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Laban: Pacific Health Provider Development Fono

Hon Luamanuvao Winnie Laban
Minister of Pacific Island Affairs

9.30am, Thursday 28 February 2008 Speech

National Pacific Health Provider Development Fono

Waipuna Lodge, 58 Waipuna Road, Mt Auckland

Talofa lava, Malo e lelei, Kia orana, Fakaalofa lahi atu, Ni sa bula vinaka, Namaste, Ia Orana, Gud de tru olgeta, Talofa ni, Talofa, Kia ora tatou and warm Pacific greetings to you all.

Thank you to Dr Joe Williams for your warm welcome. I am thrilled to be here for the second National Pacific Provider Development Fono – Akirata: Achieving Excellence in the Pacific Health Sector. It is wonderful to celebrate and acknowledge the work and progress of the Pacific health sector.

I bring apologies from my colleague the Health Minister, David Cunliffe who couldn’t be here today but sends his best wishes for a successful fono.

I would like to acknowledge Fa’amatuainu Tino Pereira for welcoming us all to this event, and Fepulea’i Margie Apa for opening the fono.

I would also like to acknowledge:
- Our international guests – Dr Roro Daniel, Mrs Neti Herman and Dr Temo Waqanivalu - welcome and thank you for travelling so far to share your knowledge and contribute to this fono
- All of the speakers - your commitment to the Pacific health sector is what makes the difference for our Pacific peoples health
- Stephen McKernan, Director General of the Ministry of Health, who will be attending the fono tomorrow.

I’d like to begin with an extract from a short story called ‘Vaka’ written by one of our great leaders, the late Sir Tom Davis.

“The canoe moved forward like some great millipede, determined and inexorable. When it reached the water’s edge, carriers, chanters, spectators and the ladies in their fashionable finery took no heed. They chanted and danced into the sea until the great canoe was afloat…and all shouted at each other in sheer joy at the success of the operation. “

I chose this extract for two reasons. Firstly Sir Tom Davis achieved such significant heights in both his medical and political career. We remember Sir Tom, and thank him for setting such a strong example for all future Pacific generations to follow.

Secondly, I think the words of Sir Tom Davis complement the theme of this fono – Akirata, the Cook Island Maori word for “new dawn”. For me, ‘new dawn’ is about possibilities. The building of a vaka is also about possibilities.

Sir Tom Davis describes the construction of the vaka which is a community undertaking where everyone has a specific role. It describes the communal exhilaration and sense of accomplishment when the vaka is built and afloat. It also encapsulates the feeling of possibility which comes at the start of a journey.

This is a fitting metaphor for what we are trying to do in the Pacific health sector. Improving the health of Pacific peoples in New Zealand requires us to all be on board, and to all be journeying towards the same destination.

It also reflects the approach of the next two days - the participation of different Pacific communities in running each part of the fono. The Cook Island community has started this wonderfully – we could not have hoped for a more vibrant and warm opening.

Recently, I took up a new role as Minister of Pacific Island Affairs. This is a great honour for me and a responsibility that I take very seriously.

As part of this role I am committed to making the health of our Pacific peoples a priority. This commitment is mirrored by my colleague David Cunliffe.

In recent years, the health sector has made great steps towards improving Pacific health outcomes and reducing health inequalities between Pacific peoples and the rest of the population.

There are some wonderful successes and achievements to celebrate.

One that stands out in my mind is the MenzB campaign, where Pacific vaccination completion rates were the highest of any group in New Zealand and have been recognised as a high point of the campaign.

I mention the MenzB results because they illustrate the contribution of the Pacific health sector to our health system. They also show how important and effective the participation of Pacific communities has been in achieving health gains and how effective Pacific peoples and leaders can be in working together and with other sectors when the health of our children, especially, is at stake.

The Primary Health Care Strategy continues to show results that are promising for Pacific peoples.

Pacific PHO enrolments are very high, and evidence suggests that Pacific patients are benefiting from reduced fees.

