Hon Tariana Turia - PRIMARY HEALTH STRATEGIES
Hon Tariana Turia
Associate Minister of
Health
Speech Notes
PRIMARY HEALTH
STRATEGIES
&
UPDATE
08 June 2000
11.30am
UAWA (Tologa Bay)
Tena koutou katoa kua tatu mai nei
i runga i te karanga o te ra.
Kei te tautoko ahau i nga
mihi kua mihia. Na reira, Te Aitanga A Hauiti tae atu ki
Ngati Porou whanui, he mihi nui tenei ki a koutou.
Ahakoa nga piki me nga heke, e pa ana ki nga mahi hauora, ko koutou ano e kaha tonu nei ki te mahi i enei tu momo mahi.
Ä, kia kaha koutou. Ma te wä pea ka kitea tätou he huarahi ora, hei whakakaha i nga whänau katoa huri noa te motu.
No
reira, Tena koutou, Tena koutou, Tena koutou
katoa
Primary health care is the first level of
contact that people have with the health system.
That
is why all you people here have a pivotal role in the
delivery of health services to Mäori and others in the
communities that you serve.
I cast my mind back to
1993 when there were only about five independent Mäori
health providers contracting services. So it is reassuring
that since then, there has been a tenfold increase in the
past five years and that there are now 240
providers.
Probably the most disturbing thing is that,
despite the health status of Mäori they don’t all access
these primary health services. The advent of the Mäori
service providers has certainly increased though this hasn’t
necessarily improved health status.
There are many
reasons for the lack of access. Some criteria has been too
restrictive and the past and current model, as well as the
dollars, focuses on the medicalisation of health (ie. a
disease focus) and doesn’t focus on what Mäori want for
their well-being.
Most Mäori providers have a relatively
small whänau base of people, however, their work encompasses
a lot more than just the services that they are contracted
for. The most positive aspect is that the Ministry of
Health has been able to engage more effective providers who
work actively to meet requirements of physical and mental
health needs of their whänau.
Mäori health goals,
therefore, cannot be divorced from the broader development
of whänau, hapü and iwi in their social and economic
objectives.
We have to move to a cross-sectoral
approach to address the wider determinants of health. Mäori
health gain priority areas will remain immunisation,
hearing, smoking cessation, diabetes, asthma, mental health,
oral health and injury prevention.
I acknowledge the
distress Mäori providers of health and social services will
have with yet further changes within the health sector.
However, it is not unfamiliar territory for us. Shifting
the goal posts has been a deliberate strategy of past
Governments to retain centralised control of many Mäori
initiatives.
I also want to acknowledge the serious
misgivings that many of you have already expressed about the
changes. I understand that, over the next two days, you
will be working on these issues and I look forward to a
report on the outcomes of these deliberations.
We need
a health system that we can trust. One that is publicly
accountable and designed to address both the disparities
that exist and also addresses the wider social issues that
impact on health.
This Government accepts the Treaty of
Waitangi as New Zealand’s founding document and as the basis
of constitutional Government in this country.
By signing
that Treaty, the Crown guaranteed the rights of hapü and
undertook to protect them. The Crown also recognised Mäori
as co-signatories under the Articles of the Treaty. This
Government is committed to fulfilling its obligations as a
Treaty partner to support self-determination for whänau,
hapü and iwi.
The strategy for Mäori development was
not effective and the Crown, under the Treaty of Waitangi,
had a responsibility to ensure Mäori progressed in the same
way as other people in New Zealand. That hasn’t happened,
so there’s a lot of work to do and for the first time, I
think, we do have a Government that is committed to saying
‘look we don’t have all the answers for indigenous peoples
in this country’.
Around the world it’s been shown
that indigenous peoples progress at a far greater rate when
they are in control of their own development, and this is
really what we are committed to doing. Mäori communities
must be involved at all levels in developing
solutions.
This Government proposes a partnership
approach which will ensure engagement of Mäori at all levels
in the health sector.
We need a separate Mäori
strategy and the Ministry of Health is working on this
strategy right now. This strategy must be developed in
co-operation with experienced people in the Mäori health
sector who have already played a major role in health
developments.
The New Zealand health strategy will be
the overarching document and will form the framework for
achieving optimum results in health. Our people deserve a
health system that is about quality, equity, access and is
culturally safe.
It is interesting to note that the
New Zealand health strategy gives considerable priority to
addressing the health disparities between Mäori, Pacific
peoples and other New Zealanders.
There isn’t an
unlimited pool of money to meet all the health needs of
people in this country. However, we do spend more than $6
billion in this sector and we must ensure that Mäori,
regardless as to where they live, and regardless of their
socio-economic status, will have access to those resources
to improve their health status. Positive consideration must
be given to ensure that this happens.
In the end, we
need to know how much resource is needed.
The gaps, in
Mäori health status, are well publicised:
we
die younger (in fact only 3% survive beyond 65 years of
age),
the infant death rate was 1½ times higher
than the non-Mäori rate,
the teenage pregnancy
rate is four times higher
diabetes - nine
times higher
lung cancer - four times
higher
cervical cancer - six times
higher
coronary heart disease - 2½ times
higher
And so the statistics go on.
