Hon Tariana Turia
Associate Minister of Health

University of Auckland Faculty of Medical and Health Services;
Te Kupenga Hauora Maori

Maori health is every health worker's business

Monday 11 July 2011 Speech
(online)

When I received the invitation from Associate Professor Papaarangi Reid to join with you in the events of this week I was delighted to do so on three counts.

The first, was that it was an ideal opportunity to share the stage with speakers the calibre of Professor Des Gorman – of Ngapuhi and the Executive Chair of Health Workforce New Zealand; and Mr Pat Sneddon – renown Treaty advocate; former chair of the Counties Manukau DHB and current chair of Housing New Zealand.

I have seen the imprint of Des and Pat’s contribution in many discernible ways, in health, in policy making, in the pursuit of treaty and social justice, and I am pleased to be here this morning to acknowledge the difference they continue to make. Tena korua.

The second reason, was that it provides me with the chance to mihi to Papaarangi for her consistent leadership in Maori health. Her dedication to addressing the challenge of current and persistent inequities is well known. Her expertise in exploring remedies to change, whilst all the time recruiting and inspiring more Maori into the health workforce, make her one of the leading lights in this sector, and I am glad to be able to recognise her today, to pay tribute to the legacy she has created.

To bring together 430 second year students in the fields of medicine, nursing and pharmacy – under the kaupapa of Maori health- as she has done with this programme – is remarkable and I really want to thank you, Papaarangi, for all that you do to make a better nation for us all.

My third reason, connects us to a global cause.

Earlier this year, the United Nations Secretary-General Ban Ki moon gave the opening address of the Permanent Forum on Indigenous Issues held in New York.

Much of his address urged participants to uphold the United Nations Declaration on the Rights of Indigenous Peoples - adopted by the General Assembly in September 2007 – and counter-signed by New Zealand, only last year in the historic reversal of Government’s formal refusal to sign.

In his address to the Forum, on 17 May 2011, Ban Ki Moon reminded the world, and I quote:

Indigenous peoples do not live as long as others. They suffer higher rates of diseases like diabetes and tuberculosis. Their children are less likely to survive past the age of five. Their communities are less likely to thrive. We must end the oppression, and we must ensure that indigenous peoples are always heard. Raise your voices here at this Forum and beyond. I will urge the world to listen to your voices.

And so, today, part of my reason for being here, was to remind ourselves, to raise our voices, and in the context of Aotearoa, to raise the issues emerging out of Maori health.

As all of you will be aware, Maori have on average the poorest health status of any group in New Zealand.

The recent Waitangi Tribunal report, commonly referred to as WAI 262, articulated what they described as the ongoing crisis In Maori health in their report, Ko Aotearoa Tenei.

They reported that Maori have significantly lower life expectancy, and much higher rates of infant mortality than non-Maori, and much higher rates of heart disease, stroke, lung cancer, diabetes, asthma, meningococcal disease, schizophrenia and many other illnesses.

The Tribunal went further and spelt out the expectations of the Treaty partnership, explaining that the Crown must put in place laws and policies to support and promote health, while also, to the greatest extent practicable, protecting the authority of iwi and hapu in relation to their taonga, including the practice of rongoa and the knowledge and concepts on which it is based.

Today then, is our ideal opportunity, to bring together the received wisdom of all the textbooks, the experts, our elders, our experiences, and to start thinking about how we can raise our voices to protect perhaps the greatest taonga of all – the gift of good life and sustainable health and wellbeing.

The great news is that whilst appreciating the historical and socio-economic issues that impact on Maori access to health services is important, there are some clear findings from the research that provide us with a starting point for where our voices can be heard.

And if there is one paper I would urge you all to read before the end of the day, it is the paper by Bacal, Jansen and Smith, “Developing cultural competency in accordance with the Health Practitioners Competence Assurance Act.

In that paper we are told Maori receive fewer referrals, fewer diagnostic tests and less effective treatment plans from their doctors than do non-Maori patients, they are offered treatments at substantially decreased rates, interviewed for less time, and prescribed fewer secondary services such as physiotherapy, chiropractors and rehabilitation.