We are seeing a tremendous amount of innovation from Pacific health providers in services and models of care being developed and delivered. Pacific health providers work in some of New Zealand’s most deprived areas and provide examples of successful engagement with high need communities.

Equally pleasing is the level of information sharing that seems to be happening between all health providers that serve large Pacific populations.

I know that this sharing will continue over the next two days, and we will all take pleasure in recognising the Pacific health sector’s, and the broader health systems, collective achievements.

We must not forget however that when it comes to health of Pacific peoples, families and communities in New Zealand there are still many challenges.

Pacific health need remains high and Pacific peoples continue to experience persistent health inequalities.

This is not acceptable and we need to improve. Pacific health is a priority for our Labour-led government and the Health Minister and I have been working together on a joint action plan between the Ministry of Health and Ministry of Pacific Island Affairs.

As we know, the Pacific population is diverse. It is young - nearly half of Pacific peoples are under 19 years old. Despite this, the number of older people is also set to increase rapidly over the next two decades.

We belong to diverse ethnic groups – there are over 22 different Pacific ethnic communities in New Zealand. We have our commonalities, but also our own unique cultural practices, and world views.

We are also represented across the whole spectrum of the health sector disciplines and professions. During this fono we will get a taste of this diversity – and the vitality of our various communities.

Within this context of diversity and complexity, there is a need for a clear focus for action. The priority areas we have identified for focussing on to improve Pacific health outcomes are:
- Child Health
- Risk factors – this includes things such as smoking, physical inactivity, unhealthy eating and obesity
- Chronic disease – such as diabetes and cardiovascular disease

In identifying priority areas we have made a conscious effort to avoid “trying to do everything”.

It focuses our efforts to areas where we know we can make an immediate impact and where the greatest gains in achieving our ultimate outcomes - better health and reduced inequalities – are possible.

I would like to do give some specific examples of the action we are taking, and going to take.

1. Child Health

The latest Census figures showed that 48 per cent of the Pacific population are under the age of 19 years, and that this is increasing steadily.

Most Pacific children are born and raised in New Zealand and are multiethnic - over half of all Pacific children born had more than one ethnicity and 23 percent had more than one Pacific ethnicity.

There is significant health need amongst our children. Rates of obesity and overweight are highest for Pacific children. Because of poor socioeconomic circumstances, many children are more vulnerable to disease and illness.

We can do a lot to reduce risk factors such as bad diet, physical inactivity and exposure to second hand smoke especially. I am keen to ensure that government agencies and local authorities consider how they can work more cooperatively to ensure that Pacific children are living and playing in healthy environments.

If we want to improve the lot of our community, now and in the future, we must focus on our children. I want to talk about some responses to this.

Kids in Action is an obesity prevention programme run by South Seas Healthcare Trust in Auckland. The programme adopts an integrated approach to weight loss - offering participants not just physical activity sessions, but nutrition advice and peer support too.

Children take part in gym sessions and once-a-week swimming pool sessions, and are linked in to community organisations that run sports activities or performing arts.

A big part of the programme’s success is it’s inclusion of families. I think this is an important theme for any response that we develop for our children – it is crucial that we encourage and support Pacific families to make positive steps to benefit their children.

I note that paediatrician Dr Teuila Percival – one of the people responsible for making Kids in Action a success - will be speaking tomorrow during the sessions about “Responsive Health Services”. I’m sure she will provide a timely address about Pacific child health issues.

B4 School Checks is another great initiative. Children are assessed at the age of four and five for things such as vision, hearing, and development and behaviour, to make sure that they are ready for school. Our Labour-led government wants to ensure that all New Zealand children have the opportunity to succeed, and getting these checks done as they start their life at school is a crucial part of their ability to learn

2. Risk Factors - Smoking and Obesity, Nutrition and Physical Activity.

Looking at key risk factors for Pacific peoples poor health – in particular smoking and obesity, nutrition and physical activity – is another priority area.

Tobacco smoking is considered a significant contributor to the increasing incidence of lung cancer, heart disease, stroke and respiratory disease among Pacific people.

