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Speech: Public Health Association Māori Caucus Hui

Hon Tariana Turia
Associate Minister for Health

14 July 2014

Public Health Association Māori Caucus Hui
Manawanui Marae, Pt Chevalier, Auckland

Delivered by Adrian Te Patu on behalf of Minister Turia who was unable to attend due to flight cancellations


I want to thank Waitangi Wood and Lee Tuki, current Māori caucus representatives for the opportunity to talk with you and Warren Lindberg in his role as Chief Executive.

In ten days’ time, I will be preparing to give my valedictory speech. Usually in election year there is a curious intensity, as campaign fever takes over Parliament. Add to that, the frenzy that is associated with the impending closure of the Parliament, let alone the end of eighteen years of service, and you can probably guess that the demands on my time are at an all-time high.

I have become very selective about who and what I spend time with, as I try to leave with all ends tied, no regrets and hopefully the satisfaction of having served our people to the very best of my ability. But when I saw the focus of this hui I had to accept your invitation.

It was all to do with your mission statement “He oranga Māori, He oranga mō te motu.” (If we get it right for Māori, we’ll get it right for all). The challenge is how do we get it right?

I want to commend you on your disciplined approach to debating a vision for Māori health for determining the actions that must occur if Māori health is to progress and prosper and articulating ideas around how the interest of Māori can be best represented and realised.

These are great questions. Important questions. And the context is just as meaningful – that the council of the Public Health Association wants you – the Māori caucus – to have a much greater influence over the strategic direction of your organisation.

It would appear that all the stars of Puanga are in alignment.

The challenge is then, what to do with this moment? One of the key things I know about the Public Health Association is your willingness to promote informed debate and
inspire co-ordinated action on public health issues.

And I strongly support your goals around Te Mana Whakahaere (autonomy), Ngā Manakura (leadership), collaboration and communities coming together to address their health issues. So let’s start then with a relatively simple concept – the meaning of health.

Contrary to some views, health is not synonymous with an NHI number; elevation on a surgical list; a clinical reading of your blood count; the state of your lipids or your BMI rating.

I believe in a far more encompassing definition.

Health is not merely the absence of illness or disease, a medical condition, a pinpoint on a chart. It must be found in the sense that one’s life is rich and vibrant, the capacity to take action; to purposely make life better.

The World Health Organisation asserts that health is a “positive concept emphasizing personal and social resources, as well as physical, mental and spiritual capacities.” If we are to follow this definition, we must organise to do whatever it takes to improve, promote and protect the health of the whole population. We must mobilise on many fronts – participating in public policy processes, sharing information, building our workforce.

Or perhaps we need a whole new definition. We might call it mauri ora – which is about whānau flourishing – about vitality, integrity and energy. We find mauri ora through positive relationships in the wider environment, sometimes people may refer to this as one’s life force.

The other day I came across an organisation called the Unstoppable Foundation whose mission is to ensure that every child on the planet receives access to the lifelong gift of education.

And I thought wouldn’t it be great to extend that same concept to health – the Relentless Institute to create equity of access and opportunity to health outcomes.

My first target would be Institutional Racism. If there is any area that I wish we could be relentless in our approach it would be the elimination of institutional racism.

And I’m not talking about a three-hour course, or going online and answering a few questions, and saying we are then culturally competent.

It’s about understanding the difference culture makes to the overall health and wellbeing of people and acting accordingly.

I have to say how very impressed I am by the decision to create a special interest group on institutional racism. It gives me great confidence for our future to know there is a group of public health professionals committed to ending institutional racism within the administration of the public health sector.

I am advised that in the development of the Ministry’s Public Health Service Specifications your group focused on developed an overarching Tier 1 Kaupapa Māori service specification. The purpose of such a specification would be to strengthen compliance with the Treaty of Waitangi, strengthen services for Māori and reduce health inequalities for Māori and others.

The great thing for me about your recommendations are that of course service specifications guide the negotiation of contracts with public health service providers-it moves cultural competency from rhetoric to practice.

One of the things I am proudest of is the foundation we have laid through the Health Practitioners Competence Assurance Act 2003 where essentially we are asking all health professionals to step up to the mark.

Cultural competency has been a long established standard in the health profession – in its essence it encompasses the need for health workers to be conscious of their own cultural awareness as a pre-requisite to relating to other cultures.

Cultural competency is also about understanding how our values impact on practice, it assists effective communication, and it is about enhancing relationships to ensure the best possible outcomes

As an example I talked not long ago to a specialist in the Hutt Valley who realised something was not working out and hired a Cook Islands’ nurse. That nurse sat in and talked with patients afterwards and the specialist saw a reduction in the number of people coming back and going into hospital. Their ability to understand, to be spoken to in a way they felt comfortable with, made a big difference and as a consequence outcomes were lifted.
We need to examine our systems and processes to see how we can better meet the needs of the people. A big part of our success will be in empowering them to be more active and engaged in decisions relating to their health through health literacy - becoming more aware of the opportunities for transformation.
Another building block we can be pleased about is the recent launch of updated He Korowai Oranga: Māori Health Strategy. The revised strategy asks us to lift our sights to think about Pae Ora – the concept of Māori health horizons. Pae Ora asks us to think carefully about a multi-sectoral approach to our wellbeing.
That is where Whānau Ora is so important. It makes explicit the connections between healthy housing, the significance of taking the wider environment into account when planning for our future and the role that education plays in creating life chances.
As one example how a Whānau Ora approach directly changes health outcomes, one study showed how introducing better insulation to homes reduced increased visits to Middlemore Hospital for respiratory illnesses affecting the elderly.
We cannot continue to operate as if health occurs in isolation of any other factor. We need to address issues like poverty and overcrowding. We need sufficient investment in understanding what keeps people healthy, truly scoping out how we confront health determinants in a way which drives towards optimal wellbeing.
And I want to really thank the Public Health Association for your thought leadership in areas such as introducing plain packaging for tobacco products, how to prevent child abuse and improve child health outcomes and your commitment to growing and developing our Māori workforce as a key priority to improve Māori health.
You have a very big agenda ahead of you. But is there any more pressing issue ahead of all of us here than to improve Māori health and reduce inequalities?

So if we don’t set up a relentless institute in terms of a physical building, we can at least commit to being relentless in our attitude, our effort and our application of our faith in our families, our belief in whānau.

Keep asking the curly questions, demand answers that are sourced in our own solutions. We must leave no stone unturned until we can change the circumstances for the health of all our whānau and enable all our families to flourish. Mauri Ora!

ENDS

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