Hon Tariana Turia

Associate Minister of Health

Tuesday 20 May 2014; 4.45pm

Waitemata CEO Lecture Series 2014

Tēnā koutou katoa

Thank you for inviting me here today to speak with you on this very important topic, the future of the New Zealand health system.

I am appreciative of this unique opportunity provided by your Chief Executive, Dr Dale Bramley, as well as the Board members and members of the Waitemata DHB Executive Leadership team. Tēnā koutou katoa.

I want to mihi in particular to Awhina Health Campus and its partners.

I applaud your commitment to make education, learning, research, innovation and knowledge sharing a part of Waitemata DHB’s organisational culture. It is my view that this approach will support the health system to work in a way that ensures patients and their whānau receive quality care and achieve the best health outcomes.

The purpose of this lecture series is to encourage positive debate around issues facing the health sector and in particular to focus on our future.

I come to you today, with an aching heart that no conventional medicine can heal. My grief reflects the massive loss in our rohe over the last week with tangi occurring in Ohakune, Ratana Pa, Kaiwhaiki, and impacting not just across Whanganui but right across the nation.

Just this morning we paid our last farewell to an extraordinary talent – the composer, choreographer, conductor and historian, Anatipa Morvin Simon.

As he lay in state, I reflected on how perilous our hold on life can be. The losses we have endured over this last week have reminded me yet again of the trauma that far too many whānau experience in watching their loved ones struggle to live. Without exception, all of the deaths that have impacted on our whānau, hapū and iwi over this last week were lives stolen from us before their time.

There is nothing more tragic than the lingering question in the air: could we have done more; could the health system have done more; what would it have taken to save a life?

These are big questions – but I do not apologise for them. If we cannot, hand on heart, face the scrutiny that all of our whānau demand of us, then we can not truly say the system is working for all.

For a health system to be truly successful it needs to work for everyone. In New Zealand we should ask how well the system delivers for people with disabilities, for people on low incomes, for refugee populations, and for Pasifika people. And of course you there is no question that the health system must perform and deliver the quality of excellence for whānau, hapū and iwi that every New Zealander is entitled to. It’s all about equity.

Achieving health equity is a key challenge facing the health system. The World Health Organisation defines equity as the absence of avoidable or remedial differences among groups of people. The concept acknowledges that differences in health status are unfair and unjust and are the result of differential access to the resources necessary to lead healthy lives.

This lecture will focus on three areas, then, that are key to achieving health equity through further improvements in tangata whenua health.

These areas include
· the impact of the environment on health,

· the place of whānau in health, and

· the need to ensure we deliver health services that are accessible, effective, and responsive to the needs of tangata whenua.

But first – a preliminary statement about why I think change needs to happen.

I am driven by a vision for the future in which whānau are self-managing, living long and healthy lives, participating fully in society, are economically secure and successful, cohesive, resilient and nurturing.

It would be all too easy to focus on the deplorable state of health tangata whenua currently experience – the disproportionate and persistent inequities that continue to be reported in life expectancy, mortality rates, health outcomes across almost all chronic and infectious diseases, as well as preventable unintended and intended injuries, including suicide.

This record of poor performance is unacceptable – and it is our collective responsibility to do what we can to change the picture.

But I choose not to focus on what is wrong – but instead to be heartened by what is right – and that is the incredible commitment that I know some DHBs, some health professionals, are doing to establish a health system that works with whānau, builds on their strengths and supports them to take control of their own health and wellbeing.

The concept of kotahitanga resonates strongly with me. I’m all about moving from ‘some’ to ‘all’. To realise this vision of the future we need unity of purpose and co-ordinated effort at all levels of the health system and wider social sector. We all have a role to play in achieving this vision. Mā te kotahitanga e whai kaha ai tātou. In unity we have strength.

I’m also one of those people who believe that nothing is impossible – it’s all a matter of attitude. The psychologist Abraham Maslow shares my view – he once said, ‘If the only tool you have is a hammer you tend to see every problem as a nail”. In essence, it’s all about defining the problem; exploring possibilities, and creating solutions. And that means, putting down the hammer and looking all around you for ways of making the change we need.

The environment in which we live has a significant impact on the health and wellbeing of individuals, whānau and communities. In many cases, to improve health and wellbeing we must first look to the environment.