The development of smoking cessation services in the Auckland region will provide an effective personal health service for Pacific people who are ready to quit smoking.

This three year initiative is a collaborative effort between Auckland, Waitemata and Counties Manukau DHBs and will be similar to those already provided in Wellington, Christchurch and Hamilton.

Trained Pacific staff will provide ongoing support to participants to help them make quit attempts, with 3 month follow ups.

The intensive focus provided through these services is what is needed to make inroads into smoking rates of our men, women, and our youth.

It will complement other services and offer Pacific people an additional option for taking up – and achieving - the challenge to quit smoking.

A change in dietary habits, and physical activity, can have a major impact in reducing rates of these chronic diseases.

Our Labour-led government has introduced a variety of programmes and initiatives to promote healthy lifestyles, including the ‘Healthy Eating, Healthy Action’ (HEHA) framework for activity.

Part of the HEHA framework focuses on Pacific community based projects focusing on reducing obesity, improving nutrition and increasing physical activity.

One of the key contributions these community based projects aim to make is addressing target areas around the consumption of fruit of vegetables.

We have strong leadership and networks in our Pacific communities. This initiative acknowledges this and puts control into the hands of the community to identify issues related to nutrition, physical activity and obesity and develop solutions or actions to these issues.

We are mobilising our communities to look at these issues in the context of families and communities. But we are also supporting them – supports at a local and district level will be put in place.

This initiative supports and reinforces the wonderful work that is taking place in community and church-based health promoting programmes such as LotuMoui and Health Village Action Zone.

I urge to you to attend tomorrow afternoons session dedicated to Church and Community Programmes, where many of these innovative programmes will be discussed.

3. Chronic Disease

Cardiovascular conditions, diabetes, stroke, cancers and respiratory diseases, are the leading causes of premature mortality and disability for Pacific peoples.

The facts are shocking. Cardiovascular disease is the main cause of death for Pacific peoples and cardiovascular mortality rates are significantly higher than for the general population.

Prevalence of diabetes in Pacific populations is approximately three times higher than among other New Zealanders. Diabetes accounts for approximately one-quarter of the gap in life expectancy between Pacific and European ethnic groups.

It is something that affects so many of us – either personally, or through family members, and community members. Many of our people develop chronic diseases relatively early in their lives.

As I have said previously, we have to step up our efforts to prevent the onset of chronic diseases. We must also support those experiencing chronic disease to manage their conditions as effectively as possible.

Again, programmes such as Lotu Moui, Healthy Village Action Zone and Let’s Beat Diabetes have drawn on the strengths and values of Pacific family, church and community networks to support people with chronic conditions and their families to manage health and wellbeing within the community.

Get Checked is a national programme that enables people diagnosed with diabetes to an annual check with their GP or nurse.

The programme aims to help people manage their diabetes and educate them about what they need to do to protect their own health.

Pacific peoples have been more likely than any other group to have enrolled in the Get Checked programme.

Sitting alongside our priority areas we have a set of key delivery mechanisms and enablers:
- Pacific health provider development
- Pacific health and disability workforce development
- Mainstream responsiveness to Pacific health and cultural competence
- Intersectoral Action to improve Pacific health determinants
- Pacific health research
- Pacific community action

There will be opportunities to look closer at these mechanisms and enablers during the fono. After lunch today, the theme is “A Strong Pacific Workforce” and how an investment in our Pacific health workforce is an investment into Pacific health. After that, the focus turns to “Stronger Pacific Providers”.

All of these things are our tools, because they will enable us to drive improvement in the health of our Pacific peoples.

I want to congratulate and thank those that are our “enablers” - Pacific primary health providers, NGOs, community organisations, Pacific health sector leaders and community leaders - for the tireless, hard work that you do to improve the health of our people and some of the most vulnerable in our communities.

I wish you all the very best for a successful fono, and our journey together to a new dawn in Pacific health, a dawn which signals Pacific peoples with excellent health outcomes in our Aotearoa home.

Fa’afetai tele ma ia manuia.


ENDS

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