The Whanau Paradigm

Tariana Turia’s Speech to Nga Ngaru Hauora o Aotearoa national hui of Maori Community Health Workers Papaiouru marae, Ohinemutu, Rotorua

E nga mana o tenei whenua, tena koutou.

Ko nga awa o Whanganui, o Whangaehu hoki e mihi atu nei ki nga moana o te rohe o te Waiariki. Mihi mai, mihi mai.

E nga iwi e huihui nei, tena koutou katoa.

I am really thrilled to be here among you. This is a very important time for all of us who are interested in our peoples’ health.

In my mihi I referred to rivers, lakes and thermal waters, and before I go further, I also want to acknowledge our maunga.

The Whanganui and Whangaehu Rivers rise on Tongariro and Ruapehu. Our iwi look to those maunga, and we are born of them.

They are also important in the traditions of Te Arawa. Many of us have heard it told that Ngatoroirangi summoned fire from Hawaiki to save himself from dying in the cold south wind on Tongariro – hence the waiariki that extend “mai i Maketu ki Tongariro”.

MY peoples’ stories about OUR kahui maunga are different from the Arawa stories of their maunga - even though we all know they are the same maunga.

It’s not that one is right and the other wrong. Because we stand in different places, our view is different. We see different aspects of the same maunga, and we relate to them differently.

We have different paradigms – different views of the world, which depend on where we stand.

It is our tikanga, as tangata whenua, to hold fast to our own paradigm, while acknowledging and respecting the different paradigms of others.

Health is like a maunga. It looks different to different people, depending on your point of view. As tangata whenua, we have our own paradigm of health care and wellness, which is based on whanau ora. That’s what I want to talk about today.

In a month or so, we will release two key documents on Maori health. He Korowai Oranga is our ten-year strategy for Maori health, and the Whakatataka is an action plan. The strategy provides a consistent, long-term direction, while the action plan has a time-frame of around two years, and it will regularly be updated as we make progress.

I say ‘we and ‘our’ because these documents have been agreed between tangata whenua and the government. These are official health policy documents that acknowledge and respect the paradigms of tangata whenua. This is a major breakthrough.

The aim of He Korowai Oranga is whanau ora – tangata whenua supported to achieve their maximum health and well-being.

He Korowai Oranga has released enormous energy in the health sector by harnessing the strength of whanau and encouraging whanau to pursue their own priorities.

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 a fundamental paradigm shift for the health system. Instead of treating individuals simply as patients, the system recognises them as tangata whenua, whose mana, identity and strength comes from their membership of whanau. He Korowai Oranga requires the health system to engage with whanau.

This has opened the way for a second paradigm shift – from a deficit model to a development model. In other words, a focus on whanau potential, not individual problems. We 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 invest it in sports and recreation, or incentives not to smoke. Health funding for tangata whenua can equally well be spent on avoiding illness by empowering whanau to protect their own.

There are real health benefits for individuals when whanau have 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, knowing tribal history and whakapapa, or joining in marae-based activities.

These aspects of our collective culture bind our whanau together, and in turn, our whanau maintain our tikanga tuku iho as a living culture.

Whanau ora is a tangata whenua paradigm of health. Official recognition of whanau ora in He Korowai Oranga is a result of a long process of advocacy by whanau.

Whanau health workers fit within that paradigm – your role emerged during the 1980s as whanau advocated for a whanau ora approach to health. You owe your position to the whanau, and to the pioneering advocates of whanau ora, some of whom are here today.

Official recognition of your work has been slow – there are still no statistical data on Maori community health workers held by the Health Workforce Advisory Committee. Your position in the system is not yet secure.

However, He Korowai Oranga gives official recognition to whanau ora, and will consolidate the status of whanau health workers. He Korowai Oranga specifically promotes the development of a Maori health workforce.

It is very important that you in turn consolidate the position of the whanau at the heart of whanau ora.

For example, He Korowai Oranga fits in with the government’s Primary Health Strategy, whereby Primary Health Organisations will bring together health providers offering a range of services, in partnership with families.

You will have a role in PHOs, alongside GPs, nurses, health educators, environmental health experts, housing advisers and kaumatua as part of a multi-disciplinary team promoting whanau ora.

It is your role to ensure that the health team works for the whanau, and the whanau sets the priorities and makes the decisions about their health care – not the team.

It is your job to hold fast to the paradigm of tangata whenua, even though we recognise that others have different paradigms.

This is a tough assignment. You will be working alongside highly qualified and paid professionals, each with their own professional associations, training institutions, career structures and public status.

To maintain your own position, and that of the whanau, you and the whanau you represent will all need to support and empower each other. Remember that you, too, are professionals, with the added advantage of who you are. The greatest effects will be made by people such as yourselves.

I understand one reason for your hui is to look at setting a national framework of competencies for your work as professionals. This is an important move to consolidate your position as professionals.

But there are inherent dangers. Evaluating someone’s work against objective, measurable standards has not always been part of our tikanga.

In a tangata whenua paradigm, what counts are the strength of your relationships with the whanau, and your contribution to whanau goals. Is the whanau as a unit stronger for your work? Do you uphold the tikanga of the whanau in your work?

This is such a broad question that a ‘yes’ or ‘no’ answer is not very meaningful. There is certainly no simple formula to enable government agencies to measure your contribution.

It goes back to accountabilities. You must remain accountable to the whanau; and the whanau, not the government or the PHO, must hold you to account for delivering the results THEY want.

The whanau must be involved in setting the standards they expect, and monitoring your performance.

I believe this whole area of evaluation of development programmes needs a lot of thought. If we are to hold fast to tangata whenua paradigms, I think we need to start devising methodologies and criteria for whanau-centric evaluation of development programmes.

But that’s another matter, for discussion some other time.

For now, I want to wish you all the best for a successful and productive hui.

Kia ora.

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