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Sharples: Grand Challenges for Population Health

"Head of School' Seminar Series The School of Population Health, Faculty of Medical and Health Sciences of the University of Auckland

"Big issues and Grand Challenges for Population Health"

Dr Pita R Sharples, Co-leader of the Maori Party

Tuesday 30 September 2008; 1.30pm

Within our tribal archives, the oriori Pinepine te kura is one of the most precious chants of Ngati Kahungunu. Amongst the honouring of the whakapapa connections of the child, is a song of worship to Te Umurangi, the 'little tiny treasure' who descends from Te Whatuiapiti, a great Ngati Kahungunu chief and warrior.

In the raging debates around Section 59 of the Crimes Act, that oriori often played over in my mind. In Te Ao Maori, our songs and proverbs included constant references to safeguarding our next generation. They asked us, who will take up the challenge left to us by our ancestors? Who will carry on our name, our values, our aspirations?

Today, we might ask, who will care for us when we are old, pay for our superannuation?

Whatever way we look at it, the greatest act of respect we can pay our unique heritage, is to care for our children.

Whakatongia te aroha ki te ngakau o te tamariki Plant seeds of love in the heart of children.

I called this korero, Big Issues and Grand Challenges for Population Health deliberately in focusing on our smallest citizens.

Our mokopuna, our tamariki, our rangatahi are of especial significance to the Maori Party. On one level, the demographics are compelling.

Currently, one in four New Zealand children between 0-4 years are Maori. In the Maori population itself, 35% of our people are under fifteen years; 46% are 19 years and under. That's a big contrast to the total New Zealand population - where only 29% are 19 years and under.

But there is another reason why we focus not on living for our tomorrow, but living in a way which will prepare for the tomorrow of our children.

It is because we have no choice. The data demands it.

If we truly believe that our children are our taonga, as Pinepine te kura encourages me to, then the health statistics across Tamaki Makaurau, present a dramatic challenge to this worldview.

We see that more than half of Maori children living in Auckland city, some 56%, are living in the highest deciles of deprivation - levels 8-10; compared to just 23% of other ethnicity children.

We see that 38.9% of Maori children are living in crowded households in Counties Manukau, compared to 6.4% of European.

We see that for many Pacific and Maori families, food security is an issue, with many saying that they could not always afford to eat properly and often or sometimes ran out of food.

And not surprisingly, these conditions make the soil ripe for ill-health. There have been increases in diseases such as tuberculosis, rheumatic fever, meningitis, and gastroenteritis, especially amongst Maori, Pasifika and refugee populations.

We learn that Maori and Pasifika children have poor oral health compared to other children in Tamaki Makaurau.

Sadly, these figures are not just region specific.

The proportion of Maori children living in poverty remains unacceptably high at 27%.

And despite the Government's glossy rhetoric, the myth of the good life for children has not magically appeared in many Maori homes. In fact, there was an increase in the proportion of Maori children experiencing severe hardship from 7 percent in 2000, to 17 percent in 2004.

It would be a surprise to no-one, that particular groups within our community have been the target of a policy exclusion which acts against their wellbeing.

The dependent children of beneficiary families have suffered under the lack of entitlement to Working for Families in-work tax credits. Some 74% of beneficiary families with dependent children were living in hardship in 2004. In 2006, that group included 45.9% of all Maori children - almost 100,000 children (93,423) - compared to 12.3% of all Pakeha children.

The resource, Hauora, Maori standards of health, produced by Te Ropu Rangahau Hauora a Eru Pomare, attempts some explanation as to why Maori are disproportionately placed in the beneficiary population; and consequently amongst those in most significant hardship. They say, and I quote:

"Due to economic policies that put more Maori out of work in the 1980s and 1990s, an education system that continues to fail Maori at an unacceptable rate, and a discriminatory job market and housing market, a relatively high proportion of Maori families require a benefit to survive (whether ACC, sickness, unemployment, domestic purposes or student allowance".

Perhaps now you can understand why I entitled this paper, Big issues and Grand Challenges!

None of this information of course, will be news to this School. The School of Population Health, the first of its kind in New Zealand, has established a formidable reputation for demanding solutions which will result in population health improvement.

We, in the Maori Party, are reliant on the analysis and challenges that come from institutions such as this, to help us respond to this grand challenge of reducing inequalities in health status, investing in better integration of services, and achieving greater community responsiveness to the way in which the health system operates.

But there is no denial that these issues are very big, the challenges grand.

Let's start with the system of benefit dependency. In the Maori Party we have spoken out, passionately, against systems of income support which have tended to entangle our people in a net from which they often find it impossible to escape.

Our position has always been that we must assist people to be productive, we must care for our most vulnerable, but we must also offer real alternatives to a system which only serves to undermine the proud work ethic and strength of our people.

We in the Maori Party say a new approach is long overdue. Too many of our whanau have been unable to reach their potential or participate fully in the economy because of the institutional barriers they face in doing things that most other New Zealanders take for granted.

We know also that the hardship that children face, not only affects the health of the child, but also has long-term negative impacts over the life course.

We must see real change, now.

Some of the ideas that we are promoting within the Maori Party to address the Big Issues and the Grand Challenges are:

* We need to pledge to end child poverty in terms of all poverty measures by 2020. * We will extend the formula applied in the in-work tax credit to ensure all families with children benefit from support; * We will provide a universal child benefit; * We will exempt those whose income is $25,000 or less from income tax; * We will raise the minimum wage to $15 per hour; and * We will remove GST from food.

We believe that opportunities must be provided for every person in this land to achieve to the highest levels of their potential, regardless of the ability to pay.

And to make sure that happens, we are firm believers in the power of reporting and accountability.

The Health and Disability Services Act gives a mandatory requirement, that DHBs are charged with having "to regularly investigate, assess and monitor the health status of its resident population".

We believe that it is vital that the community receives accurate information about the performance of hospitals, PHOs and DHBs, including adverse events and so we will be expecting these agencies to be reporting progress publically every three months. We have an expectation that health care needs assessments for the next 12 months, 24 months, 48 months, must and will improve on all variables - on effectiveness, resourcing, cost-efficiencies and access for all.

Finally I want to share a thought that came from Earon Davis - the three glues that hold humankind together are the courage of women, the compassion of men and the laughter of children. It seems to me, that if we - the Maori Party, the School of Population Health, the adult population are to hear the children's laughter, we must indeed demonstrate together, the courage and the compassion to speak out loud about the injustice that keeps on keeping on. We must confront the growing inequalities, the persistent social injustice, not just to improve population health, but also, importantly, to do what is right for Aotearoa. And that indeed is the grandest challenge of all, that we can be big enough to see our children as the best investment we can ever make for the future of Aotearoa.


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