Whether it is in referral to tertiary cardiac surgery, in general surgical procedures, and in prescription rates, Maori encounter a different health system in the quality of health care they receive.

Why is this so important? Apart from the obvious issues of equity and fairness, it must be remembered that 86% of Maori are seen by non-Maori health providers.

So the call for cultural competency is one that all of us can and must take up as a call for action.

All health workers have the implicit right and responsibility to improve the health status of Maori, to enable tangata whenua to live longer, healthier lives, in order to fulfill their potential.
What we know now, is that culturally competent, patient-empowerment approaches can lead to improved health outcomes In essence what this means is that we can make a tangible difference to outcomes by adapting health care interventions to the culture, education and socioeconomic context of our patients.

Recognition of Maori health care needs is now a core part of the curriculum for health professionals, medical colleges and regulatory authorities as part of their statutory obligations.

But we have to feel compelled to act, not just on legal grounds, but on moral, cultural and scientific evidence that establishes Maori health as a collective priority and underpins cultural competency as everybody’s business.

As an example of this, Health Workforce New Zealand is working with Te Rau Matatini to improve the way emergency department staff responds to Maori.

It is also about mainstreaming health literacy so that Maori are able to access and interact with health information, ensuring they receive the treatments and the knowledge they need to be well.

Another part of the drive for protecting the greatest taonga of all – our health – is through the development of whanau ora.

Whanau Ora operates from the premise that the whanau is the key unit for taking control and determining the wellbeing of all its members, because they are the best people to make decisions for themselves, they are the best people to take ownership of their solutions.

In practice, Whanau Ora empowers whanau as a whole, rather than focusing separately on individual members of a family, or indeed treating issues specific to a sector – what we might call the silo mentality.

Whanau Ora requires multiple agencies to work together with whanau; enabling whanau to identify their own strengths, needs and priorities. It is not a one-size-fits all; it is deliberately designed to be flexible. Rather than prescribing set activities or outputs – we are focusing on a set of outcomes that suggest Whanau Ora will be achieved when whanau are:
• Self-managing
• Living healthy lifestyles
• Cohesive, resilient and nurturing
• Participating fully in society
• Confidently participating in Te Ao Maori
• Economically secure and successfully involved in wealth creation.

In sum then, Whanau Ora heralds a transformation in our own lifetimes. It is about transforming social service delivery to focus on the needs of whanau. It is about demonstrating a spirit of collaboration between funders, providers, practitioners and whanau to enable coherent service delivery, effective resourcing and competent and innovative provision.

A common situation, for example, might be where a person has presented with diabetes, has received the appropriate treatment to address the medical concerns, but the wider lifestyle focus including healthy diet and regular exercise may be missed unless there is a whole of whanau approach.

Or we might see a child being the focus of concern because of their absence from school, without realizing that child is taking care of his mother who has been unwell with respiratory conditions; conditions exacerbated by inadequate housing.

Successive Governments have tried to get agencies to work together with mixed results. And there is no question that Government agencies and NGOs need to better coordinate and align their service settings and priorities. But that is only one aspect of the transformation.

The most significant aspect of this transformation is social services enabling whanau to create their own solutions – it is about inspiring, compelling, and challenging all of us to raise our voices to keep whanau central in our sights.

And finally, a true life confession about the application of this principle – to raise our voice – in my own story.

A couple of weeks ago I attended a conference with my health advisor at which we were subjected to the views of a keynote speaker who practiced the doctrine of monoculturalism in every aspect of his speech.

I have never been one known for keeping quiet when I sense an injustice is at play, and so throughout his presentation as he systematically excluded anyone who lived outside an Anglo-Saxon reality I shared my views, in a free and frank manner, with my trusted advisor.

When his speech finally ended, I turned to Ana and asked her if she had anything for my lips – meaning a gloss or chapstick.

Ana replied “what you need for your lips is glue”.

So be under no illusion that raising your voice is always going to be easy!

But seriously – I want to wish you ongoing courage and discipline, in ending the injustices and inequities, and in fighting for the basic human right, and the undeniable Treaty right, that Maori deserve every best opportunity to thrive, to survive, and to live up to their potential.

ENDS

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