Hon Tariana Turia - Address to nursing students
Hon Tariana Turia
30 September 2002 Speech Notes
Address to nursing students, Western Institute of Technology, New Plymouth
E nga mana o tenei whenua, mihi mai, mihi mai.
Ko te awa o Whanganui tenei e mihi atu nei ki te maunga Taranaki.
No reira, e nga iwi, e nga reo, tena koutou katoa.
Thank you for inviting me to see you. This is a great time to be talking about nursing.
The Government is making steady progress on He Korowai Oranga, our ten-year strategy for improving the health of tangata whenua.
While I can’t reveal all the details, I can talk about the general outline.
He Korowai Oranga is a development strategy for tangata whenua. It contains big ideas. It may take time to see changes. But I know we will get results, because whanau and hapu are driving it, and they have the most at stake.
With community development, implementation is critical. That is why we have also developed an action plan, He Whakatataka. He Korowai Oranga is a long-term strategy, while the action plan can be adapted as we progress.
This strategy will not sit on a shelf gathering dust. Since the discussion document was released in April last year, District Health Boards, iwi, and health service providers have already begun to plan their own work around He Korowai Oranga. So its impact is already being felt, and its release is still a month or so away.
How has He Korowai Oranga released such energy in the health sector?
First, by harnessing the strength of whanau and encouraging whanau to pursue their own priorities. The aim of He Korowai Oranga is whanau ora – tangata whenua supported to achieve their maximum health and well-being.
This is a fundamental shift. Instead of treating individuals simply as patients, we are recognising them as tangata whenua, whose mana, identity and strength comes from their membership of whanau.
It is still very important to ensure that individuals have good health information and effective services when they need them. But in the long term, a strong whanau can protect the well-being of its members.
Whanau have been telling governments for years that, even though individuals have urgent health needs, they can best be treated with whanau involvement.
This leads to the second fundamental shift – from a deficit model to a development model. In other words, let’s focus on whanau potential, not individual problems.
Identify what the whanau does well and support that, instead of treating the symptoms of a breakdown. Think of Smokefree funding. It makes sense to spend it on sports and recreation, or incentives not to smoke.
Tangata whenua see real health benefits in strengthening whanau by improved housing, employment, and better education. That may seem obvious. He Korowai Oranga extends that to include anything that makes the whanau stronger – like learning te reo Maori, knowing tribal history and whakapapa, or joining in marae-based activities.
To tangata whenua, that too is obvious. In the long term, our language, traditions and tikanga need the support of a community.
Individuals may acquire knowledge, but culture is collective. It is our whanau who sustain our culture, and our culture that sustains our whanau.
At the end of the day, stronger whanau enable tangata whenua to maintain our identity, and to protect our future by taking charge of our own destiny.
He Korowai Oranga supports the rangatiratanga of tangata whenua, meaning that whanau will define what outcomes they want from health spending, what are the spending priorities, and how services should be organised to achieve their goals.
This is where the Treaty of Waitangi comes into play. The Treaty established a relationship. It envisaged that tangata whenua and the Crown would work together in mutual respect and good faith to achieve common goals.
As an aside, I want to say how pleased I am that the Kaitiaki Group is still responsible for protecting personal information about tangata whenua. As I see it, the Treaty duty to protect our dignity as a group remains in force, despite moves to change the status quo as a result of the Gisborne inquiry.
Improved health for tangata whenua is a common goal. He Korowai Oranga promotes mutual recognition and respect between tangata whenua and the Crown, whereby durable working relationships can be built.
Now, just a moment. We started talking about a health strategy. This discussion has already moved beyond the usual understanding of health, to include language, culture and identity, and whanau and community self-determination based on the Treaty of Waitangi.
Well, tangata whenua think holistically. So we’re still on the right track. But governments have tended to find our approach hard going.
A holistic approach is a challenge for government. Governments are used to measuring costs and benefits of policies and programmes – dollars in, services out, improved statistics as a result.
If you have a certain sum of health funding, you can calculate how many free consultations children can get. You might even measure a fall in hospital admissions for asthma following that expenditure.
However, the statistics do not show the improvement we want, hence the change of focus. But how do you measure the health benefits of money spent on better housing, for example? How can you count the number of times a child didn’t go to hospital for asthma after you insulated the walls?
That’s hard to measure. But a general principle is widely accepted – that prevention is better than cure. That’s the rationale for primary care. The last budget allocated 410 million dollars over the coming three years to implementing the government’s primary health care strategy.
He Korowai Oranga fits well with our Primary Health Strategy. They support each other.
What will He Korowai Oranga mean for nursing?
The government wants a steady shift of emphasis and resources from palliative care to health promotion. As I said earlier, we will still need health services. But with better health promotion, stronger whanau, and a more holistic approach to health care, then we expect less demand for hospital care.
The government recently launched a nursing innovation fund of 8.1 million dollars to help reorient nursing towards primary health care.
Nurses may find themselves working in a wide range of settings – health centres, marae-based clinics, schools, prisons, homes, and workplaces.
A more holistic approach to health care may mean nurses working in partnership with other experts – counsellors, educators, alternative healers, environmental scientists, or building inspectors.
It is likely that a nurse’s knowledge of a community will be more highly valued.
People my age remember the public health nurses, who travelled through isolated communities when I was a child. They knew us not just as patients, but as people with homes and families. We loved them, we trusted them, and we took their advice.
A new emphasis on community knowledge may have implications for nursing training. Whanau development concepts that focus on their collective potential and well-being may have to be included.
Although I’ve talked about He Korowai Oranga and the health of tangata whenua communities, I want to end by saying that He Korowai Oranga is an inclusive strategy, not exclusive. It fits in with the government’s health reforms, which give greater say to all communities over their own health.
In this way, I believe that tangata whenua, and their strategy He Korowai Oranga, can point the way forward for the whole country – and nurses will be at the forefront.
Kia ora tatou.