If we look at a
formula for measuring the gaps it is simply this:
GAPS = Mäori Entitlement - Mäori Utilisation
Mäori Entitlement
= Cost of utilisation X Mäori population
X Mäori
Compensatory adjuster
The Mäori compensatory adjuster
includes social restorative for:
Unequal
distribution of services for Mäori
Unmet Mäori
needs
Low expectation of Mäori
outcomes
Lack of advocacy for Mäori
Monocultural ineptness
It is well worth researching
and defining these issues for each of your respective
rohe.
If we then apply this formula on a nationwide
basis then the figures look like this:
Number of
expected volumes for Mäori HHS = approximately 83,00 for
the Mäori gap (volumes not fixed) or approximately 63,000
for the Mäori gap (volume fixed)
Mäori gap in
hospital utilisation services = nearly $600
million
Total cost gap for Mäori relative to
non-Mäori for: Myringotomy (hearing failure), Diabetes and
Coronary Artery Bypass Grafts = in excess of $4m
These are very graphic examples of the disparity that
exists today.
Working toward closing the gaps will
involve government departments and agencies working
co-operatively across sectors and it will rely also on
communities working together.
As I have mentioned
before, each sector is inter-related and impacts on the
social development of our people.
This Government has
agreed it will work to close those gaps because they have an
impact not just on Mäori people’s ability to participate in
all aspects of the life of New Zealand, but also on their
ability to manage and control their own development. So the
Government’s priority sectors for closing the gaps are
health, housing, education, employment, justice, welfare and
business and enterprise development.
The closing the
gaps policy provides the Government with further impetus to
focus its attention on its own departments, strategies and
systems, to produce positive results for Mäori. The
Government expects its departments to improve their
contributions to make a positive difference to the health,
housing, education, employment, justice, welfare and
business and enterprise outcomes for Mäori. In my view,
this suggests departments will need to be responsive to the
needs, interests and priorities of Mäori.
It also
suggests, to me, that departments will have to be more
rigorous in the development and implementation of their
strategies, policies, programmes and services in terms of
whether they work well for Mäori.
Closing the Gaps
means there is even more reason for departments to engage
with whänau, hapü, iwi and Mäori organisations to deliver
specified services to Mäori communities. However, it is a
‘needs-focused’ policy through which Mäori are treated as
clients.
Iwi have a number of qualities that can
enhance the ability of Government to meet its stated
commitment to closing the gaps and support whänau, hapü and
iwi self-determination through effecting a Treaty-based
partnership.
For Mäori, the main point of the closing
the gaps policy is to ensure Mäori are not prevented from
having the best possible chance to lead, manage and control
their own development. Until now, the disparities between
Mäori and non-Mäori have had the potential to be seen as a
record of the failings of Mäori people. This is neither
sustainable nor appropriate. Closing the Gaps does signal,
however, how much of the Government’s authority, expertise
and resources need to be brought to bear to make a
substantial difference to socio-economic outcomes (including
health) for Mäori.
Heoi ano, I want to now speak
briefly about District Health Boards because I know that
there are some real concerns out there in the
community.
DHB’s will play a critical role in the
future of Mäori health. It is important that DHB’s are
effective in improving the health of New Zealanders’ and
particularly our people. Primary health care providers will
have service agreements with their DHB.
DHB’s will be
required to have a relationship with mana whenua. Not a
relationship that only advantages DHB’s, but one where mana
whenua participate in the annual planning process, and one
where there are opportunities to give valued input at all
levels.
There will be equitable representation of
Mäori on DHB’s and their committees and officials are
currently examining options for the inclusion of a clause,
under the Treaty of Waitangi in the New Zealand Public
Health and Disability Bill.
Effective relationships
between DHB’s and Mäori (including good information,
communication in good faith and opportunities for korero)
will provide the strong base needed for effective
improvements in Mäori health outcomes.
DHB’s should be
consulting, right now, with communities in the development
of their strategic plans. Needs analyses will be necessary
for this strategic planning and our people should be
actively participating in these analyses.
Boards will
be required by legislation to have two committees:
1. A
Health Improvement Advisory Committee which will provide
advice to the DHB Board on the needs of the population and
priorities for utilising health funding. The committee will
help manage concern about hospital dominance in
decision-making by focussing on all health and disability
service needs to advance the health and independence of the
people in the community.
2. A Hospital Governance
Committee which will monitor hospital performance. It will
not be involved in day-to-day hospital
management.
Both committees will comprise Board
member, with external experts co-opted as
required.
Our people must be on these
committees.
In closing, I wish you well over the next
two days and hope that you will all gain more clarity about
the future developments in primary health care.
I have
absolutely no doubts about your total commitment to
improving the health status of tangata whenua and encourage
you to continue the innovations and further implementation
of traditional practices and ways that are consistent with
tikanga as it applies to your iwi.
E kii ana te
korero:
‘Na tou rourou,
Na toku rourou,
Ka piki ake
te ora o te iwi’
No reira, huri noa te whare, Tena
koutou, Tena koutou,
Tena koutou
katoa
ENDS