All New Zealanders have the right to live in an environment that sustains a healthy life. This requires access to safe drinking water and air, healthy food, and quality housing. The link between housing and rheumatic fever is a clear example of how the environments in which people live impact on their health.

There is a strong link in New Zealand between crowded housing conditions, socio-economic deprivation, and rheumatic fever. Some fairly startling recent research indicates an 88 percent increased likelihood of rheumatic fever in a crowded home as opposed to a non-crowded home. Alarmingly, at least 90 percent of rheumatic fever cases are in Māori and Pasifika children.

Like most health issues, the problems and the solutions in just this one area are complex. And so I want to dwell a bit further into this particular issue to understand how best to achieve solutions.

Tackling rheumatic fever has required us to look wider than health services, to look at the environment in which people live.

The rheumatic fever prevention programme has required partnerships between health and housing agencies to increase the quality and availability of appropriate housing. In particular, it has included a focus on insulating low income homes, implementing a warrant of fitness programme for state housing, and an emphasis on raising rheumatic fever awareness among high-risk communities.

One of the great things about this programme is that it not only recognises and addresses the social determinants of health, but it also acknowledges that whānau and communities hold the answers to the issues facing them. The programme focuses on building knowledge around rheumatic fever, and enabling whānau to participate in developing their own solutions for their communities.

Rheumatic fever reminds us that if we are to improve health outcomes for tangata whenua, we need to address the social determinants of health, such as income and education, all of which have an important role to play in determining health status.

Income deprivation also impacts substantially on health and is one of the greatest barriers to improving Māori health. The link between poverty and a range of preventable diseases, such as respiratory diseases, is well established. Taking active steps to reduce persistent income inequality is needed to achieve health equity between population groups. More equal access to resources will provide Māori with opportunities to purchase healthy kai, live in healthy home environments and lead healthier lives.

The impact that wider social and economic determinants have on health remind us that a broad approach to health is needed. In order to effectively address complex health issues, we need to work together across sectors. It is the responsibility of everyone here today to work together and to seek out connections with a wide range of partners. This includes NGOs, community based providers and government agencies – and of course the silent partner in every health conversation – the family.

My second focus in this talk today, is the revolution we know of as Whānau Ora.

Whānau Ora is a government priority –included in the Letter of Expectation for DHBs that Minister Ryall sent to all DHBs at the start of last year.

In practical terms, it means that DHBs are required to outline in their annual plans how they will support collectives to implement Whānau Ora in your districts.

Supporting the advancement of Whanau Ora will be seen in:
· Strengthening Maori workforce capacity and capability

· Strengthening Maori health planning and intelligence

· Strengthening critical relationships to improve Maori health

· Strengthening cultural competency and health literacy.

What we have seen through Whanau Ora is the growth of strong collaboration between providers who are constantly demonstrating a spirit of cooperation to work together in the best interests of whānau. In fact, in some areas, groups who may have been separate for over a hundred years have come together, for the future of whanau.

The health system must recognise the importance of the collective and the role whānau, hapū, iwi and the wider community can play as agents for change. Whanaungatanga is at the heart of this change, the people are our wealth.

So how does the health system demonstrate that it appreciates the vital role that whānau play in the health and wellbeing of individuals? It does this by respecting whānau capacity and capability to self-manage and improve their own health outcomes.

If I know one thing it is that we won’t achieve change by doing what we have always done. We need to come up with new ways to better engage with whānau.

Good communication is one way in which the health sector can work towards making health and disability services more accessible. To facilitate better communication we need to focus on building cultural competency within the health system and in all health professionals. It is an essential skill that assists health professionals to better understand and effectively communicate with Māori patients and their whānau.

Encouraging whānau to participate in conversations to remove barriers to accessing services, support, and entitlements is also important. I would like to applaud one of a number of great initiatives happening locally to facilitate this conversation with whānau. That is “In Your Shoes”, a series of workshops where past patients, their carers and families were encouraged to share their experiences and views on what works well and what needs to improve.

The workshops were intended to inform improvements to health services provided across the district. This was a great opportunity to better understand patient experience and cultural perspectives, and incorporate these into the design and delivery of health services.

Finally, we’ve looked at the environment; we’ve talked about the role that whānau play – let’s finish with reminding ourselves of the crucial role that the health workforce plays in consolidating change.

