Health Promotion Forum of New Zealand

Te Wero: Challenging Health Promotion Ratana Pa, Whanganui

Tariana Turia, Co-leader, Maori Party

Tuesday 17th October 2006

I want to firstly acknowledge the leadership of Alison Blaiklock, in the role of Executive Director. I am told that Alison is the seventh Executive Director in two years, to take up the role of bringing together the over 200 organisations who are gathered under the umbrella of the Health Promotion Forum; and I think it is fitting to remind us all, that self-determination, rangatiratanga, takes hard work. Alison has clearly demonstrated she is up to that challenge.

It is absolutely right and proper, that we are gathered here, at Ratana Pa, to consider the challenge of health promotion.

The challenge as laid down by the World Health Organisation is that health promotion is the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health.

I am excited by such a challenge - as indeed I am sure you all are - that we increase our control over the determinants of health; that we shape our direction, that we do it for ourselves.

It is of course fitting to centre such korero at Ratana Pa, in the place that honours Tahupotiki Wiremu Ratana; his vision for a healing movement to promote the total well-being of Maori.

As all those in health promotion would know, health is best understood as an holistic concept, determined by a balance of factors affecting well being. The well-being of our wairua (spiritual), hinengaro (of the mind), ngakau (of the heart), tinana (of the body), te reo rangatira, te ao turoa (environment) all impact and intersect in the well-being of whanau - whanau ora.

As a classic example, of this, one needs only to think, here, of the response TW Ratana led following the devastation of the 1918 influenza epidemic. A response which represented that for solutions to be enduring, rangatiratanga is about people determining their own answers, literally what will work for them.

At about that time, there was a recruitment policy which determined that girls from 'remote areas' and whose families 'were not too Europeanised' were preferred in the training of Maori to work amongst their own people.

Pomare, Buck, Carroll and Ngata were extremely strong advocates of this policy. In Buck's opinion the situation was so dire that it would have been a mistake to delay recruitment by insisting on full scientific qualifications (although stating that capable recruits should seek full qualifications) as he believed the:

"Maori girl has an asset which the most highly trained European nurse has not - a knowledge of the ways and language of the people"

I wonder if there is that much difference between the assets identified by Buck, and the advocacy, training and skills development that your forum still desire in the ongoing learning of the health promotion workforce.

What the early training policy signalled was the importance of working with people not on them; that advances in achieving health outcomes start and end with the local community.

It took as a basic premise, that in order for change to be permanent, a knowledge of the ways and language of the people was essential towards earning trust; it was indeed an asset.

This is in keeping with the value of whanaungatanga - recognising that inter-dependence with each other and collective responsibility will come when we are all part of the solution.

TW Ratana advanced this policy further, through the establishment of the first official building in the Pa, Piki te Ora Church Mission House. Piki te Ora, which opened in 1920, was very much akin to our Hauora centres of today. Piki te Ora was a focus for healing, for church services, for spiritual learning, and in 1922, as the influenza epidemic erupted, it was transformed into a hospital.

When the new Temple was completed in early 1927, Piki Te Ora became the official Ratana church office where business of the Ture Tangata was conducted. On the 8th October 1931, some seventy-five years ago this month, the Piki te Ora building was closed, but has long remained part of the spirit of Ratana, known as the site where miracles took place.

And so I come today, thinking very much of Piki te Ora, the essence of health, and how that connects us through place and time to today's challenges for health promotion.

As we gather here in this precious village, what will be the miracles that we seek solutions for, in the field of health promotion? What Piki te Ora established was a base for the message of wellness. Ratana understood that the health of the individual could only be managed in line with the health of the environment. Some twenty years after Piki te Ora was closed, Iriaka Ratana took up that challenge, in drawing attention to the state of Ratana Pa. Conditions were at best dire, with no proper roads, sewerage, water reticulation, or indeed, cooking or washing facilities in the houses of the pa. Overcrowding was rife, and provided a fertile ground for conditions such as tuberculosis and other diseases.

Iriaka knew the underlying causes of illness had to be addressed as well as the immediate. She set about a strategy of developing alliances with key stakeholders. The benefits of her programme were evident in a housing programme, road development, effective systems for sewerage - and subsequently a significant improvement in the health of the people.

Today, of all days, it is timely to consider the environmental influence on good health, on this, International Anti-Poverty day.

The impact of low wages, growing income inequality, increased pressures on standards of living, unaffordable and unhealthy housing, food insecurity are as much a reality in Aotearoa in 2006, as they were in Ratana in the 1950s.

In fact, new research from the Wellington School of Medicine, released in last week's Medical Journal, indicates that the incidence of tuberculosis in New Zealand is still relatively high amongst Maori and Pasifika peoples. In that research, Dr Michael Baker suggested that higher rates for Pacific peoples and for Maori could well be linked to household crowding.

If we know one thing for sure, it is that a glowing record of health is at least partly dependent on the attainment of other social and economic advantages.

