Hon Tariana Turia - PRIMARY HEALTH STRATEGIES
Hon Tariana Turia
Associate Minister of Health
PRIMARY HEALTH STRATEGIES
08 June 2000
UAWA (Tologa Bay)
Tena koutou katoa kua tatu mai nei
i runga i te karanga o te ra.
Kei te tautoko ahau i nga mihi kua mihia. Na reira, Te Aitanga A Hauiti tae atu ki Ngati Porou whanui, he mihi nui tenei ki a koutou.
Ahakoa nga piki me nga heke, e pa ana ki nga mahi hauora, ko koutou ano e kaha tonu nei ki te mahi i enei tu momo mahi.
Ä, kia kaha koutou. Ma te wä pea ka kitea tätou he huarahi ora, hei whakakaha i nga whänau katoa huri noa te motu.
No reira, Tena koutou, Tena koutou, Tena koutou katoa
Primary health care is the first level of contact that people have with the health system.
That is why all you people here have a pivotal role in the delivery of health services to Mäori and others in the communities that you serve.
I cast my mind back to 1993 when there were only about five independent Mäori health providers contracting services. So it is reassuring that since then, there has been a tenfold increase in the past five years and that there are now 240 providers.
Probably the most disturbing thing is that, despite the health status of Mäori they don’t all access these primary health services. The advent of the Mäori service providers has certainly increased though this hasn’t necessarily improved health status.
There are many reasons for the lack of access. Some criteria has been too restrictive and the past and current model, as well as the dollars, focuses on the medicalisation of health (ie. a disease focus) and doesn’t focus on what Mäori want for their well-being.
Most Mäori providers have a relatively small whänau base of people, however, their work encompasses a lot more than just the services that they are contracted for. The most positive aspect is that the Ministry of Health has been able to engage more effective providers who work actively to meet requirements of physical and mental health needs of their whänau.
Mäori health goals, therefore, cannot be divorced from the broader development of whänau, hapü and iwi in their social and economic objectives.
We have to move to a cross-sectoral approach to address the wider determinants of health. Mäori health gain priority areas will remain immunisation, hearing, smoking cessation, diabetes, asthma, mental health, oral health and injury prevention.
I acknowledge the distress Mäori providers of health and social services will have with yet further changes within the health sector. However, it is not unfamiliar territory for us. Shifting the goal posts has been a deliberate strategy of past Governments to retain centralised control of many Mäori initiatives.
I also want to acknowledge the serious misgivings that many of you have already expressed about the changes. I understand that, over the next two days, you will be working on these issues and I look forward to a report on the outcomes of these deliberations.
We need a health system that we can trust. One that is publicly accountable and designed to address both the disparities that exist and also addresses the wider social issues that impact on health.
This Government accepts the Treaty of Waitangi as New Zealand’s founding document and as the basis of constitutional Government in this country.
By signing that Treaty, the Crown guaranteed the rights of hapü and undertook to protect them. The Crown also recognised Mäori as co-signatories under the Articles of the Treaty. This Government is committed to fulfilling its obligations as a Treaty partner to support self-determination for whänau, hapü and iwi.
The strategy for Mäori development was not effective and the Crown, under the Treaty of Waitangi, had a responsibility to ensure Mäori progressed in the same way as other people in New Zealand. That hasn’t happened, so there’s a lot of work to do and for the first time, I think, we do have a Government that is committed to saying ‘look we don’t have all the answers for indigenous peoples in this country’.
Around the world it’s been shown that indigenous peoples progress at a far greater rate when they are in control of their own development, and this is really what we are committed to doing. Mäori communities must be involved at all levels in developing solutions.
This Government proposes a partnership approach which will ensure engagement of Mäori at all levels in the health sector.
We need a separate Mäori strategy and the Ministry of Health is working on this strategy right now. This strategy must be developed in co-operation with experienced people in the Mäori health sector who have already played a major role in health developments.
The New Zealand health strategy will be the overarching document and will form the framework for achieving optimum results in health. Our people deserve a health system that is about quality, equity, access and is culturally safe.
It is interesting to note that the New Zealand health strategy gives considerable priority to addressing the health disparities between Mäori, Pacific peoples and other New Zealanders.
There isn’t an unlimited pool of money to meet all the health needs of people in this country. However, we do spend more than $6 billion in this sector and we must ensure that Mäori, regardless as to where they live, and regardless of their socio-economic status, will have access to those resources to improve their health status. Positive consideration must be given to ensure that this happens.
In the end, we need to know how much resource is needed.
The gaps, in Mäori health status, are well publicised:
we die younger (in fact only 3% survive beyond 65 years of age),
the infant death rate was 1½ times higher than the non-Mäori rate,
the teenage pregnancy rate is four times higher
diabetes - nine times higher
lung cancer - four times higher
cervical cancer - six times higher
coronary heart disease - 2½ times higher
And so the statistics go on.