Māori health workforce development must remain a key priority for the future. The Māori population is projected to grow faster than the non-Māori population. Sustained efforts to grow the Māori health workforce are needed to ensure it is able to meet higher demand from a growing Māori population.

Our efforts need to focus on increasing the number of Māori in the health and disability workforce, further expanding the skill base of the Māori workforce, and providing equitable access for Māori to training opportunities.

And we need to be flexible, as a health system, in order to respond to people’s needs. I firmly believe that services should be organised around the needs of Māori consumers and their whānau rather than the needs of providers.

Enabling Good Lives is an example of a cross-agency approach that aims to better respond to the needs of disabled whānau. It offers disabled persons greater control over the supports they receive and the lives they lead.

Disabled people were clear that they wanted to work with one system, Enabling Good Lives developed as a cross-agency approach in response to this need.

So how do we best put in practice the ideas we each have to achieve a vision that addresses health equity?

The annual DHB Māori health plans are one important way in which we can monitor and assess progress towards improving Māori health and achieving health equity. It creates a level of accountability for DHBs to reduce Māori health inequities.

Looking over Waitemata DHB's Māori Health Plan for the 2013/2014 year, I was particularly impressed by the efforts you made to involve Māori in working towards improving their own health outcomes. This included whānau input into developing optimal cervical screening pathways and engagement with Māori women to test and develop key messages for text messaging support service to promote breastfeeding.

Quality ethnicity data underpins Māori health plans. It is a key factor in understanding the health needs and experiences of Māori. High quality ethnicity data allows us to track health trends by ethnicity and effectively monitor performance so as to improve health outcomes and achieve health equity.

I want to acknowledge the committed professionals, many of whom are here today, who worked hard on developing and piloting the Primary Care Ethnicity Data Audit Toolkit. This development of this toolkit has been instrumental in improving the quality of ethnicity data in primary care settings, allowing providers all over the country to improve their understanding of Māori health need.

The impact of the environment on health, the place of Māori in health, and the need to ensure health services are accessible, effective and responsive are areas that are key to lifting the performance of the health system to achieve better health outcomes for Māori into the future.

Under each of these areas is a series of challenges which we must rise to meet.

Today in my role as Associate Minister of Health I am pleased to announce two further health initiatives in Budget 2014 which help to respond to the multiple challenges I know you are all working so hard to address.

Firstly there is new funding of $10 million for Better Oral Health for children and adolescents over the next four years. The new funding will support a range of activities that promote better oral health for children and adolescents, including aims to
· increase regular tooth brushing among pre-school children

· increase the number of adolescents using the free oral health services that are available to them

· provide well health promotions about the importance of reducing the intake of sugary food and drink as part of a healthy diet.

I’m really pleased about this investment in helping our communities to receive all the necessary information to support them in their vital roles of educating our children about the importance of brushing teeth twice daily from an early age. I believe we should also continue to actively campaign against foods and drinks with high levels of sugar and particularly the impact of juices and sugary drinks in babies bottles.

The other announcement I am delighted to make is that $10 million has been allocated for bariatric surgeries over the next four years.

This is a wonderful announcement for whānau who have experienced too many severe impacts of weight-related illnesses such as diabetes, sleep apnoea and hypertension.

It is an investment in total health and wellbeing – hauora – and of course the health economists among us would be able to share the substantial savings that accrue with the prevention of adverse impacts in diabetes, heart conditions, obesity and other related conditions.

A New Zealand study by Jo, Tobias and Yeh predicted a 20% increase in the prevalence of diabetes from 2012 to 2021 – that’s right, just nine years – translating into an estimated 271,000 New Zealanders. Other predictions have estimated the number could rise as high as 386,000 if there is no change in practice or management.

So I am very hopeful that with these two announcements today, we might see further changes towards ensuring the health system works well for all New Zealanders.

Of course they are but two steps – and we have many more to make in the staircase towards optimum health – but at least we’re on the move.

We must take a united approach to working towards this one common purpose. It requires effective coordination and cooperation at all levels of the health system – but the results are surely worth it.

A health system that works well for everyone will ensure all of us – whānau Māori, our Pasifika nations, tauiwi, young and old, can participate fully in society, and live long and healthy lives. That’s a vision I would hope any Government would invest in – and a vision that I believe is paramount in the focus of the Āwhina Health Campus.

Kia kaha, kia maia, kia manawanui.

ENDS

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