Socio-economic disadvantage is also associated with increased risk of child abuse; violence at many levels linked with issues such as poverty, unemployment and poor housing. So what can we do with the ongoing feast of doom and gloom? At the risk of speaking to the converted, I am absolutely convinced that a key platform in improving our health status as a nation is in emphasising the positive dimensions of health. I was interested in reading over your 2005 annual report, to see in the strategic plan, the goal of working with people who build the capacity of communities whose health status is most vulnerable because of poverty, discrimination or other social disadvantage. I want to really commend you for such a goal, - and add to it - the impact of personal, cultural and institutional racism. But I would also point out the obvious that for true benefits of the supposed $11.5 billion surplus to be realised, change must involve all sectors of society and the environment. The other interesting feature in your report was the comment made that the Health Promotion Forum is heavily reliant on Ministry of Health funding, and that your future will need to include diversified funding as well. And again, I applaud that recognition of the need for your own organisation to be a self-determining agency. For I think one of the difficulties with the targeting of government funding, is the fact that so many of the contracts are tied into what could be seen as negative messages in stopping drug and alcohol abuse; obesity; smoking; gambling - indeed any health related risk.

I want to also recognise the great health promotion modelling you represent in restricting membership of your organisation to members who do not receive revenue or gain from either the tobacco industry or companies with a financial interest in the tobacco industry. You will be aware of the strategy being advanced by my colleague, Hone Harawira, in achieving TOA - Tobacco out of Aotearoa. Your inspiration is a great example.

The greatest challenge of course comes not in identifying what we are doing wrong; or what all the risks are - but in identifying what are the success factors towards achieving safe and secure whanau - what is it that keeps a whanau well? Returning to our case study of Piki te Ora, leadership in whanau ora was based on community participation, control over health and quality of life, attitudinal change, partnership and alliances between groups, and critically, the role of Te Tiriti o Waitangi.

I have read in your materials that Te Tiriti o Waitangi underpins health promotion work in Aotearoa - based on the principles of tino rangatiratanga (absolute sovereignity) and mana motuhake (the right to control one's own destiny.

You as health promoters, are central to that journey. If you can see a way in which Te Tiriti o Waitangi underpins health promotion work for all people living in Aotearoa, you will be part of a movement to achieve relationships that value all people.

One excellent way of honouring the commitments made in Te Tiriti o Waitangi is to prepare a submission to the Justice and Electoral Select committee, regarding the Principles of the Treaty of Waitangi Deletion Bill; by the end of this week, 20 October 2006!

The long term challenge of Te Tiriti o Waitangi is how to ensure that Maori share equally in all the benefits of a healthy life.

And I want to just celebrate with you all, the exciting news that we had last week, when our Bill, to Repeal the Foreshore and Seabed Bill, was pulled from the Ballot.

The system of a Bills Ballot is such that Private Members Bills are put into a ballot, to draw out a specific number of Bills for the next session. It is all in the lap of the Gods whether or not your Bill is drawn.

Or what I would say, is it was the work of te hunga wairua that last Thursday, which was the exact day marking my 10th year anniversary of my time in Parliament, this Bill to turn back the waves of confiscation was drawn.

What I have tried to draw on this morning, in remembering the aspirations of those who have helped to drive strategies for well-being here at the pa, are a number of crucial elements to whanau ora: - Whanau ora is the achievement of holistic wellbeing; - Whanau ora is often successful when the leadership is driven by our own; - Whanau ora is about collective responsibility, recognising that we are the best people to determine our own solutions; - Whanau ora is attained when change is enacted not just at an individual level, but across the total environment; and - Whanau ora emphasises the positive dimensions of health.

Finally, I cannot resist one last example of rangatiratanga in action.

In this very last weekend, in this rohe, Whanganui iwi moved on to landbank properties in Whanganui and ploughed up the lawns ready for spring planting. Like the precedent established by the pacific leadership of Te Whiti and Tohu of Taranaki, local iwi began ploughing, weeding and gardening on four land-banked properties in Whanganui.

Whanganui iwi wanted to point out that Crown is allowing landbanked properties to run down, they are leaving these properties empty or selling properties rather than being offered back to the people, and that essentially the Crown is setting all the rules related to landbanked properties.

The theme for your conference, Te Wero - Challenging Health Promotion - is absolutely captured in this activity. It is a strategy of self-determination, of locally determined solutions, involving the community of interest, and demonstrating leadership in laying a foundation to secure the future wellbeing of their whanau.

It is, at its very essence, the stuff of self-determination; of rangatiratanga in a 2006 context. Just as Piki te Ora was established, here, to create a total solution for achieving well-being on many fronts, what Whanganui iwi is doing right now, is another example for this forum to consider, of shaping our destiny.

I wish you all a very challenging and positive conference - where you too, will all find the heart and the resolve to further your own solutions - whether they be as whanau, hapu and iwi; as the health promotion forum; as health providers; or just yourselves.

Piki te ora ki a koutou katoa.

Helen Leahy

Senior Advisor Leaders' Unit, Maori Party Parliament Buildings WELLINGTON

ENDS

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