If we look at a formula for measuring the gaps it is simply this:
GAPS = Mäori Entitlement - Mäori Utilisation
= Cost of utilisation X Mäori population
X Mäori Compensatory adjuster
The Mäori compensatory adjuster
includes social restorative for:
Unequal distribution of services for Mäori
Unmet Mäori needs
Low expectation of Mäori outcomes
Lack of advocacy for Mäori
It is well worth researching and defining these issues for each of your respective rohe.
If we then apply this formula on a nationwide basis then the figures look like this:
Number of expected volumes for Mäori HHS = approximately 83,00 for the Mäori gap (volumes not fixed) or approximately 63,000 for the Mäori gap (volume fixed)
Mäori gap in hospital utilisation services = nearly $600 million
Total cost gap for Mäori relative to non-Mäori for: Myringotomy (hearing failure), Diabetes and Coronary Artery Bypass Grafts = in excess of $4m
These are very graphic examples of the disparity that exists today.
Working toward closing the gaps will involve government departments and agencies working co-operatively across sectors and it will rely also on communities working together.
As I have mentioned before, each sector is inter-related and impacts on the social development of our people.
This Government has agreed it will work to close those gaps because they have an impact not just on Mäori people’s ability to participate in all aspects of the life of New Zealand, but also on their ability to manage and control their own development. So the Government’s priority sectors for closing the gaps are health, housing, education, employment, justice, welfare and business and enterprise development.
The closing the gaps policy provides the Government with further impetus to focus its attention on its own departments, strategies and systems, to produce positive results for Mäori. The Government expects its departments to improve their contributions to make a positive difference to the health, housing, education, employment, justice, welfare and business and enterprise outcomes for Mäori. In my view, this suggests departments will need to be responsive to the needs, interests and priorities of Mäori.
It also suggests, to me, that departments will have to be more rigorous in the development and implementation of their strategies, policies, programmes and services in terms of whether they work well for Mäori.
Closing the Gaps means there is even more reason for departments to engage with whänau, hapü, iwi and Mäori organisations to deliver specified services to Mäori communities. However, it is a ‘needs-focused’ policy through which Mäori are treated as clients.
Iwi have a number of qualities that can enhance the ability of Government to meet its stated commitment to closing the gaps and support whänau, hapü and iwi self-determination through effecting a Treaty-based partnership.
For Mäori, the main point of the closing the gaps policy is to ensure Mäori are not prevented from having the best possible chance to lead, manage and control their own development. Until now, the disparities between Mäori and non-Mäori have had the potential to be seen as a record of the failings of Mäori people. This is neither sustainable nor appropriate. Closing the Gaps does signal, however, how much of the Government’s authority, expertise and resources need to be brought to bear to make a substantial difference to socio-economic outcomes (including health) for Mäori.
Heoi ano, I want to now speak briefly about District Health Boards because I know that there are some real concerns out there in the community.
DHB’s will play a critical role in the future of Mäori health. It is important that DHB’s are effective in improving the health of New Zealanders’ and particularly our people. Primary health care providers will have service agreements with their DHB.
DHB’s will be required to have a relationship with mana whenua. Not a relationship that only advantages DHB’s, but one where mana whenua participate in the annual planning process, and one where there are opportunities to give valued input at all levels.
There will be equitable representation of Mäori on DHB’s and their committees and officials are currently examining options for the inclusion of a clause, under the Treaty of Waitangi in the New Zealand Public Health and Disability Bill.
Effective relationships between DHB’s and Mäori (including good information, communication in good faith and opportunities for korero) will provide the strong base needed for effective improvements in Mäori health outcomes.
DHB’s should be consulting, right now, with communities in the development of their strategic plans. Needs analyses will be necessary for this strategic planning and our people should be actively participating in these analyses.
Boards will be required by legislation to have two committees:
1. A Health Improvement Advisory Committee which will provide advice to the DHB Board on the needs of the population and priorities for utilising health funding. The committee will help manage concern about hospital dominance in decision-making by focussing on all health and disability service needs to advance the health and independence of the people in the community.
2. A Hospital Governance Committee which will monitor hospital performance. It will not be involved in day-to-day hospital management.
Both committees will comprise Board member, with external experts co-opted as required.
Our people must be on these committees.
In closing, I wish you well over the next two days and hope that you will all gain more clarity about the future developments in primary health care.
I have absolutely no doubts about your total commitment to improving the health status of tangata whenua and encourage you to continue the innovations and further implementation of traditional practices and ways that are consistent with tikanga as it applies to your iwi.
E kii ana te korero:
‘Na tou rourou,
Na toku rourou,
Ka piki ake te ora o te iwi’
No reira, huri noa te whare, Tena
koutou, Tena koutou,
Tena koutou katoa