Keynote Speaker

Te Ururoa Flavell
MP for Waiariki

NZ General Practice Conference
Rotorua Energy Events Centre
Friday 15th March 2013

Numbers Matter

Tena koutou katoa kua tae mai ki a au ki a Te Arawa. Nau mai haere mai.

Thanks for the invitation to speak to your conference. As you will have heard my background has been in education so I wondered why you would ask me to speak. I struggle with how a stethoscope works and if asked any questions, my response will be “panadol’!!!

I note that the theme of your conference is, “Let’s get connected – connecting the rural health community via technology’. I hope my work can contribute to that theme.

As the local Member of Parliament, first let me congratulate you for choosing the best conference location in Aotearoa. I am sure that you are having a great time as you learn together, and I hope that you will take some time to get out and about to explore everything this beautiful region has to offer. And can I recommend that you take home some valuable mementoes of your stay, and that you return with your whanau very soon for an extended holiday.

Right, that’s my economic development work out of the way, let’s turn to health.

It is a great pleasure to welcome the Rural General Practise Network to Rotorua. You share in the challenges and the rewards of living in some of the most wonderful parts of Aotearoa.

The rewards are obvious: it’s about living in a much closer relationship to the natural environment. And it’s about living in much closer relationships with one another. That’s about life the way it’s meant to be lived.

The challenges are equally obvious: they are distance, density and deprivation.

Distance, because the services we each need may be many, many kilometres away. And distance means time and money. And distance can mean the difference between life and death, when it’s a farm accident in the back blocks that means help is hours away.

Density, because some specialised services are only economically viable for a certain population size. That’s true not just for direct health services, but also other infrastructure services such as broadband which have such an important role to play in any modern health system.

And deprivation, because many of our poorest citizens live in rural areas, where they are out of sight, and unfortunately out of mind for many of our urban cousins.

Deprivation is a particular issue for Maori in rural areas. The illegal and immoral confiscations of land in the nineteenth century destroyed the economic base of whole communities. The migrations to the cities, particularly after the Second World War, nearly destroyed the cultural base of those same communities.

Nearly, but not quite. Because the historic Maori renaissance that began in the 1970s continues to gather pace.

The consequence of the economic catastrophe of the confiscations can still be seen today in the health statistics.

Last August the Ministry of Health published Mātātuhi Tuawhenua, a report into the health of rural Maori.

In its dry statistical language, it is unrelentingly grim reading. It shows clearly that numbers matter.

On page 24: 35% of rural Maori adults are obese, compared to 21% of rural non-Maori.

Page 26: the gap between rural Maori and rural non-Maori life expectancy at birth was 9.6 years for males and 9.8 years for females.

Page 28: 12.9% of Maori in rural areas report a disability affecting their eyesight, compared to 5.2% of non-Maori. Yet on page 52 we learn that just 5.3% of rural Maori have seen an optometrist or optician in the previous year, compared to 10.5% of non-Maori.

Page 40: the chronic obstructive pulmonary disease mortality rate for those aged over 45 is 99.2 per 100,000 for rural Maori, compared to 34.3 for rural non-Maori.

Page 42: the suicide mortality rate for rural Maori aged 15 to 24 years is 34 per 100,000, compared to 21.7 per 100,000 non Maori.

Page 45: assault and homicide mortality, 4.2 per 100,000 for rural Maori, compared to 0.7 for non-Maori.

On page 53, we read that within rural populations aged zero to 74, the Maori avoidable mortality rate was over two and a half times that of non-Maori.

And then there’s amenable mortality, a subset of avoidable mortality, which is defined as “deaths from those conditions which … reflects variation in the coverage and quality of health care delivered to individuals.”

It’s bad enough that the amenable mortality rate for non-Maori in rural areas is 69.4 per 100,000, but the comparable rate for Maori is 186.9 per 100,000.

So we have a situation where generally Maori come in twice as bad as our other countrymen and women and that is how it has been for decades.

Are you shocked by any of those numbers? Am I shocked by any of those numbers? No. Because we’ve known this forever, haven’t we?

We’ve known it forever, and yet we haven’t actually done anything about it yet. This must be the conclusion because as I say the relative discrepancies between Maori and non-Maori remains significant.

We’ve come to accept these numbers as ‘normal’, which is just one step away from thinking of them as ‘acceptable’.

But they’re not acceptable. Not even close. These are scandalous numbers. They are numbers that we should be ashamed of.

They are prima facie evidence of systemic racism in our health system. Which is not an accusation against any individual, it’s an accusation against all of us. It’s a recognition that there’s something seriously flawed about a health system that delivers such uneven outcomes.

More than that, these numbers should make us weep, each and every New Zealander. Because they represent so much lost potential, so many lost dreams.

Hopefully, these numbers will make us angry. Angry enough to actually do something about them.

Let’s look at some other numbers.

These ones come from the United States, specifically the University of Wisconsin Population Health Initiative.

This programme is attempting to understand the relationship between certain health factors and the health outcomes for all fifty counties in Wisconsin.

