promote a new approach to whanau policy and whanau wellbeing – a truly integrated approach to care.

 

I am delighted to announce today that I have established a taskforce aimed to do exactly that – to help to advance the focus of our interventions to significantly improve outcomes for whanau.

 

That taskforce will be charged with developing a policy framework to create a new method of government interacting with Maori providers, to achieve an integrated approach to whanau wellbeing.

 

We are all aware that currently a lot of the services Maori providers may provide to whanau may be outside the terms of the contract but totally consistent with a holistic approach to whanau ora.

 

Conventional programmes are frequently flawed by concentrating on individuals rather than the whanau as a whole; each service delivering only a partial response to the longer term goals of that whanau.

 

In the competitive tendering environment, we might see agencies providing overlapping services or duplicating efforts with the result being that the whanau can often feel overwhelmed by all the different and fragmented programmes coming into the family home.

 

I want to do something about that, and my priority is thus to improve the whanau focus of interventions by ensuring an integrated approach which is targeted at strengthening whanau capabilities – our ability to do for ourselves.

 

While this work is being developed, there is no reason to wait.

 

And that is why I have brought with me today, copies of the Whanau Ora outcome statements that were recently released in the Statement of Intent signed between the Government and the Ministry of Health.

 

I am really pleased that whanau ora : Maori families being supported to achieve their maximum health and wellbeing - is one of the seven priority outcomes that the Government has agreed to, in ensuring all New Zealanders lead longer, healthier and more independent lives.

 

In that statement it states in black and white, that the Ministry will focus on outcomes, not activities, including working towards and promoting strengthened whanau capabilities.

 

I note that the priorities of the Maori Partnership Board include the goal of reducing disparities particularly in services relating to diabetes, cardiovascular disease, cancer, respiratory illness, mental health and child health.

 

There are also commitments to improve mainstream responsiveness and effectiveness through monitoring and evaluation, and supporting the development of the next Maori health strategy.

 

These are all important indicators of a pathway to wellbeing – and they are reflected in the Statement of Intent. But I am also passionate about health being seen not just as the absence of disease, but also on identifying the outcomes we would expect to see if we could measure whanau progress in achieving whanau ora.

 

I expect that we would see an emphasis on cultural competence in the health sector, and we also expect to see more recognition of the need to support whanau to access and use health care services, to better realise their desired health outcomes.

 

This is not just about doing a quick sweep and waiting for the dust to settle. This is about a whole new approach which takes its inspiration, first and foremost, from the challenge to achieve real gains for whanau Maori in specific and deliverable health outcomes.

 

To help make this happen, I am looking forward to being able to announce some increased funding in the near future to invest in whanau ora, to affirm Maori approaches to wellbeing, and to improve Maori health outcomes.

 

I want to support Maori delivery systems to operate in a way which values health and social service integration as the means by which to achieve whanau wellbeing.

 

These are just some of the priorities and aspirations that I have for promoting whanau ora and improving Maori health outcomes.

 

We know that none of us can achieve wonders on our own. Achieving real gains for our whanau will require action by the entire health system; and it will require a coordinated approach across all levels.

 

Within that, I know that Maori health providers have drawn on our tupuna histories, and have become excellent navigators, explorers and entrepreneurs in terms of grappling with the complex and changing policy environments that characterise the health system.

 

We know too, that the multifarious demands of our whanau, coupled with the enormous expectations of the system for Maori providers to be expert in all matters Maori, can and has lead to burnout and early departure from the health and disability sector.

 

The Capital and Coast DHB Maori Partnership Board has a vital role to play in ensuring that the Maori health workers across this rohe, are supported, upskilled and sufficiently nourished to want to remain in health.

 

At the same time, the decision makers across the DHB have a Treaty obligation and a policy responsibility to ensure that the issues confronting Maori health workers are taken into account across all of the health services within this region.

 

In this context, I have to share some concerns that have arisen around the proposed changes to the structure and composition of staff within the Capital and Coast DHB Maori Health Development Group.

 

I have to admit to some surprise that the cuts recently announced appear to have been singularly focused on reducing operational services, while management and administration seem to remain virtually intact.

 

I will be interested to learn what rationale there could be for reducing the numbers of kaiawhina and kaitakawaenga, community liaison within whanau care services. It is obviously critical that whanau services can be delivered to Maori in a way which reflects both cultural competence and cultural sensitivity.

 

I want to make it clear that I endorse the approach promoted by the Maori Health Development Group that strategic planning, capability and service delivery are the basic foundation to achieve the mission: “To work together to improve whanau health and wellbeing.” My questions are simply– how can this be achieved when the delivery function appears to have been compromised so significantly?

 

I want to say to you all – your role is just so important in helping to safeguard and invest in the improvement of far better health outcomes for our people.

 

I want to hear from you – if not today – then in whatever ways you can – to ensure that the ideas we are developing on whanau ora are informed by the real life experience you all have to offer.

 

We have no time to wait for the dust to settle. Our inspiration is in front of us now – our mokopuna await our action and our commitment today. I wish us all the greatest courage and strength in taking ourselves forward.

 

Tena tatou katoa.