Tangata whenua and rural health
19 July 2002
Hon Tariana Turia
Tangata whenua and rural health
E nga iwi, e nga reo, tena koutou katoa.
Thank you for inviting me to your Rural Health Promotion Conference today.
I enjoy coming into this forum, because the challenges you face and the opportunities you are creating for rural communities are very familiar to me.
There are many parallels between the experience and aspirations of rural people, and those of tangata whenua.
Obviously, many rural people are tangata whenua, and many tangata whenua live in rural areas. However, I want to focus on the fact that tangata whenua and rural people both have a sense of belonging to distinct communities within a wider society.
I find it really exciting that you are developing approaches to health promotion that recognise this sense of community, this part of the identity of both tangata whenua and of rural people.
The approaches you are exploring present significant challenges to central government.
As everyone here will be well aware, the World Health Organisation (WHO) defines health promotion as “the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health.”
In other words, health promotion is not about central government defining good health, and then designing and implementing measures to ensure that tangata whenua and rural people measure up.
The WHO approach is about empowering individuals and communities to set their own criteria, and devise their own solutions, with appropriate support from central government.
This understanding is critical if we, as politicians and bureaucrats, as health workers and community leaders, and as whanau and community members, want to improve the health and well-being of New Zealanders.
We must recognise there are many determinants of health. They include obvious things like housing, employment and income, and access to health services.
There are social and cultural aspects to community health. Simple things, like people taking a neighbourly interest in each other, and looking after the weaker members of the community. Things like pride in our history and those who have gone before, protection of our natural and cultural heritage, and preparing our younger generations to contribute to their full potential.
Attitude is important. Empowerment thrives on personal and collective self-confidence - recognition of our own strengths and potential.
Healthy communities also require infrastructure and facilities - communications and transport networks, schools and hospitals, marae and community halls, churches, shops and banks.
There is also the matter of resources. Not just access to resources on certain conditions, but control over them. Not dependency, but the power to make wise decisions. Good decision-making in turn requires vision, information, organisation and leadership.
As communities gain control over all these determinants of health, they gain control over their own destiny.
The WHO definition, and the principles that follow from it in documents such as the Ottawa Charter, resonate strongly with the calls from tangata whenua for recognition of their rangatiratanga.
Rangatiratanga does not mean separatism. It does, however, require recognition by central government of the distinct communities of tangata whenua, and acceptance that tangata whenua know better than central government what’s best for themselves. It requires engagement with their leadership, and support for their efforts to set and reach their own goals.
Rangatiratanga is not about cutting yourself off from the rest of the country – almost the opposite. It’s about establishing ongoing relationships based on mutual recognition and respect.
I want to acknowledge the vision and the dedication of the health promotion sector over the years. Throughout repeated restructuring of the health sector, and cutbacks in funding and resources, you have consistently held up the torch for health promotion as an exercise in community empowerment and development.
This government has responded by establishing DHBs, adopting national and Maori health strategies, and allocating various funding packages for primary and rural health care and workforce development. What has driven these changes is the principle of local community decision-making and control.
We have also established partnerships with local communities to address many of the other determinants of health that I have mentioned – housing, roading, telephone and broadband communication, economic development, cultural facilities and so on. We believe a whole-of-government response to the needs of rural communities will improve community health.
Finally, I want to mihi to you for the way the sector as a whole has embraced the Treaty of Waitangi.
There have been many things said about the Treaty during the election campaign. Most of what is said makes me pretty angry. Some people try to exploit others’ lack of understanding, to create fear and insecurity for short-term electoral gain.
This sector, in contrast, has taken the trouble to thoroughly investigate what the Treaty says, what it means, and how it could affect your approach to your work.
Tangata whenua have always said the Treaty sets out the basis for proper relations between their traditional communities and the Crown. What’s good for tangata whenua may be good for others – that’s not for us to say - but the model is there for rural and other distinct communities, and I’m glad you have been willing to consider it.
I commend the Health Promotion Forum’s paper ‘TUHA-NZ – a Treaty Understanding of Hauora in Aotearoa-New Zealand’. And I welcome the Public Health Association’s checklist for advocating public health policy for Maori, and their submission on ‘He Korowai Oranga’ – the government’s draft Maori Health Strategy. These are ground-breaking studies.
It’s clear you have found the Treaty is a powerful tool for analysis, and a guideline for assessing the effect of policy. I believe the whole country stands to gain from a proper understanding of Treaty principles. The Treaty is an empowering document for all citizens.
I could give many examples of Treaty relationships in action. Ngati Porou Hauora is just one that springs to mind.
In the early 1990s, Tai Rawhiti Healthcare, the CHE, had around 40 staff. Ngati Porou Hauora employed three people, through a health service contract worth $100,000.
The CHE planned to cut back services, laying off staff, closing Te Puia Hospital, and replacing it with a bus.
But the community and the Hauora rallied. Within a couple of years, they had taken on 14 staff to manage contracts worth $1.5 million. They raised funds to rebuild the health clinic at Tokomaru Bay, and then built a new clinic at Te Araroa.
They took over control of the hospital at Te Puia. Instead of closing it, they have plans to expand it, and develop the hot pools for health tourism.
This year, Ngati Porou Hauora has 120 staff, and contracts worth $6 million, and growth is projected to continue.
I’m sure I don’t need to tell you how the whole community has been uplifted. Surely this is health promotion as an exercise in community empowerment, based on Treaty relationships in action.
May there be many more examples.