Would it surprise you to find out that health factors and health outcomes are closely related? Probably not. As they say, “Where we live matters to our health.”

Here’s the surprising thing about their numbers. Or maybe not.

When they developed their model of the health factors that affect health outcomes, they had to make some choices about what factors to include, and how to weight them.

There are four basic categories: physical environment, including environmental quality and the built environment. Social and economic factors, such as education and employment and income. Clinical care, measured by access to care and the quality of that care. And health behaviours, including tobacco and alcohol use, unsafe sex, and diet and exercise patterns.

So far, so good.

Here are the surprising numbers: they’re the relative weightings of each factor. That is, how much effect does each factor have on actual health outcomes.

• Physical environment, ten percent.

• Social and economic factors, forty percent.

• Health behaviours, thirty percent.

• And clinical care, just twenty percent.

So all the money that we spend on what we think of as ‘the health system’, affects just one fifth of health outcomes for real people.

I suspect that does not surprise you. You are at the front line, day in, day out, and you know what really matters in people’s health. Things like housing, and employment, and education, and literacy. You know, we all know, that those things are the real drivers of how well each person is able to look after themselves and their whanau.

But that’s not how our health system is set up, is it? Our health system – in fact most of our public services – are about measuring inputs, not about affecting outcomes.

• How many patients did you see today?

• How many students are enrolled?

• Have you ticked this box?

• Have you filled in that form?

And so long as there’s an audit trail that proves that we’ve jumped through the right hoops and over the right hurdles, then that’s okay.

But it’s not okay.

And, again, you know it better than anybody, because you’re in the front line.

But what can you do, when these are the numbers really driving rural Maori health outcomes:

• 28% of Maori in rural areas receiving a means-tested benefit, compared to 11.4% of non-Maori.

• 19% of Maori in rural areas living in crowded housing, compared to 3.3% of non-Maori.

It’s obvious, isn’t it, that poverty is the real health issue. And the health system isn’t meant to do anything about that, is it?

That’s the other thing about input-based systems. They like firm boundaries. Health is health, and housing is housing, and never the twain shall meet.

That’s why the Whanau Ora approach championed by my colleague Tariana Turia and the Maori Party is so important, and so radical. Because it’s about real outcomes for real people.

It’s about putting the whanau in need at the centre of all decision making. And it’s about surrounding them with the right services to make a real difference in their lives. Because everything is connected: health and education and employment and housing, they’re all connected.

Yes, the numbers matter.

We have just gone through one of the most important number exercises, the Census. I’m looking forward to hearing how the numbers have changed, and what they might mean for our future.

We are about to embark on another important numbers campaign, the Maori Electoral Option. This is the opportunity for Maori to choose between being on the General or the Maori electoral roll. If enough Maori make the switch, we could add one or two more Maori seats to the seven we have already.

Let me be clear that this is not about Maori getting something extra. We still only get one vote for an electorate MP. We still only get one Party vote which helps determine the proportionality of Parliament. What it is about is ensuring that the Maori voice will continue to be heard. Because the numbers matter, and in politics there always seem to be bigger numbers to chase for the mainstream parties.

Most of all it matters because of all those numbers I talked about earlier. That the rural Maori avoidable mortality rate was over two and a half times that of rural non-Maori.

As you may know, I have my own day of destiny with the numbers. Maybe the numbers will lie with my colleague Pita Sharples. And maybe they will lie with me. The much more important thing is that the Party members will be making the decision in line with our kaupapa. That is democracy. That is how it is meant to work. A good korero, followed by a clear decision.

This issue is not about Pita or myself. It is not even about the Party. It is about all the people for whom the Party can make a difference. The people who have been turned off mainstream politics because it is about “we won, you lost, eat that”. The people who have been left out by policies that are about some, but not about all, New Zealanders . The people who believe that there needs to be a strong independent voice that can make both major parties, Labour and National, face up to the issues they would rather ignore.

You see, both major parties have shown themselves willing to ignore the mana of the Treaty of Waitangi when it suits their own narrow political interests.

It is about the people who know that we need to keep improving our entire education system, from pre-school to tertiary. Because we must not settle for an education system – or a health system - that works well for many, but utterly fails many others.

We also need to face the fact that our current welfare system is part of the problem. For too many people it’s not a safety net any more. It has become a fishing net that entangles you and restrains you and slowly drowns you in rules and regulations.

We need economic policies that focus full bore on the most important thing we need right now to improve people’s health and welfare: more better jobs. Not tomorrow, not when they trickle down, but right now. More better jobs.

And we need to expand the health budget from treating the symptoms of diseases to eliminating their origins. The Maori Party has secured funding for Rheumatic Fever and to Warm Up Homes but there is still much to do.

We need a health system – truly a Whanau Ora system – that focuses on achieving better outcomes, rather than simply measuring inputs. Because real outcomes for real people are the numbers that really matter.

Ladies and gentlemen, thank you for the opportunity to be here today. And thank you for the service that you give to the people of rural communities the length and breadth of this land. I wish you well for the rest of your hui.

ENDS

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